The Impact of Team Climate and Practice Facilitation in General Practice : A qualitative study of general practices implementing changes in their model of care

Abstract

New Zealand has undergone dramatic changes in health and health care in attempts to improve health outcomes and address the growth in public expectation. As a strategy to realise this goal, District Health Boards across the country have been implementing initiatives to change how healthcare services are delivered to patients. One of these initiatives is the Modified Diabetes Care Improvement Package (MDCIP) which aimed to change the model of care for diabetes in general practices in the Counties Manukau catchment area. This thesis aims to investigate how practice facilitation and team climate may impact on general practices in implementing change in their model of care. Methods: This research took an interpretive studies approach, using semi-structured interviews with general practices that participated in MDCIP to explore the relationships between team climate and practice facilitation. The Team Climate Inventory (TCI) was used as a framework for examining team climate and the practice facilitator roles provided by Lessard et al, (2016) as the equivalent for practice facilitation. Findings: There was a clear mention in the interviews of ways in which team climate impacts on the implementation of change projects, both as an enabler and barrier. Participants gave examples of key aspects of the implementation process and how this affected their perception of how the team was performing against the team climate domains in the TCI. Various aspects of practice facilitation was also found to be associated with team climate, with ‘task orientation’ and ‘support for innovation’ being the two team climate domains that had the greatest association. Conclusion: Team climate potentially offers insight around which areas practice teams are having difficulty with, in their change projects and how this could be addressed. It also seemed that practice facilitation had an impact on team climate of general practice teams, acting as an enabler for change.