Unlocking the Black Box

Coleman, Katie; Phillips, Kathryn E.; Borkulo, Nicole Van; Daniel, D.; Johnson, Karin; Wagner, Edward H.; Sugarman, Jonathan R.

doi:10.1097/mlr.0000000000000190

Cited by 13 publications

(3 citation statements)

References 11 publications

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“…Creating and maintaining effective practice teams requires resources. This study adds to the growing literature 21 - 23 highlighting the need for primary care redesign models and payment methods to account for enabling team activities, such as huddles and team meetings, to achieve effective practice teamwork. While other enabling structures such as collocation and coscheduling may also promote team effectiveness, further evaluation of the relationship between these elements and team effectiveness is required.…”

Section: Discussionmentioning

confidence: 93%

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

Stout

Zallman

Arsenault

et al. 2017

INQUIRY

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Team-based care is a foundation of health care redesign models like the patient-centered medical home (PCMH). Yet few practices rigorously examine how the implementation of PCMH relates to teamwork. We identified factors associated with the perception of a practice operating as a real team. An online workforce survey was conducted with all staff of 12 primary care sites of Cambridge Health Alliance at different stages of PCMH transformation. Bivariate and multivariate analyses of factors associated with teamwork perceptions were conducted. In multivariate models, having effective leadership was the main factor associated with practice teamwork perceptions (odds ratio [OR], 10.49; 95% confidence interval [CI], 5.39-20.43); in addition, practicing at a site in an intermediate stage of PCMH transformation was also associated with enhanced team perceptions (OR, 2.44; 95% CI, 1.28-4.64). In a model excluding effective leadership, respondents at sites in an intermediate stage of PCMH transformation (OR, 1.95; 95% CI, 1.1-3.4) and who had higher care team behaviors (such as huddles and weekly meetings; OR, 3.41; 95% CI, 1.30-8.92), higher care team perceptions (OR, 2.65; 95% CI, 1.15-6.11), and higher job satisfaction (OR, 2.00; 95% CI, 1.02-3.92) had higher practice teamwork perceptions. This study highlights the strong association between effective leadership, care team behaviors and perceptions, and job satisfaction with perceptions that practices operate as real teams. Although we cannot infer causality with these cross-sectional data, this study raises the possibility that providing attention to these factors may be important in augmenting practice teamwork perceptions.

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Section: Discussionmentioning

confidence: 93%

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

Stout

Zallman

Arsenault

et al. 2017

INQUIRY

View full text Add to dashboard Cite

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“…These change concepts provide direction to small practices in their efforts to transform into true learning and improvement organizations and comprise activities in the eight areas as described in Table 1 . More than a decade of work by members of our team supports these concepts as foundational to build practice capacity to learn and improve [ 17 , 18 ].…”

Section: Methodsmentioning

confidence: 99%

Study protocol for “Healthy Hearts Northwest”: a 2 × 2 randomized factorial trial to build quality improvement capacity in primary care

et al. 2016

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BackgroundLittle attention has been paid to quality improvement (QI) capacity within smaller primary care practices which comprise nearly half of all primary care settings. Strategies for external support to build such capacity include practice facilitation (PF), shared learning opportunities, and educational outreach. Although PF has proven effectiveness, little is known about the comparative effectiveness of combining these strategies. Here, we describe the protocol of the “Healthy Hearts Northwest” (H2N) study, a randomized trial designed to address these questions while improving risk factors for cardiovascular disease.Methods/designThe targeted enrollment is 250 smaller primary care practices across Washington, Oregon, and Idaho. The study is utilizing a two-by-two factorial design to assess four different combinations of practice support: PF alone, PF with educational outreach, PF with shared learning opportunities, or PF with both. A mixed methods approach is being used for evaluation and will include data from (1) baseline and follow-up practice and staff surveys; (2) baseline and quarterly clinical performance measurement from each practice on four cardiovascular risk factors: appropriate aspirin use, blood pressure control, lipid management and smoking cessation support; and (3) a quality improvement capacity assessment (QICA) survey used by external practice facilitators to guide improvement efforts.DiscussionResults from this study will inform future large-scale practice improvement initiatives by providing comparisons of promising external practice support strategies and advance our understanding of how to build QI capacity in primary care.Trial registrationClinicalTrials.gov, NCT02839382

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“…These processes are dynamic and adaptive actions or steps undertaken by patients or providers to achieve a specific goal [16]. However, we have a very limited understanding of processes in interprofessional teams because it is “ like looking into a black box” ([17] p.20, [18], p. S11).…”

Section: Introductionmentioning

confidence: 99%

Measuring patient and family perceptions of team processes and outcomes in healthcare teams: questionnaire development and psychometric evaluation

Kilpatrick

Tchouaket

Paquette

et al. 2019

BMC Health Serv Res

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BackgroundThere is a lack of validated instruments examining dimensions of team functioning from the perspective of patients and families consistent with a conceptual framework. The study aimed to develop and assess the psychometric properties of the Patient-Perceptions of Team Effectiveness (PTE) questionnaire.MethodsA cross-sectional survey was undertaken in three studies. Data were collected from May–October 2016 for Study 1, April 2018-ongoing for Study 2, and October 2016 to June 2017 for Study 3. Online and paper versions of the self-administered questionnaire were available in English and in French. The initial questionnaire included 41 items. Study 1 included 320 respondents. Reliability was assessed using Cronbach alpha. Face validity (n = 250) was assessed using a structured questionnaire. Content validity was examined using subject matter experts and Spearman’s item-total correlations. Construct validity was examined using known group comparisons (i.e., clinical specialty, education, length of follow-up, reason of consultation). Content analysis was used for open-ended questions.ResultsThe questionnaire took 10 to 15 min to complete. Positive assessments were noted for instructions, formatting, font size and logical ordering of questions. In Study 1, reliability indices for the PTE-Overall, Team Processes and Outcomes subscales ranged from 0.72 to 0.84. Item-total correlations ranged from 0.551 to 0.794 (p < 0.001). Differences were noted between clinical specialties, education, length of follow-up, reason of consultation, low and high functioning teams. No differences were noted between English and French language respondents. Psychometric properties were re-assessed in Study 2 and 3 after unclear questions were reworked. Reliability indices for the subscales ranged from 0.76 to 0.94 and differences remained significant between low and high functioning teams.ConclusionThe final 43-item instrument is easy to administer to patients and families. The studies provide evidence of validity to support the propositions in the conceptual framework. The patient-level measures can be aggregated to the team, organizational or system level. The information can be used to assess healthcare team functioning in acute and primary care and determine the role patients and families are playing in teams. Further testing is needed with patients and families who are hospitalized or receiving care from teams in rural areas.

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Unlocking the Black Box

Abstract: There is an important role for both local and national organizations to provide nonduplicative, mutually reinforcing support for primary care transformation. How (in-person, between-peers) and by whom technical assistance is provided may be important to consider.

Cited by 13 publications

References 11 publications

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

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

Study protocol for “Healthy Hearts Northwest”: a 2 × 2 randomized factorial trial to build quality improvement capacity in primary care

Measuring patient and family perceptions of team processes and outcomes in healthcare teams: questionnaire development and psychometric evaluation

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