Understanding Care Team Assets: Implications for Connecting to Community

A Dissertation Presented to the Faculty of The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.

Community connections are an important element of chronic disease management. This is especially true when providers treat patients from culturally diverse communities, because community connections offer providers an understanding of socio-cultural factors that influence health behavior.  To date, community ties have been examined at the organizational level and valued as a mechanism by which to reach diverse populations. Connection to community increases organizational presence, providing both the organization and the community with useful information about one another and helping to facilitate trust in the community.

This dissertation explores the nature of community connections at the care team level. Using social capital theory, team member community connections are explained as ‘weak’ ties, which facilitate the growth of member human capital.  The type of human capital considered here is knowledge of patient socio-environmental and cultural context.  Connection to the community fosters care team knowledge of contextual factors associated with disease management, potentially increasing the care team’s effectiveness. 

A health care organization with multiple ambulatory care sites was examined.  Sites that had implemented diabetes care teams were targeted.  Both qualitative and quantitative methodologies were employed. Data Envelopment Analysis (DEA) was used to rank team performance.   Observations were conducted at six centers with twenty-seven care teams, and policy guidelines were reviewed.  Care teams members across sites were asked to complete surveys related to community connections, cultural intelligence, and socio-cultural relational coordination.  Teams at four of the six centers (eighteen teams) participated in the survey.

This research brought to light inconsistencies in care team structure across sites, which are likely the result of the complex adaptive nature of health care delivery groups. Low, high, and super performing teams were identified both across and within sites.  No statistically significant associations were found between community connections and team performance.  However, a statistically significant negative relationship between team performance and teams that reported seeking information related to patient contextual factors at community agencies emerged. In addition, respondents reported that working at their given ambulatory care sites resulted in the development of connections to the community beyond preexisting network ties.  The construct of socio-cultural relational coordination was developed and discussed as a tool for examining cultural competence. Finally, implications for the implementation of the Culturally and Linguistically Appropriate Services (CLAS) policy were discussed using an asset-based lens.