Heloise Lima Fernandes Agreli

The relationship between team climate and interprofessional collaboration: Preliminary results of a mixed methods study

ABSTRACT Relational and organisational factors are key elements of interprofessional collaboration (IPC) and team climate. Few studies have explored the relationship between IPC and team climate. This article presents a study that aimed to explore IPC in primary healthcare teams and understand how the assessment of team climate may provide insights into IPC. A mixed methods study design was adopted. In Stage 1 of the study, team climate was assessed using the Team Climate Inventory with 159 professionals in 18 interprofessional teams based in São Paulo, Brazil. In Stage 2, data were collected through in-depth interviews with a sample of team members who participated in the first stage of the study. Results from Stage 1 provided an overview of factors relevant to teamwork, which in turn informed our exploration of the relationship between team climate and IPC. Preliminary findings from Stage 2 indicated that teams with a more positive team climate (in particular, greater participative safety) also reported more effective communication and mutual support. In conclusion, team climate provided insights into IPC, especially regarding aspects of communication and interaction in teams. Further research will provide a better understanding of differences and areas of overlap between team climate and IPC. It will potentially contribute for an innovative theoretical approach to explore interprofessional work in primary care settings.

Cross-cultural adaptation and validation of the teamwork climate scale

ABSTRACT OBJECTIVE To adapt and validate the Team Climate Inventory scale, of teamwork climate measurement, for the Portuguese language, in the context of primary health care in Brazil. METHODS Methodological study with quantitative approach of cross-cultural adaptation (translation, back-translation, synthesis, expert committee, and pretest) and validation with 497 employees from 72 teams of the Family Health Strategy in the city of Campinas, SP, Southeastern Brazil. We verified reliability by the Cronbach’s alpha, construct validity by the confirmatory factor analysis with SmartPLS software, and correlation by the job satisfaction scale. RESULTS We problematized the overlap of items 9, 11, and 12 of the “participation in the team” factor and the “team goals” factor regarding its definition. The validation showed no overlapping of items and the reliability ranged from 0.92 to 0.93. The confirmatory factor analysis indicated suitability of the proposed model with distribution of the 38 items in the four factors. The correlation between teamwork climate and job satisfaction was significant. CONCLUSIONS The version of the scale in Brazilian Portuguese was validated and can be used in the context of primary health care in the Country, constituting an adequate tool for the assessment and diagnosis of teamwork.

Contributions of team climate in the study of interprofessional collaboration: a conceptual analysis

ABSTRACT The concept of team climate is widely used to understand and evaluate working environments. It shares some important features with Interprofessional Collaboration (IPC). The four-factor theory of climate for work group innovation, which underpins team climate, could provide a better basis for understanding both teamwork and IPC. This article examines in detail the common ground between team climate and IPC, and assesses the relevance of team climate as a theoretical approach to understanding IPC. There are important potential areas of overlap between team climate and IPC that we have grouped under four headings: (1) interaction and communication between team members; (2) common objectives around which collective work is organised; (3) responsibility for performing work to a high standard; and (4) promoting innovation in working practices. These overlapping areas suggest common characteristics that could provide elements of a framework for considering the contribution of team climate to collaborative working, both from a conceptual perspective and, potentially, in operational terms as, for example, a diagnostic tool.

