Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

Abstract

BackgroundMeasuring team factors in evaluations of Continuous Quality Improvement (CQI) may provide important information for enhancing CQI processes and outcomes; however, the large number of potentially relevant factors and associated measurement instruments makes inclusion of such measures challenging. This review aims to provide guidance on the selection of instruments for measuring team-level factors by systematically collating, categorizing, and reviewing quantitative self-report instruments.MethodsData sources: We searched MEDLINE, PsycINFO, and Health and Psychosocial Instruments; reference lists of systematic reviews; and citations and references of the main report of instruments. Study selection: To determine the scope of the review, we developed and used a conceptual framework designed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). We included papers reporting development or use of an instrument measuring factors relevant to teamwork. Data extracted included instrument purpose; theoretical basis, constructs measured and definitions; development methods and assessment of measurement properties. Analysis and synthesis: We used qualitative analysis of instrument content and our initial framework to develop a taxonomy for summarizing and comparing instruments. Instrument content was categorized using the taxonomy, illustrating coverage of the InQuIRe framework. Methods of development and evidence of measurement properties were reviewed for instruments with potential for use in primary care.ResultsWe identified 192 potentially relevant instruments, 170 of which were analyzed to develop the taxonomy. Eighty-one instruments measured constructs relevant to CQI teams in primary care, with content covering teamwork context (45 instruments measured enabling conditions or attitudes to teamwork), team process (57 instruments measured teamwork behaviors), and team outcomes (59 instruments measured perceptions of the team or its effectiveness). Forty instruments were included for full review, many with a strong theoretical basis. Evidence supporting measurement properties was limited.ConclusionsExisting instruments cover many of the factors hypothesized to contribute to QI success. With further testing, use of these instruments measuring team factors in evaluations could aid our understanding of the influence of teamwork on CQI outcomes. Greater consistency in the factors measured and choice of measurement instruments is required to enable synthesis of findings for informing policy and practice.

Same-level peer-assisted learning in medical clinical placements: a narrative systematic review

“…A pragmatic approach to ensure accuracy and consistency with respect to reviewing abstracts and papers was adopted. Previous systematic reviews have engaged a second reviewer to check a proportion of decisions made by the primary reviewer, including decisions on exclusion by title, paper categorisation and data extraction . The proportion of double‐checking has ranged from 10% (14) to 37.5% (15) of all citations.…”

“…A modified version of Kirkpatrick education outcome levels published by Barr et al . was used: Level 1, learner's reaction; Level 2a, modification of attitudes or perceptions; Level 2b; acquisition of knowledge or skills; Level 3, change in behaviour; Level 4a, change in organisational practice; Level 4b, benefits to patients or clients . These descriptors were included as part of the document to assist reviewers.…”

Development and Validation of the Primary Care Team Dynamics Survey

“…When team members act and feel like a team, the literature suggests that group members will perceive a higher level of team effectiveness (Millward and Jeffries 2001;Kozlowski and Ilgen 2006;Lemieux-Charles and McGuire 2006;Brennan et al 2013). According to our conceptual model, team members may perceive a team to be successful in delivering highly effective and efficient care for patients and enhancing enthusiasm and interest among the professionals on the team (Heinemann et al 1999;Hyer et al 2000;Leipzig et al 2002).…”

Assessing content validity and user perspectives on the Team Check-up Tool: expert survey and user focus groups

“…We provide a revised TCT template based on the findings for audiences who may be interested in applying this tool to other QI initiatives (see online supplementary appendix 1). Readers may also benefit from the systematic review of instruments measuring team factors related to the success of QI in primary care conducted by Brennan et al ,32 which provides suggestions on how to select appropriate tools for QI projects or evaluations.…”