Communication in Primary Health Care Teams

Jean Carletta

University of Edinburgh

Human Communication Research Centre

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Project context

• DOH-funded work to find the determinants of teamworking effectiveness

• Primary, secondary, and community mental health teams

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Communication research questions

• Good cross-disciplinary communication is difficult, especially with status differences and where some members report to different authorities. Where teams manage it, does it make a difference?

• How can we get good cross-disciplinary communication? Do whole team meetings work?

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Data Sources

• questionnaire for team members measuring effectiveness, team processes (TCI), and mental health/stress (GHQ)

• practice manager interviews detailing team practices, including meetings

• “whole team” meeting observation

[external ratings of effectiveness and innovation]

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Self-report effectiveness measures

• how well the team works together

• patient-centredness of the practice

• general organizational efficiency

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Self-report team process measures

• how willing members are to work as team

• clarity of/commitment to team objectives

• emphasis on quality

• degree of support for innovation

• amount of reflection on team practice

• degree of member task interrelatedness

• extent of innovation in objectives/practices

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Meeting data from interviews

Type ofmeeting

Who isinvited toattend

How often is itheld (e.g.,daily, weekly,month)

Purpose Length (inhours)

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Categorization of PHCT staff

• GP

• practice management

• practice nurse

• attached staff (HV, district nurse, ...)

• admin staff (secretarial, reception, ...)

• miscellaneous

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Overall meeting practiceclinical plus (full practice or practice clinical or GP)

whole team plus (GP or practice clinical)

single discipline plus maybe nursing

full practice plus maybe single discipline

whole team only

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Table 2: The relationship between the occurrence of particular cross-disciplinarymeeting types and the effectiveness and team climate measures. Values inparentheses are degrees of freedom; df=65 unless otherwise stated.

whole team full practice clinical stafforganizational efficiency -1.25 -1.78 -1.50 (51.60)teamworking effectiveness -1.32 -2.44* -2.11* (48.78)patient orientation -.93 -2.64* (30.72) -.28team participation -.48 -2.26* -1.22 (51.13)clarity of objectives -1.69 -1.72 -.10emphasis on quality -1.73 -1.66 -.26support for innovation -1.00 -4.73** (21.73) -1.08reflexivity -.82 -4.17** (24.46) -2.13* (57.25)interrelatedness of work -1.58 -1.85 -.58innovation -1.56 -1.56 -1.08* p<.05**p<.01

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Communication measures

• general:

- total meeting time

- GP meeting time

• cross-disciplinary:

- attached meeting time

- meeting time combining attached with GP

- freedom of interaction

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Freedom of interaction

1

2

3

4

5

1

2

3

4

5

maximal minimal

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Table 1: The correlation between cross-disciplinarity of meeting opportunities andthe effectiveness and team climate measures. For values in parentheses, aggregateGHQ has been factored out.

Cross-disciplinary communicationmeasures

General communicationmeasures

freedom ofinteraction

meeting timewith GP andattached

attachedstaffmeetingtime

GPmeetingtime

totalmeetingtime

organizationalefficiency

.32**(.30**)

.25* (.28*) .21 (.23*) .14 (.19) .13 (.18)

teamworkingeffectiveness

.36**(.35**)

.23* (.26*) .23* (.25*) .13 (.18) .14 (.20)

patient orientation .15 (.12) .06 (.07) .06 (.07) .08 (.12) .10 (.14)team participation .21 (.18) .21 (.24*) .19 (.21) .00 (.05) -.03 (.01)clarity of objectives .27* (.24*) .20 (.22) .20 (.22) .06 (.10) .05 (.09)emphasis on quality .29**

(.27*).20 (.24*) .20 (.23*) .00 (.07) .00 (.07)

support forinnovation

.27* (.24*) .24* (.28*) .26* (.30**) .07 (.13) .07 (.14)

reflexivity .27* (.25*) .26* (.29*) .27* (.29**) .10 (.15) .09 (14)interrelatedness ofwork

.24* (.22) .05 (.06) .06 (.07) .04 (.08) .05 (.08)

innovation .25* (.23*) .27* (.29**) .23* (.25*) .17 (.21) .18 (.22*)* p<.05**p<.01

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Interview results

• General communication is not related to team climate or self-reported effectiveness

• Cross-disciplinary communication is related to team climate, teamworking effectiveness, and organizational efficiency

• It isn’t just that less stressed/easier task teams talk more

• but it’s not because of whole team meetings

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“Whole team” meetings

• weekly or monthly

• often cancelled or rearranged

• vague agendas which predominantly reflect practice manager’s concerns

• most time spend on AOB

• logistical content (clinic management, audit, building fabric, Christmas parties)

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Figure 3: The relationship between team size and

meeting attendance for recorded "whole team"

meetings.

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

0 10 20 30 40 50

team size

average proportion of members

attending recorded meetings

Other Teams

Team C

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Figure 5: Attendance by discipline.

0

10

20

30

40

50

60

70

80

90

general

practitioner

practicemanager practicenurse

attachedadmin/

secretarial

miscellaneous

discipline category

frequency in all recorded teams

members attending at least one

recorded meeting

members not attending any

recorded meeting

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Figure 4: The relationship between general attendance

and patient-centred care.

4

4.5

5

5.5

6

6.5

0 0.2 0.4 0.6 0.8 1

average proportion of team members attending meetings

patient-centred care (effectiveness

subscale)

Other Teams

Team A

NB: There is no relationship between team size and this effectiveness subscale.

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Figure 6: The relationship between multi-disciplinarity of

recorded meetings and support for innovation.

2.5

2.7

2.9

3.1

3.3

3.5

3.7

3.9

1 2 3 4 5 6

average number of discipline categories present at a recorded

meeting

support for innovation (self-reported team

climate variable)

Other Teams

Team A

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Whole team meeting results

• Weak: Teams provide a better patient focus when attendance at whole team meetings is good.

• Strong: Teams support change better when more disciplines attend whole team meetings, and especially when attached staff are represented.

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Why?

• not because of what happens at the meetings, but what happens around them

before, after, on the side, in defiance of agenda

• patient orientation is better when individual patients are discussed

• whole team meetings are a poor way of getting attached/GP contact, but the only one most teams have

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Recommendations

• Better bi-lateral communications in the team

• Phone? Voice-mail? Email on “the” computer? but that doesn’t mean people have time, or culture of using them

• Coffee room!