Creating Sustainable Change in the Interprofessional Academic Family Practice Setting: An Appreciative Inquiry Approach

Abstract

Background: There is a global shift toward integrated care approaches in primary care. Understanding how to optimize healthcare team effectiveness is of utmost interest in Canada, where primary care reform targets the development of interprofessional teams of providers collaborating to improve patient care. This article presents findings from a longitudinal study of one primary healthcare team in transformation. A theory-based organizational change model is applied to understanding the processes of change in interprofessional healthcare teams.
Methods and Findings: We report findings from two years after the implementation of an intervention to advance teamwork in one family health team in Ontario. The intervention was informed by the Appreciative Inquiry (AI) approach. Fifty hours of unstructured clinic observations and interviews were conducted. The findings revealed that a change in team practice, such as patient-centredness, and formal and informal communication opportunities, precede change in team discourse—the way that members speak and think about themselves as an integrated team.
Conclusions: The evolution of teamwork in the family practice setting is a gradual, steady process that begins with important changes in the way that things are done (i.e., first-order change), and with continued support and nurturance, can eventually lead to changes in the way that members think and speak about their team (i.e., second-order change).