Impact of team configuration and team stability on primary care quality

Sylvia J Hysong,Houston F Lester,Amber B Amspoker,Frederick L Oswald,Laura A Petersen,Lechauncy Woodard,Ashley M Hughes

doi:10.1186/s13012-019-0864-8

Abstract

BackgroundThe science of effective teams is well documented; far less is known, however, about how specific team configurations may impact primary care team effectiveness. Further, teams experiencing frequent personnel changes (perhaps as a consequence of poor implementation) may have difficulty delivering effective, continuous, well-coordinated care. This study aims to examine the extent to which primary care clinics in the Veterans Health Administration have implemented team configurations consistent with recommendations based on the Patient-Centered Medical Home model and the extent to which adherence to said recommendations, team stability, and role stability impact healthcare quality. Specifically, we expect to find better clinical outcomes in teams that adhere to recommended team configurations, teams whose membership and configuration are more stable over time, and teams whose clinical manager role is more stable over time.Methods/designWe will employ a combination of social network analysis and multilevel modeling to conduct a database review of variables extracted from the Veterans Health Administration’s Team Assignments Report (TAR) (one of the largest, most diverse existing national samples of primary care teams (nteams > 7000)), as well as other employee and clinical data sources. To ensure the examination of appropriate clinical outcomes, we will enlist a team of subject matter experts to select a concise set of clear, prioritized primary care performance metrics. We will accomplish this using the Productivity Measurement and Enhancement System, an evidence-based methodology for developing and implementing performance measurement.DiscussionWe are unaware of other studies of healthcare teams that consider team size, composition, and configuration longitudinally or with sample sizes of this magnitude. Results from this study can inform primary care team implementation policy and practice in both private- and public-sector clinics, such that teams are configured optimally, with adequate staffing, and the right mix of roles within the team.Trial registrationNot applicable—this study does not involve interventions on human participants.

Highlights

The science of effective teams is well documented; far less is known, about how specific team configurations may impact primary care team effectiveness
A recent study found the Veterans Health Administration (VHA) spent $774 million between 2010 and 2012 to transition to a team-based primary care model consistent with Patient-Centered MedicalHome (PCMH); their investment was linked to some improvements in care outcomes [6], as of the time of the study’s writing, VA had not yet reported a positive return on investment
This study suggests that closer adherence to PCMH principles as a whole can improve specific patient outcomes and clinical performance

Summary

Introduction

The science of effective teams is well documented; far less is known, about how specific team configurations may impact primary care team effectiveness. A recent study found the Veterans Health Administration (VHA) spent $774 million between 2010 and 2012 to transition to a team-based primary care model consistent with PCMH; their investment was linked to some improvements in care outcomes [6], as of the time of the study’s writing, VA had not yet reported a positive return on investment Findings such as these suggest better information is needed about how to best configure interprofessional teams in order to successfully implement team-based care: too few team members or the wrong type of expertise in the team may lead to reduced quality of care; too many members in a team results in wasted resources

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