Examining clinical performance feedback in Patient-Aligned Care Teams

Area of Science:

• Healthcare Management
• Clinical Performance Improvement
• Team-Based Care Models

Background:

• The shift to team-based healthcare models significantly alters clinical roles and relationships.
• Traditional audit and feedback mechanisms focus on individual providers, potentially misaligning with team-based care.

Purpose of the Study:

• To identify changes in clinical performance audit and feedback for primary care teams after implementing team-based care.
• To understand how feedback processes adapt to new team structures in healthcare settings.

Main Methods:

• Conducted semi-structured interviews with clinicians, department heads, and facility leaders across 16 diverse VA Medical Centers.
• Analyzed interview transcripts using grounded theory and content analysis, focusing on clinical performance feedback and team-based care implementation.

Main Results:

• Clinical performance ownership remains primarily with individual providers, even within team-based structures.
• Panel-management tools emerged as a key feedback change, with nurses often monitoring existing tools effectively.
• Facilities reported minimal changes in clinical performance assessment post-transition to team-based care.

Conclusions:

• New tools for clinical performance feedback have not fully supported a team-based approach.
• Audit and feedback processes largely remain unchanged despite altered team roles and responsibilities.
• Further research is needed to align team-based audit and feedback with strategic clinical objectives.