How to promote changes in primary care? The Florentine experience of the House of Community

Primary care (PC) has a central role in promoting health and preventing diseases, even during health emergencies. The COVID-19 pandemic has shown how strengthening comprehensive primary healthcare (c-PHC) services is key to ensuring community health. The Italian government decided to support PHC by investing resources from the Next Generation EU (NextGenEu) plan in the development of local health districts (LHDs) and local PC centers called "Houses of Community (HoC)". The Florence LHD (Tuscany)-in direct collaboration with the University of Florence-has represented the experimental context in which a c-PHC-inspired organizational model has been proposed and included the HoC as the nearest access point to PC services. Through multiprofessional collaboration practices, HoCs provide continuity of care as well as health and social integration. Different levels of action must coexist to initiate, implement, and sustain this new PC model: the organizational and managerial level, the experimentation of a new model of care, and the research level, which includes universities and LHD through participatory research and action approaches. This process benefits from health professionals' (HPs) participation and continuous assessment, the care for working relationships between HPs and services, an appropriate research methodology together with a "permeable" multidisciplinary research group, and educational programs. In this context, the HoC assumes the role of a permanent laboratory of experimentation in PC, supporting the effectiveness of care and answering what the Next Gen EU plan has been foreseeing for the rethinking of Italian territorial services.

Inter-Disciplinary Work in the Context of Integrated Care - a Theoretical and Methodological Framework

Inter-disciplinary team working is an essential mechanism for the delivery of integrated care. This paper summarises a narrative review of the research on the 'work' that teams do to develop inter-disciplinary practices, addressing the question 'How do interdisciplinary teams 'become' in the context of models of integrated care?'. The narrative review identities a gap in our understanding of the active boundary work that different disciplines working together to deliver care integration engage in when creating new interdisciplinary knowledge, creating an inter-disciplinary team identity and negotiating new social and power relations. This gap is particularly significant in relation to the role played by patients and care-givers. This paper presents a way of examining inter-disciplinary working as a process of creating knowledge, identity and power relations both in terms of a theoretical lens, circuits of power, and a methodology, institutional ethnography. An explicit focus on understanding power relations within inclusive inter-disciplinary teams in care integration will contribute to our understanding of the gap between theory and implementation of care integration by focusing on the 'work' that teams do to create new knowledge.

Interprofessional identity in clinicians: A scoping review

Interprofessional collaborative practice (IPCP) has been recognized as invaluable in delivering safe, high-quality patient care with finite resources. However, despite a decade of advances in interprofessional (IP) research, policy, and competency frameworks, IPCP does not always occur in practice. One reason may be the influence of a clinician's identity in an IP context. The purpose of this scoping review was to understand the nature of IP identity in healthcare clinicians. The PRISMA framework was used to support a comprehensive search strategy and screening of 1746 articles. Inclusion criteria included original research, theses, and reviews, a primary focus on IP identity or professional identity (PI) in an IP team, and a focus on health professionals, including students transitioning to practice. Ninety-five papers met the eligibility criteria, though once charted, just four of the 95 papers focused on IP identity in clinicians. Three further papers examined shared team identity, 25 papers referred to, but did not focus on IP identity, and the remaining 63 papers explored PI in an IP team. While limited studies on clinician IP identity restrict conclusive findings, patterns were identified to direct further research on the nature of IP identity in clinicians. These include values and beliefs, individual and personal factors, profession and professional experience, education, socialization, context, leadership, and the process of IP identity development. While identity is undeniably central to being a clinician, the values, beliefs, attributes, and experiences that contribute to clinician IP identity, how clinician IP identity develops, and factors that influence IP identity remain unclear. The results of this review highlight the value of further investigation of the nature of IP identity, the interplay between PI and IP identity, and identity in an IP context.

Changes in youth care use after the implementation of community-based support teams: repeated measurement study using registry data and data on team characteristics

OBJECTIVES

New legislation on youth care in the Netherlands led to the implementation of community-based support teams, providing integrated primary youth care. Important aims of the new Youth Act were more integrated, timely care and less use of intensive forms of care. Our aim was to study changes in youth care use in time and the role of newly introduced community-based support teams herein.

SETTING

Register data (2015-2018) on youth of a large city were linked and combined with administrative and aggregated data on team characteristics.

PARTICIPANTS

Data on 126 095 youth (0-18 years) were available for analyses.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary, specialised and residential youth care use were the primary outcomes.

RESULTS

Generalised estimating equations analyses adjusted for individual characteristics demonstrated that over 4 years, use of primary youth care increased from 2.2% to 8.5% (OR 1.70; 99% CI 1.67 to 1.73), specialised youth care decreased from 7.2% to 6.4% (OR 0.98; 99% CI 0.97 to 1.00) and residential youth care increased slightly (OR 1.04; 99% CI 1.01 to 1.06). Gender, age, family status, migrant background and educational level were all associated with the types of youth care use and also with some trends in time. Likelihood to receive care increased in time for preschool and younger children but did not improve for migrant children.Case load, team size, team turnover, team performance and transformational leadership showed significant associations with different types of youth care use but hardly with trends in time.

CONCLUSION

Patterns of youth care use changed towards more locally provided primary youth care, slightly less specialised and slightly more residential youth care. Furthermore, youth care use among younger children increased in time. These trends are partly in line with the trends intended by the Youth Act. Little evidence was found for the role of specific team characteristics on changes in youth care use in time.

