High Performance Teams in Primary Care: The Basis of Interdisciplinary Collaborative Care

Organization Development

One of the fundamental challenges of Primary Health Care Reform is the establishment of collaborative health care teams to meet the needs of patients and society in a timely and effective manner. The characteristics of effective primary care team function have not been well studied. Millward and Ramsay (1998) used the Cognitive Motivational Model to develop a survey tool, first used in industry and subsequently in the health care field in Britain, to examine the characteristics of effective teams. In this study we investigated whether the Team Survey developed by Millward and Jeffries (2001) for the National Health Service in Britain was valid and reliable for use in predicting primary care team effectiveness in the Canadian health care context.

Executive Summary

One of the fundamental challenges of Primary Health Care Reform is the establishment of collaborative health care teams to meet the needs of patients and society in a timely and effective manner. The characteristics of effective primary care team function have not been well studied. (San Martin-Rodriguez et al., 2005)

Millward and Ramsay (1998) used the Cognitive Motivational Model to develop a survey tool, first used in industry and subsequently in the health care field in Britain to examine the characteristics of effective teams. (Millward and Jeffries, 2001) The Team Survey® was found to have acceptable psychometric properties in the National Health Service population. In this study we investigated whether the Team Survey® developed by Millward and Jeffries (2001) for the National Health Service (NHS) in Britain was valid and reliable for use in predicting primary care team effectiveness in the Canadian Health Care context.

The Queen’s University Department of Family Medicine consists of six practice teams, each with two to three physicians, one registered nurse (RN) or registered practical nurse (RPN) and a shared receptionist. Six secretaries, a Nurse Practitioner, two float RPNs, a nutritionist, two social workers, two liaison psychiatrists, a switchboard operator and six administrative staff support the practice teams. There is also a research team giving a total of 50 participants excluding learners.

All teams were invited to attend a focus group with their team or teams to complete the Team Survey® and an evaluation of the teams effectiveness. A focus group discussion was held to assess the validity of the tool and to address other issues relating to their team work. In this paper we report the analysis of the survey tool.

Sixty-one responses were included. Factor and multiple regression analyses revealed four factors with acceptable reliability, content and construct validity, three of which predicted team effectiveness: Metacognition of team goals and performance, (ß=0.47, p<.001), Team identification and communication (ß=0.42, p<.001) and Team potency (ß=0.40, p<.001).

The tool shows promise as a measure of characteristics that predict team effectiveness in this setting. The sample size was not large enough to determine a stable factor structure and the outcome measure used was subjective. The Team Survey® tool requires further testing with primary care teams in other settings and with virtual teams and with other outcome measures to determine its generalizability. If the factors identified in this study continue to predict team effectiveness, then interventions could be directed at improving team metacognition, communication and motivation with the expectation that these are not task or context specific.

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