Kerrissey Michaela, Novikov Zhanna, Tietschert Maike, Phillips Russell, Singer Sara J
Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02116, USA.
UTHealth Houston School of Public Health, USA; Stanford University, USA.
Soc Sci Med. 2023 Mar;320:115678. doi: 10.1016/j.socscimed.2023.115678. Epub 2023 Jan 15.
In healthcare, organizations increasingly call on clinicians and staff to team up fluidly to deliver integrated services across disciplines and settings. Yet little is known about how clinicians and staff perceive of team membership in healthcare environments where team boundaries are often ambiguous and continually shifting. We draw on the context of primary care in the United States, where fluid multi-disciplinary teamwork is commonly exhorted, to investigate the extent to which clinicians and staff perceive of various roles (e.g., physician, front desk) as members in their teams, and to identify potential implications. Using a survey fielded within 59 clinics (n = 828), we find substantial variation in individuals' perceptions of the roles they consider as team members during an episode of care (e.g., mean team size = 10.60 roles; standard deviation = 5.09). Perceiving more expansive sets of roles as team members exhibits a positive association with performance as measured by care quality (b = 0.02; p < .01) but a curvilinear association with job satisfaction. Separating an individual's perceived core (roles always perceived as part of the team) and periphery (roles sometimes perceived as part of the team), perceiving a larger core is positively associated with performance (b = 0.03 p < .01). In contrast, perceiving a larger periphery is marginally negatively associated with performance (b = -0.02, p < .10). This appears to be driven by divergence from the norm perception of the core, i.e., when individuals attribute to the periphery the roles that are considered by most others to be core. Our findings suggest that individuals viewing the roles they must team with more expansively may generate higher quality output but experience a personal toll. Delivering on the ideal of team-based care in dynamic environments may require helping team members gain clarity about their teammates and implementing policies that attend to job satisfaction as team boundaries shift and expand.
在医疗保健领域，各机构越来越多地呼吁临床医生和工作人员灵活协作，以跨学科、跨场所提供综合服务。然而，对于临床医生和工作人员在团队边界往往模糊且不断变化的医疗环境中如何看待团队成员身份，我们却知之甚少。我们以美国初级保健领域为背景，该领域普遍倡导灵活的多学科团队合作，旨在调查临床医生和工作人员在多大程度上将各种角色（如医生、前台）视为其团队成员，并确定潜在影响。通过在59家诊所进行的一项调查（n = 828），我们发现个体在一次护理过程中对其视为团队成员的角色的认知存在很大差异（例如，平均团队规模 = 10.60个角色；标准差 = 5.09）。将更多角色视为团队成员与以护理质量衡量的绩效呈正相关（b = 0.02；p <.01），但与工作满意度呈曲线相关。将个体感知到的核心（始终被视为团队一部分的角色）和边缘（有时被视为团队一部分的角色）区分开来，感知到更大的核心与绩效呈正相关（b = 0.03，p <.01）。相比之下，感知到更大的边缘与绩效呈微弱的负相关（b = -0.02，p <.10）。这似乎是由与核心的规范认知存在差异所驱动的，即当个体将大多数其他人认为是核心的角色归为边缘时。我们的研究结果表明，那些更广泛地看待其必须合作的角色的个体可能会产生更高质量的产出，但会付出个人代价。在动态环境中实现基于团队的护理理想可能需要帮助团队成员明确其队友，并在团队边界变化和扩大时实施关注工作满意度的政策。
