Abstract
Background: Pakistan’s primary health services have a sound infrastructure but remain ineffective in serving the needs of the nation. A significant area of concern is the lack of support to improve teambuilding of the multi-speciality primary healthcare providers (HCP). This study had two phases: First, to deliver a teambuilding intervention using a pre-post-test design, and second, to collect qualitative data about barriers to teambuilding.
Methods: A total of 42 multi-speciality HCPs from 12 basic health units and 5 rural health centres of Punjab, Pakistan, were part of the teambuilding intervention. We conducted a sequential mixed methods approach, with a quantitative pre-post-test analysis and interviews with 34 HCPs at follow-up qualitative phase.
Results: Mean analysis at post-test revealed improved teambuilding skills for coordinating patient care plans (z=2.881, p=0.004), and skills for conflict management (z=3.468, p=0.001). HCPs above the age of 30 years and with ≥6 years of service show improvement post intervention in teambuilding skills for collaborating about resources and referrals and conflict management, suggesting that younger and less experienced HCPs need more regular training support. The qualitative data highlighted 11 barriers which prevented optimal teambuilding, falling under broad areas of: (i) system issues, (ii) behavioural and service problems, and (iii) management limitations. We conclude with eight holistic recommendations to secure optimal teamwork, and argue that apart from continued training, there is need to: increase budget allocation; develop integrated care plans; strengthen the referral system; add providers to the team for non-maternal health services; fund joint research of providers; introduce third-party supervision and accountability; and introduce a human resource department.
Conclusions: Our study is one of the few studies that attempt to address teamwork issues in primary healthcare teams of the country, showing the benefits and limitations of an interprofessional teambuilding intervention. We conclude that a holistic approach is needed to improve teamwork in the primary-level multi-speciality providers.
Trial registration: NCT05389501