Variables associated with work performance in multidisciplinary mental health teams.
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ABSTRACT:
SUBMITTER: Fleury MJ
PROVIDER: S-EPMC5548312 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:Effective mental health care requires a high performing, interprofessional team. Among 79 mental health teams in Quebec (Canada), this exploratory study aims to 1) determine the association between work role performance and a wide range of variables related to team effectiveness according to the literature, and to 2) using structural equation modelling, assess the covariance between each of these variables as well as the correlation with other exogenous variables. Work role performance was measured with an adapted version of a work role questionnaire. Various independent variables including team manager characteristics, user characteristics, team profiles, clinical activities, organizational culture, network integration strategies and frequency/satisfaction of interactions with other teams or services were analyzed under the structural equation model. The later provided a good fit with the data. Frequent use of standardized procedures and evaluation tools (e.g. screening and assessment tools for mental health disorders) and team manager seniority exerted the most direct effect on work role performance. While network integration strategies had little effect on work role performance, there was a high covariance between this variable and those directly affecting work role performance among mental health teams. The results suggest that the mental healthcare system should apply standardized procedures and evaluation tools and, to a lesser extent, clinical approaches to improve work role performance in mental health teams. Overall, a more systematic implementation of network integration strategies may contribute to improved work role performance in mental health care.
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Project description:Recent mental health (MH) reforms have had a sharp impact on practices among MH professionals. A deeper understanding of factors contributing to their job satisfaction, in this context, may help improve quality and continuity of care. The purpose of this study was to identify variables associated with job satisfaction for 315 MH professionals in Quebec (Canada) after implementation of wide-ranging MH reforms. Job satisfaction was measured with the Job Satisfaction Survey. Independent variables were conceptualized within five domains: 1) Professional Characteristics, 2) Team Attributes, 3) Team Processes, 4) Team Emergent States, and 5) Organizational Culture. Univariate, bivariate and multivariate analyses were performed. Job satisfaction was significantly associated with absence of team conflict, stronger team support, better team collaboration, greater member involvement in the decision-making process (Team Processes), Affective commitment toward the team (Team Emergent States), as well as lack of a market/rational culture (Organizational Culture). Job satisfaction was strongly related to team processes and, to a lesser extent, team emergent states.
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Project description:BackgroundYoung people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention may change this course. Shared care with mental health professionals in general practitioner (GP) offices has demonstrated its potential for improvement in these conditions.AimTo investigate whether shared care with mental health professionals in GP offices increases the detection of youth's mental health disorders and is associated with a decrease in use of unspecified symptom diagnoses, as a whole and stratified by patient and physician gender and age, and type of consulting physician.Design and settingThis was a stratified cluster-randomised controlled trial with data extraction from electronic records. Two GP offices were recruited from each of three boroughs. Each borough had 3-8 GP offices. One GP office was randomised to the intervention group and the other to the control group.MethodWe used generalised linear mixed models to assess whether the intervention helped GPs identify more International Classification of Primary Care 2 diagnoses of depression, anxiety and unspecified symptoms in youth.ResultsOver a 18-month period between between 2015 and 2017, the intervention helped GPs identify more youth with anxiety (p=0.002 for interaction), but not depression. The increase was most significant among the patients' regular GPs, less when patients met other GPs and least among external substitute physicians. The frequency of diagnoses with unspecified symptoms decreased in the intervention arm.ConclusionShared care with mental health professionals located in GP office contributed to increased detection of youth with anxiety symptoms. The increase was most prominent when the primary care physician was the patient's regular GP. GPs need to pay greater attention to detecting anxiety in youth and embrace shared care models, thereby contributing to reduced mental health disorders in this age group.Trial registration numberNCT03624829; Results.
