What makes a clinical team successful?

TORONTO – Walter Wodchis (pictured), PhD, a professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation, has been awarded a grant from the Canadian Institutes of Health Research (CIHR) worth nearly $1.5 million to lead a national study identifying strategies for successful implementation of primary health care teams.

Over a three-year period, he and his colleagues in health services research will closely follow four primary care teams in each of British Columbia, Ontario and Nova Scotia. The team includes co-principal investigators Dr. Ruth Martin-Misener at Dalhousie University and Dr. Sabrina Wong at the University of British Columbia, along with principal decision-makers in each province.

The researchers will conduct a long-term study of the factors that affect the implementation of team-based care models. Through interviews and observation of frontline providers as well as those who organize care like office administrators and data specialists, the researchers seek to understand how teams form and develop over time, the roles and functions of patients, families and communities in the teams, and how leaders can support teamwork.

They will also do quantitative analyses of patient data and surveys by patients and providers, resulting in a mixed-methods research study.

Wodchis, who is also the Research Chair in Implementation and Evaluation at the Institute for Better Health at Trillium Health Partners, notes the jurisdictions are at different points of adoption of primary care teams.

In Ontario, for instance, where this model of care is well established, there are close to 200 primary care teams; in British Columbia, there are nearly 40. “The jurisdictions themselves are at different points of maturity,” he said. “In these different contexts, we want to know how are teams evolving over time, and how do they develop to meet the needs of their local patient populations?”

To determine a team’s effectiveness, the researchers will look at factors like interdependence of work processes, communication, performance feedback, adaptation to patients over time, clarity of goals, successful conflict management and the degree of trust among the team. “We will also look to see whether patients have better health outcomes, particularly better experiences of integrated care within these teams,” Wodchis says.

Provincial governments have made significant investments into primary care teams by hiring practitioners, but, notes Wodchis, we do not know how primary health care teams are formed and adapt over time to new ways of collaborative working.

“You can’t just hire a bunch of people and expect that they’re automatically going to be a cohesive team. What do these teams need to become collective entities that work together effectively? That’s what this study will tell us,” he says.

The team’s proposal was ranked first out of 32 applications by the peer review committee from CIHR, which, after two prior unsuccessful attempts was particularly rewarding. Tracking teams over time through a qualitative study is innovative and novel, but could be risky, as reviewers from a previous funding round noted since the researchers would not know at the outset which teams would be successful.

Of this concern Wodchis says, “I guess they weren’t convinced that we’d be able to observe the emergence of successful teams. And to that, our rebuttal was that we can learn just as much from failure as we can from success.”