'Team capital’ in quality improvement teams: findings from an ethnographic study of front-line quality improvement in the NHS

Abstract

BackgroundTeamwork is important in the design and delivery of initiatives in complex healthcare systems but the specifics of quality improvement (QI) teams are not well studied.ObjectiveTo explain the functioning of front-line healthcare teams working on patient-centred QI using Bourdieu’s sociological construct of capital.MethodsOne medical ward from each of six NHS Trusts in England participated in the study, purposively selected for a range of performance levels on patient experience metrics. Three ethnographers conducted focused ethnography for 1 year, using interviews and observations to explore the organisation, management and delivery of patient-centred QI projects by the six front-line teams. Data were analysed using Bourdieu’s typology of the four forms of capital: economic, social, symbolic and cultural.ResultsWhile all teams implemented some QI activities to improve patient experience, progress was greater where teams included staff from a broad range of disciplines and levels of seniority. Teams containing both clinical and non-clinical staff, including staff on lower grades such as healthcare assistants and clerks, engaged more confidently with patient experience data than unidisciplinary teams, and implemented a more ambitious set of projects. We explain these findings in terms of ‘team capital’.ConclusionTeams that chose to restrict membership to particular disciplines appeared to limit their capital, whereas more varied teams were able to draw on multiple resources, skills, networks and alliances to overcome challenges. Staff of varying levels of seniority also shared and valued a broader range of insights into patient experience, including informal knowledge from daily practice. The construct of ‘team capital’ has the potential to enrich understanding of the mechanism of teamwork in QI work.

Perceptions of hospital staff on the performance of Quality Improvement teams in the regional referral hospitals in Tanzania: A cross sectional study

“…Therefore, the perceptions and opinions of hospital staff on the performance of QI teams are fundamental for improving the quality of healthcare services. To our knowledge and from the literature search, this study is one of the first to assess the perceptions of hospital staff of the performance of QI teams in regional referral hospitals in Tanzania [ 1 – 7 , 12 , 13 , 20 ].…”

“…Previous studies conducted in Tanzania documented several positive impacts of QI teams in terms of reducing the workload of healthcare professionals, increased patient satisfaction and increased job satisfaction [ 2 , 12 ]. However, the lack of a shared vision between QI teams and hospital staff may negatively affect staff’s and patients’ safety [ 13 ].…”

“…This study builds on several studies that have examined the sustainability of QI teams [ 2 ], the contribution of QI teams to healthcare delivery [ 12 , 17 ] and association between the healthcare context and the policies governing QI, in terms of communicating and coordinating them, clarifying roles and responsibilities, leadership and management support, and human and financial resources [ 2 , 6 – 8 , 11 – 13 , 16 – 18 ]. Although these previous studies examined the general performance of QI teams, there is a paucity of information about the specific activities performed by them and how hospital staff perceive QI teams.…”

Mass production methods for mass vaccination: improving flow and operational performance in a COVID-19 mass vaccination centre using Lean

“…National protocols are new legal instruments that support vaccination campaigns (influenza and COVID-19) by allowing a broader range of staff to safely administer authorised vaccines, including those who are not registered healthcare professionals. 14 Such protocols provide flexibility to split the vaccination process into its component parts across multidisciplinary teams (comprised of various clinical and non-clinical professionals from various seniority levels) 16 setting out the competency and professional registration requirements of each stage (eg, clinical assessment and consent, vaccine administration). 14 15 Initially, seven mass vaccination centres were established.…”

Improving flow along care pathways

“…13,14 A range of professions, grades, middle managers and data analysts need to be involved with a stake in the intervention. 15 The extent to which clinical and managerial interests align is a key determinant of success in QI interventions. 16 Several major programmes in the NHS have focused on patient flow.…”