Because of the complex health needs of the elderly, interdisciplinary teams are becoming the preferred mode of delivering care to older persons. The quality of team functioning (QTF) may exert important influences on team members' stress and patient care outcomes, yet little is known about factors that influence QTF. Team development (TD) theory provides the theoretical basis for this study.
The specific aims are: 1) to test hypotheses about the relationship of TD to QTF and team members' stress/burnout; 2) to test hypotheses about factors related to TD; and 3) to explore differences among types of teams and disciplines on team properties and stress; 4) to explore the relationship between TD, QTF and patient care outcomes in HBHC teams, where standard outcome measures are being developed. Moving beyond the small samples of previous team studies (usually one case in an experimental demonstration project), this study uses a national sample of 100 geriatric teams from 32 VAMCs in a cross- sectional survey design. To explore differences, these teams are drawn in equal numbers (30 each) from three programs -- Geriatric Evaluation and Management (GEM), Hospital-Based Home Care (HBHC), Nursing Home Care (NHC). The remaining teams (about 12) are Adult Day Health Care (ADHC) from the sampled VAMCs. A questionnaire is administered by the investigators to obtain perceptions of team properties from all disciplines represented on the teams (900-1200 members). Pilot work has refined both conceptualization and measurement. Structural equation modeling employing LISREL is used to test a set of hypotheses: 1) TD, as indicated by the structure of informal roles and low anomie in the team, positively affects QTF, which consists of a cluster of interrelated team properties (i.e., openness of communication, organizational efficiency, solidarity), and TD negatively affects team members' stress/burnout; 2) TD is positively affected by team stability and members' degree of embeddedness in their team is opposed to discipline-specific networks; 3) TD is negatively affected by team size, heterogeneity of demographic characteristics of team members, team work load, and physicians' attitudes toward team care. Since multiple indicators of some constructs are used, a measurement model is identified, estimated, tested and modified prior to testing the structural equation model. Exploratory analysis of differences of team type and discipline employ one-way and repeated measures ANOVA. Finally, the relationship between QTF and patient care outcomes in HBHC teams is explored.
| Farrell, M P; Schmitt, M H; Heinemann, G D (2001) Informal roles and the stages of interdisciplinary team development. J Interprof Care 15:281-95 |
| Heinemann, G D; Schmitt, M H; Farrell, M P et al. (1999) Development of an Attitudes Toward Health Care Teams Scale. Eval Health Prof 22:123-42 |
