Bower P, Campbell S, Bojke C, Sibbald B
National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, UK.
Qual Saf Health Care. 2003 Aug;12(4):273-9. doi: 10.1136/qhc.12.4.273.
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
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.
Primary care.
Members of the primary health care team from 42 practices.
Objective measures of quality of chronic disease management, patients' evaluations of practices, teams' self-reported ratings of effectiveness, and innovation.
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.
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.
确定执业结构（例如，患者名单规模、工作人员数量）是否能预测团队流程，以及执业结构和团队流程是否进而能预测团队成果
采用邮政问卷调查和病历审核的观察性研究。通过一种“氛围”测量方法评估团队流程，该方法考察对组织政策、实践和程序的共同认知。
初级医疗保健
来自42个执业机构的初级医疗保健团队成员
慢性病管理质量的客观测量、患者对执业机构的评价、团队自我报告的有效性评级以及创新性
单人执业机构的团队氛围优于合伙执业机构。预约间隔时间较长的执业机构提供了更优质的慢性病管理。团队氛围得分较高与糖尿病方面更优质的临床护理、患者对执业机构更积极的评价以及自我报告的创新性和有效性相关。
尽管由于样本量有限，结论是初步的，但该研究表明团队结构、流程和成果之间存在重要关系，这可能与初级医疗保健中的质量改进举措相关。这些关联背后可能的因果机制仍有待确定。
