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Relationship among team dynamics, care coordination and perception of safety culture in primary care.

ABSTRACT: Background:There remains a need to improve patient safety in primary care settings. Studies have demonstrated that creating high-performing teams can improve patient safety and encourage a safety culture within hospital settings, but little is known about this relationship in primary care. Objective:To examine how team dynamics relate to perceptions of safety culture in primary care and whether care coordination plays an intermediating role. Research Design:This is a cross-sectional survey study with 63% response (n = 1082). Subjects:The study participants were attending clinicians, resident physicians and other staff who interacted with patients from 19 primary care practices affiliated with Harvard Medical School. Main Measures:Three domains corresponding with our main measures: team dynamics, care coordination and safety culture. All items were measured on a 5-point Likert scale. We used linear regression clustered by practice site to assess the relationship between team dynamics and perceptions of safety culture. We also performed a mediation analysis to determine the extent to which care coordination explains the relationship between perceptions of team dynamics and of safety culture. Results:For every 1-point increase in overall team dynamics, there was a 0.76-point increase in perception of safety culture [95% confidence interval (CI) 0.70-0.82, P < 0.001]. Care coordination mediated the relationship between team dynamics and the perception of safety culture. Conclusion:Our findings suggest there is a relationship between team dynamics, care coordination and perceptions of patient safety in a primary care setting. To make patients safer, we may need to pay more attention to how primary care providers work together to coordinate care.

SUBMITTER: Blumenthal KJ

PROVIDER: S-EPMC7190894 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Relationship among team dynamics, care coordination and perception of safety culture in primary care.

Blumenthal Karen J KJ Chien Alyna T AT Singer Sara J SJ

Family practice 20181201 6

<h4>Background</h4>There remains a need to improve patient safety in primary care settings. Studies have demonstrated that creating high-performing teams can improve patient safety and encourage a safety culture within hospital settings, but little is known about this relationship in primary care.<h4>Objective</h4>To examine how team dynamics relate to perceptions of safety culture in primary care and whether care coordination plays an intermediating role.<h4>Research design</h4>This is a cross- ...[more]

PMID: 29788350

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Project description: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.

Project description:BackgroundPatient safety culture is an important factor in determining hospitals' ability to address and reduce the occurrence of adverse events (AEs). However, few studies have reported on the impact of nurses' perceptions of patient safety culture on the occurrence of AEs. Our study aimed to assess the association between nurses' perception of patient safety culture and their perceived proportion of adverse events.MethodsA cross-sectional survey was carried out among 2295 nurses employed in thirty-two teaching hospitals in Iran. Nurses completed the Persian version of the hospital survey of patients' safety culture between October 2018 and September 2019.ResultsPositive Response Rates of overall patient safety culture was 34.1% and dimensions of patient safety culture varied from 20.9 to 43.8%. Also, nurses estimated that the occurrence of six adverse events varied from 51.2-63.0% in the past year. The higher nurses' perceptions of "Staffing", "Hospital handoffs and transitions", "Frequency of event reporting", "Non-punitive response to error", "Supervisor expectation and actions promoting safety", "Communication openness", "Organizational learning continuous improvement", "Teamwork within units", and "Hospital management support patient safety" were significantly related to lower the perceived occurrence at least two out of six AEs (OR = 0.69 to 1.46).ConclusionsOur findings demonstrated that nurses' perception regarding patient safety culture was low and the perceived occurrence of adverse events was high. The research has also shown that the higher level of nurses' perception of patient safety culture was associated with lowered occurrence of AEs. Hence, managers could provide prerequisites to improve patient safety culture and reduce adverse events through different strategies, such as encouraging adverse events' reporting and holding training courses for nurses. However, further research is needed to assess how interventions addressing patient safety culture might reduce the occurrence of adverse events.

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Relationship among team dynamics, care coordination and perception of safety culture in primary care.

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Relationship among team dynamics, care coordination and perception of safety culture in primary care.

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