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. 2026 Feb 11;51(2):68–77. doi: 10.1097/HMR.0000000000000465

Team creativity as a catalyst for care effectiveness and well-being in primary care teams

Yuna SH Lee 1,2,3,4,5, Nancy LaVine 1,2,3,4,5, Cheryl Rathert 1,2,3,4,5, Yulia Kogan 1,2,3,4,5, Lusine Poghosyan 1,2,3,4,5
PMCID: PMC12922685  PMID: 41671418

Abstract

Background:

Primary care teams play a critical role in delivering high-quality, patient-centered care, yet they face mounting challenges, including high rates of burnout and job dissatisfaction. Creativity within teams may serve as a key resource for fostering continuous improvement and innovation while simultaneously enhancing team members' well-being.

Purpose:

This study introduces team creativity as a novel and actionable teamwork construct, assessing its relationship with burnout, job satisfaction, and perceived effectiveness of care delivery. We validate a new multidimensional measure of team creativity tailored to the primary care context.

Methodology/Approach:

Using survey data from 648 primary care team members across a large health system, we conducted confirmatory factor analysis to validate the Primary Care Team Creativity tool. We then tested hypotheses to assess associations between primary care team creativity, perceived effectiveness of care delivery, and well-being.

Results:

Findings confirm the validity of the Primary Care Team Creativity tool. Primary care team creativity was positively associated with job satisfaction and negatively associated with burnout. Perceived effectiveness of care delivery mediated these relationships, indicating that creativity enhances well-being by improving team members' perceptions of the quality of care they provide.

Conclusion:

This study establishes team creativity as a validated, actionable construct in primary care and demonstrates its potential for enhancing care effectiveness, reducing burnout and enhancing job satisfaction for primary care professionals.

Practice Implications:

Health care leaders can foster team creativity by embedding structured opportunities for idea generation, encouraging interdisciplinary collaboration, and leveraging creativity to enhance care processes—ultimately supporting both innovation and provider well-being in primary care.

Key words: Burnout, care quality, creativity, job satisfaction, primary care, teams

Primary care teams are under growing strain. Despite being central to providing high-quality, patient-centered care, these teams face high levels of burnout and declining job satisfaction. A 2023 survey found that 44%–50% of primary care team members report burnout, whereas only 35% report high job satisfaction, which are both key indicators of overall well-being (Agency for Healthcare Research and Quality [AHRQ], 2023; Buljac-Samardzic & Doekhie 2020). These conditions erode the motivation, engagement, and curiosity essential to continuous improvement and innovation. Although numerous interventions over the past two decades have aimed to improve well-being, their impact has been, at best, moderate (Cohen et al., 2023). Critically, most efforts have overlooked the team-level conditions that could simultaneously reduce burnout, enhance satisfaction, and support the improvement and innovation work that teams are increasingly expected to drive (Dyrbye et al., 2017; Panagioti et al., 2022). These challenges are especially urgent in light of calls to make health care more adaptive and responsive to learning—aspirations embodied in the Learning Health System model, which positions teams as central agents of innovation and improvement (Bindman et al., 2018). Yet, without addressing the everyday realities of team functioning and well-being, these aspirations risk remaining out of reach.

Management and organizational theory suggest that team creativity—the collective ability to generate novel and useful ideas—offers a promising approach to strengthen primary care teams, enabling continuous improvement and innovation despite the widespread challenges of burnout and job dissatisfaction (Amabile & Pratt, 2016; Lee et al., 2020). Although creativity has not traditionally been central to health care's mission, frontline teams are responsible for up to 70% of health care innovations (Berwick, 2003), playing a pivotal role in identifying and implementing practical improvements. Examples include adapting evidence-based protocols for successful implementation, streamlining electronic health record templates to reduce documentation time, establishing walk-in clinics for same-day appointments, and organizing interdisciplinary huddles to efficiently address complex cases (Lee & Nembhard, 2022). Evidence links team creativity in primary care to improved team engagement, successful innovation implementation, and enhanced patient care experiences (Jung & Cummings, 2023; West, 2002). Furthermore, organizations such as AHRQ and the National Academies of Science, Engineering, and Medicine (NASEM) emphasize creativity as essential for fostering effective teamwork, improving care quality, and promoting professional engagement (AHRQ, 2018; Frueh, 2024). Insights from management research across industries demonstrate that team creativity enhances collaboration, engagement, and job satisfaction (Harrison et al., 2022).

