Nurses’ perspectives on the characteristics of high-functioning teams in primary care during the COVID-19 pandemic

Context : The COVID-19 pandemic provides an opportunity to explore the qualities that enable greater team adaptability, as a team’s ability to respond effectively to disruption is a good indicator of how well it functions. Considering that effective teamwork develops over time and that the activities of primary care nurses are largely dependent on team functioning, highlighting what best promotes effective teamwork from their perspective could contribute to a better understanding of how to support team-based primary care.

Objective : To explore nurses’ perspectives on the qualities that characterize high-functioning primary care teams and how these qualities contributed to effective team functioning during the COVID-19 pandemic.

Study Design and Analysis : Semi-structured qualitative interviews conducted as part of a larger qualitative case study using a thematic analysis approach based on the four dimensions of Levesque’s (2017) teamwork framework: structural, operational, relational and functional.

Setting or Dataset : Data from four Canadian regions: British Columbia, Ontario, Nova Scotia and Newfoundland and Labrador.

Population Studied : Nurse Practitioners, Registered Nurses and Licensed Practical Nurses (Registered Practical Nurses in Ontario) working in primary care

Intervention/Instrument: N/A.

Outcome Measures N/A.

Results : A total of 76 nurses were interviewed. Structurally, optimal teamwork required an inclusive perspective on team members, with particular emphasis on the impact of clerical staff on team functioning. From an operational perspective, effective communication was supported through keeping communication channels open with regular meetings adapted to new modes of care delivery, daily huddles, and electronic tools. From a relational perspective, having contributions recognized by colleagues was key to maintaining effective team functioning. Finally, from a functional perspective, high functioning required team members to be interested in and aware of each other’s responsibilities in order to share the workload of clinical and non-clinical activities.

Conclusions: This study highlights specific characteristics that enabled primary care teams to cope better with change and disruption during the pandemic. As teamwork is multi-dimensional and complex, these findings provide insight into priority aspects to be supported with tools and interventions in order to build effective teamwork and increase the ability for teams to adapt.