Clima de trabalho em equipe e qualidade do cuidado na atenção primária à saúde/ Teamwork climate and quality in primary health care

Danielle Fabiana Cucolo, Paulo Gustavo Souza, Fernanda Maria de Miranda, Vivian Aline Mininel, Jaqueline Alcântara Marcelino da Silva

Abstract


Objetivo: Analisar os aspectos do clima de trabalho em equipe que interferem na qualidade do cuidado na Atenção Primária à Saúde na percepção dos profissionais de saúde. Método: Revisão integrativa realizada nas bases de dados CINAHL, Medline, Web of Science e Scopus, em maio de 2020. A seleção dos estudos foi guiada pela questão “Para os profissionais de saúde, quais os aspectos de clima de trabalho em equipe interferem na qualidade do cuidado na Atenção Primária à Saúde?”. Para análise foram adotados modelos que classificam o trabalho em equipe (Matriz input-process-output e Informing Quality Improvement Research) e a qualidade em saúde (Modelo donabediano) em contexto, processos e resultados. Resultados: Foram identificados 140 estudos e nove incluídos. As publicações ocorreram entre 2014 e 2018 e os aspectos do clima de equipe que interferem nos processos e resultados da qualidade do cuidado foram agrupados em contexto (estrutura para compartilhar informações); processo (comunicação, liderança, reconhecimento dos papéis, objetivos comuns e participação na equipe) e resultado, considerando o próprio clima de trabalho em equipe. Conclusão: A comunicação e a liderança são aspectos do clima de equipe que interferem na qualidade do cuidado na Atenção Primária em Saúde. Os modelos utilizados para análise dos achados possibilitaram compreender o contexto, os processos e os resultados no cotidiano de trabalho das equipes contribuindo para os gestores atuarem no desenvolvimento de políticas públicas, no fortalecimento da prática interprofissional colaborativa e na melhoria da qualidade da atenção à saúde.


Keywords


Relações interprofissionais, Comunicação interprofissional, Atenção Primária em Saúde, Clima de Equipe, Equipe de Assistência ao Paciente, Qualidade. Revisão.

References


- Pan American Health Organization. Renewing Primary Health Care in the Americas. Washington, DC; 2007 [acesso 2020 Nov 23]. Disponível em: https://www.paho.org/bra/index.php?option=com_docman&view=download&alias=574-renewing-primary-health-care-in-americas-4&category_slug=atencao-primaria-em-saude-944&Itemid=965

- Figueiredo DCMM, Shimizu HE, Ramalho WM, Figueiredo AM, Lucena KDT. Quality of Primary Health Care in Brazil: patients’ view. Rev Bras Enferm [Internet]. 2018 [acesso 2020 Nov 23];71(Suppl 6):2713-9. Disponível em: http://dx.doi.org/10.1590/0034-7167-2017-065

- Reeves S, Xyrichis A, Zwarenstein M. Teamwork, collaboration, coordination, and networking: Why we need to distinguish between different types of interprofessional practice. J Interprof Care [Internet]. 2018 jan [acesso 2020 Nov 23];32(1):1-3. Disponível em: https://doi.org/10.1080/13561820.2017.1400150

- Peduzzi M, Agreli HLF, Silva, JAMD, Souza, HSD. Trabalho em equipe: uma revisita ao conceito e a seus desdobramentos no trabalho interprofissional. Trab Educ Saúde. [Internet]. 2020 [acesso 2020 Nov 23];18(Supl. 1). Disponível em: https://doi.org/10.1590/1981-7746-sol00246

- Peduzzi M, Agreli HF. Teamwork and collaborative practice in Primary Health Care. Interface (Botucatu) [Internet]. 2018 [acesso 2020 Nov 23]; 22(Supl. 2):1525-34. Disponível em: https://doi.org/10.1590/1807-57622017.0827

- Anderson NR, West MA. Measuring climate for work group innovation: development and validation of team climate inventory. Journal of Organizational Behavior [Internet]. 1998 [acesso 2020 Nov 23];19(3):235-58. Disponível em: https://doi.org/10.1002/(SICI)1099-1379(199805)19:3<235::AID-JOB837>3.0.CO;2-C

