communication in primary health care teams jean carletta university of edinburgh human communication...
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Communication in Primary Health Care Teams
Jean Carletta
University of Edinburgh
Human Communication Research Centre
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Project context
• DOH-funded work to find the determinants of teamworking effectiveness
• Primary, secondary, and community mental health teams
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Communication research questions
• Good cross-disciplinary communication is difficult, especially with status differences and where some members report to different authorities. Where teams manage it, does it make a difference?
• How can we get good cross-disciplinary communication? Do whole team meetings work?
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Data Sources
• questionnaire for team members measuring effectiveness, team processes (TCI), and mental health/stress (GHQ)
• practice manager interviews detailing team practices, including meetings
• “whole team” meeting observation
[external ratings of effectiveness and innovation]
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Self-report effectiveness measures
• how well the team works together
• patient-centredness of the practice
• general organizational efficiency
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Self-report team process measures
• how willing members are to work as team
• clarity of/commitment to team objectives
• emphasis on quality
• degree of support for innovation
• amount of reflection on team practice
• degree of member task interrelatedness
• extent of innovation in objectives/practices
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Meeting data from interviews
Type ofmeeting
Who isinvited toattend
How often is itheld (e.g.,daily, weekly,month)
Purpose Length (inhours)
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Categorization of PHCT staff
• GP
• practice management
• practice nurse
• attached staff (HV, district nurse, ...)
• admin staff (secretarial, reception, ...)
• miscellaneous
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Overall meeting practiceclinical plus (full practice or practice clinical or GP)
whole team plus (GP or practice clinical)
single discipline plus maybe nursing
full practice plus maybe single discipline
whole team only
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Table 2: The relationship between the occurrence of particular cross-disciplinarymeeting types and the effectiveness and team climate measures. Values inparentheses are degrees of freedom; df=65 unless otherwise stated.
whole team full practice clinical stafforganizational efficiency -1.25 -1.78 -1.50 (51.60)teamworking effectiveness -1.32 -2.44* -2.11* (48.78)patient orientation -.93 -2.64* (30.72) -.28team participation -.48 -2.26* -1.22 (51.13)clarity of objectives -1.69 -1.72 -.10emphasis on quality -1.73 -1.66 -.26support for innovation -1.00 -4.73** (21.73) -1.08reflexivity -.82 -4.17** (24.46) -2.13* (57.25)interrelatedness of work -1.58 -1.85 -.58innovation -1.56 -1.56 -1.08* p<.05**p<.01
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Communication measures
• general:
- total meeting time
- GP meeting time
• cross-disciplinary:
- attached meeting time
- meeting time combining attached with GP
- freedom of interaction
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Table 1: The correlation between cross-disciplinarity of meeting opportunities andthe effectiveness and team climate measures. For values in parentheses, aggregateGHQ has been factored out.
Cross-disciplinary communicationmeasures
General communicationmeasures
freedom ofinteraction
meeting timewith GP andattached
attachedstaffmeetingtime
GPmeetingtime
totalmeetingtime
organizationalefficiency
.32**(.30**)
.25* (.28*) .21 (.23*) .14 (.19) .13 (.18)
teamworkingeffectiveness
.36**(.35**)
.23* (.26*) .23* (.25*) .13 (.18) .14 (.20)
patient orientation .15 (.12) .06 (.07) .06 (.07) .08 (.12) .10 (.14)team participation .21 (.18) .21 (.24*) .19 (.21) .00 (.05) -.03 (.01)clarity of objectives .27* (.24*) .20 (.22) .20 (.22) .06 (.10) .05 (.09)emphasis on quality .29**
(.27*).20 (.24*) .20 (.23*) .00 (.07) .00 (.07)
support forinnovation
.27* (.24*) .24* (.28*) .26* (.30**) .07 (.13) .07 (.14)
reflexivity .27* (.25*) .26* (.29*) .27* (.29**) .10 (.15) .09 (14)interrelatedness ofwork
.24* (.22) .05 (.06) .06 (.07) .04 (.08) .05 (.08)
innovation .25* (.23*) .27* (.29**) .23* (.25*) .17 (.21) .18 (.22*)* p<.05**p<.01
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Interview results
• General communication is not related to team climate or self-reported effectiveness
• Cross-disciplinary communication is related to team climate, teamworking effectiveness, and organizational efficiency
• It isn’t just that less stressed/easier task teams talk more
• but it’s not because of whole team meetings
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“Whole team” meetings
• weekly or monthly
• often cancelled or rearranged
• vague agendas which predominantly reflect practice manager’s concerns
• most time spend on AOB
• logistical content (clinic management, audit, building fabric, Christmas parties)
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Figure 3: The relationship between team size and
meeting attendance for recorded "whole team"
meetings.
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
0 10 20 30 40 50
team size
average proportion of members
attending recorded meetings
Other Teams
Team C
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Figure 5: Attendance by discipline.
0
10
20
30
40
50
60
70
80
90
general
practitioner
practicemanager practicenurse
attachedadmin/
secretarial
miscellaneous
discipline category
frequency in all recorded teams
members attending at least one
recorded meeting
members not attending any
recorded meeting
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Figure 4: The relationship between general attendance
and patient-centred care.
4
4.5
5
5.5
6
6.5
0 0.2 0.4 0.6 0.8 1
average proportion of team members attending meetings
patient-centred care (effectiveness
subscale)
Other Teams
Team A
NB: There is no relationship between team size and this effectiveness subscale.
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Figure 6: The relationship between multi-disciplinarity of
recorded meetings and support for innovation.
2.5
2.7
2.9
3.1
3.3
3.5
3.7
3.9
1 2 3 4 5 6
average number of discipline categories present at a recorded
meeting
support for innovation (self-reported team
climate variable)
Other Teams
Team A
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Whole team meeting results
• Weak: Teams provide a better patient focus when attendance at whole team meetings is good.
• Strong: Teams support change better when more disciplines attend whole team meetings, and especially when attached staff are represented.
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Why?
• not because of what happens at the meetings, but what happens around them
before, after, on the side, in defiance of agenda
• patient orientation is better when individual patients are discussed
• whole team meetings are a poor way of getting attached/GP contact, but the only one most teams have