Huber Thomas P, Rodriguez Hector P, Shortell Stephen M
Thomas P. Huber, PhD, MPH, is Assistant Professor, The Ohio State University College of Public Health, Columbus. E-mail:
Health Care Manage Rev. 2020 Oct/Dec;45(4):302-310. doi: 10.1097/HMR.0000000000000241.
Teamwork is a central aspect of integrated care delivery and increasingly critical to primary care practices of accountable care organizations. Although the importance of leadership facilitation in implementing organizational change is well documented, less is known about the extent to which strong leadership facilitation can positively influence relational coordination among primary care team members.
The aim of this study was to examine the association of leadership facilitation of change and relational coordination among primary care teams of accountable care organization-affiliated practices and explore the role of team participation and solidarity culture as mediators of the relationship between leadership facilitation and relational coordination among team members.
METHODOLOGY/APPROACH: Survey responses of primary care clinicians and staff (n = 764) were analyzed. Multilevel linear regression estimated the relationships among leadership facilitation, team participation, group solidarity, and relational coordination controlling for age, time, occupation, gender, team tenure, and team size. Models included practice site random effects to account for the clustering of respondents within practices.
Leadership facilitation (β = 0.19, p < .001) and team participation (β = 0.18, p < .001) were positively associated with relational coordination, but solidarity culture was not associated. The association of leadership facilitation and relational coordination was only partially mediated (9%) by team participation.
Leadership facilitation of change is positively associated with relational coordination of primary care team members. The relationship is only partially explained by better team participation, indicating that leadership facilitation has a strong direct effect on relational coordination. Greater solidarity was not associated with better relational coordination and may not contribute to better team task coordination.
Leadership facilitation of change may have a positive and direct impact on high relational coordination among primary care team members.
团队合作是综合医疗服务的核心要素，对责任医疗组织的基层医疗实践愈发关键。尽管领导推动在实施组织变革中的重要性已有充分记载，但对于强大的领导推动能在多大程度上积极影响基层医疗团队成员间的关系协调，我们所知甚少。
本研究旨在探讨责任医疗组织附属机构基层医疗团队中领导推动变革与关系协调之间的关联，并探究团队参与和团结文化作为领导推动与团队成员间关系协调之间关系的中介作用。
方法/途径：分析了基层医疗临床医生和工作人员（n = 764）的调查回复。多水平线性回归估计了领导推动、团队参与、群体团结和关系协调之间的关系，并控制了年龄、时间、职业、性别、团队任期和团队规模。模型纳入了实践地点随机效应，以考虑受访者在实践中的聚类情况。
领导推动（β = 0.19，p <.001）和团队参与（β = 0.18，p <.001）与关系协调呈正相关，但团结文化与之无关。领导推动与关系协调之间的关联仅部分由团队参与介导（9%）。
领导推动变革与基层医疗团队成员的关系协调呈正相关。这种关系仅部分由更好的团队参与来解释，这表明领导推动对关系协调有很强的直接影响。更高的团结程度与更好的关系协调无关，可能对更好的团队任务协调没有贡献。
领导推动变革可能对基层医疗团队成员间的高度关系协调产生积极直接影响。
