Abstract
Background: Integrated services delivery in primary care is essential, particularly given the current challenges in primary care in Canada. Primary care teams (PCT) provide a way to facilitate integrated care. PCTs in British Columbia (BC) have evolved with widespread implementation of primary care networks, urgent and primary care centres, and community health centres. Team culture can have significant impacts on team functioning and processes, ultimately impacting patient outcomes. patient and provider experience, and integrated care. This presentation focuses on the relationship between team culture and team function to highlight strategies that may improve team climate across primary care settings.
Approach: Case study methodology with mixed methods was used to study three PCTs in BC. Phase I consisted of expressions of interest, team selection, and team climate inventory surveys (TCI). TCI dimensions (team participation, support for new ideas, team objectives, task orientation) and an overall score were analyzed. Phase II consisted of team document reviews, team meeting observations, semi-structured interviews with managers and patients, and focus groups with team members. Data were analyzed for common themes. A follow-up dialogue with each team was facilitated to share the results and co-create actions for recommendations; final reports were shared with the teams.
Results: Overall TCI scores ranged from 76 to 84; standard deviation was greatest for Case 3. All three cases showed team participation and support for new ideas with greater variability in team objectives and task orientation. Qualitative data indicated the importance of effective communication and engagement in co-developing new initiatives. All teams focused on patient-centred care, but a lack of clarity in team objectives was found. Similarly, performance measurement/evaluation (task orientation) was limited, particularly evaluation of patient experience. There was a strong commitment to action to improve further team functioning; strategies to enhance functioning were co-developed by each team. These strategies included developing team goals, standardizing information management systems, building team capacity through training, increasing collaboration, supporting teams mental health, and using quality improvement to measure outcomes.
Implications: This research provides an in-depth exploration of PCT culture that contributes to the integration of care in primary care settings. Insights in team functioning (e.g., role identification, communication), as well as structures and processes that facilitate and act as barriers to enhancing team culture will be shared. Furthermore, the impact for teams in their reflection throughout this research process helped teams evaluate their strengths and areas where improvement was needed. Primary care can benefit from lessons learned in this study to improve PCT functioning, a key component of integrated care for patients in primary care settings.