Interprofessional teamwork in a primary care integrated behavioural health intervention: insights from a team effectiveness framework analysis

Organization of Diabetes Care

BackgroundThe move towards enhancing teamwork and interprofessional collaboration in health care raises issues regarding the management of professional boundaries and the relationship among health care providers. This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients.MethodsA comparative case study was conducted to examine the dynamics of role construction on two interprofessional primary health care teams. The data collection included interviews and non-participant observation of team meetings. Thematic content analysis was used to code and analyze the data and a conceptual model was developed to represent the emergent findings.ResultsThe findings indicate that role boundaries can be organized around interprofessional interactions (giving rise to autonomous or collaborative roles) as well as the distribution of tasks (giving rise to interchangeable or differentiated roles). Different influences on role construction were identified. They are categorized as structural (characteristics of the workplace), interpersonal (dynamics between team members such as trust and leadership) and individual dynamics (personal attributes). The implications of role construction were found to include professional satisfaction and more favourable wait times for patients. A model that integrates these different elements was developed.ConclusionsBased on the results of this study, we argue that autonomy may be an important element of interprofessional team functioning. Counter-intuitive as this may sound, we found that empowering team members to develop autonomy can enhance collaborative interactions. We also argue that while more interchangeable roles could help to lessen the workloads of team members, they could also increase the potential for power struggles because the roles of various professions would become less differentiated. We consider the conceptual and practical implications of our findings and we address the transferability of our model to other interprofessional teams.

The study of teamwork has been fragmented through the years, and the findings are generally unable to be used practically. This article argues that it is possible to boil down what researchers know about teamwork into five core components that the authors submit as the “Big Five” in teamwork. The core components of teamwork include team leadership, mutual performance monitoring, backup behavior, adaptability, and team orientation. Furthermore, the authors examine how these core components require supporting coordinating mechanisms (e.g., shared mental modes, closed-loop communication, and mutual trust) and vary in their importance during the life of the team and the team task. Finally, the authors submit a set of propositions for future research.

Barriers to expanding primary care roles for chiropractors: the role of chiropractic as primary care gatekeeper

Islamic hospital of As Syifa is public hospital in Sukabumi. The nurses are required to work and cooperate in nursing care. The nurses in room Multazam and Arafah II choose their duties and and donot assist their co-nurses made the teamwork does not run maximally. This problem is worsen by many patients’ complaints about the nurses’ work in the room, they are slothful to handle patients. Salas (2000) says that teamwork is inviduals’ behavior to support other members to reach team’s goal. The objective of this study is to obtain empirical data about teamwork effectiveness on nurses in room Multazam and Arafah II. The method used is descriptive study with 31 nurses in room Mulatazam nd Arafah II as the sample. The data are obtained by using teamwork instrument modified from the questionnaire arranged by Therese based on the theory of Salas. The results show that teamwork effectiveness in room Multazam is bad with low spreading aspects; Team leadership (56,25%) and Backup behavior (93,75%), and the high aspect is Mutual performing monitoring (62,5%), Adaptability (68,75%) and Team orientation (75%). In room Arafah II, teamwork effectiveness is good with high spreeding aspect; Mutual performance monitoring (60%) and Team orientation (60%), and the low aspects areTeam leadership (53,33%), Backup behavior (86,67%) and Adaptability (60%).

Large corporations increasingly use multinational teams to integrate their global operations. To perform this complex task efficiently, team members need to develop shared mental models (SMMs), i.e. an organized understanding of the knowledge base they are sharing. In multinational teams, the heterogeneity of team members makes SMM formation especially challenging. While previous research has investigated the influence of different diversity factors on SMMs, the impact of language differences has surprisingly been neglected so far. To address this important gap we investigate how different elements of the language barrier impede the formation of different types of SMMs. Based on 84 semi-structured interviews with team leaders, members and senior managers of 15 multinational teams in three German automotive corporations we develop a model showing how pragmatic and paraverbal barriers between team members obstruct SMMs about roles, responsibilities and interaction patterns and how shortcomings in lexical, syntactical and phonetic proficiency impede SMMs about team members' preferences, strengths, weaknesses as well as values and attitudes. These findings integrate linguistic and psychological theories with management studies and complement our understanding of the antecedents of SMMs in multinational teams. This is of crucial importance since SMMs have been established as important prerequisites for team performance.

