Learning From Pursuing Perfection: Science or only Stories?. From: Bill Mahoney [mailto:bilmah@telebyte.com]
Sent: Thursday, May 16, 2002 9:39 AM
To: Minniti, Mary; Donelson, Sarah
Cc: Stock, Ron (MD); Pierson, Marc; Scott, Jim (MD); Meyer, Summer
Subject: Re: Clinic Teams
Mary and all
I have a difficult time seeing how the team measure can be used to measure cooperation. It is certainly true that part of the role of a team member is "being cooperative" within the context of the team, the team measure does not directly assess cooperation. At best, you might be able to make some empirically unfounded extrapolations from the level of team development to assuming cooperation, but this would largely be a leap of faith.
In the context of the larger patient-centered care model I have been working with/developing there are several key variables (patient-centered cultural context, patient-centered leadership, team development, activated patient, etc.) that are closely related, but conceptually distinct. At the level of (necessary) detail that this model involves it is extremely important to make clear and maintain well-defined and empirically verified distinctions between these different constructs. Not doing so will, at best, result in confusion and, more certainly, the inability in the end to understand (from the empirical evidence) how much impact each of these key pieces has on the different outcomes.
If we think cooperation is a key concept that need to be made explicit, the concept needs to be defined and how the concept fits in the larger model needs to be explicitly stated (hypothesized). What I suspect at this point is that cooperation is a notion that is really just an independent variable that we think might impact one or more of the key components. For example, if the key players on the leadership team do not cooperate, the leadership team will not be a team. This will then lead to certain predictable (non)events. Right now, however, I just do not see this boring, but necessary conceptualization and so I am at somewhat of a loss as to the importance of whatever cooperation is.
For whatever it is worth (and at the risk of unintentionally offending by not saying it very well) let me tell you all my biases. In the end our part of P2 will be judged by our ability to understand and demonstrate what happened with hard scientific evidence. To a significant degree, 2 years from now there will be the need to call upon the research findings component of this project. Those research findings cannot magically appear. They will only come from irritatingly careful conceptualization, design and measurement that is put in place as soon after July 1 as possible. I know that this is my typical position that all of you have heard too many times. But we have the opportunity here to, in the end, be the stellar project of all of the P2 sites and I want us do everything we need to do to make that a reality. PeaceHealth is unique in that because of the wonderful people mix we have at all levels of the organization we are way out front of the rest of health care in many ways, including the whole conceptualization and understanding of patient-centerness. So you may have to rein Sarah and I in, but I think I speak for Sarah when I say that we will be bulldogs on having this project include rigorous standards of scientific research design and execution.
None of this is to say that this is not everyone's intention, but quite honestly, the research component seems to me at this point to be a little ambiguous. And this kind of ambiguity makes a researcher very, very nervous.
Bill
9:19:11 PM 
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