Different strokes for different folks? Staff perceptions of
team functioning in Ontario Community Health Centres Jennifer
Rayner Laura Muldoon Ontario Community Health Research Rounds
January 21, 2015
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Details COI - Investigators are employees of CHCs Funding from
University of Ottawa Department of Family Medicine Research Funding
Program Ethics from Ottawa Health Sciences Research Network and
Bruyre Continuing Care
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What are PC teams? Inter-professional teamwork in PHC is a
priority in Canada 2 Know 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 setting 2 Care is by the integrated
activities of clinical and non-clinical members of (PC) teams
4
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What is team function? Multi-faceted concept and includes the
following 5 : Processes and psycho-social traits of the team Links
a teams task design (types & features of the tasks) Membership
of the team Team effectiveness
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Is team function important? Quality of team function linked to
innovation and effectiveness in PC 6, technical quality of care. 7
Quality of team function may have more influence over clinical
behaviors in PC than individual provider or practice
characteristics. 8 Aspects of team function can be improved by
certain interventions. 9
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Why look at CHC teams? Quality of primary care delivered in
CHCs is equivalent or superior to that in other PC models in
Ontario. 2, 11,12,13 ICES CHC study If youve seen one CHC, youve
seen one CHC Provincial tour different feel to the teams Little is
known about CHC PC team function Quebec community-governed
practices (some similar to Ontario CHCs) had lower scores for team
climate than professionally-governed practices 14
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Previous Research Results Staff 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
functioning Organizational Features & Teams Leadership,
professional governance, solo practice, certain team cultures are
associated with better team function No 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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Methods Cross-sectional, part of proposed larger study Ethics
OHSRN/Bruyre REB All 75 CHCs invited PHC director completed
organizational survey ED distributed on-line survey to PC staff
``any person who provided or supported the provision of clinical
care on a regular basis (including administration &
reception)
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Organizational Survey Adapted from CIHI Number of sites,
staffing, size, priorities, means of communication, rurality, years
of operation, patient demographics
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Staff Survey Descriptive (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 Inventory Team Climate: shared perceptions of
policies, practices & procedures within team Short, validated
14 item version Vision Innovation Participative safety Task
Orientation
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Organizational Justice Assesses perceptions of fairness, equity
& respect Procedural Justice (PJ) 7 items (perceived fairness)
Procedures are in place to generate standards so that decisions can
be made with consistency Interactional 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: discretionary not
related to the formal reward system in 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 characteristics Responses 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 characteristics Linear regressions relating
organizational features with the various measures of team
function
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Overall Results 58 CHCs (77.8%) 674 staff physicians, NPs,
nurses 57% of the respondents Excluded system navigators due to low
numbers
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Results 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 groups
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PJ - Organizational level results
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Organizational features & team function Association ONLY
between higher number of sites and lower team function. (TCI and OJ
p