Despite its potential to address critical challenges of team improvement and innovation and team member well-being in primary care, the role and impact of team creativity remain underexplored (Gilson et al., 2019). Few studies have investigated how team creativity functions in primary care, whether it encompasses unique elements specific to this health care setting or how it relates to key outcomes such as burnout and job satisfaction. Although prior studies have explored links between creativity and well-being of health care professionals through interventions involving artistic or therapeutic practice (Barroso Alonso et al., 2020; Pieper et al., 2025)—less is known about the role of team creativity, defined as the generation of novel and useful ideas (Amabile, 1988) within routine clinical teamwork, in shaping clinician experiences and outcomes. Although organizational theory suggests that team creativity may generate energizing and synergistic effects on team performance, member well-being, and continuous improvement and innovation, these relationships have not been explicitly studied in primary care (Gilson et al., 2019). Although several validated tools exist to measure team creativity in other domains (e.g., Farh et al., 2010; Hirst et al., 2011; Shin & Zhou, 2007), they do not capture primary-care-specific elements such as clinical interdependence, time pressure, relational dynamics, and the pervasive role of standardization in shaping team workflows and decision-making—all of which are essential to understanding how creativity unfolds in this context. This study makes two primary contributions to the health services literature. First, it validates a theory-informed, context-specific measurement tool—the Primary Care Team Creativity (PCTC) tool, which was developed in a prior paper to capture dimensions of team creativity in primary care (Lee et al., 2025). Second, it empirically tests associations between primary care team creativity and outcomes central to health services research, including perceived effectiveness of care delivery, clinician burnout, and job satisfaction. Together, these contributions provide a conceptual and empirical foundation for integrating creativity into models of primary care team functioning and continuous improvement.

Theory

Team creativity—the collective ability of a team to generate novel and useful ideas (Amabile & Pratt, 2016)—is central to enabling innovation, adaptability, and continuous improvement. In other industries, team creativity produces synergistic and energizing benefits by integrating diverse perspectives, fostering shared ownership, enabling collaborative problem-solving, promoting learning and growth, and creating positive feedback loops that enhance innovation, engagement, and team morale (Gilson, 2008; Rouse & Harrison, 2021). These functions are especially valuable in primary care, where teams must continuously adapt to complex patient needs, resource constraints, and evolving care models.

Creativity allows team members to innovate within their workflows and navigate standardized practices in ways that feel personally meaningful and empowering (Gilson, 2008). Although standardization is essential for safety and consistency in health care, it can also limit opportunities for adaptation and creativity. We theorize that team creativity in health care emerges not in opposition to rules and protocols but through teams' ability to work creatively within and around those structures—adapting processes to meet patient needs while still ensuring reliability and accountability.

For example, primary care teams nationwide have been innovating standing orders for chronic disease management, enabling nurses and medical assistants to adjust medications, order lab tests, and connect patients to community partners like food banks or fitness centers under predefined protocols, enhancing care continuity and alleviating physician workload (Wagner et al., 2017). Teams are also experimenting with integrating artificial intelligence tools—such as medical note-taking and decision support systems—into their workflows in creative and adaptive ways (Sarkar & Bates, 2024). These innovations exemplify how creativity enables teams to address systemic constraints and align care delivery with their professional values.

To explain why creativity may influence clinician well-being, we draw on self-determination theory (Ryan & Deci, 2000), which posits that the fulfillment of three core psychological needs—autonomy, competence, and relatedness—is essential for motivation, engagement, and well-being. In primary care settings, the energizing effects of team creativity may help fulfill these needs by giving team members greater agency in shaping work and care provided (autonomy), opportunities to make meaningful progress (competence), and shared problem-solving experiences (relatedness; Amabile & Pratt, 2016; Dean et al., 2019).

This perspective is especially relevant given that work-related factors are a major driver of burnout in primary care teams—a syndrome characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment (Meyers et al., 2024). Work process challenges, such as computerized order entry and documentation, excessive workloads, and reduced control, are strongly linked to burnout in this context (Dyrbye et al., 2017). However, research also highlights the potential of work-related improvements, including enhanced autonomy, a stronger sense of meaning, and increased connection, as effective antidotes to burnout (Rathert et al., 2023). Moreover, team-level interventions have shown promise, addressing systemic shortcomings that individual-level strategies alone cannot resolve (Buljac-Samardzic & Doekhie 2020).

We propose that team creativity may support psychological need fulfillment by enabling autonomy (through greater agency in problem-solving), competence (through progress and innovation), and relatedness (through collaboration and shared ownership). For example, creativity enhances a team's sense of contribution through the “progress principle”—the positive effects of making meaningful progress and having one's voice and suggestions recognized (Amabile & Pratt, 2016). Engaging in creative work fosters a positive task orientation, which buffers against burnout. By fostering team progress and shared solidarity, team creativity offers a conceptual antidote to feelings of individual disempowerment and diminishment (AHRQ, 2023).

