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Implementation Science
Published in: Implementation Science 1/2019

Open Access 01-12-2019 | Care | Study protocol

Impact of team configuration and team stability on primary care quality

Authors: Sylvia J. Hysong, Amber B. Amspoker, Ashley M. Hughes, Lechauncy Woodard, Frederick L. Oswald, Laura A. Petersen, Houston F. Lester

Published in: Implementation Science | Issue 1/2019

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Abstract

Background

The science of effective teams is well documented; far less is known, however, about how specific team configurations may impact primary care team effectiveness. Further, teams experiencing frequent personnel changes (perhaps as a consequence of poor implementation) may have difficulty delivering effective, continuous, well-coordinated care. This study aims to examine the extent to which primary care clinics in the Veterans Health Administration have implemented team configurations consistent with recommendations based on the Patient-Centered Medical Home model and the extent to which adherence to said recommendations, team stability, and role stability impact healthcare quality. Specifically, we expect to find better clinical outcomes in teams that adhere to recommended team configurations, teams whose membership and configuration are more stable over time, and teams whose clinical manager role is more stable over time.

Methods/design

We will employ a combination of social network analysis and multilevel modeling to conduct a database review of variables extracted from the Veterans Health Administration’s Team Assignments Report (TAR) (one of the largest, most diverse existing national samples of primary care teams (nteams > 7000)), as well as other employee and clinical data sources. To ensure the examination of appropriate clinical outcomes, we will enlist a team of subject matter experts to select a concise set of clear, prioritized primary care performance metrics. We will accomplish this using the Productivity Measurement and Enhancement System, an evidence-based methodology for developing and implementing performance measurement.

Discussion

We are unaware of other studies of healthcare teams that consider team size, composition, and configuration longitudinally or with sample sizes of this magnitude. Results from this study can inform primary care team implementation policy and practice in both private- and public-sector clinics, such that teams are configured optimally, with adequate staffing, and the right mix of roles within the team.

Trial registration

Not applicable—this study does not involve interventions on human participants.
Appendix
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Metadata
Title
Impact of team configuration and team stability on primary care quality
Authors
Sylvia J. Hysong
Amber B. Amspoker
Ashley M. Hughes
Lechauncy Woodard
Frederick L. Oswald
Laura A. Petersen
Houston F. Lester
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
Implementation Science / Issue 1/2019
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-019-0864-8

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