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Research ArticleResearch

Self-reported teamwork in family health team practices in Ontario

Organizational and cultural predictors of team climate

Michelle Howard, Kevin Brazil, Noori Akhtar-Danesh and Gina Agarwal
Canadian Family Physician May 2011, 57 (5) e185-e191;
Michelle Howard
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  • For correspondence: mhoward@mcmaster.ca
Kevin Brazil
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Noori Akhtar-Danesh
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Gina Agarwal
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    Table 1

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

    DESCRIPTIONONTARIO REGION
    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†
    • Provider7120
    • Mixed3310
    • Community1012
    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 study8132
    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 meetings6030
    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.

    SUBSCALEMEAN (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 decisions3.9 (0.7)
      • Communication with providers4.3 (0.7)
      • Communication with patient3.7 (0.8)
      • Prescription refills4.4 (0.8)
      • Timely access to medical records4.2 (0.8)
      • Avoiding medication errors4.0 (0.7)
      • Delivery of preventive care that meets guidelines4.1 (0.7)
      • Delivery of chronic illness care that meets guidelines4.0 (0.7)
      Overall team climate score*3.8 (0.6)
    • ↵* Lowest 1, highest 5.

    • ↵† Major negative impact 1; major positive impact 5.

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    Table 3

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

    FACTORUNIVARIATE ANALYSIS β (95% CI)PVALUEMULTIPLE VARIABLE ANALYSIS β (95% CI)PVALUE
    Leadership scale score0.63 (0.56 to 0.69)< .0010.48 (0.40 to 0.55)< .001
    Organizational culture
      • Group0.13 (0.11 to 0.16)< .0010.04 (0.001 to 0.07).04
      • Developmental0.08 (0.03 to 0.13).0020.05 (−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).001NANA
    No. of EMR capabilities used*0.07 (−0.01 to 0.15).100.03 (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).07NA> .10
    No. of staff in FHT0.001 (−0.003 to 0.006).60NANA
    Full team meetings at least monthly−0.12 (−0.47 to 0.22).50NANA
    No. of patients per physician (< 1000, 1000–1999, ≥2000)0.04 (−0.21 to 0.30).75NANA
    Single site versus multiple sites0.09 (−0.23 to 0.41).59NANA
    • 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.

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Canadian Family Physician: 57 (5)
Canadian Family Physician
Vol. 57, Issue 5
1 May 2011
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Self-reported teamwork in family health team practices in Ontario
Michelle Howard, Kevin Brazil, Noori Akhtar-Danesh, Gina Agarwal
Canadian Family Physician May 2011, 57 (5) e185-e191;

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