BACKGROUND/RATIONALE:
An increasing trend in health care is to deliver service at the outpatient level. At the end of 2003, VHA reported a total of 49.8 million outpatient visits; including 10 million visits to CBOCs. Despite these numbers, a limited number of studies have examined ambulatory health care teams and the characteristics of teams that provide high quality care; most studies have focused on characteristics of groups that are associated with effective inpatient care. To be able to better deal with the changes and demands of the Veteran population, VHA managers and team leaders need information on which characteristics of ambulatory health care teams relate to patient care outcomes. Reports on performance are typically provided for the facility-level, but the study proposes to systematically provide information at the team level.
OBJECTIVE(S):
The study will examine ambulatory care divisions within hospitals and CBOCs for variation in levels of care delivered and on important team characteristics. We hypothesize that primary care team characteristics of team goal orientation, learning, communication and civility will be positively associated with measures of patient care including patient satisfaction; appointment wait times; continuity of care; and team assessment of care. We also hypothesize that the team characteristics mediate the relationship between group/teamwork organizational culture and patient care. We propose to conduct case studies to identify the best practices of high performing primary care teams.
METHODS:
The study will use a cross-sectional observational design in the first phase. The VHA health care team will be used as the unit of observation. We will use the Spring 2006 census administration of the All Employee Survey (AES) to identify the teams. The AES consists of three sections to assess perspectives at the individual, team and organizational level. We will use data on the team level perspective for the primary care teams in the study. Team measures will be tested for the strength of their association with measures of patient care. Patient care measures will include: patient satisfaction; appointment wait times; continuity of care; and team assessment of care. The second phase will involve case study interviews with teams and facilities that score the highest in the measures related to patient care.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
The findings on important characteristics of primary care teams that affect patient care outcomes can be used to develop training and intervention programs focused on those team characteristics that influence patient care in VHA and external settings.
PUBLICATIONS:
Journal Articles
- Young GJ, Burgess JF, White B. Pioneering pay-for-quality: lessons from the rewarding results demonstrations. Health Care Financing Review. 2008; 29(1): 59-70.
- Mohr DC, Burgess JF, Young GJ. The influence of teamwork culture on physician and nurse resignation rates in hospitals. Health Services Management Research. 2008; 21(1): 23-31.