The core components of teamwork include five overarching constructs: team leadership, team orientation, mutual performance monitoring, backup behavior, and adaptability. Many clinicians will describe teamwork as a vitally important component of emergency medical service (EMS) work. The patient's condition, the scene, and numerous other factors have an impact on the EMS team's actions and teamwork. For many EMS teams, teamwork may occur without verbal direction or communication. EMS teams often include a combination of any two of the following types of EMS clinicians: first responders, emergency medical technician basics, emergency medical technician intermediates, and emergency medical technician paramedics. In addition to the common forms of EMS training, there are various voluntary, specialty certifications offered by independent organizations and advisory committees. Team configuration can differ based on the type of EMS organization and its mission. Standard measures of EMS team performance are lacking, which makes it difficult to quantitatively assess EMS team performance.

Changes in medicine domestically and globally are transforming primary care in the United States. Many have suggested that primary care is in crisis or at least at a crossroads in the United States. The Annals of Internal Medicine recently devoted much of one issue to this topic.1 Primary care for children and adolescents, however, was not addressed specifically. This article focuses on pediatrics and identifies potential roles and new models for primary care pediatrics. The Institute of Medicine has defined primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”2 Starfield3 has defined 4 attributes of primary care including first-contact care, longitudinality, comprehensiveness, and coordination. September 11, 2001, the anthrax scare, and emerging threats such as severe acute respiratory syndrome (SARS) have brought a new focus on the importance of individual-level contacts in addressing population-level threats. Before these world events, however, primary care pediatrics was already grappling with its identity and responding to significant changes in medical systems, science, and family needs. The pace and scope of these changes are such that primary care pediatricians of the future will not be performing the same role as today. Historically, American medicine has tended to be reactive rather than proactive in defining its roles in society. However, dynamic change demands collective reflection; it is time to be proactive in assessing the needs of patients, exploring potential roles as health care providers, and developing the mechanisms to redefine the primary care pediatrician of the future. Projecting future trends requires reflection on the history of the profession of preventive pediatrics. In the 1800s, few physicians in the United States routinely … Address correspondence to Tina L. Cheng, MD, MPH, Johns Hopkins University Department of Pediatrics, 600 N Wolfe St, Park 392, Baltimore, MD 21287. E-mail: tcheng2{at}jhmi.edu

Teamwork is essential in surgery. A surgeon alone cannot fulfill his daily tasks. Surgical departments are divided into surgical teams: the surgical team in the operating theater, the surgical ward team, and the surgical emergency team. The common task of those teams is adequate patient care. The characteristics of team members describe necessary abilities such as: open communication, effective coordination skills, collaboration willingness, interdependency, mutual performance monitoring, backup behavior, adaptability, team orientation, and personality type. Team processes are recurring and ongoing short-term courses that occur in the team. The team developmental model separates the development of a team in four stages over a longer period of time. In the last stage, the team reaches the highest level of teamwork performance. Each team must be assessed for their nontechnical skills with team measurement tools. Surgical teams are insufficiently measured. There are possible disadvantages in teamwork, which must be considered and discussed versus the obvious benefits. Leadership is a process where the leading team member sets the direction for the others. There are different styles of leadership, whereby the dominant role of the leader is more or less pronounced. Leadership and teamwork are not contradicting characteristics of teams in the surgical department.

The past decade witnessed momentum toward redesigning the U.S. health care system with the intent to improve quality of care. To achieve and sustain this change, health professions education must likewise reform to prepare future practitioners to optimize their ability to participate in the new paradigm of health care delivery. Recognizing that interprofessional education (IPE) is gaining momentum as a crucial aspect of health care professions training, this article provides an introduction to IPE programs from three different academic health centers, which were developed and implemented to train health care practitioners who provide patient-centered, collaborative care. The three participating programs are briefly described, as well as the processes and some lessons learned that were critical in the process of adopting IPE programs in their respective institutions. Critical aspects of each program are described to allow comparison of the critical building blocks for developing an IPE program. Among those building blocks, the authors present information on the planning processes of the different institutions, the competencies that each program aims to instill in the graduates, the snapshot of the three curricular models, and the assessment strategies used by each institution. The authors conclude by providing details that may provide insight for academic institutions considering implementation of IPE programs.