Impact of shared leadership on team performance through team reflexivity: examining the moderating role of task complexity

Purpose

To react quickly and to be flexible to respond to environmental uncertainty, working in teams is preferable. However, leadership must be decentralised for effective team performance. This paper aims to examine the impact of shared leadership on team performance through team reflexivity with task complexity.

Design/methodology/approach

To test the hypothesised relationships, a quantitative research design with purposive sampling technique was used. Data were gathered from employees working in teams. A total of 351 valid responses were analysed via SPSS PROCESS macro.

Findings

The findings signify that shared leadership positively impacts team reflexivity, which, in turn, has a significant impact on team performance. Results also revealed that team reflexivity strongly affects team performance in the presence of shared leadership and complex tasks.

Originality/value

Research related to effective team performance is scarce. Similarly, a review of a recently published article revealed that team reflexivity could work as a mediating mechanism in the relationship between shared leadership and effective team performance. Moreover, the concept of task complexity in the existing literature is scattered and needs to be integrated.

Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes

BACKGROUND

Nurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare team. We aimed to examine the influence of individual, team, and organizational characteristics, and role clarity on outcomes of care mediated by team processes in primary healthcare teams that include NPs.

METHODS

A cross-sectional survey across six sites representing practices with NPs in Québec, Canada, was conducted between March 2018 and April 2019 as part of a multiple-case study. Patients and families (n = 485; response rate: 53%) completed a validated questionnaire, which included a patient-reported experience measure (PREM) and a patient-reported outcome measure (PROM) of team functioning (Cronbach alpha: 0.771 (PROM) to 0.877 (PREM)). We performed logistic regression and mediation analyses to examine relationships between the individual, team, and organizational characteristics, role clarity, and outcomes of care mediated by team processes.

RESULTS

Patients and families expressed positive perceptions of team functioning (mean 4.97/6 [SD 0.68]) and outcomes of care (5.08/6 [0.74]). Also, high team processes (adjusted odds ratio [AOR] 14.92 [95% CI 8.11 to 27.44]) was a significant predictor of high outcomes of care. Role clarity (indirect effect coefficient ab = 6.48 [95% CI 3.79 to 9.56]), living in an urban area (-1.32 [-2.59 to -0.13]), patient as respondent (-1.43 [-2.80 to -0.14]), and income (1.73 [0.14 to 3.45]) were significant predictors of outcomes of care mediated by team processes.

CONCLUSIONS

This study provides key insights on how primary healthcare teams with NPs contribute to team functioning, using a validated instrument consistent with a conceptual framework. Results highlight that high role clarity, living in a non urban area, family as respondent, and adequate income were significant predictors of high outcomes of care mediated by high team processes. Additional research is needed to compare teams with and without NPs in different settings, to further explicate the relationships identified in our study.

Corporate Sustainability: It’s Mine! Effect of Green Product Psychological Ownership on the Environmental Behavior and Performance of Employees

Green shared vision (GSV) has provided a research prototype for past green management research topics; however, few studies have examined the confusion related to environmental issues among employees. Therefore, to fill the aforementioned research gap, this study used psychological ownership theory and expectancy–valence theory to establish a research framework for GSV. This study explored the relationships of GSV with employee green confusion (EGC) and employee environmental performance (EEP) as well as the mediating effect of green product psychological ownership (GPPO) on these relationships. The research results indicate that GSV positively affects GPPO, EGC, and EEP. Moreover, GSV also influences behavior and performance through personal psychological processes. Thus, if an enterprise wishes to establish GSV, it must adopt a series of supporting measures, including improving members’ GPPO, to effectively reduce EGC and improve EEP to realize the goal of sustainable development.

How to Shape an Organization’s Sustainable Green Management Performance: The Mediation Effect of Environmental Corporate Social Responsibility

Corporate social responsibility (CSR), a current mainstream issue in global corporate governance, is often used to verify a company’s financial performance and corporate image; however, few studies have focused on CSR for environmental issues. On the basis of the perspectives of the expectation value and signal theories, this study presents a new concept for determining the impact of green shared vision (GSV) on employee environmental performance (EEP) and green product development performance (GPDP), which could aid in exploring the GSV–environmental CSR (ECSR) relationship further. The current results demonstrated that ECSR contributes to enhancing EEP and GPDP. Therefore, enterprises must implement the promotion of ECSR to enhance their overall green management performance and achieve sustainable management.

Mix It Up? The Influence of Team Composition on Employee Perceptions of Stressors in a Post-Merger Environment

Organizational restructuring that follows mergers can be stressful for employees. Heterogeneous team structures may intensify merger-related stressors, as legacy company serves as a faultline, which can create conflict and disunity. However, findings from diversity studies suggest that team heterogeneity has some advantages. We addressed a major shortcoming in the team stressor research, which has insufficiently considered the roles of team heterogeneity (vs. homogeneity) in perceptions of stressors. We explored how team composition (based on legacy company) shapes perceptions of merger-related stressors. Qualitative analysis of employee comments post-merger revealed that stressors varied across team compositions. Heterogeneous teams were not unequivocally stressful and results differed by employee legacy company. Homogeneous acquired teams were most disadvantaged. Homogeneous acquiring teams were least stressed. Accordingly, we created labels that describe each team’s unique context, which can advance team stressor research and help leaders properly support employees in a post-merger environment based on their teams’ composition.