Team competencies in patient care
Mehl SJ, Anderson A, Gunn L, Stearns J, Simpson D. Team competencies in patient care. J Patient-Centered Res Rev. 2014;1:54-55.
Presented at 2013 Aurora Scientific Day, Milwaukee, WI
Background/significance: Effective team functioning plays an integral role in patient experience and resultant scores. Several initiatives across Aurora Health Care address quality, patient satisfaction and communication but none have explicitly addressed the competencies required to be effective team members.
Purpose: Determine if implementation of TeamSTEPPS (TS), an evidence-based teamwork system, curriculum training to all caregivers will result in improved patient experience metrics and caregiver satisfaction; and if the 55-item TS assessment can be shortened without significant loss of content.
Methods: The TS team assessment, a Likert scale questionnaire, was administered to all caretakers prior to training at two Family Medicine residency ambulatory clinics. The TS curriculum was customized for initial caregiver training based on the pre-assessment results and needs of the pilot sites, and delivered following a “train the trainer” approach. Caregivers were taught core team skills and site specific skills during a 4-hour session. Item responses to the 55-item pre-questionnaire (N=50/80) were used for cluster analysis using MINITAB software. The entire set and the large cluster 1 was subjected to principle component factor analysis, including Scree plot, with Varimax rotation. The resulting 17 questions and three retrospective questions based on “commitment to change” were administered 2 months after training (N=55/80). CGCAPS metrics were utilized. Chi-square test with Yates correction was used for 2x2 tables of dichotomized responses.
Results: Factor analysis/Scree plot of the pre-questionnaire responses indicated 2 factors. Factor 1 (team member characteristics) explained 36% of the variance and Factor 2 (team leader characteristics) explained 24% of the variance. When Likert scale responses were dichotomized, 2/20 questions improved after training alone (p<0.05). These questions included “team has adequate skills and member resources to achieve its goals” and “I make a focused effort to communicate better.” Merged CGCAPS Scores in service impact, provider, provider communication and office staff all improved post vs. pre-training (11-57 percentage points).
Conclusion: Here, the 55-item questionnaire could be significantly shortened, still convey general content, and improve response rate. TS training alone did not show significant change in perceived team behaviors, yet metrics all showed improvement. Given concurrent initiatives, it cannot be concluded that this improvement is solely a result of TS training.