The influence mechanism analysis of family doctor team effectiveness: a mixed-method approach

Team-based delivery of family doctor services is associated with improved patient experiences, better health outcomes, and more efficient healthcare utilization. Team effectiveness is related to the team's output, and family doctor team effectiveness (FDTE) directly impacts the quality and efficiency of contracted family doctor services. We aimed to explore the path and mechanisms influencing FDTE, propose strategies for improvement, and enhance both team effectiveness and service quality.

The literature review, key informant interviews, expert consultation, and questionnaire survey were employed. The questionnaire, based on the input-mediator-output-input model, was designed to measure FDTE and its influencing factors. Using stratified random sampling, we distributed the questionnaire to family doctors in both developed and underdeveloped areas of Zhejiang Province, China. We performed hierarchical linear regression analysis to examine the relationship between team effectiveness and influencing factors. Subsequently, we used structural equation model (SEM) to explore and validate the relationships and mechanisms of action among "team input factors," "member input factors," "team behavioral process," and "team emotional process" on team effectiveness.

The questionnaire was divided into five main sections: "team input factors," "member input factors," "team behavioral process," "team emotional process," and "team effectiveness," with 11 dimensions and 42 items. A total of 508 valid questionnaires were returned. The main factors influencing FDTE are team composition (β = -0.116, P < .01), goals and systems (β = 0.165, P < .01), cooperative attitude (β = 0.123, P < .05), team behavioral process (β = 0.161, P < .001), and team emotional process (β = 0.193, P < .001). SEM analysis revealed that team input factors, member input factors, and team behavioral process had direct and indirect effects on team effectiveness, while the team emotional process had a direct effect.

It is recommended to optimize the basic inputs of family doctor teams, enhance the intrinsic motivation of team members, promote team interaction and cooperation, and foster a positive atmosphere for family doctor teamwork.