UCLA

Team-based care can be associated with improved care quality, but simply being on a team is not sufficient for achieving the “quadruple aim” of enhancing patient care experiences, improving population health, reducing healthcare costs and improving provider experience. Rather, implementation of healthcare teams varies greatly across and within organizations, and there is a growing body of contradictory evidence on how implementing team models can impact the well-being of team members. This dissertation examines how healthcare organizations may take steps to improve team functioning and team member well-being in primary care settings.Our first study addresses this question by contributing empirical evidence to guide practices on how to optimize team functioning. We examined how the implementation strategy, evidence-based quality improvement (EBQI), was used to change PC team processes at two VA medical centers (Sites A and B) over a two year period. We used a comparative case study, analyzing multiple qualitative data sources collected from those sites: baseline and follow-up interviews with key stakeholders and provider team (“teamlet”) members (n=64), and EBQI meeting notes, reports, and supporting materials. Our analysis showed that the sites developed unique innovations upon participating in EBQI, with each project tailored to their site’s respective needs, context and capacity: Site A’s QI project entailed engaging in structured daily huddles using a huddle checklist and developing a protocol clarifying team member roles and responsibilities; and Site B initiated weekly virtual team meetings that spanned two practice locations. Respondents from both sites perceived these projects as improving team structure and staffing, team communications, role clarity, staff voice and personhood, accountability, and ultimately, overall team functioning over time. Our second study examines the association between team processes and team members’ well-being, as well as the practices that optimize their team experiences in those areas. We used a sequential explanatory mixed methods approach and examined: cross-sectional survey data (n=244) to explore the relationship between team processes such as communication and participation in decision-making with job satisfaction, as well as the more distal outcome of turnover intent; and interview data (n=73) to conduct a thematic analysis of how various practices and mechanisms impacted team members’ experiences with those team processes. Additionally, we explored whether team members varied in their reported well-being and team experiences by role. We found a strong and significant association between team member processes (e.g., communication and participation in decision-making) with team members’ reported rate of job satisfaction and, to a lesser degree, their intent to remain in their positions. Job satisfaction and intent to continue were generally high among care teams, but clinical associates were less likely to be satisfied with their jobs, and clerical associates were less likely to report an intent to stay in their current positions. Qualitative analysis found some clerical and clinical staff still experiencing an imbalance in voice and participation within their teams. The qualitative analysis affirmed the importance of the proximity, availability and attributes of providers and staff in how their team members experienced team processes.