| Objectives:This study explains the concept of family doctor team effectiveness（FDTE）,identifies the factors that influence FDTE and the indicators to assess them;and analyses the action vein of the factors that influence FDTE based on the IMOI model,constructs the FDTE influence mechanism model;explores the pathways and mechanisms of the factors that influence FDTE by empirical research;and proposes strategies to improve FDTE,providing a theoretical basis and methodological guidance for the improvement of FDTE and service quality.Methods:（1）Literature research:To define the conceptual of FDTE,to identify the influencing factors and assessment indicators of FDTE,and to explain the IMOI model and its application in team effectiveness.（2）Key informant interview method:22 family doctor team members in Hangzhou were selected for semi-structured interviews by the purposive sampling method,and the factors influencing the FDTE and the assessment content of team effectiveness were sort out to construct the influence mechanism model based on the IMOI model.（3）Delphi method:20 experts with rich experience in primary healthcare services and related fields were invited to conduct two rounds of expert consultation,and the questionnaire dimensions and items were modified according to the results of the expert consultation to form the final questionnaire.（4）Questionnaire method:Cluster analysis was used to divide Zhejiang Province into more developed and less developed areas,and a survey was conducted in these areas in proportion to the number of community healthcare centers（stations）.689 questionnaires were collected in the survey,with 508 valid questionnaires and an effective rate of 73.73%.（5）Mathematical and statistical methods:Cronbach’s alpha and composite reliability were used to test the reliability,Delphi method,confirmatory factor analysis,and convergent and discriminant validity were used to test the validity.And ceiling effect and floor effect of each item were tested.Descriptive analyses such as median and quartile range were used to describe the basic information of team members,inputs and mediating processes influence factors,and the state of perceived team effectiveness.The relationships between different demographic and team characteristics and individual variables were analyzed using Mann-Whitney U tests,Kruskal-Wallis tests,and Spearman correlation analysis.The relationship between each influencing factor of FDTE and team effectiveness was investigated through hierarchical linear regression analysis.Structural equation models were constructed to empirically investigate the pathways of influence on FDTE and hypothesis testing.Results:（1）Basic information:The questionnaire with 11 dimensions and 42items consists of five parts:team input factors（team composition,leadership behavior,goals and systems）,member input factors（member cognition,member motivation,and cooperative attitude）,team behavioral process,team emotional process,and team effectiveness（team service ability,member satisfaction,and team redevelopment）.（2）Reliability and validity:In terms of internal consistency,the overall Cronbach’s alpha of the questionnaire was 0.944 and the Cronbach’s alpha of each dimension was greater than 0.750.In terms of combined reliability,the CR values of each dimension of the questionnaire were greater than 0.700.In terms of content validity,the I-CVI values for all dimensions and items in both rounds of expert consultation were greater than 0.780 and S-CVI values were greater than 0.900.In terms of structural validity,the confirmatory factor analysis results of the first-order model for each part of the questionnaire met the model fitting criteria.In terms of convergent validity,the factor loading of each item on the corresponding dimension were all greater than 0.500,and the AVE values of all 11 latent variables were also greater than 0.500.In terms of discriminant validity,the square root value of AVE for each dimension was greater than the correlation coefficient between that factor and the other factors.（3）Team effectiveness:The survey results showed that the median team effectiveness score of FDTE was 35（28,39）,the median team service capability score was 12（8,13）,the median member satisfaction score was 12（9,13）and the median team redevelopment expectation score was 12（10,14）.（4）Regression analysis results:The main influencing factors of FDTE were:number of team members,goals and system,cooperative attitude,team behavioral process,team emotional process（β=-0.116,P<0.01;β=0.165,P<0.01;β=0.123,P<0.05;β=0.161,P<0.001;β=0.193,P<0.001）.The main influencing factors of team service capacity were:number of team members,goals and system,team behavioral process,and team emotional process（β=-0.125,P<0.05;β=0.134,P<0.01;β=0.125,P<0.05;β=0.174,P<0.001）.The main influencing factors of team member satisfaction were:member perceptions,member motivation,team behavioral process,team emotional process（β=0.159,P<0.01;β=-0.133,P<0.01;β=0.122,P<0.05;β=0.176,P<0.001）.The main influencing factors for team redevelopment were:goals and systems,cooperative attitude,team behavioral process,and team affective process（β=0.172,P<0.01;β=0.128,P<0.05;β=0.135,P<0.01;β=0.117,P<0.05）.