Teamdiagnose (German Edition)

Table 2 illustrates the healthcare professional samples for the data collection periods. Regarding age, gender, occupational groups and percentage of working hours, samples were similar for both periods of data collection. Physical therapists were the biggest occupational group. Of the participants analyzed at time t2 at the intervention clinics, 56 took part in the intervention. In total, patient questionnaires were sent to nine clinics at t1, of which were handed out.

Clinic-specific response rates are displayed in Table 1. The difference in questionnaires distributed in the patient sample was due to the distribution process in the clinics and due to the fact that not the same cohort of patients was examined in the pre and post survey. Overall, more women than men participated in the patient survey see Table 3.

Most of the patients were married, and most indicated a lower education level. The majority was no longer employed.

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In terms of specialization, it is important to note the large percentage of orthopedic and rheumatologic indications. The onset of illness was between six months and three years ago for most of the patients, and another large percentage indicated an onset more than six years ago. The ICCs were below 0. Intraclass Correlation Coefficient; t1: The comparison of baseline levels showed that means were higher for the control group than for the intervention group on all teamwork variables analyzed. Subsequent univariate tests showed significant interaction effects for team organization and willingness to accept responsibility, with higher mean values for t2 than for t1 in the intervention group and higher mean values for t1 than for t2 in the control group see Table 7.

The comparison of baseline levels showed higher mean values for the control group than for the intervention group on all CCRQ scales. As in the staff survey, the analysis was conducted again excluding patients of clinics 3 and 9 and also clinic 8 for the patient survey only. Overall, for some dimensions of teamwork, there were small significant interaction effects between the intervention and control group over time in the staff survey. Analysis showed that after the intervention means of dimension such as team organization and willingness to accept responsibility and knowledge integration when excluding two clinics from the analysis improved.

Those univariate effects must be regarded as small [ 42 ]. The multivariate interaction effect over all analyzed teamwork dimensions in the staff survey only reached significance when excluding two clinics from analysis and could then be considered as moderate, with the restriction that this result can only be regarded a hint towards possible additional effects if staff support TCC. Descriptive statistics showed that effects were due to an improvement in the intervention group and a decline in mean values in the control group.

For other teamwork-related processes e. Therefore, hypothesis one, that the TCC will improve interprofessional teamwork in medical rehabilitation, was partly supported for some dimensions of teamwork. Hypothesis two, which states that the team intervention concept can enhance the external participation aspect of patient-centeredness, could not be confirmed by the results of the patient survey. The effects on specific teamwork dimensions such as organization, responsibility and knowledge integration can be explained by looking at the main themes addressed by the TCC and by the requests of team members and executives expressed in the pilot study [ 31 ].

Although requests varied among clinics, some common themes could be identified, such as an optimization of team meetings [ 44 ]. Consistent with the literature [ 45 ], improvements in the organization of team meetings, optimal knowledge and information exchange about patients and agreements on responsibilities were the focus of the interviews and focus groups in the pilot study.

The rather small effect sizes in our study may be related to the fact that all employees in the clinics were surveyed, rather than only those who participated in the team intervention. This approach was deliberately chosen because employees are often members of multiple teams, meaning that dissemination processes in the sense of organizational learning may be initiated. Even so, the TCC has initiated some processes of change, such as improvements in team organization and knowledge integration that can be regarded as a basis for other, slower processes.

However, such transfer processes take time, and the intervention may also have been too specific to be able to involve greater changes in the whole organization. Given the fact that only a small part of staff completing the questionnaires actually took part in the team training 56 of at t2 , it would be interesting to have a subgroup analysis of only those staff members that participated in the training.

Regrettably, few staff members filled in the code that would allow for matched comparisons, and many staff members took the survey only once. Therefore the sample of staff that took part in the intervention and traceably completed two questionnaires is too small to calculate the inferential statistics used in this study. In line with the small effect sizes in the staff survey, the missing effects in the patient survey can be explained by the fact that although the approach was patient-centered, the team intervention only targeted staff; there was no intervention in which patients themselves could participate.

A combined intervention that includes information materials, decision-making support and patient education units would probably be perceived as more effective for improving patient-centeredness. Other studies in the medical setting have shown combined interventions to be effective in enhancing patient-centered care [ 46 — 48 ]. Moreover, it is very likely that different patient populations were asked to participate during the two data collection periods. Even though the samples were comparable, there could be individual differences between these two samples, for instance in terms of situational awareness and expectations.

Another possibility is that the absent patient effect is due to the small staff effect, meaning that changes or improvements might have been too small or too specific to be recognizable by patients or that it would require more time for patients to notice effects. Although common themes regarding the needs for team training could be identified see also [ 31 ] , the team intervention was need-specific at a clinic level. Hence, the contents of the clinic-specific interventions were not standardized, although the process of the intervention was.

