Advancing Health Equity Among Integrated Care Teams for Staff, Learners, and Patients

Background
Community health centers are on the frontlines to achieving high-functioning, team-based care that advances health equity. To fulfill this mission, there is a need to provide rapid assessment of how well teams operate in a busy health care environment and how equality among team members is directly related to team functioning and patient outcomes. Some of the greatest tensions in health care include systemic racism and hierarchy which is associated with team dysfunction and poor quality outcomes. To this call of action, a leadership team at Community University Health Care Center (CUHCC) located in South Minneapolis sought out to understand the breakdown between team members. In addition to implementing a validated survey tool (Tilden, 2016) to provide rapid assessment of team functioning, we investigated how survey participants of different ethnic backgrounds and professional designation answered to specific survey questions in an attempt to assess the disparities among teams.

Study Design
This study was applied to a quality improvement project to provide pre and post data to assess team functioning. A sub-analysis was completed on three teamness questions from the survey. Three self-identified hypotheses (ethnic background, professional designation and direct patient care vs non-direct patient care) were applied to the data to determine a plausible cause for the variability among answers. An intervention, team stories, was implemented and studied among the integrated care teams.

Results
A large data set was collected and analyzed which demonstrated high teamness, high intra-team disagreement from year one to year two. The data also demonstrated high intra-team disagreement, a widening gap in teamness questions, among team members' ethnic background and professional designation.Team stories offered a lower barrier to participation with less clinical formality and improved value and knowledge of roles among team members.

Conclusion
This project demonstrated how to engage staff and learners to self-disclose data that can be used to advance equity among team members. To deliver high quality, equitable care, there must be equity among teams to positively impact the health of diverse communities.
Immediate actionable skills/practical knowledge:
Equity among team members roles translates to effective team functioning and health equity for patients
Give opportunities for staff and learners to self-identify (ethnic background, sexual orientation, disability)
Ask learners and staff for feedback, be open to changing questions for organization inclusion

Active Learning Strategies:
A "how to" model and pearls for advancing IPE in the clinical setting, specifically we will discuss:
- Development of formal team design in a community health center
- On-going measurement of team functioning, example: ACE-15 Teamness Survey
- Interprofessional case consultation

Learning Objectives
After attending the session, the learner will be able to…
- Explain the call of action to promote team-based care in community health centers to improve patient experience and the well-being of team members.
- Identify how to engage staff and learners to discover the barriers among team members to address equity among roles.
- Analyze how equity among roles within a team can address disparities and advance health equity for patients.