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Different strokes for different folks? Staff perceptions of team functioning in Ontario Community Health Centres Jennifer Rayner Laura Muldoon Ontario Community Health Research Rounds January 21, 2015

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Details COI - Investigators are employees of CHCs Funding from University of Ottawa Department of Family Medicine Research Funding Program Ethics from Ottawa Health Sciences Research Network and Bruyre Continuing Care

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What are PC teams? Inter-professional teamwork in PHC is a priority in Canada 2 Know more about who team members are than what they do or how they work together. 3 Membership of PC teams vary widely depending on the setting 2 Care is by the integrated activities of clinical and non-clinical members of (PC) teams 4

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What is team function? Multi-faceted concept and includes the following 5 : Processes and psycho-social traits of the team Links a teams task design (types & features of the tasks) Membership of the team Team effectiveness

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Is team function important? Quality of team function linked to innovation and effectiveness in PC 6, technical quality of care. 7 Quality of team function may have more influence over clinical behaviors in PC than individual provider or practice characteristics. 8 Aspects of team function can be improved by certain interventions. 9

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Why look at CHC teams? Quality of primary care delivered in CHCs is equivalent or superior to that in other PC models in Ontario. 2, 11,12,13 ICES CHC study If youve seen one CHC, youve seen one CHC Provincial tour different feel to the teams Little is known about CHC PC team function Quebec community-governed practices (some similar to Ontario CHCs) had lower scores for team climate than professionally-governed practices 14

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Previous Research Results Staff Groups & Teams Ontario: admin staff reported suboptimal team climate more than GPs. 14 US CHC physicians dissatisfied with high workloads and administrative management. 15,16 No literature on how other team members view team functioning Organizational Features & Teams Leadership, professional governance, solo practice, certain team cultures are associated with better team function No association previously found with size of the team or number of sites (in PC)

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Our Questions... How do CHC staff rate the functioning of their teams? Are there differences between different groups of staff in how team function is perceived? Are there differences between different CHC organizations? Are there organizational features which can explain the differences?

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Methods Cross-sectional, part of proposed larger study Ethics OHSRN/Bruyre REB All 75 CHCs invited PHC director completed organizational survey ED distributed on-line survey to PC staff ``any person who provided or supported the provision of clinical care on a regular basis (including administration & reception)

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Organizational Survey Adapted from CIHI Number of sites, staffing, size, priorities, means of communication, rurality, years of operation, patient demographics

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Staff Survey Descriptive (professional role, full-time status, number of years employed at the CHC, working off- site from the main clinic) 3 different scales

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Team Climate Inventory Team Climate: shared perceptions of policies, practices & procedures within team Short, validated 14 item version Vision Innovation Participative safety Task Orientation

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Organizational Justice Assesses perceptions of fairness, equity & respect Procedural Justice (PJ) 7 items (perceived fairness) Procedures are in place to generate standards so that decisions can be made with consistency Interactional Justice (IJ) 6 items (politeness, dignity & respect) Primary health care team members consider your viewpoint.

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Organizational Citizenship Behaviour Perceptions of the presence of work related behaviors that are: discretionary not related to the formal reward system in the aggregate promote the effective functioning of the organization. 20 13 items Help each other out if someone falls behind in his/her work

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Analysis Staff characteristics Responses stratified by staff group (manager, physician, NP, registered nurse, medical secretary, allied health, counselor, outreach, admin assistants) One-way Anova to determine overall difference in team climate, organizational justice and citizenship behaviour between the different provider groups. Bonferroni posthoc analysis based on apriori hypothesis Organizational characteristics Linear regressions relating organizational features with the various measures of team function

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Overall Results 58 CHCs (77.8%) 674 staff physicians, NPs, nurses 57% of the respondents Excluded system navigators due to low numbers

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Results One way ANOVA significant difference between staff groups on mean scores for: Procedural Justice (p= 0.01) Total TCI (p=0.03) Innovation subscale of TCI (p=0.011)

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Team Climate Inventory

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Organizational Justice

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Organizational Citizenship Behaviour

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Differences between groups

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PJ - Organizational level results

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Organizational features & team function Association ONLY between higher number of sites and lower team function. (TCI and OJ p