Team Processes in Canadian Primary HealthCare : A Realist Review Protocol

Background Team-based care delivery is considered one of the most effective and efficient ways of providing medical and social care services to complex patients in the community. A number of national and provincial initiatives have funded team-based approaches to community-based care (Government of Canada 2007; Health Council of Canada 2009; Longhurst & Cohen 2019). Although team-based care delivery can have optimal outcomes for providers and patients, the shift from traditional primary care solo provider models to team-based models requires careful planning and implementation (Longhurst & Cohen 2019). Effective teamwork depends on team processes, which are social or relational processes associated with interpersonal aspects of teamwork, such as communications and decision-making (LePine et al. 2008). Despite the importance of teamwork and numerous publications on ‘how to’ develop and manage teams, little is known about team development and sustainment from a social/relational perspective. This realist review will explore the social processes, team processes associated with effective team performance. Our realist review research questions were: What team processes are associated with team effectiveness in Canadian primary healthcare settings? What mechanisms and contextual factors result in team effectiveness in Canadian primary healthcare settings? Study Design Realist review is a form of theory-driven evidence synthesis. Realist reviews seek to explain the causes of outcomes by analyzing the literature to develop context (C) mechanism (M) outcomes (O) configurations (CMOCs). Expressing causation in such a way enables testable hypotheses about processes of interest, such as team processes, to be developed and then confirmed, refuted or tested and refined using data from documents included in a review. Building up and testing CMOCs is unique to realist methodology (Berg & Nanavati 2016). Testable CMOCs are arranged within a schematic or program theory that represents how a program or process should unfold over time. A key objective of a realist review is to create a program theory with CMOCs that amalgamates evidence from disparate data sources. For example, our data sources for this realist review were peer-reviewed and grey literature. Our review method was based on Pawson’s iterative review process (Pawson 2006). We followed the RAMESES realist review quality standards (Wong et al. 2014). Our research team consisted of subject matter experts with backgrounds in medicine, nursing and psychology.