title: Team Process Variation Across Diabetes Quality of Care Trajectories.
abstract: Conceptual frameworks in health care do not address mechanisms whereby teamwork processes affect quality of care. We seek to fill this gap by applying a framework of teamwork processes to compare different patterns of primary care performance over time. We thematically analyzed 114 primary care staff interviews across 17 primary care clinics. We purposefully selected clinics using diabetes quality of care over 3 years using four categories: consistently high, improving, worsening, and consistently low. Analyses compared participant responses within and between performance categories. Differences were observed among performance categories for action processes (monitoring progress and coordination), transition processes (goal specification and strategy formulation), and interpersonal processes (conflict management and affect management). Analyses also revealed emergent concepts related to psychological and organizational context that were reported to affect team processes. This study is a first step toward a comprehensive model of how teamwork processes might affect quality of care.
authors.affiliation: VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA VISN 17 Center of Excellence for Research on Returning War Veterans, TX, USA justin.benzer@va.gov.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Benzer
authors.affiliation: VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.affiliation: VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA.
authors.forename: Leigh
authors.initials: L
authors.lastname: Evans
authors.affiliation: Northeastern University Center for Health Policy and Healthcare Research, Boston, MA, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Young
authors.affiliation: VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Meterko
authors.affiliation: National Center for Organization Development, Veterans Health Administration, Cincinnati, OH, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Moore
authors.affiliation: VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Nealon Seibert
authors.affiliation: National Center for Organization Development, Veterans Health Administration, Cincinnati, OH, USA.
authors.forename: Katerine
authors.initials: K
authors.lastname: Osatuke
authors.affiliation: VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stolzmann
authors.affiliation: VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.
authors.forename: Bert
authors.initials: B
authors.lastname: White
authors.affiliation: VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Charns
mesh_terms: D003695:Delivery of Health Care; D003920:Diabetes Mellitus / Q000628:therapy*; D006126:Group Processes; D006801:Humans; D007407:Interviews as Topic; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards*; D011320:Primary Health Care; D011787:Quality of Health Care / Q000592:standards*; D014728:Veterans; D016526:Workload / Q000523:psychology
keywords: coordination; diabetes mellitus; primary care; teams; veterans; workload