As a result, reproducibility between clinics can be considered limited. However, a description of the concept can be found in a manual that gives practitioners guidelines and toolkits for carrying out a team intervention based on the principles developed in our study [ 33 ]. There might also be unknown selection effects both on a clinic and individual level. Due to the fact that participation in the study was voluntary, we do not know if only those clinics took part that are especially open to measures for improving the quality of treatment and as a result already practice better teamwork and patient-centered care or if particularly clinics with a high demand for team development and thus a lower level of teamwork and patient-centeredness might have taken part.

This is, however, a natural self-selection process for interventions, with only those taking part who are motivated for one reason or another.

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Nevertheless, it would be interesting to examine if the TCC is only effective under special conditions and why some clinics were not interested in the TCC. This should be part of future research.

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Certainly, one reason might be the time required to participate in an intervention during routine operations on the ward, and it would be of interest to find ways to motivate clinics and design interventions in a way that they seem applicable to a broad range of clinics.

Limitations can also be found in the data analysis. Although the intervention and control clinics were assigned randomly, the data analysis showed that the baseline levels for the outcome criteria diverged significantly, with better baseline levels in the control clinics both in the staff and the patient survey. Moreover, the deterioration of means in the control group over time suggests a different explanation. Employees who were dissatisfied with teamwork at their clinics may have been more likely to complete the quite extensive questionnaire for a second time, whereas employees who were satisfied may have been less motivated to complete it again.

Another limiting factor is the low, but not unusual, response rate. Since drop-out analysis was not possible, an attrition bias might exist.



However, the process evaluation [ 43 ] showed that staff accepted the training, so that we cannot draw the conclusion that the low response rate was due to low engagement or acceptance; instead, it is probably due to the high workload of staff. On the other hand it must be noted that of 71 participants in the training, 56 completed the questionnaire at t2. Here it should also be acknowledged that one clinic failed to engage with the intervention because of persisting conflict on a more global, structural level.

This shows that the intervention is not suitable for solving problems that go beyond the team level.



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Regarding the statistical analysis, as mentioned above, a MANOVA is not the optimal statistical procedure to examine the research question, which has to be regarded as a limitation of the study. Unfortunately, the data did not allow calculating a repeated measures design as only very few of the participants filled in the code that allows matching the questionnaires.

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In summary, the TCC can be recommended to improve teamwork, especially team organization, willingness to accept responsibility and knowledge integration. The TCC meets the challenges of a holistic treatment approach by optimizing knowledge integration of the different health care professionals working together in an interprofessional team. The TCC is a combination of focusing tasks, processes and cooperation in the team.

It supported teams in their reflection how to accomplish the common task best. It is a time-saving and effective approach to both use the capabilities of every team member and join together to become a whole team. The first implementation showed that the concept is well accepted by the teams and is a feasible team development approach. As the first team intervention approach for rehabilitation clinics in Germany, it permits a standardized procedure but since every team is unique it is needs-specific and therefore applicable to different clinical settings where effective teamwork is required.

The approach has been evaluated in a cluster-randomized controlled study and, as one of very few studies, also considered the patient perspective in its development [ 4 ]. A further evaluation of the approach should be carried out in a larger study that includes more clinics. Furthermore, collecting data at more points in time would both allow for a continuous formative evaluation and help to measure processes that might take longer than six months.

The collection of qualitative data could help answer unresolved questions regarding how the intervention was perceived by staff and what factors potentially lead to success or failure of an intervention. It is suspected that there might be effects of the intervention that were not captured by the assessment tools, such as effects on information flow or the effectiveness of team meetings.

Those gaps are estimated to be filled in a follow-up study with a more qualitative design. In further a study, multilevel analyses might also bring to light structural conditions on the clinic level that benefit or hinder the implementation of the intervention. To achieve sustainable improvements in healthcare, the TCC is manualized, and a train-the-trainer concept will be developed on its basis in order to achieve more widespread use of the approach in the future. The aim is to empower team leaders to coach their teams rather than employ an external counselor. Furthermore, the TCC is not specific to rehabilitation.

It could also be used in acute care or other health care settings because content can be matched individually. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Teamwork, Teamdiagnose, Teamentwicklung

National Center for Biotechnology Information , U. Published online Jul Author information Article notes Copyright and License information Disclaimer. The authors have declared that no competing interests exist. Received Aug 4; Accepted Jun This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This article has been corrected. This article has been cited by other articles in PMC. SPSS datafile of staff data.

Data of staff survey for both data collection periods without missing values. SPSS datafile of patient data. Data of patient survey for both data collection periods without missing values. Abstract Purpose Although the relevance of interprofessional teamwork in the delivery of patient-centered care is well known, there is a lack of interventions for improving team interaction in the context of rehabilitation in Germany.

