Developing High-Functioning Teams: Factors Associated With Operating as a “Real Team” and Implications for Patient-Centered Medical Home Development

Stout, Somava; Zallman, Leah; Arsenault, Lisa; Sayah, Assaad; Hacker, Karen

doi:10.1177/0046958017707296

Cited by 16 publications

(17 citation statements)

References 20 publications

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“…At the system‐level, GeriPACTs reported leadership challenges such as perceived support for team objectives, stable team membership with minimal sharing, and co‐location of team members. Study of PACTs showed how leadership support limits the ability to build high‐functioning teams 3,5,10,11,14 . GeriPACTs described leadership support as limiting the ability of the team to provide geriatrics care by putting staffing, scheduling, and space needs in the context of patient characteristics, such as clinical complexity.…”

Section: Discussionmentioning

confidence: 99%

Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams

Solimeo

Steffen

Gardner

et al. 2020

J American Geriatrics Society

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OBJECTIVES To identify the perceived organizational resources required by healthcare workers to deliver geriatric primary care in a geriatric patient aligned care team (GeriPACT). DESIGN Cross‐sectional observational study using deductive analyses of qualitative interviews conducted with GeriPACT team members. SETTING GeriPACTs practicing at eight geographically dispersed Department of Veterans Affairs (VA) healthcare systems. PARTICIPANTS GeriPACT clinicians, nurses, clerical associates, clinical pharmacists, and social workers (n = 67). MEASUREMENTS Semistructured qualitative interviews conducted in person, transcribed, and then analyzed using the PACT Resources Framework. RESULTS Using the PACT Resources Framework, we identified facility‐, clinic‐, and team‐level resources critical for GeriPACT implementation. Resources within each level reflect how the needs of older adults with complex comorbidity intersect with general population primary care medical home practice. GeriPACT implementation is facilitated by attention to patient characteristics such as cognitive impairment, ambulatory limitations, or social support services in staffing and resourcing teams. CONCLUSION Models of geriatric primary care such as GeriPACT must be implemented with an eye toward the most effective use of our most limited resource‐trained geriatricians. In contrast to much of the literature on medical home teams serving a general adult population, interviews with GeriPACT members emphasize how patient needs inform all aspects of practice design including universal accessibility, near real‐time response to patient needs, and ongoing interdisciplinary care coordination. Examination of GeriPACT implementation resources through the lens of traditional primary care teams illustrates the importance of tailoring primary care design to the needs of older adults with complex comorbidity.

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Section: Discussionmentioning

confidence: 99%

Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams

Solimeo

Steffen

Gardner

et al. 2020

J American Geriatrics Society

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“…We were also not surprised to see the strong association of practice leadership with TE. Within the practice transformation literature, more effective leadership has been associated with greater engagement of practice teams in change activities [ 37 ]. In an editorial, Bohmer outlines key physician leadership activities critical to organizational change, including leadership responsibilities with 1) defining care goals, 2) ensuring that “clinical microsystems” can execute such goals, 3) engaging in data driven QI methods, and 4) modeling how to step beyond usual boundaries in order to drive organizations towards “relentless” improvement [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Practice level factors associated with enhanced engagement with practice facilitators; findings from the heart health now study

Halladay

Weiner

Kim

et al. 2020

BMC Health Serv Res

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Background Practice facilitation is a promising strategy to enhance care processes and outcomes in primary care settings. It requires that practices and their facilitators engage as teams to drive improvement. In this analysis, we explored the practice and facilitator factors associated with greater team engagement at the mid-point of a 12-month practice facilitation intervention focused on implementing cardiovascular prevention activities in practice. Understanding factors associated with greater engagement with facilitators in practice-based quality improvement can assist practice facilitation programs with planning and resource allocation. Methods One hundred thirty-six ambulatory care small to medium sized primary care practices that participated in the EvidenceNow initiative’s NC Cooperative, named Heart Health Now (HHN), fit the eligibility criteria for this analysis. We explored the practice and facilitator factors associated with greater team engagement at the mid-point of a 12-month intervention using a retrospective cohort design that included baseline survey data, monthly practice activity implementation data and information about facilitator’s experience. Generalized linear mixed-effects models (GLMMs) identified variables associated with greater odds of team engagement using an ordinal scale for level of team engagement. Results Among our practice cohort, over half were clinician-owned and 27% were Federally Qualified Health Centers. The mean number of clinicians was 4.9 (SD 4.2) and approximately 40% of practices were in Medically Underserved Areas (MUA). GLMMs identified a best fit model. The Model presented as odd ratios and 95% confidence intervals suggests greater odds ratios of higher team engagement with greater practice QI leadership 17.31 (5.24–57.19), [0.00], and practice location in a MUA 7.25 (1.8–29.20), [0.005]. No facilitator characteristics were independently associated with greater engagement. Conclusions Our analysis provides information for practice facilitation stakeholders to consider when considering which practices may be more amendable to embracing facilitation services.

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“…Because individual PACT members often report to different leaders within the clinic, PACT members rely upon local healthcare leadership to assist with resolution of within-team conflict resultion [ 5 ]. Notably, leadership support of the PACT model has been associated with: better recruitment and retention of PACT members [ 1 ]; stronger PACT teamwork [ 6 ]; greater sense of team member accountability to the PACT [ 5 ]; and better patient-reported access to care [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

The importance of soft skills development in a hard data world: learning from interviews with healthcare leaders

2021

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Background Learning healthcare systems have invested heavily in training primary care staff to provide care using patient-centered medical home models, but less is known about how to effectively lead such teams to deliver high quality care. Research is needed to better understand which healthcare leadership skills are most utilized or in need of development through additional training. Method Semi-structured telephone interviews with healthcare leaders familiar with Patient-Aligned Care Teams (PACT) implementation in the U.S. Department of Veterans Affairs (VA). We interviewed sixteen (N = 16) physician, nursing, and administrative leaders at VA facilities located in the upper Midwestern United States. Content analysis of interviews transcripts using template techniques. Results Participants described instrumental challenges that they perceived hindered leadership effectiveness, including the supervisory structure; pace of change; complexity of the clinical data infrastructure; an over-reliance on technology for communication; and gaps in available leadership training. Factors perceived as facilitating effective leadership included training in soft skills, face-to-face communication, and opportunities for formal training and mentorship. A cross-cutting theme was the importance of developing “soft skills” for effective PACT leadership. Conclusions Although formal leadership training and development were perceived as beneficial, healthcare leaders familiar with PACT implementation in the VA described a mismatch between the skills and knowledge PACT leaders need to succeed and the training available to them. Closing this gap could improve retention of skilled and knowledgeable healthcare leaders, thereby reducing the costs associated with training and leading to improvements in healthcare delivery.

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Developing High-Functioning Teams: Factors Associated With Operating as a “Real Team” and Implications for Patient-Centered Medical Home Development

Cited by 16 publications

References 20 publications

Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams

Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams

Practice level factors associated with enhanced engagement with practice facilitators; findings from the heart health now study

The importance of soft skills development in a hard data world: learning from interviews with healthcare leaders

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