Teamwork in Colorectal Cancer Screenings: A Closer Look at Federally Qualified Health Centers

Objective Explore multi-level drivers of effective teamwork in colorectal cancer screening (CRCS) at institutions that serve persistently impoverished patients. Background Teamwork is vital to quality care in outpatient settings, including routine cancer screenings. In recent years, CRCS guidelines have changed, decreasing the screening age from 50 to 45 years. Institutions that serve individuals who live in persistent poverty have lower CRCS rates. Teamwork, and other institutional characteristics that facilitate or hinder success of care coordination, test ordering, and results communication have been underexplored in this area. Method We collected qualitative and quantitative data through surveys and interviews of providers at seven Federally Qualified Health Centers located in the Midwest region of the United States. Data were gathered concordantly, analyzed separately, and merged for mixed method integration according to a scientifically-based heuristic for teamwork, the 7 Cs of teamwork. Results Fourteen providers participated, including primary care providers and staff. Organizational-level conditions, such as time, staff availability, and materials appeared to bar successful CRCS. Interestingly, several team-level factors, such as communication and coordination, reportedly served to facilitate CRCS when staffing was sufficient. Cognitions within clinic teams were good; however, several barriers to shared cognition were noted when clinicians interfaced with patients. Additionally, patient-level characteristics were noted to impede collaborative work in CRCS completion. Discussion Teamwork facilitates CRCS; however, several organizational conditions impede CRCS completion. Needs arose for including the patient in shared decision making as well as the pros and cons of coordination via EHR. Conclusions Multi-level drivers to successful CRCS were identified at the individual, team, and organizational level. Interventions seeking to improve CRCS should target identified levels in clinics serving persistently impoverished patient populations.