Cross‐Functional Team Processes and Patient Functional Improvement

Abstract

Objective. To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes. Data Sources/Study Setting. Primary data were collected during the period 1992-1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S. Study Design. A longitudinal, multilevel analysis assessed the relationship between individual-and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables. Data Collection Methods. Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument. Principal Findings. Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning. Conclusions. Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the potential appropriateness of managerial interventions to encourage member investment in team processes.

The Organization of Multidisciplinary Care Teams: Modeling Internal and External Influences on Cancer Care Quality

“…Most studies of team structure within both the cancer-related and general health-care delivery literatures tend to conceptualize team structure as either team composition (24,25) or team size (26). Generally, the influence of both variables on team performance or patient outcomes is mixed.…”

“…(25) in their excellent review of health-care team effectiveness. Among the key findings are that 1) full participation of all team members is considered necessary for MDC teams to function effectively, although status differences among team members may depress team functioning (26,28); 2) teams with shared egalitarian values tend to work together effectively, leading to improved team performance, although value structures and the degree of meritocracy at team formation influence performance (18); and 3) team coordination improves team performance, but this effect can be diluted or mitigated by the emergence of conflict (29).…”

“…• team "functioning" (26), which can be thought of as team process variables, such as coordination mechanisms and conflict (31); • clinical-or patient-reported outcomes, such as improved health (6,31), patient functional status (26), or other measures of patient, family, staff satisfaction (32); • the "quality of the team's work," which uses indicators such as timeliness, productivity, accuracy (21), and goal achievement, which encompasses meeting standards, compliance with clinical practice guidelines (33), and innovation in treatment (25); and • indicators of organization-level efficiency, such as care cost and cost-effectiveness (6). Of these measures, the third set-in particular, indicators of team performance and innovation-appear most promising for defining and measuring team performance in terms of qualities that describe how people work together as members of an MDC team and the effectiveness of their work together.…”

Reducing the Failure Risk of Interdisciplinary Healthcare Teams

“…Alexander et al 19 conducted a longitudinal study of 40 cross-functional psychiatric treatment teams in Veteran's Administration facilities across the nation. Individual team members were surveyed using instruments to measure team participation and team functioning.…”

Steps towards effective teamworking in Community Mental Health Teams

“…For example, there may be differing perceptions of who does what within a team which would necessitate discussion about an agreement on team member role definitions. Data from the MHDAT could be supplemented by data from other scales including the Team Participation and Team Functioning scales(Alexander et al 2005). Moreover, to evaluate the leadership skills displayed across CMHTs measures such as the Psychological Safety and Team Learning scales…”