The Role of Perceived Team Effectiveness in Improving Chronic Illness Care
Jill A. Marsteller, PhD , MPP, for the ICICE Organizations Team
Stephen M. Shortell, PhD, MPH, Michael Lin, MSPH, Marjorie L. Pearson, PhD, Shin-Yi Wu, PhD, Peter Mendel, PhD, Shan Cretin, PhD, and Mayde Rosen, RN, BSN
June 6, 2004
Outline of Talk
• Teams and quality of care • Defining team effectiveness • Building effective teams
• Team effectiveness and Quality improvement (QI)
activity
• Results
• Relation to clinical quality of care • Implications for Quality Improvement
JAM 06/06 Keeler 02/04
Teams and Quality
• 97 percent of US health care organizations report
use of teams
• Literature shows teams improved quality of care
for frailty, nutrition, cognition, and depression
• Coordination of care and complex treatment plans
for chronically ill patients require meaningful communication among team members, strong leadership, and an appreciation of roles among multiple disciplines
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Defining Team Effectiveness
• Overall Perceived Team Effectiveness
(Cronbach’s alpha = 0.95) – Organizational support – Team self-assessed skill – Goal agreement – Norms for participation of team members – Team autonomy – Information/help available
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Building Effective Teams
Organizational Culture
Group, Developmental, Hierarchical, Rational
Organizational Commitment to Quality Improvement
Baldrige scale on patient
satisfaction focus
Perceived Team Effectiveness
Team Champion
*Controlling for team size, team composition, and disease treated.
JAM 06/06 Keeler 02/04
Analysis 1:Variables for Team Effectiveness
Independent Dependent
•Cultural balance of organization
H= 1-∑pi2
•Overall perceived team
effectiveness
•Patient satisfaction focus of
organization
•Presence of a team champion •Percent physicians on team
(team composition)
•Disease- dummy for Asthma •Team size
•Multivariate OLS Regression
JAM 06/06 Keeler 02/04
QI Activity of Effective Teams
Number of Changes Made
Perceived Team Effectiveness
Depth of Changes Made Quality of Care
*Controlling for team size, team composition, and disease treated.
JAM 06/06 Keeler 02/04
Analysis 2:Variables for QI Activity
Independent Dependent
•Cultural balance of
organization
•Number of Changes Made to
Patient Care (count)
•Patient satisfaction focus of
organization
•Depth of Changes Made to
Patient Care (sum of 23 items scored 0-2)
•Presence of a team
champion
•Percent physicians on team •Disease- Asthma •Team size & Size2 •Overall perceived team
effectiveness
•Multivariate OLS Regression
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Results—Descriptive Statistics
Measure N
N 40 40 40 Mean 6.53 27.5 25.68 SD 3.04 Min 3 0 0 Max 14 1 60
Mean
Team Size HaveBalance Team Champion (%) Cultural 40 0.7 0.05 0.47 Patient Satisfaction Focus 40 3.63 0.46 2.52 Human Resource Utilization 40 3.13 0.47 Physicians on Team (%)2.22 Employee Involvement in 40 3.52 0.47 2.44 Quality Planning Cultural Balance 3.83 0.53 2.6 Leadership 40 Overall Team Effectiveness 40 5.24 0.74 3.47 Team Skill 40 0.9 Patient Goal Agreement 40 5.03 Focus Satisfaction 0.64 3.13 Participation/ 5.85 4.57 Organizational Support 40 4.78 0.93 2.2 Number of Changes 40 Overall Perceived41.83 21.04 8 Team Depth of Changes 40 22.85 6.38 8 Asthma Team (%) 40 30 0 Effectiveness 40 22.5 CHF Team (%) 0 Depression Team (%) 40 12.5 0 Number (%) Changes of Diabetes Team 40 35 0 Depth of Changes
Measure Team Size Have Team Champion (%) Physicians on Team (%)
40 6.53 40 27.5 0.75 4.56 4.11 40 25.68 4.53 40 0.7 4.67 6.64 6.73 40 3.63 7 6.27 130 40 5.24
35 1 1 1 1
Std. Dev. 3.04
Min Max
0.05 0.46 0.74
3 14 0 1 0 60 0.47 0.75 2.52 4.56 3.47 6.64 8 8 130 35
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40 41.83 21.04 40 22.85 6.38
Results—Team Effectiveness
Independent Variable
Constant Team Size
Overall Perceived Team Effectiveness
Coefficient (sig. lvl)
1.11 -0.06*
Team Champion Patient Satisfaction Focus Cultural Balance Asthma
Physician Percentage on Teams
N F p-value Adj R-Sq
*indicates p<0.10; ** indicates p<0.05; *** indicates p<0.01
0.69*** 0.49** 3.10* 0.09
1.27*
40 5.29 0.0006 0.4
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Results—Quality Improvement Activity
Independent Variable Number of Changes
Coefficient (sig. lvl)
Depth of Changes
Coefficient (sig. lvl)
Constant
-49.62
-11.13
Team Size Team Size Squared Patient Satisfaction Focus Cultural Balance
Asthma Overall Perceived Team Effectiveness
N F p-value Adj R-Sq
* indicates p<0.10; ** indicates p<0.05; *** indicates p<0.01
5.79 -0.22 -21.58*** 118.85*
-10.75 12.00***
40 3.28 0.0122 0.26
3.90*** -0.19** -4.79** 17.54
-3.52** 4.69***
40 5.66 0.0004 0.42
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Relation to Quality of Care: Methods
• ~1300 patients, 13 diabetes + 4 CHF + 12 asthma = 29 organizations
•From chart review, patient-level clinical process score from collaborative period regressed on precollaborative score, took the residual (positive residual => more improvement than average)
•Analyzed separately by disease •Not corrected for clustering
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Relation to Quality of Care: Results
•Smaller teams do better than larger teams (esp. with 10+ members) in all 3 diseases •The percentage of MDs, having a champion, team effectiveness and team skill are consistently associated with improved process
•No other variables were significantly and consistently correlated with process improvement across diseases
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Implications for Quality Improvement
•Teams that perceive themselves to be more effective take more intense (in number and depth) actions to improve care and have better clinical quality of care
•Implications for clinical leaders and managers
-develop effective teams (skill, goal agreement, respect for individual participation) -develop and demonstrate a focus on patient satisfaction -identify and support team champions -involve physicians in improving quality of care
JAM 06/06 Keeler 02/04