Development and validation of the primary care team dynamics survey.

OBJECTIVE To develop and validate a survey instrument designed to measure team dynamics in primary care. DATA SOURCES/STUDY SETTING We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care. STUDY DESIGN We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall survey's goodness-of-fit using structural equation modeling. DATA COLLECTION We administered the survey between September 2012 and March 2013. PRINCIPAL FINDINGS Overall response rate was 68 percent (732 respondents). Results support a seven-factor model of team dynamics, suggesting that conditions for team effectiveness, shared understanding, and three supportive processes are associated with acting and feeling like a team and, in turn, perceived team effectiveness. This model demonstrated adequate fit (goodness-of-fit index: 0.91), scale reliability (Cronbach's alphas: 0.71-0.91), and discriminant validity (average factor correlations: 0.49). CONCLUSIONS It is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes).

[1]  France Légaré,et al.  Decision aids for people facing health treatment or screening decisions. , 2017, The Cochrane database of systematic reviews.

[2]  Ingrid M. Nembhard,et al.  Measuring Teamwork in Health Care Settings: A Review of Survey Instruments , 2014, Medical care.

[3]  Yasushi Miyata,et al.  Joint Principles of the Patient-Centered Medical Home , 2015 .

[4]  R. Phillips,et al.  The Harvard Medical School Academic Innovations Collaborative: transforming primary care practice and education. , 2014, Academic medicine : journal of the Association of American Medical Colleges.

[5]  D. Margolius,et al.  Less tinkering, more transforming: how to build successful patient-centered medical homes. , 2013, JAMA internal medicine.

[6]  Sally E. Green,et al.  Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments , 2013, Implementation Science.

[7]  T. Ferris,et al.  Guidance for structuring team-based incentives in healthcare. , 2013, The American journal of managed care.

[8]  B. Moulton,et al.  Group Health's participation in a shared decision-making demonstration yielded lessons, such as role of culture change. , 2013, Health affairs.

[9]  J. Hibbard,et al.  What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. , 2013, Health affairs.

[10]  Judith H Hibbard,et al.  Patients with lower activation associated with higher costs; delivery systems should know their patients' 'scores'. , 2013, Health affairs.

[11]  J. Fowles,et al.  When activation changes, what else changes? the relationship between change in patient activation measure (PAM) and employees' health status and health behaviors. , 2012, Patient education and counseling.

[12]  S. Sarma,et al.  Does team-based primary health care improve patients' perception of outcomes? Evidence from the 2007-08 Canadian Survey of Experiences with Primary Health. , 2012, Health policy.

[13]  M. Barry,et al.  Shared decision making--pinnacle of patient-centered care. , 2012, The New England journal of medicine.

[14]  Bill Holtsnider,et al.  Managing Your IT Team , 2012 .

[15]  Marissa L. Shuffler,et al.  There’s a Science for That , 2011 .

[16]  Bradley R. Staats,et al.  Dynamically Integrating Knowledge in Teams: Transforming Resources into Performance , 2011 .

[17]  M. Paterson,et al.  Development and pilot testing of the collaborative practice assessment tool , 2011, Journal of interprofessional care.

[18]  Nick Sevdalis,et al.  Information Transfer and Communication in Surgery: A Systematic Review , 2010, Annals of surgery.

[19]  R. E. Hoye,et al.  Is Patient Activation Associated With Future Health Outcomes and Healthcare Utilization Among Patients With Diabetes? , 2009, The Journal of ambulatory care management.

[20]  Eduardo Salas,et al.  Does Team Building Work? , 2009 .

[21]  Nancy Arthur,et al.  Role understanding and effective communication as core competencies for collaborative practice , 2009, Journal of interprofessional care.

[22]  F. Herzberg.  One More Time: How Do You Motivate Employees? , 2008 .

[23]  Phil Wood.  Confirmatory Factor Analysis for Applied Research , 2008 .

[24]  I. Heath.  American College of Physicians Ethics Manual (Fifth Edition) , 2007, BMJ : British Medical Journal.

[25]  Barbara Senior,et al.  Inside Management Teams: Developing a Teamwork Survey Instrument , 2007 .

[26]  Daniel R. Ilgen,et al.  Enhancing the Effectiveness of Work Groups and Teams , 2006, Psychological science in the public interest : a journal of the American Psychological Society.

[27]  L. Lemieux-Charles,et al.  What Do We Know about Health Care Team Effectiveness? A Review of the Literature , 2006, Medical care research and review : MCRR.

[28]  Erin V. Lehman,et al.  Team Diagnostic Survey , 2005 .

[29]  Erin Graydon-Baker,et al.  Closing the loop: follow-up and feedback in a patient safety program. , 2005, Joint Commission journal on quality and patient safety.

[30]  J. Alexander,et al.  Cross-functional team processes and patient functional improvement. , 2005, Health services research.

