Promoting high-functioning mental health treatment teams in the context of low staffing ratios

Abstract

Background: Many previous studies of health care teamwork have taken place in clinical teams with high staffing ratios (i.e., high ratios of staff to patients). Purpose: The aim of this study was to identify clinicians' viewpoints of foundational resources necessary to support good team functioning in the context of low staffing ratios. Methodology: We used administrative data, validated with local mental health chiefs, to identify mental health teams that had achieved high team functioning despite low staffing ratios in U.S. Department of Veterans Affairs medical centers. Guided by a recently developed model of team effectiveness, the Team Effectiveness Pyramid, we conducted qualitative interviews with 21 team members across three teams within two medical centers. Interview questions focused on the resources needed to support good team functioning despite low staffing ratios. We used directed content analysis to analyze results. Results: We found there were several domains of relevant resources: material, staffing, temporal, organizational, and psychological. These represent an expansion of the domains originally included in the Team Effectiveness Pyramid. Conclusions: Within the five domains, we identified key tensions to be addressed when forming teams, including the balances between providing care for new versus established patients, emphasizing shared caseloads within the team versus matching patients to clinicians based on individual expertise, and establishing reporting structures by clinical discipline versus team membership. Practice Implications: Establishing high-functioning health care teams in the context of low staffing ratios requires attention to key resource domains and fundamental trade-offs in how teams are structured.

Sustainability of the Collaborative Chronic Care Model in Outpatient Mental Health Teams Three Years Post-Implementation: A Qualitative Analysis

“…Specifically, interview respondents noted that consistent leadership support for CCM-based BHIP teams, especially in the form of appropriate staffing and dedicated time for BHIP team meetings, was crucial to sustaining this model of care delivery. Other related work (Miller et al, 2022) has suggested that a "two-by-two" approach to team staffing, with each discipline having at least two representatives on the clinical team, may help protect against the negative impacts of staff turnover, as it allows for some level of continuity within the team even if one person leaves. In contrast, in the current project, in one case the presence of one influential nonsupportive leader (e.g., an Associate Chief of Staff) resulted in the dismantling of several years of BHIP-related process improvement work.…”

Developing Relational Coordination: A Qualitative Study of Outpatient Mental Health Teams

“…We used a qualitative study design to examine the relational aspects of high-functioning clinician teams in the context of low staffing ratios. This paper builds on our work examining resources required to support team functioning in the context of low staffing ratio teams (Miller et al, 2021). This study was approved by the VA Boston Institutional Review Board.…”

“…We used a two-step process to identify BHIP teams that achieved high-functioning despite low staffing ratios. First, teams were initially identified through administrative data from FY2017 (the last year with complete data at the time that we began identifying teams) including the VA All Employee Survey (AES), the VA Mental Health Provider Survey (MHPS), VA Corporate Data Warehouse (CDW), the VA Mental Health Management System (MHMS) and further detailed elsewhere (Miller et al, 2021; also see Supplemental File 1). Briefly, high-functioning BHIP teams were defined as those with high levels of self-reported job satisfaction, low burnout, and no plans or intentions to leave their current job (i.e., low turnover plans/intentions).…”

“…The current manuscript presents results from a novel analysis of qualitative interview data (Miller et al, 2021). In Miller et al, 2021, authors exmined the foundational resources that were necessary to build effective teams in the context of low staffing ratios.…”

“…Thus, in a previous study, we set out to investigate how low-resourced BHIP teams (i.e. BHIP teams with low staffing ratios) were able to overcome this challenge to develop high team functioning (Miller et al, 2021). Our initial analyses for that study focused on the structural and operational components necessary to promote teamwork in resource-constrained clinical settings.…”