Shortell Stephen M, Marsteller Jill A, Lin Michael, Pearson Marjorie L, Wu Shin-Yi, Mendel Peter, Cretin Shan, Rosen Mayde
University of California, Berkeley 94720-7360, USA.
Med Care. 2004 Nov;42(11):1040-8. doi: 10.1097/00005650-200411000-00002.
BACKGROUND/OBJECTIVES: The importance of teams for improving quality of care has received increased attention. We examine both the correlates of self-assessed or perceived team effectiveness and its consequences for actually making changes to improve care for people with chronic illness. STUDY SETTING AND METHODS: Data were obtained from 40 teams participating in the national evaluation of the Improving Chronic Illness Care Program. Based on current theory and literature, measures were derived of organizational culture, a focus on patient satisfaction, presence of a team champion, team composition, perceived team effectiveness, and the actual number and depth of changes made to improve chronic illness care.
A focus on patient satisfaction, the presence of a team champion, and the involvement of the physicians on the team were each consistently and positively associated with greater perceived team effectiveness. Maintaining a balance among culture values of participation, achievement, openness to innovation, and adherence to rules and accountability also appeared to be important. Perceived team effectiveness, in turn, was consistently associated with both a greater number and depth of changes made to improve chronic illness care. The variables examined explain between 24 and 40% of the variance in different dimensions of perceived team effectiveness; between 13% and 26% in number of changes made; and between 20% and 42% in depth of changes made.
The data suggest the importance of developing effective teams for improving the quality of care for patients with chronic illness.
背景/目的：团队对于提高医疗质量的重要性已受到越来越多的关注。我们考察自我评估或感知到的团队效能的相关因素，以及其对实际做出改善慢性病患者护理的改变所产生的影响。
数据来自参与慢性病护理改善计划全国评估的40个团队。基于当前的理论和文献，我们得出了关于组织文化、对患者满意度的关注、团队倡导者的存在、团队构成、感知到的团队效能，以及为改善慢性病护理而实际做出的改变的数量和深度的衡量指标。
对患者满意度的关注、团队倡导者的存在，以及团队中医生的参与，均与更高的感知团队效能始终保持正相关。在参与、成就、对创新的开放性，以及遵守规则和问责制等文化价值观之间保持平衡似乎也很重要。反过来，感知到的团队效能与为改善慢性病护理而做出的改变的数量和深度始终相关。所考察的变量在感知团队效能的不同维度中解释了24%至40%的方差；在做出的改变数量方面解释了13%至26%；在做出的改变深度方面解释了20%至42%。
数据表明，建立有效的团队对于提高慢性病患者的护理质量很重要。