- Silva MC, Peduzzi M, Sangaleti CT, Silva D, Agreli HF, West MA, et al. Cross-cultural adaptation and validation of the teamwork climate scale. Rev Saude Publica [Internet]. 2016 [acesso 2020 Nov 23];50:52. Disponível em: https://doi.org/10.1590/S1518-8787.2016050006484

– Giannitrapani KF, Leung L, Huynh AK, Stockdale SE, Rose D, Needleman J et al. Interprofessional training and team function in patient-centred medical home: Findings from a mixed method study of interdisciplinary provider perspectives, J Interprof Care [Internet]. 2018 [acesso 2020 Nov 23];32(6):735-44. Disponível em: http://doi.org/10.1080/13561820.2018.1509844

- Becker E, Roblin DW. Translating primary care practice climate into patient activation: the role of patient trust in physicians. MedCare [Internet], 2008 [acesso 2020 Nov 23];46(8):795–805. Disponível em: http://doi.org/10.1097/MLR.0b013e31817919c0

– Espinoza P, Peduzzi M, Agreli HF, Sutherland MA. Interprofessional team member’s satisfaction: a mixed methods study of a Chilean hospital. Human Resources For Health [Internet]. jul. 2018 [acesso 2020 Nov 23];16(1):290-296. Disponível em: https://doi.org/10.1186/s12960-018-0290-z

– Proudfoot J, Jayasinghe UW, Holton C, Grimm J, Bubner T, Amoroso C, et al. Team climate for innovation: what difference does it make in general practice?Int J Qual Health Care [Internet] 2007 [acesso 2020 Nov 23];19(3):164-169. Disponível em:

https://doi.org/10.1093/intqhc/mzm005

- Mundt MP, Agneessens F, Tuan WJ, Zakletskaia LI, Kamnetz SA, Gilchrist VJ. Primary care team communication networks, team climate, quality of care, and medical costs for patients with diabetes: A cross-sectional study. Int J Nurs Stud [Internet]. 2016 [acesso 2020 Nov 23];58:1-11. Disponível em: http://doi.org/10.1016/j.ijnurstu.2016.01.013

- Beaulieu MD, Haggerty J, Tousignant P, Barnsley J, Hogg W, Geneau R et al. Characteristics of primary care practices associated with high quality of care. CMAJ [Internet]. 2013 [acesso 2020 Nov 23];185(12):E590-6. Disponível em: http://doi.org/10.1503/cmaj.121802

- Shea CM, Turner K, Albritton J, Reiter KL. Contextual factors that influence quality improvement implementation in primary care: The role of organizations, teams, and individuals. Health Care Manage Rev [Internet] 2018 [acesso 2020 Nov 23];43(3):261-269. Disponível em: http://doi.org/10.1097/HMR.0000000000000194

- Donabedian A. Striving for Quality in HealthCare. An Inquiry into Policy and Practice. AnnArbor, Michigan: Health Administration Press; 1991.

–Schneider B, Ehrhart MG, Macey WH. Organizational climate and culture. Ann Rev Psychol [Internet]. 2013 [acesso 2020 Nov 23];64:361-88. Disponível em: http://doi.org/10.1146/annurev-psych-113011-143809

- Santana MJ, Manalili K, Jolley RJ, Zelinsky S, Quan H, Lu M. How to practice person-centred care: A conceptual framework. Health Expect [Internet]. 2018 [acesso 2020 Nov 23];21:429–440. Disponível em: http://doi.org/10.1111/hex.12640

– Tanaka OY. Avaliação da atenção básica em saúde: uma nova proposta. Saúde e soc [Internet]. 2011 [acesso 2020 Nov 23];20(4):927-934. Disponível em: http://doi.org/10.1590/s0104-12902011000400010

- Körner M, Bütof S, Müller C, Zimmermann L, Becker S, Bengel J. Interprofessional teamwork and team interventions in chronic care: A systematic review, JInterprof Care [Internet]. 2016 [acesso 2020 Nov 23];30(1):15-28. Disponível em: http://doi.org/10.3109/13561820.2015.1051616

– Pomare C, Long JC, Churruca K, Ellis LA, Braithwaite J. Interprofessional collaboration in hospitals: a critical, broad-based review of the literature, J Interprof Care [Internet]. 2020 [acesso 2020 Nov 23];34(4):509-519. Disponível em: http://doi.org/10.1080/13561820.2019.1702515