For these reasons, we offer our first hypothesis:

H1. Team creativity is negatively associated with burnout in primary care teams.

Creativity within primary care teams may foster a sense of meaningful work, which is a critical driver of job satisfaction. Robertson et al. (2020) emphasize that work becomes more fulfilling when employees feel their contributions are purposeful and valued. Creative environments enable team members to engage in problem-solving and innovative idea generation, reinforcing their sense of competence, autonomy, and professional impact (Liu et al., 2024). These processes not only enrich the meaningfulness of their work but also create a sense of empowerment and alignment with organizational goals, both of which are strongly associated with higher job satisfaction (Robertson et al., 2020). Additionally, the collaborative nature of creativity strengthens interpersonal ties within teams, fostering a supportive atmosphere that enhances motivation and workplace satisfaction.

Rouse and Harrison (2021) highlight how creative teams promote group cohesion and individual engagement. Their findings show that when team members contribute novel ideas and see their input integrated into collective outcomes, they experience a sense of belonging and recognition (Rouse & Harrison, 2021). For primary care teams, which often face repetitive tasks, engaging in creativity provides opportunities to break monotony, build camaraderie, and feel that their unique perspectives matter (Dyrbye et al., 2017). For example, internal medicine practice teams at Boston Medical Center implemented regular hour-long meetings twice a month focused on innovation and improvement to foster open communication, improve workflows, and build camaraderie, empowering team members to contribute meaningfully to patient care (O'Reilly, 2017). These dynamics create a work environment where employees feel valued and connected, leading to greater satisfaction with their roles and the overall team experience. Together, these insights illustrate how team creativity may serve as a catalyst for job satisfaction in primary care teams. This leads to our second hypothesis:

H2. Team creativity is positively associated with job satisfaction in primary care teams.

Creativity within primary care teams fosters continuous improvement and innovation, improving care delivery effectiveness and directly enhancing team members' well-being (Kraft et al., 2017). According to Amabile and Pratt's (2016) dynamic componential model of creativity, progress in meaningful work boosts motivation and organizational outcomes, providing team members with a sense of accomplishment and purpose when creative efforts lead to tangible improvements in care delivery. Similarly, Dean et al. (2019) highlight that creative contributions can bridge the alignment between health care professionals' values and their work outcomes, reducing moral distress and reinforcing job satisfaction while mitigating burnout.

Self-determination theory (Ryan & Deci, 2000) further supports this relationship, emphasizing how high-quality care outcomes satisfy core psychological needs such as competence, autonomy, and relatedness. Creative improvements validate clinicians' professional capabilities, empower them with greater autonomy, and strengthen collaboration through team problem-solving (Dyrbye et al., 2017). These outcomes create a positive feedback loop, fostering professional fulfillment and alleviating burnout (Ryan & Deci, 2000). Additionally, perceived effectiveness of care delivery bolsters team dynamics, enhancing collective efficacy and cohesion while reducing frustrations linked to systemic barriers (Robertson et al., 2020). By mediating the effects of team creativity, perceived effectiveness of care delivery transforms continuous improvement and innovation into improved well-being and a workplace where primary care teams feel valued and effective. Thus:

H3. Perceived effectiveness of care delivery mediates the relationship between team creativity, burnout, and job satisfaction in primary care teams.

These hypotheses and conceptual framework are summarized in Figure 1.

FIGURE 1.

FIGURE 1

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Conceptual framework.

To empirically test these hypotheses, we required a context-specific, theory-informed way to measure team creativity in primary care. Although existing creativity scales (e.g., Farh et al., 2010; Gilson & Shalley, 2004; Hirst et al., 2011) offer validated starting points, they were not designed for primary care teams. Our prior work (Lee et al., 2025) developed the PCTC tool, which captures five dimensions of creativity as enacted by primary care teams: team orientation to creativity, team creative processes, job-required creativity, team creative outputs, and leveraging team creativity. This tool provides a theoretically grounded and practically relevant approach to capturing how creativity functions in primary care settings.

Methods

Study Design and Setting

A cross-sectional survey approach addressed the study's two primary aims: to validate and test a new scale designed to systematically measure dimensions of creativity within primary care teams (Lee et al., 2025) and to evaluate the validity and influences of creativity by examining its relationship to team members' perceived effectiveness of care delivery and their well-being, by testing the three hypotheses described above. The study was conducted within a large New York State health system with 85,000 employees, 21 hospitals, and 890 outpatient care centers, covering a service area of 12 million people and including approximately 400 primary care providers. Participating practices provided adult primary care across three operational regions (Western, Central, Eastern) serving diverse populations insured through Medicaid, Medicare, and private payers. The study was approved by the first author's university Human Research Protection Office Institutional Review Board (IRB-AAAS8724).

