Relationship among team dynamics, care coordination and perception of safety culture in primary care
Relationship among team dynamics, care coordination and perception of safety culture in primary care
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DOI：
10.1093/fampra/cmy029
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发表时间：
2018-12-01
期刊：
影响因子：
2.2
通讯作者：
Singer, Sara J.
中科院分区：
文献类型：
--
作者：
Blumenthal, Karen J.;Chien, Alyna T.;Singer, Sara J.
背景资料。仍然需要改善初级保健环境中的患者安全。研究表明，创建高绩效的团队可以改善患者的安全，并鼓励医院环境中的安全文化，但对初级保健中的这种关系知之甚少。研究团队动力如何与初级保健中的安全文化观念相关，以及护理协调是否起到中介作用。这是一项横断面调查研究，回应率为63%(n=1082)。受试者。研究参与者是临床医生、住院医生和其他工作人员，他们与哈佛医学院附属19家初级保健诊所的患者进行了互动。主要措施。与我们的主要措施相对应的三个领域：团队活力、关怀协调和安全文化。所有项目均按5分Likert量表进行测量。我们使用线性回归的方法来评估团队动力与安全文化感知之间的关系。我们还进行了中介分析，以确定护理协调在多大程度上解释了团队动态感知和安全文化之间的关系。整体团队活力每增加1分，对安全文化的认知就会增加0.76分[95%可信区间(CI)0.70-0.82，P<；0.001]。护理协调在团队动力与安全文化知觉之间起中介作用。我们的发现表明，在初级保健环境中，团队动力、护理协调和患者安全感之间存在关系。为了让患者更安全，我们可能需要更多地关注初级保健提供者如何合作协调护理。
Background. There remains a need to improve patient safety in primary care settings. Studies have demonstrated that creating high-performing teams can improve patient safety and encourage a safety culture within hospital settings, but little is known about this relationship in primary care.Objective. To examine how team dynamics relate to perceptions of safety culture in primary care and whether care coordination plays an intermediating role.Research Design. This is a cross-sectional survey study with 63% response (n = 1082). Subjects. The study participants were attending clinicians, resident physicians and other staff who interacted with patients from 19 primary care practices affiliated with Harvard Medical School.Main Measures. Three domains corresponding with our main measures: team dynamics, care coordination and safety culture. All items were measured on a 5-point Likert scale. We used linear regression clustered by practice site to assess the relationship between team dynamics and perceptions of safety culture. We also performed a mediation analysis to determine the extent to which care coordination explains the relationship between perceptions of team dynamics and of safety culture.Results. For every 1-point increase in overall team dynamics, there was a 0.76-point increase in perception of safety culture [95% confidence interval (CI) 0.70-0.82, P < 0.001]. Care coordination mediated the relationship between team dynamics and the perception of safety culture.Conclusion. Our findings suggest there is a relationship between team dynamics, care coordination and perceptions of patient safety in a primary care setting. To make patients safer, we may need to pay more attention to how primary care providers work together to coordinate care.