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Cross-Functional Team Processes and Patient Functional Improvement


  • Jeffrey A. Alexander,

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    • Address correspondence to Jeffrey Alexander, Ph.D., Richard Carl Jelinek Professor, Health Management and Policy, School of Public Health, University of Michigan, 109 Observatory Dr., Ann Arbor, MI. 48109. Richard Lichtenstein, Ph.D., is with Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI. Kimberly Jinnett, Ph.D., Research Director, is with Integrated Benefits Institute, San Francisco, CA. Rebecca Wells, Ph.D., Assistant Professor, is with Health Policy and Administration, Pennsylvania State University, University Park, PA. James Zazzali, Ph.D., Associate Health Policy Researcher, is with RAND Corporation, Santa Monica, CA. Dawei Liu, Doctoral Candidate, is with the Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI.

  • Richard Lichtenstein,

  • Kimberly Jinnett,

  • Rebecca Wells,

  • James Zazzali,

  • Dawei Liu


Objective. To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes.

Data Sources/Study Setting. Primary data were collected during the period 1992–1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S.

Study Design. A longitudinal, multilevel analysis assessed the relationship between individual- and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables.

Data Collection Methods. Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument.

Principal Findings. Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning.

Conclusions. Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the potential appropriateness of managerial interventions to encourage member investment in team processes.