（5）Structural equation modeling results:（1）FDTE impact mechanism model:team input factors have direct and indirect effects on team effectiveness(E direct=0.238,E indirect=0.265,E total=0.503),member input factors have direct and indirect effects on team effectiveness(E direct=0.179,E indirect=0.124,E total=0.303),team behavioral processes have direct and indirect effects on team effectiveness(E direct=0.166,E indirect=0.044,E total=0.210),and team emotional processes had a direct effect on team effectiveness(E direct=0.207).（2）Team service capacity impact mechanism model:team input factors have direct and indirect effects on team service capacity(E direct=0.187,E indirect=0.113,E total=0.300),member input factors have only indirect effects on team service capacity(E indirect=0.061),team behavioral processes have only indirect effects on team service capacity(E indirect=0.041),and the team emotional process had a direct effect on team service capacity(E direct=0.192).（3）Member satisfaction impact mechanism model:team input factors have direct and indirect effects on member satisfaction(E direct=0.212,E indirect=0.162,E total=0.374),member input factors have only indirect effects on member satisfaction(E indirect=0.052),team behavioral processes have only indirect effects on member satisfaction(E indirect=0.034),and team emotional process had a direct effect on member satisfaction(E direct=0.162).（4）Team redevelopment impact mechanism model:team input factors had only an indirect effect on team redevelopment(E indirect=0.206),member input factors had direct and indirect effects on team redevelopment(E direct=0.163,E indirect=0.089,E total=0.252),team behavioral process had direct and indirect effects on team redevelopment(E direct=0.153,E indirect=0.023,E total=0.176),and team emotional process had no any effect on team redevelopment.Conclusion:（1）The FDTE impact mechanism questionnaire with 11 dimensions and 42 items was developed with good reliability and validity.The questionnaire contains five parts:team input factors,member input factors,team behavioral process,team emotional process and team effectiveness.（2）The FDTE in the sample areas of this study is in the middle to upper range,and the overall scores of team members’expectations for team redevelopment are relatively high and concentrated,followed by member satisfaction,while the overall scores of team service capability are relatively low and scattered.Therefore,there is still a need to further improve the"hardware"and"software"configuration of family doctor teams,to train more talents in multiple channels,and to improve the team service quality.（3）The number of team members,goals and systems,cooperative attitudes,team behavioral process,and team emotional process are the main influencing factors of FDTE;the number of team members,goals and systems,team behavioral process,and team emotional process are the main influencing factors of team service capability;the member perceptions,member motivation,team behavioral process,and team emotional process are the main influencing factors of team member satisfaction;and goals and systems,cooperative attitudes,team behavioral process,and team emotional process are the main influencing factors of team member redevelopment.（4）Team input factors have direct and indirect effects on team effectiveness,team service capability and member satisfaction,and only indirect effects on team redevelopment;member input factors have direct and indirect effects on team effectiveness and team redevelopment,and only indirect effects on team service capability and member satisfaction;team behavioral process have direct and indirect effects on team effectiveness and team redevelopment,and only indirect effects on team service capability and member satisfaction;team emotional process have direct and indirect effects on team effectiveness,team service capability and member satisfaction,and no any effect on team redevelopment.（5）It is recommended that the basic input of family doctor teams should be optimised,the intrinsic motivation of team members should be enhanced,team interaction and cooperation should be promoted,and a good atmosphere of family doctor team cooperation should be formed,and the service mode and concept of the team should be changed at an appropriate time to promote the quality and efficiency of family doctor team services and become a solid and reliable health gatekeeper for residents. |
PDF Full Text Request