Atenção centrada no paciente na prática interprofissional colaborativa

Este estudo foi realizado com o objetivo de descrever os elementos-chave da atencao centrada no paciente e sua relacao com a pratica interprofissional colaborativa na atencao primaria a saude, no contexto do Sistema Unico de Saude, apoiado em revisao de literatura nacional e internacional. Os resultados mostram que, a medida que os profissionais centram atencao no paciente e suas necessidades de saude, operam simultaneamente um deslocamento de foco para um horizonte mais amplo e alem de sua propria atuacao profissional. Esse deslocamento e reconhecido como componente de mudanca do modelo de atencao a saude na perspectiva da integralidade, com potencial de impacto na qualidade da atencao.Este estudo foi realizado com o objetivo de descrever os elementos-chave da atencao centrada no paciente e sua relacao com a pratica interprofissional colaborativa na atencao primaria a saude, no contexto do Sistema Unico de Saude, apoiado em revisao de literatura nacional e internacional. Os resultados mostram que, a medida que os profissionais centram atencao no paciente e suas necessidades de saude, operam simultaneamente um deslocamento de foco para um horizonte mais amplo e alem de sua propria atuacao profissional. Esse deslocamento e reconhecido como componente de mudanca do modelo de atencao a saude na perspectiva da integralidade, com potencial de impacto na qualidade da atencao.

Patient centred care in interprofessional collaborative practice

Este estudo foi realizado com o objetivo de descrever os elementos-chave da atencao centrada no paciente e sua relacao com a pratica interprofissional colaborativa na atencao primaria a saude, no contexto do Sistema Unico de Saude, apoiado em revisao de literatura nacional e internacional. Os resultados mostram que, a medida que os profissionais centram atencao no paciente e suas necessidades de saude, operam simultaneamente um deslocamento de foco para um horizonte mais amplo e alem de sua propria atuacao profissional. Esse deslocamento e reconhecido como componente de mudanca do modelo de atencao a saude na perspectiva da integralidade, com potencial de impacto na qualidade da atencao.Este estudo foi realizado com o objetivo de descrever os elementos-chave da atencao centrada no paciente e sua relacao com a pratica interprofissional colaborativa na atencao primaria a saude, no contexto do Sistema Unico de Saude, apoiado em revisao de literatura nacional e internacional. Os resultados mostram que, a medida que os profissionais centram atencao no paciente e suas necessidades de saude, operam simultaneamente um deslocamento de foco para um horizonte mais amplo e alem de sua propria atuacao profissional. Esse deslocamento e reconhecido como componente de mudanca do modelo de atencao a saude na perspectiva da integralidade, com potencial de impacto na qualidade da atencao.

Atención centrada en el paciente y práctica interprofesional colaborativa

Este estudo foi realizado com o objetivo de descrever os elementos-chave da atencao centrada no paciente e sua relacao com a pratica interprofissional colaborativa na atencao primaria a saude, no contexto do Sistema Unico de Saude, apoiado em revisao de literatura nacional e internacional. Os resultados mostram que, a medida que os profissionais centram atencao no paciente e suas necessidades de saude, operam simultaneamente um deslocamento de foco para um horizonte mais amplo e alem de sua propria atuacao profissional. Esse deslocamento e reconhecido como componente de mudanca do modelo de atencao a saude na perspectiva da integralidade, com potencial de impacto na qualidade da atencao.Este estudo foi realizado com o objetivo de descrever os elementos-chave da atencao centrada no paciente e sua relacao com a pratica interprofissional colaborativa na atencao primaria a saude, no contexto do Sistema Unico de Saude, apoiado em revisao de literatura nacional e internacional. Os resultados mostram que, a medida que os profissionais centram atencao no paciente e suas necessidades de saude, operam simultaneamente um deslocamento de foco para um horizonte mais amplo e alem de sua propria atuacao profissional. Esse deslocamento e reconhecido como componente de mudanca do modelo de atencao a saude na perspectiva da integralidade, com potencial de impacto na qualidade da atencao.