| S-EPMC8712985 | biostudies-literature
Project description:IntroductionVacuum extraction is generally considered an operator-dependent task, with most attention directed toward the obstetrician's technical abilities (1-3). Little is known about the effect of the team and non-technical skills on clinical outcomes in vacuum-assisted delivery. This study aimed to investigate whether the non-technical skills of obstetricians were correlated with their level of clinical performance via the analysis of video recordings of teams conducting actual vacuum extractions.MethodsWe installed between two or three video cameras in each delivery room at Aarhus University Hospital and Horsens Regional Hospital and obtained 60 videos of teams managing vacuum extraction. Appropriate consent was obtained. Two raters carefully reviewed the videos and assessed the teams' non-technical skills using the Assessment of Obstetric Team Performance (AOTP) checklist, rating all items on a Likert scale score from 1 to 5 (1 = poor; 3 = average; and 5 = excellent). This resulted in a total score ranging from 18 to 90. Two different raters independently assessed the teams' clinical performance (adherence to clinical guidelines) using the TeamOBS-Vacuum-Assisted Delivery (VAD) checklist, rating each item (0 = not done, 1 = done incorrectly; and 2 = done correctly). This resulted in a total score with the following ranges (low clinical performance: 0-59; average: 60-84; and high: 85-100). Interrater agreement was analyzed using intraclass correlation (ICC), and the risk of high or low clinical performance was analyzed on a logit scale to meet the assumption of normality.ResultsTeams that received excellent non-technical scores had an 81% probability of achieving high clinical performance, whereas this probability was only 12% among teams with average non-technical scores (p < 0.001). Teams with a high clinical performance often had excellent behavior in the non-technical items of "team interaction," "anticipation," "avoidance fixation," and "focused communication." Teams with a low or average clinical performance often neglected to consider analgesia, had delayed abandonment of the attempted vaginal delivery and insufficient use of appropriate fetal monitoring. Interrater reliability was high for both rater-teams, with an ICC for the non-technical skills of 0.83 (95% confidence interval [CI]: 0.71-0.88) and 0.84 for the clinical performance (95% CI: 0.74-0.90).ConclusionAlthough assisted vaginal delivery by vacuum extraction is generally considered to be an operator-dependent task, our findings suggest that teamwork and effective team interaction play crucial roles in achieving high clinical performance. Teamwork helped the consultant anticipate the next step, avoid fixation, ensure adequate analgesia, and maintain thorough fetal monitoring during delivery.
| S-EPMC10987771 | biostudies-literature
Project description:AimThe 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.BackgroundDespite 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.MethodsA 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.FindingsA 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).
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Project description:ObjectiveTo explore the moderating effects of sociodemographic and work-related variables on levels of burnout and mental health among medical residents.MethodA cross-sectional online survey was administered at the beginning of the second wave of COVID-19 at different public teaching hospitals where medical residents practiced in Mexico City. A total of 201 medical residents of different years completed the survey.ResultsDifferent univariate inferential analyses on the level of burnout and mental health indices showed significant differences between sex, marital status, previous reports of physical illness or psychological conditions, and residency ranking. However, the effect sizes of those differences were of low to medium size. A predictive path analysis revealed that the three stages of burnout (emotional exhaustion, depersonalization, and achievement dissatisfaction) negatively affect psychological wellbeing and positively affect psychological distress. Finally, even though sociodemographic variables showed some significant variation, the effect sizes were small and did not moderate the direct effect of burnout on mental health indices.ConclusionsMedical residents deling with every day medical situations, will be exposed to stressors that might increase the probability to experience emotional exhaustion. This would negatively affect levels of wellbeing and positively affect distress, despite their sociodemographic characteristics.