[31]  David A Asch,et al.  In a mailed physician survey, questionnaire length had a threshold effect on response rate. , 2005, Journal of clinical epidemiology.

[32]  Scott B. MacKenzie,et al.  Common method biases in behavioral research: a critical review of the literature and recommended remedies. , 2003, The Journal of applied psychology.

[33]  Paula Johnson,et al.  Creating an integrated patient safety team. , 2003, Joint Commission journal on quality and safety.

[34]  D. Garvin,et al.  What you don't know about making decisions , 2001, IEEE Engineering Management Review.

[35]  F. Herzberg.  One more time: how do you motivate employees? 1968. , 2003, Harvard business review.

[36]  R. Thomson,et al.  Decision aids for people facing health treatment or screening decisions. , 2003, The Cochrane database of systematic reviews.

[37]  Jody Hoffer Gittell,et al.  Coordinating Mechanisms in Care Provider Groups: Relational Coordination as a Mediator and Input Uncertainty as a Moderator of Performance Effects , 2002 .

[38]  C. Cassel,et al.  Attitudes Toward Working on Interdisciplinary Healthcare Teams: A Comparison by Discipline , 2002, Journal of the American Geriatrics Society.

[39]  L. A. Hill,et al.  A Note on Team Process , 2001 .

[40]  Gary P. Pisano,et al.  Speeding Up Team Learning. , 2001 .

[41]  R. Wageman.  How Leaders Foster Self-Managing Team Effectiveness: Design Choices Versus Hands-on Coaching , 2001 .

[42]  L. Millward,et al.  The team survey: a tool for health care team development. , 2001, Journal of advanced nursing.

[43]  Amy P. Hutton,et al.  Four rules for taking your message to Wall Street. , 2001, Harvard business review.

[44]  B. Byrne.  Structural equation modeling with EQS : basic concepts, applications, and programming , 2000 .

[45]  S. Kozlowski,et al.  Multilevel Theory, Research, and Methods in Organizations: Foundations, Extensions, and New Directions , 2000 .

[46]  J. H. Gittell.  Organizing work to support relational co-ordination , 2000 .

[47]  K. Hyer,et al.  Measuring attitudes related to interdisciplinary training: Revisiting the Heinemann, Schmitt and Farrell 'attitudes toward health care teams' scale , 2000 .

[48]  Erry,et al.  Measuring attitudes related to interdisciplinary training : revisiting the Heinemann , Schmitt and Farrell ` attitudes toward health care teams ’ scale , 2000 .

[49]  Dorothy A. Leonard,et al.  When Sparks Fly: Igniting Creativity in Groups , 1999 .

[50]  R. Hays,et al.  Psychometric properties of the CAHPS 1.0 survey measures. Consumer Assessment of Health Plans Study. , 1999, Medical care.

[51]  Sara A. Brallier,et al.  Development of an Attitudes toward Health Care Teams Scale , 1999, Evaluation & the health professions.

[52]  C. Darby,et al.  Consumer Assessment of Health Plans Study (CAHPS). Foreword. , 1999, Medical care.

[53]  David L. Bradford,et al.  Power Up: Transforming Organizations Through Shared Leadership , 1998 .

[54]  K. Eisenhardt,et al.  Conflict and Strategic Choice: How Top Management Teams Disagree , 1997 .

[55]  G. Stasser,et al.  Expert Roles and Information Exchange during Discussion: The Importance of Knowing Who Knows What , 1995 .

[56]  J. Baggs.  Development of an instrument to measure collaboration and satisfaction about care decisions. , 1994, Journal of advanced nursing.

[57]  R. Saavedra,et al.  Complex interdependence in task-performing groups , 1993 .

[58]  J. Katzenbach,et al.  The discipline of teams. , 1993, Harvard business review.

[59]  Ron D. Hays,et al.  Beyond internal consistency reliability: Rationale and user’s guide for Multitrait Analysis Program on the microcomputer , 1990 .

[60]  R W Toseland,et al.  Teamwork in psychiatric settings. , 1986, Social work.

[61]  Henry L. Tosi,et al.  Managing Organizational Behavior , 1986 .

[62]  S. Weiss,et al.  Validity and Reliability of the Collaborative Practice Scales , 1985, Nursing research.

[63]  L. James,et al.  Estimating within-group interrater reliability with and without response bias. , 1984 .

[64]  K. Williams,et al.  Many Hands Make Light the Work: The Causes and Consequences of Social Loafing , 1979 .

[65]  Donald A. Schön,et al.  Organizational Learning: A Theory Of Action Perspective , 1978 .

[66]  W B McGrath,et al.  Principles of medical ethics. , 1966, Arizona medicine.

[67]  F. Herzberg.  One more time : How do you motivate your employees? , 1968 .

[68]  James D. Thompson.  Organizations in Action: Social Science Bases of Administrative Theory , 1967 .