The aim of the study was to describe practices that support collaboration in interprofessional primary health care teams, and identify performance indicators perceived to measure the impact of this collaboration from the perspective of interprofessional health providers. Despite the surge of interprofessional primary health care models implemented across Canada, there is little evidence as to whether or not the intended outcomes of primary health care teams have been achieved. Part of the challenge is determining the most appropriate measures that can demonstrate the value of collaborative care. To date, little remains known about performance measurement from the providers contributing to the collaborative care process in interprofessional primary care teams. Having providers from a range of disciplinary backgrounds assist in the development of performance measures can help identify measures most relevant to demonstrate the value of collaborative care on the intended outcomes of interprofessional primary care models. A qualitative study; part of a larger mixed methods developmental evaluation to examine performance measurement in interprofessional primary health care teams. A stakeholder workshop was conducted at an annual association meeting of interprofessional primary health care teams in the province of Ontario, Canada. Six questions guided the workshop groups and participant responses were documented on worksheets and flip charts. All responses were collected and entered verbatim into a word document. Qualitative analytic strategies were applied to each question. A total of 283 primary health care providers from 14 health professions working in interprofessional primary health care teams participated. Top three elements of interprofessional collaboration (total n = 628) were communication (n = 146), co-treatment (n = 112) and patient-based conferences (n = 81). Top three performance indicators currently used to demonstrate the value of interprofessional collaboration (total n = 241) were patient experience (n = 71), patient health status (n = 35) and within team referrals (n = 30).

Background The relationship between nursing teamwork and patient falls is a crucial area of study in healthcare, as effective teamwork has been consistently linked to improved patient outcomes and safety. Objective To examine the relationship between nursing teamwork and patient falls in Jordanian hospitals. Methods A descriptive correlational research design was conducted, involving 375 registered nurses from four hospitals representing three health sectors in Jordan. The participants completed the “Nursing Teamwork Survey,” which contains 33 questions divided into five subscales, measured on a five‐point Likert scale. Additionally, there is one question regarding the nurses’ experiences with patient falls in their units, which is measured on a seven‐point Likert scale. The data collection process took place from September to October 2024. Results The total mean nursing teamwork score was 116.36 (SD = 35.2), while the frequency of patient falls mean reported by nurses was 0.54 (SD = 0.67). The shared mental model subscale received the highest score (M = 3.58, SD = 1.0) among all nursing teamwork subscales, while the team orientation subscale received the lowest (M = 3.45, SD = 1.0). A weak negative significant relationship was found between nursing teamwork and patient falls ( r s = −0.248, p < 0.001). Although the correlation is weak, it suggests that improving nursing teamwork may positively impact patient safety by potentially reducing the incidence of patient falls. Also, weak negative significant correlation was showed between patient falls and the following teamwork subscales: Shared mental model ( r s = −0.260, p < 0.001), Backup ( r s = −0.242, p < 0.001), Team leadership ( r s = −0.267, p < 0.001), Mutual trust ( r s = −0.223, p < 0.001), and Team orientation ( r s = −0.223, p < 0.001). Conclusion Enhancing nursing teamwork is vital for improving patient outcomes and ensuring safety within healthcare settings. The moderate level of teamwork identified highlights the need for targeted interventions, such as training programs focused on communication and collaboration, to foster a more cohesive nursing staff. The observed correlation between teamwork and patient falls suggests that a stronger emphasis on teamwork can directly impact patient safety, emphasizing the importance of creating an environment that encourages collaboration. Additionally, the development and implementation of policies that address specific areas of teamwork, along with ongoing assessments of teamwork dynamics, are essential for sustained improvement. By prioritizing these efforts, healthcare organizations can create a culture of safety and teamwork that ultimately benefits both patients and healthcare providers.

<h3>Context:</h3> Effective IP collaborative practice and teamwork is proposed to improve quality of care, patient safety and health outcomes. While interprofessional teamwork has been evident in hospitals for some time, a better understanding of team dynamics and factors influencing IP practice in primary care settings is needed especially from the perspectives of primary care providers, including those training future clinicians. <h3>Objective:</h3> The primary objective of this research was to explore the experiences of providers regarding the processes fostering team-based care in a single academic primary care clinic. <h3>Study Design and Analysis:</h3> A phenomenological case study approach aimed to identify the factors that foster team-based care as conveyed through individual interviews and focus groups. Data was inductively coded, based on interpretative phenomenological analysis. <h3>Setting:</h3> All data was collected on site at a University of Manitoba academic primary care teaching clinic. <h3>Population Studied:</h3> Data was gathered from eleven members of the interdisciplinary team representing five disciplines. <h3>Outcome Measures:</h3> Eight individual interviews and one focus group discussion were audiotaped and transcribed verbatim. <h3>Results:</h3> This team’s care was conceptualized as an interrelated web and is framed by three themes: 1) modalities of communication that support team-based care; 2) development of interdependent working relationships and; 3) the administrative and organizational support that is required to achieve the desired team stability. Modelling interprofessional practice and collaboration benefited both team members and family medicine residents, playing an essential role in enabling a more diverse set of skills while challenging the power hierarchy. <h3>Conclusions:</h3> Working together, health care professionals can attend to a wide range of patient’s health care needs in an efficient and effective manner. The overarching concept of an inter-related web characterizes interprofessional teamwork, while effective communication and collaboration support interprofessional collaboration in primary care settings.

