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2015 HSR&D/QUERI National Conference Abstract

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1060 — The Role of Team Processes for Improving Diabetes Quality of Care

Benzer JK, VA Boston Healthcare System and Boston University; Mohr DC, VA Boston Healthcare System and Boston University; Evans L, VA Boston Healthcare System and Boston University; Young G, Northeastern University; Meterko MM, VA Boston Healthcare System and Boston University; Moore SC, VA National Center for Organization Development; Nealon Seibert M, VA Boston Healthcare System; Osatuke K, VA National Center for Organization Development; Stolzmann KL, VA Boston Healthcare System; Charns MP, VA Boston Healthcare System and Boston University

Objectives:
Much of current team-based research focuses on the psychological environment of the organization (e.g., social relationships) rather than behavioral team processes, such as action processes (e.g., coordination), interpersonal processes (e.g., conflict management), and transition processes (e.g., planning). We seek to fill this gap by applying a team process framework to identify processes that are associated with different patterns of primary care team performance over time.

Methods:
We used thematic analysis on 114 primary care staff interviews across 17 primary care clinics. We purposefully selected primary care clinics using diabetes quality of care (i.e., intermediate outcomes from EPRP) over three years using four categories: consistently high, improving, worsening, and consistently low. The interview guide was developed using the healthcare teams literature. Interviewers were blind to performance level. Two coders ( > 90% agreement) recognized the applicability of the team process framework as they engaged closely with the data. The team process framework was used for coding but coders were also open to emergent concepts. Analyses were conducted by comparing participant responses within and between performance groups.

Results:
Differences were observed among the four performance categories for action processes (monitoring progress, systems monitoring, backup, coordination), interpersonal processes (conflict management, motivation, affect management), and transition processes (mission analysis, goal specification, strategy formulation). Analyses also revealed emergent concepts related to psychological and organizational context that were reported to impact team processes.

Implications:
Team processes were associated with differences in diabetes care quality over time. Results also highlight how workload may impact physician involvement, the potential negative effects of nurse rotation on coordination, the negative relationship of centralized leadership with transition processes, and how the psychological context (shared mental models, empowerment, and psychological safety) may impact team processes.

Impacts:
Team processes were associated with differences in diabetes care quality over time. Results also highlight how workload may impact physician involvement in quality improvement, the potential negative effects of nurse rotation on coordination, the negative relationship of centralized leadership with transition processes, and how the psychological context (shared mental models, empowerment, and psychological safety) may impact team processes.