Self-reported teamwork in family health team practices in Ontario:Organizational and cultural predictors of team climate

Objective: To determine the organizational predictors of higher scores on team climate measures as an indicator of the functioning of a family health team (FHT). Design: Cross-sectional study using a mailed survey. Setting: Family health teams in Ontario. Participants: Twenty-one of 144 consecutively approached FHTs; 628 team members were surveyed. Main outcome measures: Scores on the team climate inventory, which assessed organizational culture type (group, developmental, rational, or hierarchical); leadership perceptions; and organizational factors, such as use of electronic medical records (EMRs), team composition, governance of the FHT, location, meetings, and time since FHT initiation. All analyses were adjusted for clustering of respondents within the FHT using a mixed random-intercepts model. Results: The response rate was 65.8% (413 of 628); 2 were excluded from analysis, for a total of 411 participants. At the time of survey completion, there was a median of 4 physicians, 11 other health professionals, and 4 management and clerical staff per FHT. The average team climate score was 3.8 out of a possible 5. In multivariable regression analysis, leadership score, group and developmental culture types, and use of more EMR capabilities were associated with higher team climate scores. Other organizational factors, such as number of sites and size of group, were not associated with the team climate score. Conclusion: Culture, leadership, and EMR functionality, rather than organizational composition of the teams (eg, number of professionals on staff, practice size), were the most important factors in predicting climate in primary care teams.

The Politics of Actually Existing Unsustainability:Human Flourishing in a Climate-Changed, Carbon-Constrained World

Going against both the naive techno-optimist of ‘greening business as usual’ and a resurgent ‘catastrophism’ within green thinking and politics, The Politics of Actually Existing Unsustainability offers an analysis of the causes of unsustainability and diminished human flourishing. The books locates the causes of unsustainability in dominant capitalist modes of production, debt-based consumer culture, the imperative for orthodox economic growth and the dominant ideology of neoclassical economics. It suggests that valuable insights into the causes of and alternatives to unsustainability can be found in a critical embracing of human vulnerability and dependency as both constitutive and ineliminable aspects of what it means to be human. The book defends resilience, the ability to ‘cope with’ rather than somehow ‘solve’ vulnerability. The book offers a trenchant critique of the dominant neoclassical economic ‘groupthink’, viewing it not as some value-neutral form of ‘expert knowledge’, but as a thoroughly ideological ‘common sense’. Outlining a green political economic alternative replacing economic growth with economic security, it argues economic growth has done its work in the minority, affluent world, which should now focus on improving human flourishing, lowering socio-economic equality and fostering solidarity as part of a new re-orientation of public policy. Complementing this, a, ‘green republicanism’ is developed as an innovative and original contribution to contemporary debates on a ‘post-growth’ economy and society. The Politics of Actually Existing Unsustainability draws widely from a range of disciplines and thinkers, from cultural critic Susan Sontag to the critical theory of the Frankfurt School, contemporary debates in green political thinking, and the latest thinking in heterodox and green economics, to produce a highly relevant, timely, and provocatively original statement on the human predicament in the twenty-first century.