El clima de equipo

BMC Research Notes
Short Report

BioMed Central

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Team climate and quality of care in primary health care: a review of studies using the Team Climate Inventory in the United Kingdom
Teik T Goh*1,2 and Martin P Eccles1
Address: 1Institute of Health & Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK and 2Northumbria General Practice Vocational TrainingScheme, Northern Deanery, 10/12 Framlington Place, Newcastle upon Tyne, NE2 4AB, UK Email: Teik T Goh* - t.t.goh@ncl.ac.uk; Martin P Eccles - martin.eccles@ncl.ac.uk * Corresponding author

Published: 29 October 2009 BMC Research Notes 2009, 2:222 doi:10.1186/1756-0500-2-222

Received: 1 May 2009 Accepted: 29 October 2009

This article is available from:http://www.biomedcentral.com/1756-0500/2/222 © 2009 Goh et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Background: Attributes of teams could affect the quality of caredelivered in primary care. The aim of this study was to systematically review studies conducted within the UK NHS primary care that have measured team climate using the Team Climate Inventory (TCI), and to describe, if reported, the relationship between the TCI and measures of quality of care. Findings: The databases MEDLINE, EMBASE, and CINAHL were searched. The reference lists of included articlewere checked and one relevant journal was hand-searched. Eight papers were included. Three studies used a random sample; the remaining five used convenience or purposive samples. Six studies were cross sectional surveys, whilst two were before and after studies. Four studies examined the relationship between team climate and quality of care. Only one study found a positive association between teamclimate and higher quality care in patients with diabetes, positive patient satisfaction and self-reported effectiveness. Conclusion: While the TCI has been used to measure team attributes in primary care settings in the UK it is difficult to generalise from these data. A small number of studies reported higher TCI scores being associated with only certain aspects of quality of care; reasons forthe pattern of association are unclear. There are a number of methodological challenges to conducting such studies in routine service settings. Further research is needed in order to understand how to measure team functioning in relation to quality of care.

Findings
There is considerable interest in what predicts, or results in, an increase in the quality of healthcare. Reviews of variousempirical interventions that aim to improve the quality of healthcare have been inconclusive [1,2]. Authors have suggested the use of generalisable frameworks within which to consider issues relating to the quality of healthcare [3,4]. Ferlie and Shortell suggested that quality improvement in healthcare can be implemented at four different levels: individual professionals, groups and

teams,organisations, and the overall system [5]. In a primary care setting the management of common chronic diseases is commonly provided by multidisciplinary teams of healthcare professionals and ancillary staff. The 'team' shares the responsibility for, and the provision of, care to patients [6-9]. Previous studies in the UK and elsewhere examined relationships between team working in primary care found thatmeasurable aspects of team working were associated with improved outcomes such as effectiveness and patient satisfaction [8,10-13]. However,
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it remains uncertain which team attributes are important in improving the quality of care in primary care [7,13]. At the level of...