Participants

Eligible participants included members of primary care teams that included both clinical (e.g., physicians Doctor of Medicine/Doctor of Osteopathic Medicine, nurse practitioners, physician assistants, registered nurses, and medical assistants) and nonclinical (e.g., supervisors, managers, and front desk staff) team members, with a total of 1,641 eligible team members across 227 practices. We partnered with the enterprise medical director of primary care practices to recruit the study sample. The director led a meeting to introduce the study to practice leaders and received permission to send the survey via the system's regional email listservs (East, West, and Central). Regional leaders provided information on the total number of employees on listservs and the composition of roles for each geographic cluster. Emails included an explanation of the study signed by the enterprise medical director. Two email reminders were sent to nonresponders. Each completed survey was followed up with a $5 gift card (to a vendor of choice for the respondent, e.g., Amazon.com), sent via email to the respondent. The final sample of completed surveys was 648 out of 1,641 team members associated with 227 practices, for a response rate of 40%.

Measures

Independent variable

Primary care team creativity measures

The independent variable in this study was measured with the PCTC tool, which was developed and described in a companion paper (Lee et al., 2025). The tool comprises 20 items grouped into five domains and is shown in Supplementary Digital Content 1, http://links.lww.com/HCMR/A180. All items utilized a 5-point Likert-type response scale where 1 = strongly disagree and 5 = strongly agree. The domains were identified in prior work through a systematic review of team creativity concepts in the management literature, expert panel adaptations for primary care, and exploratory factor analysis (EFA; Lee et al., 2025). Together, these five domains operationalize the broader construct of primary care team creativity.

Team orientation to creativity refers to the team's openness to generating and expressing creative ideas, which can be interpersonally risky because the outcome of creative ideas is often unknown. This measure consists of five items, for example: “My team is receptive to changes to how we provide care.”

Team creative process refers to interactions within the team that foster creativity such as brainstorming, learning from success and failures, iterating and experimenting, bringing in new ideas from outside sources, and adapting ideas that come “from the top.” These interactions can overlap with other team behaviors such as coordination or collaboration but have a unique focus on creativity. This measure consists of five items, for example: “My team iterates and experiments to improve how we provide care.”

Job required creativity refers to the degree to which creativity is essential to the team's tasks, which may vary in industries where creativity is not explicitly part of the mission. This measure consists of three items, for example: “The work we do requires my team to be creative.” One item was reverse coded (“In my team we consistently follow guidelines and protocols”), which assesses orientation to standardization.

Team creative outputs refer to the tangible outputs or products of creativity, including for improving care and outcomes or for improving work processes. This measure consists of three items, for example: “My team's creative ideas are effective for improving work processes.”

Leveraging team creativity refers to the availability of resources and support necessary to realize creative potential. This measure consists of four items, for example: “Our team has adequate resources (e.g., time, equipment) to generate and test new ideas.”

Primary care team creativity composite

Once the dimensions of the primary care team creativity construct were identified, we sought to examine how the higher-level construct of team creativity related to well-being. We constructed a composite measure of primary care team creativity by calculating a weighted average of the five dimensions (described below in the Analysis section; Fornell & Larcker, 1981). This measure was used in the hypothesis testing regression analyses.

Dependent variables

Burnout

Respondents rated their overall level of burnout using a single-item scale with Likert-type 1–5 responses: “Overall, how would you rate your level of burnout?” (1 = no burnout to 5 = severe burnout). This validated measure correlates with multi-item measures of burnout, such as the Maslach Burnout Inventory (Dolan et al., 2015).

Job satisfaction

Respondents rated their overall satisfaction using a single-item scale with Likert-type 1–5 responses: “Overall, how satisfied are you with your job?” (1 = very dissatisfied to 5 = very satisfied). This validated measure correlates strongly with multi-item job satisfaction scales and is widely recognized in management and organizational behavior research as a pragmatic tool for assessing job satisfaction (Wanous et al., 1997).

Mediating variable

Respondents rated the perceived effectiveness of care delivery using a single-item scale with Likert-type 1–5 responses: “Overall, how would you rate the effectiveness of the care provided by your practice?” (1 = very ineffective to 5 = very effective). This validated measure assesses perceptions of quality of care provided by health care professionals and is widely used in health services research (Friedberg et al., 2014).

