Implementing Optimal Team-Based Care to Reduce Clinician Burnout (original) (raw)
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What Do We Know about Health Care Team Effectiveness? A Review of the Literature
Medical Care Research and Review, 2006
This review of health care team effectiveness literature from 1985 to 2004 distinguishes among intervention studies that compare team with usual (nonteam) care; intervention studies that examine the impact of team redesign on team effectiveness; and field studies that explore relationships between team context, structure, processes, and outcomes. The authors use an Integrated Team Effectiveness Model (ITEM) to summarize research findings and to identify gaps in the literature. Their analysis suggests that the type and diversity of clinical expertise involved in team decision making largely accounts for improvements in patient care and organizational effectiveness. Collaboration, conflict resolution, participation, and cohesion are most likely to influence staff satisfaction and perceived team effectiveness. The studies examined here underscore the importance of considering the contexts in which teams are embedded. The ITEM provides a useful framework for conceptualizing relationships between multiple dimensions of team context, structure, processes, and outcomes.
International Journal of Health Professions, 2014
Interprofessional teamwork among healthcare professionals in healthcare organizations is a key factor for both their job satisfaction and patients' effective and efficient treatment. One precondition for successful interprofessional teamwork is a shared mental model (a common cognitive frame of reference and knowledge) of working together as a team. However, there often exist subcultures, and each of these has its own mental model of teamwork. Hence, it can be assumed that different healthcare professional groups do not share the evaluation of their interprofessional teamwork and job satisfaction (Hypothesis 1). Additionally, based on the input-process-output model of team effectiveness, it can be expected that interprofessional teamwork determines job satisfaction (Hypothesis 2). These hypotheses were tested in a survey of 272 employees in 15 rehabilitation clinics in Germany. Results showed that healthcare professionals' evaluation of their interprofessional teamwork (F(3, 203) = 9.118, p < 0.001, η 2 = 0.119) as well as their job satisfaction (F(3, 210) = 3.357, p = 0.02, η 2 = 0.046) differed significantly. Physicians reported the highest level of interprofessional teamwork and job satisfaction compared with other groups. Perceptions of interprofessional teamwork explain approximately 20% of the variance in job satisfaction. Thus, both hypotheses were confirmed. Interprofessional interventions in education and practice are recommended to establish a shared mental model, which could improve teamwork and subsequently job satisfaction.
What do doctors mean when they talk about teamwork? Possible implications for interprofessional care
Journal of Interprofessional Care, 2018
The concept of teamwork has been associated with improved patient safety, more effective care and a better work environment. However, the academic literature on teamwork is pluralistic, and there are reports on discrepancies between theory and practice. Furthermore, healthcare professionals' direct conceptualizations of teamwork are sometimes missing in the research. In this study, we examine doctors' conceptualizations of teamwork. We also investigate what doctors think is important in order to achieve good teamwork, and how the empirical findings relate to theory. Finally, we discuss the methodological implications for future studies. The research design was explorative. The main data consisted of semi-structured interviews with twenty clinically active doctors, analyzed with conventional content analysis. Additional data sources included field observations and interviews with management staff. There was large variation in the doctors' conceptualizations of teamwork. The only characteristic they shared in common was that team members should have specific roles. This could have consequences for practice, because the rationale behind different behaviors depends on how teamwork is conceptualized. Several of the teamwork-enabling factors identified concerned non-technical skills. Future studies should put more emphasis on the practitioners' perspective in the research design, to create a more grounded foundation for both research and practice.
Mayo Clinic Proceedings, 2019
In this article, we describe the implementation of a team-based care model during the first 2 years (2016-2017) after Mayo Clinic designed and built a new primary care clinic in Rochester, Minnesota. The clinic was configured to accommodate a team-based care model that included complete colocation of clinical staff to foster collaboration, designation of a physician team manager to support a physician to advanced practice practitioner ratio of 1:2, expanded roles for registered nurses, and integration of clinical pharmacists, behavioral health specialists, and community specialists; this model was designed to accommodate the growth of nonvisit care. We describe the implementation of this team-based care model and the key metrics that were tracked to assess performance related to the quadruple aim of improving population health, improving patient experience, reducing cost, and supporting care team's work life.
Team Effectiveness in Patient Health Management: An Overview of Reviews
International Journal of Clinical Medicine, 2012
Background: The desire to improve the quality of health care for an aging population with multiple chronic diseases is fostering a rapid growth in inter-professional team care, supported by health professionals, governments, businesses and public institutions. However, the weight of evidence measuring the impact of team care on patient and health system outcomes has not, heretofore, been clear. To address this deficiency, we evaluated published evidence for the clinical effectiveness of team care within a chronic disease management context in a systematic overview. Methods: A search strategy was built for Medline using medical subject headings and other relevant keywords. After testing for performance, the search strategy was adapted to other databases (Cinhal, Cochrane, Embase, PsychInfo) using their specific descriptors. The searches were limited to reviews published between 1996 and 2011, in English and French languages. The results were analyzed by the number of studies favouring team intervention, based on the direction of effect and statistical significance for all reported outcomes. Results: Sixteen systematic and 7 narrative reviews were included. Diseases most frequently targeted were depression, followed by heart failure, diabetes and mental disorders. Effectiveness outcome measures most commonly used were clinical endpoints, resource utilization (e.g., emergency room visits, hospital admissions), costs, quality of life and medication adherence. Briefly, while improved clinical and resource utilization endpoints were commonly reported as positive outcomes, mixed directional results were often found among costs, medication adherence, mortality and patient satisfaction outcomes. Conclusions: We conclude that, although suggestive of some specific benefits, the overall weight of evidence for team care efficacy remains equivocal. Further studies that examine the causal interactions between multidisciplinary team care and clinical and economic outcomes of disease management are needed to more accurately assess its net program efficacy and population effectiveness.