Skip to main content
PMC home page
Quality & Safety in Health Care logoLink to Quality & Safety in Health Care
. 2003 Aug;12(4):273–279. doi: 10.1136/qhc.12.4.273

Team structure, team climate and the quality of care in primary care: an observational study

P Bower 1, S Campbell 1, C Bojke 1, B Sibbald 1
PMCID: PMC1743743  PMID: 12897360

Abstract

Objectives: To determine whether practice structure (for example, list size, number of staff) predicts team processes and whether practice structure and team process in turn predict team outcomes

Design: Observational study using postal questionnaires and medical note audit. Team process was assessed through a measure of "climate" which examines shared perceptions of organisational policies, practices, and procedures.

Setting: Primary care.

Subjects: Members of the primary health care team from 42 practices.

Main outcome measures: Objective measures of quality of chronic disease management, patients' evaluations of practices, teams' self-reported ratings of effectiveness, and innovation.

Results: Team climate was better in singlehanded practices than in partnerships. Practices with longer booking intervals provided superior chronic disease management. Higher team climate scores were associated with superior clinical care in diabetes, more positive patient evaluations of practice and self-reported innovation and effectiveness.

Conclusions: Although the conclusions are preliminary because of the limited sample size, the study suggests that there are important relationships between team structure, process, and outcome that may be of relevance to quality improvement initiatives in primary care. Possible causal mechanisms that might underlie these associations remain to be determined.

