Abstract
BackgroundCoordination is critical to successful team-based health care. Most clinicians, however, are not trained in effective coordination or teamwork. Audit and feedback (A&F) could improve team coordination, if designed with teams in mind.AimThe effectiveness of a multifaceted, A&F-plus-debrief intervention was tested to establish whether it improved coordination in primary care teams compared with controls.Design & settingCase-control trial within US Veterans Health Administration medical centres.MethodThirty-four primary care teams selected from four geographically distinct hospitals were compared with 34 administratively matched control teams. Intervention-arm teams received monthly A&F reports about key coordination behaviours and structured debriefings over 7 months. Control teams were followed exclusively via their clinical records. Outcome measures included a coordination composite and its component indicators (appointments starting on time, timely recall scheduling, emergency department utilisation, and electronic patient portal enrolment). Predictors included intervention arm, extent of exposure to intervention, and degree of multiple team membership (MTM).ResultsIntervention teams did not significantly improve over control teams, even after adjusting for MTM. Follow-up analyses indicated cross-team variability in intervention fidelity; although all intervention teams received feedback reports, not all teams attended all debriefings. Compared with their respective baselines, teams with high debriefing exposure improved significantly. Teams with high debriefing exposure improved significantly more than teams with low exposure. Low exposure teams significantly increased patient portal enrolment.ConclusionTeam-based A&F, including adequate reflection time, can improve coordination; however, the effect is dose dependent. Consistency of debriefing appears more critical than proportion of team members attending a debriefing for ensuring implementation fidelity and effectiveness.
Highlights
Primary care is the gateway for most patients into the healthcare system, and care coordination is one of its most essential functions.[2]
Consistency of debriefing appears more critical than proportion of team members attending a debriefing for ensuring implementation fidelity and effectiveness
A&F in health care has largely consisted of summaries or dashboards of clinical performance[1] to individuals at varying levels of aggregation and little else
Summary
Primary care is the gateway for most patients into the healthcare system, and care coordination is one of its most essential functions.[2]. Effective tools designed for teams are needed to improve team coordination and, in turn, coordination of care. Without understanding the 'how' of coordination, it is difficult to improve team coordination and, in turn, deliver higher quality care. Gittel’s theory of relational coordination[5] begins to address this shortcoming, by positing that shared goals, shared knowledge and mutual respect between groups or teams promote frequent, timely, accurate, problem-solving communication and vice versa, allowing them to effectively coordinate their work. Coordination is critical to successful team-b ased health care. Most clinicians are not trained in effective coordination or teamwork. Audit and feedback (A&F) could improve team coordination, if designed with teams in mind
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