Covariates

The survey also collected demographic and covariate data, including respondent characteristics (e.g., race, organizational tenure, gender, role) and practice characteristics (e.g., practice location, patient population served, size of care team). Supplemental Digital Content 2, http://links.lww.com/HCMR/A180, shows more information on these covariates. As shown in Table 2, all bivariate correlations among study variables were below .40, indicating no concerns about multicollinearity. To account for the clustering of individuals within teams and practices, we used clustered standard errors at the team level. This approach helped correct for the potential violation of the assumption of independence in the data, as individuals within the same team may have correlated outcomes.

TABLE 2.

Descriptive statistics and bivariate correlations of study variables (N = 648)

Research variables Mean (SD) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16)
Dimensions of primary care team creativity
 (1) Team orientation to creativity 4.27 (0.91) 1.00
 (2) Team creative process 3.92 (0.92) .57* 1.00
 (3) Job required creativity 3.71 (0.72) .66** .69* 1.00
 (4) Team creative outputs 3.52 (0.98) .61* .58* .55* 1.00
 (5) Leveraging team creativity 3.98 (0.89) .71** .69* .65* .59* 1.00
Independent variable
 (6) Primary care team creativity 3.89 (0.79) .91 .93 .79 .81 .91 1.00
Dependent variables
 (7) Job satisfaction 3.94 (1.05) .78** .67** .71** .59* .81** .67** 1.00
 (8) Burnout 2.22 (1.02) −.53* −.54* −.67* −.61 −.81** −.43** −.91** 1.00
 (9) Perceived effectiveness of care delivery 4.35 (0.99) .77** .67* .65* .71** .79** .52 .84** −.35 1.00
Covariates
 (10) COVID-19 4.08 (0.95) .22 .24 .18 .25 .27 .55 .09 .65* .07 1.00
 (11) Tenure 2.62 (1.13) .34 .34 .28 .29 .31 .30 .28 .39 .37 .18 1.00
 (12) Job role (physician) 1.02 (1.02) .45* .46 .38 .49 .31 .39 .28 .45* .28 .02 .18 1.00
 (13) Supervisor 1.83 (0.37) .43 .35 .19 .28 .40 .21 .28 .28 .29 .07 .61* .55* 1.00
 (14) Gender (male) 1.98 (0.44) .31 .28 .19 .29 .27 .17 .45 .56* .31 .08 .09 .10 .13 1.00
 (15) Race/ethnicity (White) 4.76 (0.48) .25 .18 .20 .19 .17 .16 .45 .53 .39 .08 .02 .23 .13 .23 1.00
 (16) % patients Medicaid 0.38 (0.48) .45* .35 .47* .45 .37 .34 .37 .45* .29 .09 .07 .12 .14 .03 .21 1.00
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*p < .05. **p < .01. ***p < .001.

Analysis

Factor structure validation

Confirmatory factor analysis (CFA) was used to assess the tool's factorial structure and construct validity. The dataset was randomly divided into two equal subsamples, each consisting of 324 observations, ensuring robust and independent validation processes (Lorenzo-Seva, 2022). The EFA sample from the companion paper (Lee et al., 2025) was used to identify the underlying factor structure, providing initial insights into the potential dimensions of the tool (citation redacted; Lorenzo-Seva, 2022).

The CFA was conducted to validate the five latent constructs identified in the EFA: team orientation to creativity, team creative processes, team creative outputs, job required team creativity, and leveraging team creativity. To examine the reliability of these constructs, Cronbach's alpha was employed to assess internal consistency. Model fit was evaluated using fit indices: comparative fit index and root mean square error of approximation (RMSEA).

Hypothesis testing

Factor loadings obtained from the CFA were used to weight each dimension of primary care team creativity, creating a composite score that captures the relative contribution of each dimension to the overall construct (Hatcher, 1994). This method ensured that the composite measure accurately reflected the influence of each dimension based on its statistical relationship to the latent construct of team creativity (Hatcher, 1994).

To test Hypotheses 1–3, which examine the relationships between primary care team creativity, well-being outcomes (burnout and job satisfaction), and perceived effectiveness of care delivery, we conducted a multilevel mediation analysis. The composite measure of primary care team creativity was utilized in these analyses. Given the hierarchical structure of the data, where individuals are nested within teams and teams are nested within practices, we employed a multilevel modeling approach to account for these nested relationships. This method provided more accurate estimates of both direct and indirect effects, while incorporating the data's hierarchical structure. Although we considered aggregating responses to the team level, variability in the number of respondents per team limited the robustness of that approach.

