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The Role of Perceived Team Effectiveness in Improving Chronic Illness Care
Shortell SM, Marsteller JA, Lin M, Pearson ML, Wu S-Y, Mendel P, Cretin S, Rosen M. Medical Care, Vol. 42, No. 11, Nov 2004, pp. 1040-1048.

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http://www.lww-medicalcare.com/pt/re/medcare/abstract.00005650-200411000-00002.htm

Research Objective: The importance of teams for improving quality of care has received increased attention. We examine both the correlates of self-assessed team effectiveness and the consequences of this effectiveness for actually making changes to improve care for people with chronic illness.

Study Design: Survey data were obtained from individual providers on 40 teams participating in the national Evaluation of the Improving Chronic Illness Care Program. Based on current theory and literature, measures were derived of organizational culture, a focus on patient satisfaction, team composition, team effectiveness and the presence of a team champion. The actual number and depth of changes made to improve chronic illness care were assessed using monthly reports from teams to faculty of the quality improvement program.

Population Studied: 40 multidisciplinary teams from hospitals, physician groups, health plans and Bureau of Primary Health Care clinics. Teams participated in one of three IHI/MacColl Institute Improving Chronic Illness Care collaboratives on asthma, diabetes, congestive heart failure or depression. Teams comprised from 3 to 14 nurses, physicians, pharmacists, case managers, administrators, and other staff.

Principal Findings: A focus on patient satisfaction, the presence of a team champion, and the involvement of physicians on the team were each consistently and positively associated with greater team effectiveness. Maintaining a balance among culture values of participation, achievement, openness to innovation, and adherence to rules and accountability also appear to be important. Team effectiveness, in turn, was consistently associated with both a greater number and a greater depth of changes made to improve chronic illness care. The various measures explain between 24 and 40 percent of the variance in team effectiveness; between 13 and 26 percent in number of changes made; and between 20 and 42 percent in depth of changes made.

Conclusions: Organizational commitment to measuring and pursuing patient satisfaction, the presence of team champions, and involvement of physicians on teams all enhanced team effectiveness. More effective teams, in turn, made more changes to improve care for patients with chronic illnesses, and also made changes that were expected to be more effective in improving patient health.

Implications for Policy, Delivery or Practice: The data support recommendations that clinical and managerial leaders should develop effective teams, show support for focusing on patient satisfaction, identify and support team champions, and involve physicians to improve the quality of care for patients with chronic illness.

Presented at the AcademyHealth meeting by: Jill Marsteller, NCHS/AcademyHealth Fellow at the National Center for Health Statistics, Center for Disease Control, at the panel on Does Participation in Collaborative Quality Improvement Programs Improve Care for Patients with Chronic Illness? 3:00 - 4:30 pm, June 6, Chair: Emmett Keeler, RAND