title: Development and validation of the primary care team dynamics survey.
abstract: OBJECTIVE
  To develop and validate a survey instrument designed to measure team dynamics in primary care.
  
  
  METHODS
  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.
  
  
  METHODS
  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 survey's goodness-of-fit using structural equation modeling.
  
  
  METHODS
  We administered the survey between September 2012 and March 2013.
  
  
  RESULTS
  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 (Cronbach's 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).
authors.affiliation: PhD Program in Health Policy (Management), Harvard University, Boston, MA.
authors.forename: Hummy
authors.initials: H
authors.lastname: Song
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Alyna T
authors.initials: AT
authors.lastname: Chien
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, MA.
authors.forename: Josephine
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital , Boston, MA.
authors.forename: Julia
authors.initials: J
authors.lastname: Martin
authors.affiliation: Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA.
authors.forename: Antoinette S
authors.initials: AS
authors.lastname: Peters
authors.affiliation: Allegheny County Health Department, Pittsburgh, PA.
authors.forename: Karen
authors.initials: K
authors.lastname: Hacker
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, MA.
authors.forename: Meredith B
authors.initials: MB
authors.lastname: Rosenthal
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, MA.|Department of Medicine, Harvard Medical School, 677 Huntington Avenue, Boston, MA, 02115.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006126:Group Processes; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011594:Psychometrics; D044469:Racial Groups; D015203:Reproducibility of Results
keywords: Survey; primary care; team dynamics; team effectiveness