The mediation analysis followed a stepwise approach. First, we estimated the direct effect of primary care team creativity on burnout and job satisfaction. Next, we introduced perceived effectiveness of care delivery as a mediator and estimated both the direct effect of primary care team creativity on the outcomes and the indirect effect through perceived effectiveness of care delivery. The significance of the indirect effect was assessed using bias-corrected bootstrap confidence intervals, ensuring robust estimates of the mediation pathways. All analyses were conducted in SAS using the PROC CALIS procedure.

Results

Characteristics of Study Participants

The sample characteristics of survey respondents shown in Table 1 revealed that 32% of respondents had been employed at the practice for over 5 years. Among the respondents, 16% were physicians, and 24% were registered nurses. Regarding demographics, 82% identified as female, and 56% identified as White.

TABLE 1.

Respondent sample characteristics

Characteristic Respondents (N = 648), %
Tenure in practice
 Less than 1 year 20.77
 1–2 years 28.97
 3–5 years 18.72
 More than 5 years 31.54
Primary role
 Primary care physician 15.60
 Physician assistant or nurse practitioner 25.83
 Registered nurse/nurse case manager/LVN/LPN 24.04
 Medical assistant 11.76
 Other clinician (e.g., pharmacist, social worker) 0.77
 Clerk/receptionist 14.07
 Administrator 1.53
 Other 6.39
Supervisor
 Yes 16.88
 No 83.12
Gender
 Male 12.34
 Female 81.49
 Nonbinary 1.29
 Other 4.88
Race
 Native Hawaiian or other Pacific Islander 0.77
 Black or African American 7.46
 Asian 10.54
 American Indian or Alaska Native 1.29
 White 55.27
 Hispanic/Latino 24.68
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LVN, Licensed Vocational Nurse; LPN, Licensed Practical Nurse.

Confirming Latent Constructs for Primary Care Team Creativity

The CFA validated the five latent dimensions of primary care team creativity initially identified (citation redacted). The five-factor model demonstrated excellent internal consistency and construct validity across the dimensions. As shown in Table 2, Cronbach's alphas for the dimensions were sufficient based on the .70 or higher benchmark (Peterson, 1994). Additionally, the model fit indices further supported the robustness of the five-factor model. The comparative fit index was 0.95, the Tucker Lewis Index was 0.94, and the RMSEA was 0.05, all indicating a good fit between the model and the observed data. The results confirm that the five latent dimensions are distinct yet interrelated constructs that effectively capture the various aspects of primary care team creativity.

Hypothesis Testing

Bivariate correlations of all variables indicated no evidence of multicollinearity: no bivariate correlations exceeded .7, and variance inflation factors were less than 4 (Table 2). Table 3 presents the results of hypothesis testing, summarizing the relationships between primary care team creativity, well-being outcomes, and perceived effectiveness of care delivery. Supplemental Digital Content 3, http://links.lww.com/HCMR/A180, presents the covariate effects.

TABLE 3.

Findings from hypothesis testing analyses (N = 648)

Direct effects
Path Coefficient (B) Standard error T value p value 95% CI
Primary care team creativity job satisfaction 0.42 0.04 10.70 <.001 0.34, 0.50
Primary care team creativity burnout −0.35 0.05 −7.58 <.001 −0.45, −0.25
Primary care team creativity perceived effectiveness of care delivery 0.41 0.04 10.11 <.001 0.33, 0.49
Perceived effectiveness of care delivery job satisfaction 0.31 0.04 7.61 <.001 0.23, 0.39
Perceived effectiveness of care delivery burnout −0.19 0.05 −4.13 <.001 −0.29, −0.09
Indirect effects primary care team creativity on burnout and job satisfaction via perceived effectiveness of care delivery (N = 648)
Path Indirect effect Bootstrap SE 95% CI (B) p value
Primary care team creativity job satisfaction (via perceived effectiveness of care delivery) 0.13 0.03 0.07, 0.19 <.001
Primary care team creativity burnout (via perceived effectiveness of care delivery) −0.08 0.02 −0.13, −0.04 <.001
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  • H1: Primary care team creativity is negatively associated with burnout. Hypothesis 1 was supported, as primary care team creativity was negatively associated with burnout (b = −0.35, SE = 0.05, t = −7.58, p < .001). A 1-point increase in primary care team creativity score (out of 5) was associated with a 0.35-point reduction in burnout score (out of 5).

  • H2: Primary care team creativity is positively associated with job satisfaction. Hypothesis 2 was supported, as primary care team creativity was positively associated with job satisfaction (b = 0.42, SE = 0.04, t = 10.70, p < .001). A 1-point increase in primary care team creativity score (out of 5) was associated with a 0.42-point increase in job satisfaction score (out of 5).

