Communication in Primary Health Care Teams

1. Communication in Primary Health Care Teams Jean Carletta University of Edinburgh Human Communication Research Centre

2. Project context • DOH-funded work to find the determinants of teamworking effectiveness • Primary, secondary, and community mental health teams Communication in Primary HCT

3. 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? Communication in Primary HCT

4. 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] Communication in Primary HCT

5. Self-report effectiveness measures • how well the team works together • patient-centredness of the practice • general organizational efficiency Communication in Primary HCT

6. 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 Communication in Primary HCT

7. Meeting data from interviews Communication in Primary HCT

8. Categorization of PHCT staff • GP • practice management • practice nurse • attached staff (HV, district nurse, ...) • admin staff (secretarial, reception, ...) • miscellaneous Communication in Primary HCT

9. Overall meeting practice Communication in Primary HCT

10. Communication in Primary HCT

11. Communication measures • general: • total meeting time • GP meeting time • cross-disciplinary: • attached meeting time • meeting time combining attached with GP • freedom of interaction Communication in Primary HCT

12. Freedom of interaction maximal minimal Communication in Primary HCT

13. Communication in Primary HCT

14. 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 Communication in Primary HCT

15. “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) Communication in Primary HCT

16. Communication in Primary HCT

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18. NB: There is no relationship between team size and this effectiveness subscale. Communication in Primary HCT

19. Communication in Primary HCT

20. 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. Communication in Primary HCT

21. 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 Communication in Primary HCT

22. 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! Communication in Primary HCT