– Brennan SE, Bosch M, Buchan H, Green SE. Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: A systematic review of instruments. Implementation Science [Internet]. 2012 [acesso 2020 Nov 23];7(1):121. Disponível em: http://doi.org/10.1186/1748-5908-7-121

- Brennan SE, Bosch M, Buchan H, Green SE. Measuring team factors thought to influence the success of quality improvement in primary care: A systematic review of instruments. Implementation Science [Internet]. 2013 [acesso 2020 Nov 23];8(20). Disponível em: https://doi.org/10.1186/1748-5908-8-20

- Goh TT, Eccles MP. Team climate and quality of care in primary health care: a review of studies using the Team Climate Inventory in the United Kingdom. BMC Res Notes [Internet]. 2009 [acesso 2020 Nov 23];2:222. Disponível em: http://doi.org/10.1186/1756-0500-2-222

- Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. [Internet]. 2005 Dec [acesso 2020 Nov 23];52(5):546-53. Disponível em: http://doi.org/10.1111/j.1365-2648.2005.03621.x

- Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med [Internet]. 2009 Jul [acesso 2020 Nov 23];6(7):e1000100. Disponível em: http://doi.org/10.1371/journal.pmed.1000100

–Brown JB, Ryan BL, Thorpe C, Markle EKR, Hutchison B, Glazier RH. Measuring teamwork in primary care: Triangulation of qualitative and quantitative data. Families, Systems and Health [Internet]. 2015 [acesso 2020 Nov 23];33(3):193–202. Disponível em: https://doi.org/10.1037/fsh0000109

–Mundt MP, Gilchrist VJ, Fleming MF, Zakletskaia LI, Tuan WJ, Beasley JW. Effects of primary care team social networks on quality of care and costs for patients with cardiovascular disease. Annals of Family Medicine [Internet]. 2015 [acesso 2020 Nov 23];13(2):139–148. Disponível em: https://doi.org/10.1370/afm.1754

–Rayner J, Muldoon L. Staff perceptions of community health centre team function in Ontario. Can Fam Physician [Internet]. 2017 [acesso 2020 Nov 23];63(7), e335–e340. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28701459/

- Smits M, Keizer E, Giesen P, Deilkås ECT, Hofoss D, Bondevik GT. Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey. Scand J Prim Health Care[Internet]. 2018 [acesso 2020 Nov 23];36(1):28–35. Disponível em: https://doi.org/10.1080/02813432.2018.1426150

- Maun A, Engström M, Frantz A, Brämberg EB, Thorn J. Effective teamwork in primary healthcare through a structured patient-sorting system - A qualitative study on staff members’ conceptions. BMC Fam Pract. [Internet]. 2014 [acesso 2020 Nov 23];15(1):189. Disponível em: http://doi.org/10.1186/s12875-014-0189-2

- Bodenheimer T, Ghorob A, Willard-Grace R, Grumbach K. The 10 Building Blocks of High-Performing Primary Care. Ann Fam Med [Internet]. 2014 [acesso 2020 Nov 23];12(2):166-71. Disponível em: http://doi.org/10.1370/afm.1616

- Harris MF, Advocat J, Crabtree BF, Levesque JF, Miller WL, Gunn JM et al. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries. J Multidiscip Healthc [Internet]. 2016 jan [acesso 2020 Nov 23];9:35-46. Disponível em: http://doi.org/10.2147/JMDH.S97371

- Sellera PEG, Pedebos LA, Harzheim E, Medeiros OL, Ramos LG, Martins C et al. Monitoring and evaluation of Primary Health Care attributes at the national level: new challenges. Ciênc saúde coletiva [Internet]. 2020 Apr [acesso 2020 Nov 23];25(4):1401-1412. Disponível em: https://doi.org/10.1590/1413-81232020254.36942019

– Ministério da Saúde (Brasil). Portaria nº 2.979, de 12 novembro de 2019. Institui o Programa Previne Brasil, que estabelecenovo modelo de financiamento de custeio daAtenção Primária à Saúde no âmbito do SistemaÚnico de Saúde, por meio da alteração da Portariade Consolidação nº 6/GM/MS, de 28 de setembro de2017. Diário Oficial da União 13 nov 2019 [acesso em 2020 Nov 23];Seção 1:97. Disponível em: http://189.28.128.100/dab/docs/portaldab/documentos/financiamento/portarias/prt_2979_12_11_2019.pdf