  • H3: Perceived effectiveness of care delivery mediates the relationship between team creativity, burnout, and job satisfaction in primary care teams. Hypothesis 3 was supported, as perceived effectiveness of care delivery significantly mediated the relationship between primary care team creativity and both burnout and job satisfaction. The path from primary care team creativity to perceived effectiveness of care delivery was strong and significant (b = 0.41, SE = 0.04, t = 10.11, p < .001), suggesting that teams with higher creativity levels were more likely to perceive their effectiveness of care delivery as superior. This perceived effectiveness of care delivery, in turn, was negatively associated with burnout (b = −0.19, SE = 0.05, t = −4.13, p < .001) and positively associated with job satisfaction (b = 0.31, SE = 0.04, t = 7.61, p < .001).

The fit indices for this model indicated acceptable fit to the data. The chi-squared test was significant (χ2 = 71.88, df = 1, p < .05), reflecting the sensitivity of the test to sample size (Hu & Bentler, 1999). Alternative fit indices provided a more consistent evaluation: RMSEA = 0.07, [Standardized Root Mean Square Residual (SRMR)] = 0.08, and [Goodness-of-Fit Index (GFI)] = 0.90. The RMSEA, SRMR, and GFI values suggest that the model adequately represents the relationships in the data and the model is acceptable for interpretation (Hu & Bentler, 1999). The significance of these paths suggests that perceived effectiveness of care delivery plays an important role in explaining the link between primary care team creativity and well-being.

Discussion

Key Findings

The purpose of this study was to provide evidence for the validity of a new measure of primary care team creativity and to test hypotheses related to the predictive potential of the measure. This research establishes primary care team creativity as a novel and actionable teamwork construct in health care. We found support for the validity of the five dimensions of creativity and for associations of a weighted composite of the dimensions with important health care worker well-being variables: job satisfaction and reduced burnout. Furthermore, we found that creativity was associated with perceived quality of care provided, and perceived quality of care mediated relations between job satisfaction and reduced burnout. This means that it is because of perceived quality of care that team creativity is positively associated with job satisfaction and negatively associated with burnout.

These findings help shed new light on predictors of worker well-being in health care; that is, although most previous research on burnout and well-being has focused on elements of the work environment, such as workload, time pressure, and resource limitations, or individual characteristics such as resilience or stress reduction (Linzer et al., 2025), our research demonstrated that creativity and its resultant effects on perceived quality of care may play a role. This may be explained in part by some of the attributes of team creativity noted earlier (enhanced autonomy, collaborative problem-solving, learning and growth; Gilson, 2008; Rouse & Harrison, 2021; West, 2002). These elements are underpinned by self-determination theory as they appear to encompass support for the basic human needs of competence, autonomy, and connection (Ryan & Deci, 2000). The finding that perceived quality of care mediates relations between creativity and well-being suggests that important predictors of well-being for primary care workers go beyond typically studied work attributes and encompass care providers' deep commitment to providing high-quality care. Providing high-quality care may evoke experienced meaningfulness of work, which has been shown to be associated with enhanced job satisfaction and reduced burnout (Rathert et al., 2023). Thus, it appears that enabling team creativity not only may serve to lead to innovative problem-solving and potentially more effective practices but also may enable some of the important psychological characteristics that lead to enhanced well-being.

This study makes three new contributions. First, it enhances understanding of a novel and potentially important aspect of teamwork in health care—team creativity. The importance of high-functioning health care teams for quality and safety is widely recognized (AHRQ, 2018). Our findings show that team creativity is an important aspect of health care teamwork, adding to knowledge on how teams innovate and improve using insights from daily practice (Meyers et al., 2024; NASEM, 2021). Furthermore, our study is the first to show the importance of team creativity to well-being outcomes in primary care, a setting that requires optimal teamwork for high-quality, patient-centered care (Panagioti et al., 2022). Second, this work contributes to health services research by providing a validated survey tool for measuring team creativity in primary care teams (development described in Lee et al., 2025), supporting health care professionals and researchers in defining the practices and behaviors that foster team creativity in these teams (AHRQ, 2024; Sullivan et al., 2023). Finally, this study advances our conceptual understanding of how the work life of health care professionals impacts their well-being and, subsequently, patient care (Dyrbye et al., 2017). By showing that primary care team creativity improves well-being through the mechanism of perceived effectiveness of care delivery, this study suggests that the daily experience of teamwork matters for these care teams and the patients they serve (Dyrbye et al., 2017).

