Functional diversity and team innovation: A study on the mediating role of social cohesion in primary care teams.

BACKGROUND: Bringing together professionals with different knowledge and skills comes with the opportunity to spur the innovativeness of primary care teams. Nevertheless, empirical evidence shows that it is not self-evident that these innovations are also realized. The social categorization theory suggests that a better understanding of whether these potential team innovations are realized can be obtained by looking at the social cohesion of such teams. PURPOSE: The aim of this study was to study the relationship between functional diversity and team innovation in primary care teams by examining the mediating role of social cohesion. METHODOLOGY: Survey responses and administrative data of 887 primary care professionals and 75 supervisors in 100 primary care teams were analyzed. Structural equation modeling was used to examine a curvilinear mediated relationship among functional diversity and team innovation through social cohesion. RESULTS: The findings show a positive relationship between social cohesion and team innovation as expected. Contrary to the expectations, the relationship between functional diversity and social cohesion is insignificant, and the results show an inverted U-shaped relationship between functional diversity and team innovation instead. CONCLUSIONS: This study reveals an unexpected inverted U-shaped relationship between functional diversity and team innovation. This relationship is not mediated by social cohesion; however, social cohesion is still a significant predictor of team innovation. PRACTICE IMPLICATIONS: Policymakers should be aware of the relevance as well as the complexity of creating social cohesion in functionally diverse primary care teams. As long as it remains unknown how social cohesion is stimulated in functionally diverse teams, it seems best for the team innovation to prevent bringing together too many, but also too few, different functions.

Changes in youth care use after the implementation of community-based support teams: repeated measurement study using registry data and data on team characteristics.

OBJECTIVES: New legislation on youth care in the Netherlands led to the implementation of community-based support teams, providing integrated primary youth care. Important aims of the new Youth Act were more integrated, timely care and less use of intensive forms of care. Our aim was to study changes in youth care use in time and the role of newly introduced community-based support teams herein. SETTING: Register data (2015-2018) on youth of a large city were linked and combined with administrative and aggregated data on team characteristics. PARTICIPANTS: Data on 126 095 youth (0-18 years) were available for analyses. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary, specialised and residential youth care use were the primary outcomes. RESULTS: Generalised estimating equations analyses adjusted for individual characteristics demonstrated that over 4 years, use of primary youth care increased from 2.2% to 8.5% (OR 1.70; 99% CI 1.67 to 1.73), specialised youth care decreased from 7.2% to 6.4% (OR 0.98; 99% CI 0.97 to 1.00) and residential youth care increased slightly (OR 1.04; 99% CI 1.01 to 1.06). Gender, age, family status, migrant background and educational level were all associated with the types of youth care use and also with some trends in time. Likelihood to receive care increased in time for preschool and younger children but did not improve for migrant children.Case load, team size, team turnover, team performance and transformational leadership showed significant associations with different types of youth care use but hardly with trends in time. CONCLUSION: Patterns of youth care use changed towards more locally provided primary youth care, slightly less specialised and slightly more residential youth care. Furthermore, youth care use among younger children increased in time. These trends are partly in line with the trends intended by the Youth Act. Little evidence was found for the role of specific team characteristics on changes in youth care use in time.

Towards sustainable local welfare systems: The effects of functional heterogeneity and team autonomy on team processes in Dutch neighbourhood teams.

Nowadays, many European countries delegate health and social care responsibilities from the national level to local authorities. In January 2015, the Netherlands similarly introduced a policy programme authorising municipalities to set their own social welfare policy. A specific feature of this programme is that it stimulates municipalities to implement teams wherein professionals from different disciplines are collectively responsible for a team's decision-making. This suggests that teams ideally have (a) high levels of functional heterogeneity (professionals from different disciplines) and (b) high levels of team autonomy (collective responsibility and decision-making). Based on the policy programme, it can be further assumed that (a) information elaboration, (b) boundary management and (c) team cohesion in teams will improve. In practice, the majority (87%) of Dutch municipalities implemented neighbourhood teams in January 2015. A common feature of these neighbourhood teams is that the various professionals are collectively responsible for all the curative and preventive healthcare, social work and voluntary social support of the citizens in a specific neighbourhood. Nevertheless, the structure and organisation of neighbourhood teams (including the level of functional heterogeneity and team autonomy) vary within and between municipalities. Given this situation, our aim was to examine to what extent functional heterogeneity and team autonomy influence information elaboration, boundary management and team cohesion in neighbourhood teams. We developed six hypotheses based on literature that were then tested on data collected (between May 2016 and January 2017) through an online survey from 1335 professionals in 170 neighbourhood teams. An SEM analysis showed a positive effect of team autonomy on information elaboration, boundary management and team cohesion. Results further showed a negative effect of functional heterogeneity on information elaboration and boundary management. The implications of these findings for practitioners and academics are discussed.