Team structure, team climate and the quality of care in primary care: an observational study
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ABSTRACT:
Objectives: To determine whether practice structure (for example, list size, number of staff) predictsteam processes and whether practice structure and team process in turn predict team outcomesDesign: Observational study using postal questionnaires and medical note audit. Team process wasassessed through a measure of “climate” which examines shared perceptions of organisationalpolicies, practices, and procedures.Setting: Primary care.Subjects: Members of the primary health care team from 42 practices.Main outcome measures: Objective measures of quality of chronic disease management, patients’evaluations of practices, teams’ self-reported ratings of effectiveness, and innovation.Results: Team climate was better in singlehanded practices than in partnerships. Practices with longerbooking intervals provided superior chronic disease management. Higher team climate scores wereassociated with superior clinical care in diabetes, more positive patient evaluations of practice andself-reported innovation and effectiveness.Conclusions: Although the conclusions are preliminary because of the limited sample size, the studysuggests that there are important relationships between team structure, process, and outcome that maybe of relevance to quality improvement initiatives in primary care. Possible causal mechanisms thatmight underlie these associations remain to be determined.
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