BackgroundTeamwork in the operating room is of paramount importance to provide high-quality patient care. It has been shown that increased team member familiarity predicts improved teamwork. A complicating factor is the often-changing composition of the operating room teams. Team member familiarity is associated with shared mental models and mutual trust, which are in turn important factors for team effectiveness. However, it remains unclear how this interplay takes place and can be influenced (eg, through team training). Our aim was to investigate the relationship between team member familiarity and perceived team effectiveness in operating room teams. We hypothesized that shared mental models and mutual trust mediate this relationship. MethodsWe performed a prospective, correlational study in 2 hospitals in the Netherlands. A questionnaire was used to assess team member familiarity, mutual trust, shared mental models (perceived and content-related), and perceived team effectiveness. Data were analyzed using a random intercept multilevel model. ResultsTeam member familiarity significantly predicted perceived team effectiveness, both through a direct effect, as well as mediated by perceived shared mental models. Mutual trust also significantly predicted team effectiveness. Variance is determined mostly at an individual level, but also partly (12%) at the operating room level. ConclusionGreater team member familiarity predicts greater team effectiveness, and this relationship is mediated by shared mental models. Training should be aimed at these aspects of team functioning to optimize team performance in the operating room.

&lt;p&gt;Background: The quality of team-based care impacts patient post-hospitalization outcomes, yet there is a gap in our understanding of how specific team processes impact patient post-hospitalization outcomes. Shared Mental Models (SMMs) is a team process from organizational psychology; it provides an understanding of how providers coordinate complex tasks as a team. SMMs are the team members’ organized knowledge needed for effective team performance. Military research shows that teams with more convergent SMMs have higher performance and better outcomes. In healthcare, patient discharge exemplifies an activity that requires a high level of coordination among interprofessional team members. Two relevant domains of SMMs are Taskwork SMM (team assessment of patient’s readiness for hospital discharge) and Teamwork SMM (quality of day of discharge teamwork). Because of the newness of SMM to healthcare, we lack measures to understand SMMs among interprofessional discharge teams.&lt;/p&gt;&lt;p&gt;Study Purpose &amp; Aims: The purpose was to pilot a novel measurement approach assessing SMMs of discharge teams, and explore their relationships to patient 30-day post-hospitalization outcomes (quality of care transition and utilization of unplanned medical services). Aim 1 determined the content and degree of convergence of discharge teams’ SMMs (taskwork and teamwork). Aim 2 examined the relationship between discharge team SMMs and patient post-hospitalization outcomes.&lt;/p&gt;&lt;p&gt;Methods: A prospective longitudinal pilot study was used to examine the SMMs of 64 unique discharge events in three inpatient units at a single hospital. Discharge team members independently completed a questionnaire measuring the Teamwork SMM (using the Shared Mental Model Scale) and the Taskwork SMM (using the Discharge Provider-Readiness for Hospital Discharge Scale). Data were collected from the patient 30 days post-discharge to determine the quality of transition (using the Care Transition Measure or CTM-15) and use of unplanned utilization of medical services (unplanned readmission or ED visit). Interrater Agreement (r*wg(j)) was used to determine the SMM convergence (or level of agreement) among the discharge team. The relationship between SMMs and the quality of transition outcome (n = 42) was determined using standard regression analysis. Logistic regression was used determine the relationship of SMMs with utilization of unplanned medical services (n = 56).&lt;/p&gt;&lt;p&gt;Results: Overall, discharge teams reported high levels of Taskwork SMMs (M = 8.46, SD =.91) and Taskwork SMM Convergence (M = .90, SD =.10), indicating that the discharge team perceived and agreed that patients had high levels of readiness for hospital discharge. Discharge teams also reported having high-quality Teamwork SMMs (M = 6.11, SD = 0.39) and Teamwork SMM Convergence (M = .85, SD = .10), suggesting that most discharge teams perceived and agreed that high quality teamwork was provided during the discharge process. Discharge events from the three inpatient units significantly differed in their Teamwork and Teamwork SMM content and convergence scores. Discharge teams’ Teamwork SMMs and Taskwork SMMs were positively associated with the CTM-15 score, while controlling for key contextual factors (t = 3.94, p = .001; t = 3.94, p = .001, respectively).&lt;/p&gt;&lt;p&gt;Conclusion : Discharge teams’ Taskwork SMM and Teamwork SMM was positively associated with patient-reported quality of transition from the hospital. There was insufficient evidence to support that utilization of unplanned medical services is related to discharge teams’ SMMs. Measuring the SMMs of the discharge team provides a method for assessing a team process critical to safe patient discharges.&lt;/p&gt;