Improving primary care team functioning through evidence based quality improvement: A comparative case study.
Comparative case study
EBQI
Primary care
Team functioning
Journal
Healthcare (Amsterdam, Netherlands)
ISSN: 2213-0772
Titre abrégé: Healthc (Amst)
Pays: Netherlands
ID NLM: 101622189
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
23
12
2022
revised:
15
04
2023
accepted:
26
04
2023
medline:
12
6
2023
pubmed:
9
5
2023
entrez:
8
5
2023
Statut:
ppublish
Résumé
Provision of team-based primary care (PC) is associated with improved care quality, but limited empirical evidence guides practices on how to optimize team functioning. We examined how evidence-based quality improvement (EBQI) was used to change PC team processes. EBQI activities were supported by research-clinical partnerships and included multilevel stakeholder engagement, external facilitation, technical support, formative feedback, QI training, local QI development and across-site collaboration to share proven practices. We used a comparative case study in two VA medical centers (Sites A and B) that engaged in EBQI between 2014 and 2016. We analyzed multiple qualitative data sources: baseline and follow-up interviews with key stakeholders and provider team ("teamlet") members (n = 64), and EBQI meeting notes, reports, and supporting materials. Site A's QI project entailed engaging in structured daily huddles using a huddle checklist and developing a protocol clarifying team member roles and responsibilities; Site B initiated weekly virtual team meetings that spanned two practice locations. Respondents from both sites perceived these projects as improving team structure and staffing, team communications, role clarity, staff voice and personhood, accountability, and ultimately, overall team functioning over time. EBQI enabled local QI teams and other stakeholders to develop and implement innovations to improve PC team processes and characteristics in ways that improved teamlet members' perceptions of team functioning. EBQI's multi-level approach may empower staff and facilitate innovation by and within teams, making it an effective implementation strategy for addressing unique practice-based challenges and supporting improvements in team functioning across varied clinical settings. VI.
Sections du résumé
BACKGROUND
BACKGROUND
Provision of team-based primary care (PC) is associated with improved care quality, but limited empirical evidence guides practices on how to optimize team functioning. We examined how evidence-based quality improvement (EBQI) was used to change PC team processes. EBQI activities were supported by research-clinical partnerships and included multilevel stakeholder engagement, external facilitation, technical support, formative feedback, QI training, local QI development and across-site collaboration to share proven practices.
METHODS
METHODS
We used a comparative case study in two VA medical centers (Sites A and B) that engaged in EBQI between 2014 and 2016. We analyzed multiple qualitative data sources: baseline and follow-up interviews with key stakeholders and provider team ("teamlet") members (n = 64), and EBQI meeting notes, reports, and supporting materials.
RESULTS
RESULTS
Site A's QI project entailed engaging in structured daily huddles using a huddle checklist and developing a protocol clarifying team member roles and responsibilities; Site B initiated weekly virtual team meetings that spanned two practice locations. Respondents from both sites perceived these projects as improving team structure and staffing, team communications, role clarity, staff voice and personhood, accountability, and ultimately, overall team functioning over time.
CONCLUSION
CONCLUSIONS
EBQI enabled local QI teams and other stakeholders to develop and implement innovations to improve PC team processes and characteristics in ways that improved teamlet members' perceptions of team functioning.
IMPLICATIONS
CONCLUSIONS
EBQI's multi-level approach may empower staff and facilitate innovation by and within teams, making it an effective implementation strategy for addressing unique practice-based challenges and supporting improvements in team functioning across varied clinical settings.
LEVEL OF EVIDENCE
METHODS
VI.
Identifiants
pubmed: 37156131
pii: S2213-0764(23)00018-0
doi: 10.1016/j.hjdsi.2023.100691
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
100691Informations de copyright
Published by Elsevier Inc.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.