The impact of general practice team composition and climate on staff and patient experiences: a systematic review.

Abstract

Recent policy initiatives seeking to address the workforce crisis in general practice have promoted greater multidisciplinarity. Evidence is lacking on how changes in staffing and the relational climate in practice teams affect the experiences of staff and patients. To synthesise evidence on how the composition of the practice workforce and team climate affect staff job satisfaction and burnout, and the processes and quality of care for patients. Four different searches were carried out between December 2021 and March 2022 using MEDLINE, Embase, Cochrane, CINAHL PsycINFO and Web of Science. PRISMA guidelines were followed and data were synthesised thematically. Eleven studies set in primary care were included, 10 from US integrated healthcare systems, one from Canada. Findings indicate that when teams are understaffed and work environments are stressful, patient care and staff wellbeing suffer. However, a good relational climate can buffer against burnout and protect patient care. Good team dynamics and team cohesion have a greater impact on job satisfaction and patient care coordination than team composition; stable team membership is also important. Better patient experiences are associated with female physicians. However, these same physicians are at higher risk of burnout. Evidence regarding team composition and team climate in relation to staff and patient outcomes remains limited. Challenges exist when drawing conclusions across different team compositions and differing definitions of team climate. Future research may benefit from exploring the conditions that generate a productive team climate.