Method A multicenter, cluster-randomized controlled intervention study was conducted with both staff and patient questionnaires. Results In order to analyze the effect of TCC on internal participation and teamwork, questionnaires were included for t1 and for t2 in the staff survey. Introduction Interprofessional teamwork is becoming more and more significant based on current developments, for instance the discussion of quality and safety of care, the focus on patient-centered care, shifting demographics and an increase in chronic illnesses, patient empowerment and participation linked with rising consumerism and increasing costs of care [ 1 ].

Aim of the study The aim of the present study was to evaluate the below-described TCC. The research questions were as follows: Can the TCC improve a teamwork and b patient-centeredness? Methods A multicenter, cluster randomized, controlled intervention study was used for evaluation. Team coaching concept TCC The TCC was developed for medical rehabilitation based on a systematic literature search on team development [ 4 ] and a qualitative pilot study including interviews with executives, group interviews with team members as well as focus groups with patients.

The process includes the following four distinct, sequential phases: Identification of the expectations for team coaching need-specific. Open in a separate window. Recruitment The principles of the team development approach require implementation on a group level teams , but outcome criteria were assessed on an individual level. Table 1 Clinic characteristics. Assessment Whereas staff questionnaires see S1 Quest were used to measure internal participation and other aspects of teamwork like team organization and leadership, patient questionnaires see S2 Quest aimed to assess external participation for patient-centeredness [ 8 , 16 ].

The following instruments were used: Staff questionnaire The Internal Participation Scale IPS is based on the model of patient-centeredness [ 16 , 34 ] and defines internal participation as interprofessional, patient-centered teamwork, including processes like communication, cooperation, coordination, climate, agreement and respect. Data analysis Data quality was controlled by means of double data entry of random samples and verification of plausibility.

Results Sample of healthcare professionals At t1 and t2, and questionnaires were distributed to staff, and and questionnaires were completed. Table 2 Distribution of healthcare professionals for the pre- and post-intervention periods. Patient sample In total, patient questionnaires were sent to nine clinics at t1, of which were handed out. Table 3 Patient sample for t1 and t2. Intraclass correlation coefficient The ICCs were below 0. Table 4 ICC for independent variables for staff and patients.

Table 5 Clinic specific means of outcome criteria of the staff survey Cluster 1 to 3. Table 6 Clinic specific means of outcome criteria of the staff survey Cluster 4 and 5. Table 7 Staff survey: Univariate comparisons of the patient orientation and teamwork variables for group and time of data collection. Results of the patient survey The comparison of baseline levels showed higher mean values for the control group than for the intervention group on all CCRQ scales. Table 8 Clinic specific means of outcome criteria of the patient survey Cluster 1 and 3. Table 9 Clinic specific means of outcome criteria of the patient survey Cluster 4 and 5.

Table 10 Patient survey: Univariate comparisons of CCRQ scales for group and time of data collection. Discussion Overall, for some dimensions of teamwork, there were small significant interaction effects between the intervention and control group over time in the staff survey. SAV Click here for additional data file. S1 Quest Staff questionnaire. PDF Click here for additional data file.

S2 Quest Patient questionnaire. Data Availability All relevant data are within the paper and its Supporting Information files. The effectiveness of interprofessional education: Key findings from a new systematic review. Journal of Interprofessional Care ; 24 3: Interprofessionelle Teamarbeit im Gesundheitsbereich: The effects of a shared decision-making intervention in primary care of depression: Patient Education and Counseling ; 67 3: Journal of Interprofessional Care ; 30 1: Effective Health Care Teams: A model of six characteristics developed from shared perceptions.

Journal of Interprofessional Care ; 19 4: Kockert S, Schott T. Rehabilitation ; 19 4: Patient-centered care through internal and external participation in medical rehabilitation. Health ; 5 6A2: Patient-centered care and adherence: Definitions and applications to improve outcomes.

J Am Acad Nurse Pract ; 20 Konzepte, Methoden und Problembereiche In: Reliability and construct validity of the client-centred rehabilitation questionnaire. Mead N, Bower P. An integrative model of patient-centeredness—A systematic review and concept analysis.

Teamwork, Teamdiagnose, Teamentwicklung : Rolf van Dick :

Conceptual and historical perspectives. Disabil Rehabil ; 29 20— Transforming the Clinical Method. Radcliffe Medical Press Ltd; Papadimitriou C, Cott C. Client-centred practices and work in inpatient rehabilitation teams: Disability and Rehabilitation ; 37 Analyzing the effects of shared decision-making, empathy and team interaction on patient satisfaction and treatment acceptance in medical rehabilitation using a structural equation modeling approach.

Patient Education and Counseling ; 91 2: Recovery coaching in an acute older people rehabiliation ward. Stepping Back and Listening: Qualitative Health Research ; 26 Amazon Music Stream millions of songs. Amazon Advertising Find, attract, and engage customers. Amazon Drive Cloud storage from Amazon. Alexa Actionable Analytics for the Web. AmazonGlobal Ship Orders Internationally. Amazon Inspire Digital Educational Resources. Amazon Rapids Fun stories for kids on the go.

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