Responding to calls for more research on theory-driven, team-level, work-focused factors to address crisis levels of well-being in primary care teams, this study highlights the pivotal role of creativity in these teams (AHRQ, 2018). Drawing on decades of research in management, organizational behavior, and social psychology, this work demonstrates that team creativity has energizing and synergistic effects, leading to decreased burnout and increased job satisfaction among primary care team members (Amabile & Pratt, 2016; Robertson et al., 2020; Ryan & Deci, 2000). The potential of team creativity lies in its ability to empower team members in a system that often leaves workers feeling powerless (Dean et al., 2019). By enhancing the perceived effectiveness of care delivery, team creativity emerges as a driver of well-being. These findings offer significant implications for how we understand and address burnout in health care. They suggest a shift towards team-level interventions that focus on the work itself and reconnect health care professionals with their original motivations—to help others and alleviate suffering (Dean et al., 2019). This study underscores the need for further exploration of these effects, paving the way for innovative strategies to improve team dynamics and well-being in primary care settings.

Future Research

The findings emphasize the need for targeted interventions to cultivate team creativity, not only to enhance employee well-being but also to improve patient outcomes. Future research should focus on establishing more evidence to link team creativity to well-being and patient outcomes, such as patient care experiences or care quality, exploring the relationship between elements of the work environment that facilitate team creativity, and designing and testing team-level interventions that foster creativity in daily primary care practice.

Limitations

Despite these promising findings, this study has limitations. First, the sample was drawn from a single health system, which, despite its diversity in geography, patient mix, and provider roles, may limit generalizability to other settings. Second, the cross-sectional design prevents definitive conclusions about causality between primary care team creativity and outcomes like job satisfaction, burnout, and perceived effectiveness of care delivery. Additionally, the use of self-reported data for both independent and dependent variables has the potential for common method bias (Podsakoff et al., 2003). To address this, CFA validated the distinctiveness of the PCTC tool, and multilevel models controlled for confounding factors at individual and team levels, supporting the robustness of the findings (Podsakoff et al., 2003). Although this study provides evidence of internal construct validity and predictive validity of the PCTC tool, further validation such as comparisons to external measures of team creativity will be important to strengthen its broader applicability.

Practice Implications

Existing knowledge on health care teams emphasizes the importance of continuous improvement and innovation, but this study uniquely identifies the specific team dimensions that support these goals (AHRQ, 2024; Meyers et al., 2024). The five dimensions of primary care team creativity—team orientation to creativity, team creative process, job-required team creativity, team creative outputs, and leveraging team creativity—are practical and require minimal financial investment or specialized individual skills (AHRQ, 2023). For instance, enhancing a team's creative process can be as simple as incorporating creativity into routine practices, such as brainstorming or exploring ways to improve existing workflows. Similarly, leveraging team creativity involves recognizing creative efforts during patient care, huddles, or group meetings, without the need for significant investment or new technology.

Although these dimensions may seem intuitive given their presence in everyday primary care practice, this study is the first to identify and articulate them as a distinct and impactful, practical teamwork construct. Additionally, we provide a validated survey tool for primary care practice leaders and researchers to measure primary care team creativity. Practice leaders can use this tool to assess baseline levels of team creativity and implement targeted interventions to enhance these levels over time. These interventions can be designed at both the team and practice levels, informed by the survey tool to ensure they are evidence-based and theory-driven (Dyrbye et al., 2017; Panagioti et al., 2022). For health services researchers, incorporating primary care team creativity into teamwork surveys is critical to avoid overlooking these important capabilities when studying the relationship between teamwork and outcomes (Jabbarpour et al., 2024; NASEM, 2021). By adding this construct, researchers can better understand and capture the full scope of teamwork's impact on health care delivery and outcomes (NASEM, 2021).

In conclusion, this study underscores the pivotal role of primary care team creativity in advancing patient-centered, team-based care. By bridging the concepts of teamwork and innovation, it sheds light on how creativity within primary care teams arises from their interactions with patients and each other and contributes to addressing ongoing challenges with agility and ingenuity. Through the validation of the PCTC tool, this work provides a robust framework for measuring primary care team creativity and establishes its connections to improved team member well-being. Ultimately, this study highlights that the daily experience of teamwork profoundly impacts both care teams and the patients they serve, offering a promising avenue for innovation and resilience in primary care.

Supplementary Material

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Acknowledgments

We thank our colleagues and practice partners for their invaluable contributions to this research. We are grateful to Michael Sparer and Alden Lai for their developmental feedback and to participants at the Academy of Management Conference for their thoughtful comments.

Footnotes

This work was supported by Grant 5R03HS027502-02 from the Agency for Healthcare Research and Quality.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal’s website,www.hcmrjournal.com.

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