The Health care network for integrated care in Brazil / La red de atención de salud para la atención integrada en Brasil

Introduction: The Health Care Network (HCN) in Brazil is a proposal from Health Ministry to link different health services in order to promote integrated care. There has been observed in Brazil a situation of triple burden of diseases, characterized by the co-existence of infectious/parasitic diseases and malnutrition, avoidable child and maternal deaths, chronic diseases and external causes (Brazil, 2010). The ultimate goal of HCN is to overcome the contemporary crisis of health care system and the complex epidemiological situation. Description of the policy: The HCN aims to meet longitudinally the needs of users/ family/ community, taking into account the social determinants of health to deliver comprehensive care, it is constituted of three elements: population, operational structure and model of health care. Population is the rationale and orientation for HCN. Operational structure is referred to material and immaterial connections in health network. It highlights the role of Primary Health Care as coordinator of HCN in articulating services and interprofessional teams from different levels of complexity. The model of care suggested is focused in chronic conditions rather than the current acute model (Mendes, 2010). Highlight: Evidences suggest that Health Care Network may triggers a positive impact on health determinants and also contribute to a shift towards comprehensive, collaborative and person centred care. In that sense, it establishes the practice of Extended Clinic (Campos, Amaral, 2007), strengthening the autonomy of users and families through participation in decision-making process. The HCN incorporates a concept internationally diffused, the clinical governance strategy. This strategy establish clinical guidelines for improving communication between teams and services; management of the health condition; management of collective and environmental risks; case management, clinical audit and waiting list (Brazil, 2010). Conclusion: The integration of care focused on users, families, communities and population can be significantly strengthened by the implementation of HCN in Brazil. It is a powerful initiative to effect quality and effectiveness improvement in health care systems. International Journal of Integrated Care – Volume 15, 17 Nov – URN:NBN:NL:UI:10-1-117330 – http://www.ijic.org 3 rd World Congress on Integrated Care, Mexico City, Mexico, 19-21 November, 2015 Conference abstract Spanish Introduccion: La Red de Atencion de la Salud (HCN) en Brasil es una propuesta del Ministerio de Salud para vincular diferentes servicios de salud con el fin de promover la atencion integrada. Se ha observado en Brasil una situacion de triple carga de enfermedades, que se caracteriza por la coexistencia de enfermedades infecciosas y/o parasitarias, desnutricion infantil evitable y la mortalidad materna, las enfermedades cronicas y causas externas (Brasil, 2010). El objetivo final de HCN es superar la crisis contemporanea del sistema de salud y la situacion epidemiologica compleja. Descripcion de la politica: El HCN tiene como objetivo satisfacer longitudinalmente las necesidades de los usuarios / familia / comunidad, teniendo en cuenta los determinantes sociales de la salud para ofrecer atencion integrada, que esta constituido por tres elementos: la poblacion, la estructura operativa y el modelo de atencion de la salud. La poblacion es el fundamento y la orientacion de HCN. La estructura operativa se refiere a las conexiones materiales e inmateriales en la red de salud. Se destaca el papel de la Atencion Primaria de Salud como coordinador de HCN en la articulacion de los servicios y equipos interprofesionales de diferentes niveles de complejidad. El modelo de atencion propuesto se centra en las enfermedades cronicas y no el modelo agudo actual (Mendes, 2010). Aspectos Interesantes: Las evidencias sugieren que la Red de Atencion de la Salud puede desencadenar un impacto positivo sobre los determinantes de salud, asi como contribuir a un cambio hacia la atencion integrada centrada, colaborativa y en las persona. En ese sentido, se establece la practica de la Clinica extendida (Campos, Amaral, 2007), el fortalecimiento de la autonomia de los usuarios y las familias a traves de la participacion en el proceso de toma de decisiones. El HCN incorpora un concepto difundido a nivel internacional, la estrategia de gestion clinica. Esta estrategia establece las directrices clinicas para mejorar la comunicacion entre los equipos y los servicios; gestion de la condicion de salud; gestion de los riesgos colectivos y ambientales; manejo de casos, la auditoria clinica y la lista de espera (Brasil, 2010). Conclusion: La atencion integrada centrada en los usuarios, las familias, las comunidades y la poblacion puede fortalecer de manera significativa por la implementacion de HCN en Brasil. Es una poderosa iniciativa para llevar a cabo la mejora de la calidad y la eficacia de los sistemas de atencion de salud.