- Hofhuis J, Mensen M, ten Den LM, van den Berg AM, Koopman-Draijer M, van Tilburg MC et al. Does functional diversity increase effectiveness of community care teams? The moderating role of shared vision, interaction frequency, and team reflexivity. Journal of Applied Social Psychology [Internet]. 2018 [acesso 2020 Nov 23];48(10):535–548. Disponível em:https://doi.org/10.1111/jasp.12533

- Morgan S, Pullon S, Mcinlay E. Observation of interprofessional collaborative practice in primary care teams: An integrative literature review. Int J Nurs Stud[Internet] 2015 [acesso 2020 Nov 23];52(7):1217-1230. Disponível em: https://doi.org/10.1016/j.ijnurstu.2015.03.008

- Sangaleti C, Scveitzer MC, Peduzzi M, Zoboli ELCP, Soares CB. Experiences and shared meaning of teamwork and interprofessional collaboration among health care professionals in primary health care settings: a systematic review. JBI Database System Rev Implement Rep [Internet]. 2017 Nov [acesso 2020 Nov 23];15(11):2723-2788. Disponível em: http://doi.org/10.11124/JBISRIR-2016-003016

- van Dongen JJ, van Bokhoven MA, Daniëls R, Lenzen SA, van der Weijden T, Beurskens A. Interprofessional primary care team meetings: a qualitative approach comparing observations with personal opinions. Fam Pract [Internet]. 2017 [acesso 2020 Nov 23];34(1):98-106. Disponível em: http://doi.org/10.1093/fampra/cmw106

- Previato GF, Baldissera VDA. Communication in the dialogical perspective of collaborative interprofessional practice in Primary Health Care. Interface (Botucatu) [Internet]. 2018 [acesso 2020 Nov 23];22(Supl. 2):1535-47. Disponível em: http://doi.org/10.1590/1807-57622017.0647

- Brown JB, Ryan BL. Processes that influence the evolution of family health teams. Can Fam Physician [Internet]. 2018 Jun [acesso 2020 Nov 23];64(6):e283-e289. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999255/pdf/064e283.pdf

– Kukenberger MR, D'Innocenzo L. The building blocks of shared leadership: The interactive effects of diversity types, team climate, and time. Personnel Psychology [Internet]. 2020 [acesso 2020 Nov 23];73(1):125-50. Disponível em: https://doi.org/10.1111/peps.12318

- Soratto J, Pires DEP, Scherer MDA, Witt RR, Ceretta LB, Farias JM. Family Health Strategy professional satisfaction in Brazil: a qualitative study. Texto Contexto Enferm [Internet]. 2020 [acesso 2020 Nov 23];29:e20180104. Disponível em: https://doi.org/10.1590/1980-265X-TCE-2018-0104

- Agreli HF, Peduzzi M, Bailey C. The relationship between team climate and interprofessional collaboration: Preliminary results of a mixed methods study, J Interprof Care [Internet]. 2017 [acesso 2020 Nov 23];31(2):184-186. Disponível em:https://doi.org/10.1080/13561820.2016.1261098

- Agreli HF, Peduzzi M, Bailey C. Contributions of team climate in the study of interprofessional collaboration: A conceptual analysis. J Interprof Care [Internet]. 2017 Nov [acesso 2020 Nov 23];31(6):679-684. Disponível em: http://doi.org/10.1080/13561820.2017.1351425

- Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open [Internet] 2019 [acesso 2020 Nov 23];9:e028280. Disponível em: http://doi.org/10.1136/bmjopen-2018-028280

- Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews [Internet] 2017 [acesso 2020 Nov 23];6(CD000072). Disponível em: http://doi.org/10.1002/14651858.CD000072.pub3

- Cassiani SHB, Fernandes MNF, Reveiz L, Filho JRF, Silva FAM. Combinação de tarefas do enfermeiro e de outros profissionais na atenção primária em saúde: uma revisão sistemática. Rev Panam Salud Publica [Internet]. 2020 [acesso 2020 Nov 23];44:e82. Disponível em: http://doi.org/10.26633/RPSP.2020.82




DOI: https://doi.org/10.34119/bjhrv4n3-231

Refbacks

  • There are currently no refbacks.