Self-reported teamwork in family health team practices in Ontario: Organizational and cultural predictors of team climate

Michelle Howard; Kevin Brazil; Noori Akhtar-Danesh; Gina Agarwal

Article Figures & Data

Tables

View popup

Table 1

Description of the FHTs included in this study: N = 21.

DESCRIPTION	ONTARIO REGION
DESCRIPTION	WEST (N = 11)	NORTH (N = 4)	CENTRAL (N = 4)	SOUTH (N = 2)
Median no. of sites (range)	1 (1–7)	2 (1–6)	7 (1–19)	1 (1–1)
Median no. of staff^* (range)	11 (6–46)	13 (2–50)	25.5 (5–156)	9.5 (8–11)
Median no. of staff^* hired since inception of FHT (range)	10 (6–23)	11 (1–50)	16 (6–65)	11 (9–13)
Governance, n^†
• Provider	7	1	2	0
• Mixed	3	3	1	0
• Community	1	0	1	2
Median no. of patients per physician (range)	1572 (499–3200)	1307 (765–1833)	1863 (1000–2927)	2716 (2100–3333)
No. of sites in operation for more than 1 year at time of study	8	1	3	2
Median no. EMR capabilities used^‡ (range)	10 (6–12)	9 (7–10)	9.5 (7–11)	8 (6–10)
Total no. of FHTs having monthly clinical and support staff meetings	6	0	3	0
Mean team climate inventory score, out of 5 (range)	4.0 (2.6–4.2)	3.9 (3.7–4.4)	3.7 (3.6–3.8)	3.8 (3.6–4.0)

EMR—electronic medical record, FHT—family health team.
↵* Health care professionals working on site.
↵† Governance is divided into 3 categories: provider refers to health care professional–initiated and governed FHTs, community refers to community organization–initiated and governed FHTs, and mixed refers to a combination of provider- and community organization–initiated and governed FHTs.
↵‡ Of a possible 22, including scheduling appointments, billing, within-clinic messaging, clinical notes, prescribing information (drug interactions, warnings, direct-to-pharmacy prescribing), laboratory or radiology requisitions, viewing laboratory and imaging results (history and follow-up notes), patient demographic information, patient problem lists, medications, disease registries, decision-support tools, queries, and reminders for guideline-based interventions.

View popup

Table 2

Team climate inventory subscale scores of FHT staff: N=411; 68.6% (n = 282) of respondents identified their organizational cultures as group cultures; 8.3% (n = 34) were part of developmental cultures; 14.4% (n = 59) were part of hierarchical cultures; and 8.8% (n = 36) were part of rational cultures.

SUBSCALE	MEAN (SD) SCORE
SUBSCALE	MEAN (SD) SCORE	Participative safety^*	3.8 (0.8)
Team objectives^*	3.5 (0.8)
Vision^*	3.9 (0.7)
Support for innovation^*	3.7 (0.8)
Leadership^*	3.7 (0.7)
Perception of EMR^†
• Quality of clinical decisions	3.9 (0.7)
• Communication with providers	4.3 (0.7)
• Communication with patient	3.7 (0.8)
• Prescription refills	4.4 (0.8)
• Timely access to medical records	4.2 (0.8)
• Avoiding medication errors	4.0 (0.7)
• Delivery of preventive care that meets guidelines	4.1 (0.7)
• Delivery of chronic illness care that meets guidelines	4.0 (0.7)
Overall team climate score^*	3.8 (0.6)

↵* Lowest 1, highest 5.
↵† Major negative impact 1; major positive impact 5.

View popup

Table 3

Associations between organizational or cultural factors for participating FHTs and team climate scores

FACTOR	UNIVARIATE ANALYSIS β (95% CI)	PVALUE	MULTIPLE VARIABLE ANALYSIS β (95% CI)	PVALUE
Leadership scale score	0.63 (0.56 to 0.69)	< .001	0.48 (0.40 to 0.55)	< .001
Organizational culture
• Group	0.13 (0.11 to 0.16)	< .001	0.04 (0.001 to 0.07)	.04
• Developmental	0.08 (0.03 to 0.13)	.002	0.05 (−0.005 to 0.10)	.08
• Hierarchical	−0.20 (−0.23 to −0.16)	< .001	−0.06 (−0.10 to −0.009)	.02
• Rational	−0.08 (−0.13 to −0.03)	.001	NA	NA
No. of EMR capabilities used^*	0.07 (−0.01 to 0.15)	.10	0.03 (0.003 to 0.06)	.03
Months operational as an FHT	−0.012 (−0.02 to −0.004)	.002	−0.003 (−0.0006 to −0.006)	.04
EMR perceptions	−0.05 (−0.10 to 0.003)	.07	NA	> .10
No. of staff in FHT	0.001 (−0.003 to 0.006)	.60	NA	NA
Full team meetings at least monthly	−0.12 (−0.47 to 0.22)	.50	NA	NA
No. of patients per physician (< 1000, 1000–1999, ≥2000)	0.04 (−0.21 to 0.30)	.75	NA	NA
Single site versus multiple sites	0.09 (−0.23 to 0.41)	.59	NA	NA

CI—confidence interval, EMR—electronic medical record, FHT—family health team, NA—not applicable.
↵* Of a possible 22, including scheduling appointments, billing, within-clinic messaging, clinical notes, prescribing information (drug interactions, warnings, direct-to-pharmacy prescribing), laboratory or radiology requisitions, viewing laboratory and imaging results (history and follow-up notes), patient demographic information, patient problem lists, medications, disease registries, decision-support tools, queries, and reminders for guideline-based interventions.