A house divided: A mixed method investigation of primary care interprofessional teams using the core principles and values of teamwork framework

Context: Primary care teams are facing increased demands, turnover, and escalating rates of burnout. A primary care team aligned in its core values and organized according to common teamwork principles is essential for delivering patient-centered, coordinated, and effective healthcare. Methods: As part of a series of studies on workplace factors and burnout among primary care practice team members, we selected an urban practice with high rates of burnout to assess their teamwork via a practice-wide survey and six focus groups divided by role. The interview guide focused on identifying areas for potential intervention around teamwork. Transcripts were open-coded using a blend of conventional and directed content analysis. Codes were mapped onto the Core Principles and Values Framework for the final thematic analysis and we examined alignment with these principles, identifying barriers and facilitators of teamwork. Findings: In a survey, participants rated their teamwork as low in a primary care practice with high rates of burnout and turnover during and after the COVID-19 pandemic. In focus groups, participants identified how pre-existing issues (demands, short staffing), coupled with high turnover in key clinical and leadership positions, prevented teamwork as they lacked the time to build relationships and devalued investment in temporary employees. Collaborative processes for determining workflows and implementing best practices of shadowing and huddles were identified as facilitators. Conclusions: Primary care practice teams operate best when members adhere to the core principles of teamwork, which are predicated on having consistent team members and time for intentional assessment, investment, and support of teams.