| S-EPMC9481024 | biostudies-literature
Project description:BackgroundA recent government white paper sets out proposals for reforms to the Mental Health Act 1983 (MHA). Some of these proposals affect people with intellectual disabilities and/or autism.AimsTo explore both positive and unintended negative effects of the proposed reforms by gathering the perspectives of healthcare workers from multiple disciplines, working with intellectual disability and/or autism in community and in-patient settings.MethodA 14-question electronic questionnaire, comprising free-text, multiple choice and five-point Likert scale responses, was sent out via email between April and July 2021, to all multidisciplinary team professionals working in specialist intellectual disability community and in-patient teams in Hertfordshire Partnership University NHS Foundation Trust.ResultsThere were 45 responders, of whom 53% worked in in-patient settings and 47% in out-patient teams. Respondents comprised healthcare professionals from multiple disciplines, 80% of which were non-medical. Most responders agreed with the general principles of the proposed reforms. However, 80% felt there would be potentially unintended consequences, and 76% thought that substantial investment in community services was required in advance of the proposed reforms.ConclusionsThe proposed MHA reforms may have unintended consequences for people with intellectual disabilities and/or autism. The findings of this study raised key concerns that need to be explored further and addressed before the MHA reforms are implemented. These include community provision, safeguards and use of the Mental Capacity Act, the potential for under or overdiagnosis of mental illness, and effects associated with the criminal justice system.
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Project description:Previous studies have shown Relational Coordination improves team functioning in healthcare settings. The aim of this study was to examine the relational factors needed to support team functioning in outpatient mental health care teams with low staffing ratios. We interviewed interdisciplinary mental health teams that had achieved high team functioning despite low staffing ratios in U.S. Department of Veterans Affairs medical centers. We conducted qualitative interviews with 21 interdisciplinary team members across three teams within two medical centers. We used directed content analysis to code the transcripts with a priori codes based on the Relational Coordination dimensions, while also being attentive to emergent themes. We found that all seven dimensions of Relational Coordination were relevant to improved team functioning: frequent communication, timely communication, accurate communication, problem-solving communication, shared goals, shared knowledge, and mutual respect. Participants also described these dimensions as reciprocal processes that influenced each other. In conclusion, relational Coordination dimensions can play pivotal roles in improving team functioning both individually and in combination. Communication dimensions were a catalyst for developing relationship dimensions; once relationships were developed, there was a mutually reinforcing cycle between communication and relationship dimensions. Our results suggest that establishing high-functioning mental health care teams, even in low-staffed settings, requires encouraging frequent communication within teams. Moreover, attention should be given to ensuring appropriate representation of disciplines among leadership and defining roles of team members when teams are formed.
| S-EPMC9996570 | biostudies-literature
Project description:BackgroundThe integration of mental health and social services for people diagnosed with severe mental illness (SMI) has been a key aspect of attempts to reform mental health services in the UK and aims to minimise user and carer distress and confusion arising from service discontinuities. Community mental health teams (CMHTs) are a key component of UK policy for integrated service delivery, but implementing this policy has raised considerable organisational challenges. The aim of this study was to identify and explore facilitators and barriers perceived to influence continuity of care by health and social care professionals working in and closely associated with CMHTs.MethodsThis study employed a survey design utilising in-depth, semi-structured interviews with a proportionate, random sample of 113 health and social care professionals and representatives of voluntary organisations. Participants worked in two NHS Mental Health Trusts in greater London within eight adult CMHTs and their associated acute in-patient wards, six local general practices, and two voluntary organisations.ResultsTeam leadership, decision making, and experiences of teamwork support were facilitators for cross boundary and team continuity; face-to-face communication between teams, managers, general practitioners, and the voluntary sector were facilitators for information continuity. Relational, personal, and longitudinal continuity were facilitated in some local areas by workforce stability. Barriers for cross boundary and team continuity were specific leadership styles and models of decision making, blurred professional role boundaries, generic working, and lack of training for role development. Barriers for relational, personal, and longitudinal continuity were created by inadequate staffing levels, high caseloads, and administrative duties that could limit time spent with users. Incompatibility of information technology systems hindered information continuity. Flexible continuity was challenged by the increasingly complex needs of service users.ConclusionsSubstantive challenges exist in harnessing the benefits of integrated CMHT working to deliver continuity of care. Team support should be prioritised in terms of IT provision linked to a review of current models of administrative support. Investment in education and training for role development, leadership, workforce retention, and skills to meet service users' complex needs are recommended.
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Project description: Not available
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