Different strokes for different folks? Staff perceptions of team functioning in Ontario Community Health Centres

Building stronger teams at your Health Centre

Jennifer RaynerLaura MuldoonCanadian Association of CHCs September 18, 2015

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Team Functioning...good and bad teams?

Describe well-functioning and not well-functioning teams.What causes teams to function poorly?

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DetailsCOI - Investigators are employees of CHCsFunding from University of Ottawa Department of Family Medicine Research Funding ProgramEthics from Ottawa Health Sciences Research Network and Bruyre Continuing Care

What are PC teams?Inter-professional teamwork in PHC is a priority in Canada2Know more about who team members are than what they do or how they work together.3 Membership of PC teams vary widely depending on the setting2Care is by the integrated activities of clinical and non-clinical members of (PC) teams4

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What is team function?Team function (the processes and psycho-social traits of the team) links a teams task design (types & features of the tasks, team members) to its effectiveness

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Is team function important? linked to innovation and effectiveness in PC , technical quality of care. may have more influence over clinical behaviors in PC than individual provider or practice characteristics.8can be improved by certain interventions.9

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Why look at CHC teams?Quality of primary care equivalent or superior to that in other PC models in Ontario.2, 11,12,13 ICES CHC studyIf youve seen one CHC, youve seen one CHCProvincial tour different feel to the teamsLittle is known about CHC PC team functionQuebec community-governed practices (some similar to Ontario CHCs) had lower scores for team climate than professionally-governed practices14

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Previous Research ResultsStaff Groups & Teams Ontario: admin staff reported suboptimal team climate more than GPs.14 US CHC physicians dissatisfied with high workloads and administrative management.15,16 No literature on how other team members view team functioningOrganizational Features & Teams Leadership, professional governance, solo practice, certain team cultures are associated with better team functionNo association previously found with size of the team or number of sites (in PC)

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Our Questions...How do CHC staff rate the functioning of their teams?Are there differences between different groups of staff in how team function is perceived?Are there differences between different CHC organizations?Are there organizational features which can explain the differences?

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MethodsCross-sectional, part of proposed larger study Ethics OHSRN/Bruyre REBAll 75 CHCs invitedPHC director completed organizational surveyED distributed on-line survey to PC staffany person who provided or supported the provision of clinical care on a regular basis (including administration & reception)

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Organizational SurveyAdapted from CIHINumber of sites, staffing, size, priorities, means of communication, rurality, years of operation, patient demographics

Staff SurveyDescriptive (professional role, full-time status, number of years employed at the CHC , working off-site from the main clinic) 3 different scales

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Team Climate InventoryTeam Climate: shared perceptions of policies, practices & procedures within teamShort, validated 14 item versionVision Innovation Participative safetyTask Orientation

Vision - How far are you in agreement with your teams objectives?Innovation In this team we take the time needed to develop new ideas.Participative safety (We have a we are in it together attitude.) Task Orientation ( Do members of the team build on each others ideas to achieve the best possible outcome?)

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Organizational JusticeAssesses perceptions of fairness, equity & respectProcedural Justice (PJ) 7 items (perceived fairness)Procedures are in place to generate standards so that decisions can be made with consistencyInteractional Justice (IJ) 6 items (politeness, dignity & respect) Primary health care team members consider your viewpoint.

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Organizational Citizenship Behaviour Perceptions of the presence of work related behaviors that are:discretionarynot related to the formal reward systemin the aggregate promote the effective functioning of the organization.20 13 items Help each other out if someone falls behind in his/her work

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Analysis Staff characteristicsResponses stratified by staff group (manager, physician, NP, registered nurse, medical secretary, allied health, counselor, outreach, admin assistants)One-way Anova to determine overall difference in team climate, organizational justice and citizenship behaviour between the different provider groups. Bonferroni posthoc analysis based on apriori hypothesis Organizational characteristicsLinear regressions relating organizational features with the various measures of team function

Responses stratified by staff group (manager, physician, nurse practitioner, registered nurse, medical secretary, allied health, counselor, outreach, administrative assistants). Allied health provider group - pharmacists, physiotherapists, dietitians, an occupational therapist.

Apriori hypothesis - clinical providers would be significantly different compared to the administrative, other less proximate providers

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Overall Results58 CHCs (77.8%)674 staff (approx. 60%) physicians, NPs, nurses 57% of the respondentsExcluded system navigators due to low numbers

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Results Staff characteristics One way ANOVA significant difference between staff groups on mean scores for: Procedural Justice (p= 0.01)Total TCI (p=0.03) Innovation subscale of TCI (p=0.011)

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Team Climate Inventory

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Organizational Justice

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Organizational Citizenship Behaviour

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Differences between groupsNPs and FPs rated Procedural Justice statistically significantly lower than nurses, managers, secretaries and admin assistants (p