Full Text

The Full Text of this article is available as a PDF (206.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baines D. L. A healthy disposition? The use and limitations of the characteristics approach to general practice research. Br J Gen Pract. 2001 Sep;51(470):749–752. [PMC free article] [PubMed] [Google Scholar]
  2. Bower Peter, Mead Nicola, Roland Martin. What dimensions underlie patient responses to the General Practice Assessment Survey? A factor analytic study. Fam Pract. 2002 Oct;19(5):489–495. doi: 10.1093/fampra/19.5.489. [DOI] [PubMed] [Google Scholar]
  3. Campbell J. L., Ramsay J., Green J. Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care. Qual Health Care. 2001 Jun;10(2):90–95. doi: 10.1136/qhc.10.2.90. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Campbell J. L., Ramsay J., Green J. Practice size: impact on consultation length, workload, and patient assessment of care. Br J Gen Pract. 2001 Aug;51(469):644–650. [PMC free article] [PubMed] [Google Scholar]
  5. Campbell S. M., Hann M., Hacker J., Burns C., Oliver D., Thapar A., Mead N., Safran D. G., Roland M. O. Identifying predictors of high quality care in English general practice: observational study. BMJ. 2001 Oct 6;323(7316):784–787. doi: 10.1136/bmj.323.7316.784. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Campbell S. M., Hann M., Hacker J., Durie A., Thapar A., Roland M. O. Quality assessment for three common conditions in primary care: validity and reliability of review criteria developed by expert panels for angina, asthma and type 2 diabetes. Qual Saf Health Care. 2002 Jun;11(2):125–130. doi: 10.1136/qhc.11.2.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Campbell S. M., Roland M. O., Shekelle P. G., Cantrill J. A., Buetow S. A., Cragg D. K. Development of review criteria for assessing the quality of management of stable angina, adult asthma, and non-insulin dependent diabetes mellitus in general practice. Qual Health Care. 1999 Mar;8(1):6–15. doi: 10.1136/qshc.8.1.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Campbell S. M., Sheaff R., Sibbald B., Marshall M. N., Pickard S., Gask L., Halliwell S., Rogers A., Roland M. O. Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance. Qual Saf Health Care. 2002 Mar;11(1):9–14. doi: 10.1136/qhc.11.1.9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Chapple Alison, Campbell Stephen, Rogers Anne, Roland Martin. Users' understanding of medical knowledge in general practice. Soc Sci Med. 2002 Apr;54(8):1215–1224. doi: 10.1016/s0277-9536(01)00091-0. [DOI] [PubMed] [Google Scholar]
  10. Davies H. T., Nutley S. M., Mannion R. Organisational culture and quality of health care. Qual Health Care. 2000 Jun;9(2):111–119. doi: 10.1136/qhc.9.2.111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Firth-Cozens J. Celebrating teamwork. Qual Health Care. 1998 Dec;7 (Suppl):S3–S7. [PubMed] [Google Scholar]
  12. Firth-Cozens J. Individual and organizational predictors of depression in general practitioners. Br J Gen Pract. 1998 Oct;48(435):1647–1651. [PMC free article] [PubMed] [Google Scholar]
  13. Freeman George K., Horder John P., Howie John G. R., Hungin A. Pali, Hill Alison P., Shah Nayan C., Wilson Andrew. Evolving general practice consultation in Britain: issues of length and context. BMJ. 2002 Apr 13;324(7342):880–882. doi: 10.1136/bmj.324.7342.880. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Goñi S. An analysis of the effectiveness of Spanish primary health care teams. Health Policy. 1999 Aug;48(2):107–117. doi: 10.1016/s0168-8510(99)00036-6. [DOI] [PubMed] [Google Scholar]
  15. Green J. M. The views of singlehanded general practitioners: a qualitative study. BMJ. 1993 Sep 4;307(6904):607–610. doi: 10.1136/bmj.307.6904.607. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Howie J. G., Heaney D. J., Maxwell M., Walker J. J., Freeman G. K. Developing a 'consultation quality index' (CQI) for use in general practice. Fam Pract. 2000 Dec;17(6):455–461. doi: 10.1093/fampra/17.6.455. [DOI] [PubMed] [Google Scholar]
  17. Howie J. G., Porter A. M., Forbes J. F. Quality and the use of time in general practice: widening the discussion. BMJ. 1989 Apr 15;298(6679):1008–1010. doi: 10.1136/bmj.298.6679.1008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kivimäki M., Sutinen R., Elovainio M., Vahtera J., Räsänen K., Töyry S., Ferrie J. E., Firth-Cozens J. Sickness absence in hospital physicians: 2 year follow up study on determinants. Occup Environ Med. 2001 Jun;58(6):361–366. doi: 10.1136/oem.58.6.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. McClure L. M. Teamwork, myth or reality: community nurses' experience with general practice attachment. J Epidemiol Community Health. 1984 Mar;38(1):68–74. doi: 10.1136/jech.38.1.68. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Poulton B. C., West M. A. Effective multidisciplinary teamwork in primary health care. J Adv Nurs. 1993 Jun;18(6):918–925. doi: 10.1046/j.1365-2648.1993.18060918.x. [DOI] [PubMed] [Google Scholar]
  21. Ramsay J., Campbell J. L., Schroter S., Green J., Roland M. The General Practice Assessment Survey (GPAS): tests of data quality and measurement properties. Fam Pract. 2000 Oct;17(5):372–379. doi: 10.1093/fampra/17.5.372. [DOI] [PubMed] [Google Scholar]
  22. Shortell S. M., Rousseau D. M., Gillies R. R., Devers K. J., Simons T. L. Organizational assessment in intensive care units (ICUs): construct development, reliability, and validity of the ICU nurse-physician questionnaire. Med Care. 1991 Aug;29(8):709–726. doi: 10.1097/00005650-199108000-00004. [DOI] [PubMed] [Google Scholar]
  23. Wiles R., Robison J. Teamwork in primary care: the views and experiences of nurses, midwives and health visitors. J Adv Nurs. 1994 Aug;20(2):324–330. doi: 10.1046/j.1365-2648.1994.20020324.x. [DOI] [PubMed] [Google Scholar]
  24. van Weel C. Teamwork. Lancet. 1994 Nov 5;344(8932):1276–1279. doi: 10.1016/s0140-6736(94)90756-0. [DOI] [PubMed] [Google Scholar]

Articles from Quality & safety in health care are provided here courtesy of BMJ Publishing Group

RESOURCES