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PPO 16-329 – HSR Study

PPO 16-329
Enhancing team-based care in VA
Christopher J. Miller, PhD
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: January 2018 - June 2019
The delivery of healthcare in the U.S. is increasingly based on healthcare teams, with an emphasis on coordination among providers from different disciplines. Poor team functioning is associated with poor patient care through adverse events, lack of coordination, and spiraling costs. While numerous models suggest a set of common elements for building effective healthcare teams, such team formation requires a significant time and resource investment-and time and resources are in short supply for many VA healthcare teams. Many studies have held up high-performing teams as examples of good teamwork-but such teams are frequently selected without regard for the baseline resources they have available. This raises the possibility that much of what we think we know about high-performing teams could be better labeled as 'what we know about well-resourced teams.' In such cases, the lessons learned may not be applicable to the lower-functioning, lower-resourced teams most in need of assistance. There is therefore an urgent need to develop concrete, actionable guidance for improving team outcomes in the context of the resource constraints faced daily by VA healthcare providers.

In the context of VA outpatient general mental health (GMH) clinics, which are in the process of implementing team-based care, we aim to refine a process for identifying teams with good staff outcomes in the context of high workload-to-staffing ratios. We will also explore the teamwork processes and contextual factors that characterize these types of high-performing teams. This mixed-methods study will therefore lay the foundation for a follow-up IIR that aims to more comprehensively identify generalizable ways for teams to achieve good staff outcomes in the context of high workload-to-staffing ratios.

AIM 1: We will classify VA outpatient GMH clinics as high versus low in staff outcomes (staff satisfaction, burnout, and turnover), and high versus low in workload-to-staffing ratios using existing VA data sources (the All-Employee Survey and Corporate Data Warehouse). We will contact VISN- and facility-level mental health leaders to identify outpatient teams located within those clinics that have high staff outcomes despite high workload.

AIM 2: We will conduct semi-structured interviews with teams identified in Aim 1. These interviews will allow us to validate the Aim 1 team selection process, and to identify teamwork and contextual factors (e.g. team composition) that most strongly characterize these successful teams. Analyses will be pursued by Directed Content Analysis, with additional attention given to emergent themes.

Forthcoming (project was funded this month).

Team-based healthcare is becoming increasingly widespread, but there is still a dearth of evidence-based guidance on how to help lower-resourced teams improve their staff outcomes. By carefully considering workload-to-staffing ratios in team selection, this mixed-methods pilot proposal will inform recruitment for a follow-up IIR that aims to more comprehensively identify generalizable ways for teams to achieve good staff outcomes specifically in the context of high workload-to-staffing ratios. Moreover, by focusing on teams that have achieved good staff outcomes despite higher-than-average workload, the proposed research will also provide preliminary data regarding the most promising levers for improving staff outcomes for these resource-strapped teams. Our study results will therefore have profound implications for primary care and specialty healthcare teams across VA.

External Links for this Project

NIH Reporter

Grant Number: I21HX002301-01A1

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Journal Articles

  1. Spitzer EG, Kaitz J, Fix GM, Harvey KLL, Stadnick NA, Sullivan JL, Williamson AK, Miller CJ. Developing Relational Coordination: A Qualitative Study of Outpatient Mental Health Teams. Administration and policy in mental health. 2023 Jul 1; 50(4):591-602. [view]
  2. Miller CJ, Sullivan JL, Harvey KLL, Williamson AK, Stadnick NA. Promoting high-functioning mental health treatment teams in the context of low staffing ratios. Health care management review. 2022 Jan 1; 47(1):12-20. [view]

DRA: Health Systems
DRE: Treatment - Implementation, TRL - Applied/Translational
Keywords: Attitudes/Beliefs, Best Practices, Management and Human Factors
MeSH Terms: none

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