The impact of team functioning on the quality of care in rural hospitals: a cross-sectional survey study on similarity and multidisciplinarity

Abstract

Background: The World Health Organization recommends improving the quality of care in rural areas of developing countries by enhancing teamwork. Effective teamwork is especially essential for rural hospital care delivered to complex patients, which requires multidisciplinary coordination and cooperation. However, evidence on teamwork in hospitals is mostly from urban hospitals and developed countries, leaving team functioning in rural hospitals in developing countries largely under-researched. The distinctive contextual characteristics of rural areas in developing countries, such as increased diversity, impact teamwork dynamics. To advance the understanding of teamwork in hospitals in rural areas of developing countries, this study investigates the relationships among perceived similarity, multidisciplinarity, coordination and perceived quality of care in rural Chinese hospitals. Methods: We conducted a quantitative study via an online survey in four rural county-level hospitals from different provincial administrative regions in China. 1017 respondents including doctors, nurses and other healthcare professionals provided valid responses. A multilevel moderated mediation model was used for data analysis. Results: Perceived similarity is positively related to coordination, which in turn leads to higher perceived quality of care. Coordination partially mediates the relationship between perceived similarity and perceived quality of care. However, multidisciplinarity does not moderate the effect of perceived similarity on coordination. Conclusions: Perceived similarity can promote coordination and subsequently perceived quality of care. Multidisciplinarity does not moderate the relationship between perceived similarity and coordination, and further research into the role of multidisciplinarity is called for. Hospital management may leverage the advantage of similarity to form teams whose members perceive each other as similar. The functioning of teams perceived as less similar may require additional effort to promote coordination and perceived quality of care. Such challenges caused by dissimilarity are especially relevant in the process of workforce strengthening with the aim of quality improvement towards universal health coverage in rural areas of developing countries.