Hummy Song

Development and validation of the primary care team dynamics survey.

OBJECTIVE To develop and validate a survey instrument designed to measure team dynamics in primary care. DATA SOURCES/STUDY SETTING We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care. STUDY DESIGN We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall surveys goodness-of-fit using structural equation modeling. DATA COLLECTION We administered the survey between September 2012 and March 2013. PRINCIPAL FINDINGS Overall response rate was 68 percent (732 respondents). Results support a seven-factor model of team dynamics, suggesting that conditions for team effectiveness, shared understanding, and three supportive processes are associated with acting and feeling like a team and, in turn, perceived team effectiveness. This model demonstrated adequate fit (goodness-of-fit index: 0.91), scale reliability (Cronbachs alphas: 0.71-0.91), and discriminant validity (average factor correlations: 0.49). CONCLUSIONS It is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes).

Closing the Productivity Gap: Improving Worker Productivity Through Public Relative Performance Feedback and Validation of Best Practices

Public relative performance feedback (RPF) on an individual worker’s productivity metrics is used in various organizations with the hopes of improving worker productivity, but its effects are not well understood. We examine whether public RPF could be leveraged to facilitate adoption of best practices in an organization by enabling the validation of best practices shared by identifiable top performers. We use data from two emergency departments, both of which shared best practices for improving productivity and one of which changed from privately to publicly disclosing RPF to physicians. The public disclosure of RPF allowed workers to identify their top-performing coworkers, which in turn enabled the identification and validation of best practices within the work group. We find that the intervention is associated with a 10.9% improvement in physician productivity. We also find evidence for a significant reduction in variation in productivity across providers, which stems from bottom-ranked workers exhibit...

Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study.

Background: Team-based care is essential for delivering high-quality, comprehensive, and coordinated care. Despite considerable research about the effects of team-based care on patient outcomes, few studies have examined how team dynamics relate to provider outcomes. Purpose: The aim of this study was to examine relationships among team dynamics, primary care provider (PCP) clinical work satisfaction, and patient care coordination between PCPs in 18 Harvard-affiliated primary care practices participating in Harvard’s Academic Innovations Collaborative. Methodology: First, we administered a cross-sectional survey to all 548 PCPs (267 attending clinicians, 281 resident physicians) working at participating practices; 65% responded. We assessed the relationship of team dynamics with PCPs’ clinical work satisfaction and perception of patient care coordination between PCPs, respectively, and the potential mediating effect of patient care coordination on the relationship between team dynamics and work satisfaction. In addition, we embedded a qualitative evaluation within the quantitative evaluation to achieve a convergent mixed methods design to help us better understand our findings and illuminate relationships among key variables. Findings: Better team dynamics were positively associated with clinical work satisfaction and quality of patient care coordination between PCPs. Coordination partially mediated the relationship between team dynamics and satisfaction for attending clinicians, suggesting that higher satisfaction depends, in part, on better teamwork, yielding more coordinated patient care. We found no mediating effects for resident physicians. Qualitative results suggest that sources of satisfaction from positive team dynamics for PCPs may be most relevant to attending clinicians. Practice Implications: Improving primary care team dynamics could improve clinical work satisfaction among PCPs and patient care coordination between PCPs. In addition to improving outcomes that directly concern health care providers, efforts to improve aspects of team dynamics may also help resolve critical challenges in workforce planning in primary care.

Pooling Queues with Discretionary Service Capacity

Contrary to traditional queueing theory, recent case studies in health care and call centers indicate that pooling queues may not necessarily result in less expected work-in-process. In this paper, we propose that this phenomenon may arise when servers have some discretion over their choice of service capacity and are work-averse, i.e., bear a cost associated with either their expected workload or their degree of busyness. Under a pooled configuration, the servers’ incentives to invest in service capacity are indeed lower due to their ability to free ride and due to the greater operational efficiency of the pooled configuration. Moreover, the type and extent of work aversion matter; specifically, we find that dedicated configurations yield less expected work-in-process than pooled configurations when servers exhibit high degrees of workload aversion or low degrees of busyness aversion. We also find that busyness aversion tends to hurt more to the point that it could negate the operational benefits of queue pooling at their highest potential. Overall, our work suggests that service system designers may need to consider the servers’ type and extent of work aversion as well as their degree of capacity choice discretion before pooling their workload.

Performance Improvement in Health Care Organizations

Performance improvement is an important organizational capability that is essential for health care organizations to achieve excellence on the three components of the Triple Aim: patient experience, health, and cost. In this monograph, we present a framework for performance improvement in health care organizations: the Model of Transformational Performance Improvement. This model takes a system-level approach to performance improvement and comprises six key components: (1) determining and communicating a system-level goal; (2) developing and using system-level performance measures; (3) understanding and managing interdependencies; (4) selecting a portfolio of projects aligned with system-level goals; (5) creating an organizational engine for improvement; and (6) implementing, spreading, and sustaining improvements. In addition to presenting this model, we review the operations management literature on performance improvement with a special focus on operations management tools and principles that may help with successful implementation of these six components. Though work has already been done in these areas, much remains unknown and many opportunities for future research exist. This monograph seeks to inform the research of operations management scholars and to equip clinicians and health care leaders with techniques that may be leveraged to improve performance in health care organizations.

Cohort Turnover and Operational Performance: The July Phenomenon in Teaching Hospitals

We consider the impact of cohort turnover on operational performance in the context of teaching hospitals. Using 12 years of data from a sample of U.S. hospitals, we show that the annual July turnover of residents results in longer lengths of stay, though not a significant change in mortality rates. In major teaching hospitals, we find evidence of an anticipation effect that presents as a gradual decrease in operational performance beginning several months before the actual cohort turnover. We also identify managerial levers for mitigating the decrease in hospital operational performance both at the time of and in the months leading up to the cohort turnover.