Measuring team development in clinical care settings.

BACKGROUND AND OBJECTIVES Our objective was to describe the psychometric properties of a measure of team development that can be used to assess and guide team functioning in health care settings. METHODS The Team Development Measure (TDM) is a 31-item questionnaire constructed using the Rasch rating scale measurement model. We conducted an Mplus exploratory factor analysis using data collected from 1,194 individuals representing 120 different teams. Team size ranged from three to 39 members from rural and urban inpatient and ambulatory health care settings. Here we characterize the domains of teamness, while taking into account the development of teams over time. RESULTS The TDM was found to have good psychometric properties with little measurement error and a Rasch person reliability of 0.95. Overall Cronbach's alpha was 0.97. An Mplus exploratory factor analysis combined with the stochastic nature of the Rasch model suggests a developmental sequence in building teams consisting of four sub-domains with the following mean item difficulty scores: cohesion=40.5, standard deviation (SD)=2.68, communication=49.3 (SD=2.78), roles and goals=52.7 (SD=2.74), and team primacy=53.3 (SD=1.06). This pattern suggests cohesiveness is an initial element for team development, followed by communication, roles and goals clarity, and team primacy. CONCLUSIONS We developed and tested a measure of team development that has strong psychometric properties. This tool could be used to study how team functioning affects clinical outcomes and as a quality improvement tool to improve team function.