'Team capital’ in quality improvement teams: findings from an ethnographic study of front-line quality improvement in the NHS

Catherine Montgomery* (Corresponding Author), Stephen Parkin, Alison Chisholm, Louise Locock

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
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Background Teamwork is important in the design and delivery of initiatives in complex healthcare systems but the specifics of quality improvement (QI) teams are not well studied.

Objective To explain the functioning of front-line healthcare teams working on patient-centred QI using Bourdieu’s sociological construct of capital.

Methods One medical ward from each of six NHS Trusts in England participated in the study, purposively selected for a range of performance levels on patient experience metrics. Three ethnographers conducted focused ethnography for 1 year, using interviews and observations to explore the organisation, management and delivery of patient-centred QI projects by the six front-line teams. Data were analysed using Bourdieu’s typology of the four forms of capital: economic, social, symbolic and cultural.

Results While all teams implemented some QI activities to improve patient experience, progress was greater where teams included staff from a broad range of disciplines and levels of seniority. Teams containing both clinical and non-clinical staff, including staff on lower grades such as healthcare assistants and clerks, engaged more confidently with patient experience data than unidisciplinary teams, and implemented a more ambitious set of projects. We explain these findings in terms of ‘team capital’.

Conclusion Teams that chose to restrict membership to particular disciplines appeared to limit their capital, whereas more varied teams were able to draw on multiple resources, skills, networks and alliances to overcome challenges. Staff of varying levels of seniority also shared and valued a broader range of insights into patient experience, including informal knowledge from daily practice. The construct of ‘team capital’ has the potential to enrich understanding of the mechanism of teamwork in QI work.
Original languageEnglish
Article numbere000948
Number of pages9
JournalBMJ Open Quality
Issue number2
Early online date26 May 2020
Publication statusPublished - 2020

Bibliographical note

Acknowledgements: The authors would like to thank the ward teams and senior
management teams at the six participating case study sites, as well as the US-PEx team of investigators and lay panel members. All authors were employed by the Nuffield Department of Primary Care Health Sciences at the University of Oxford at the time of undertaking the research. The views expressed are those of the authors and do not necessarily reflect the views and opinions of the authors' institutions.

Funding: This research was funded by the NIHR Health Services and Delivery
Research Programme 14/156/06, with scholarship by CM supported in part by the Wellcome Trust through grant number 209519/Z/17/Z. LL was supported by Oxford
NIHR Biomedical Research Centre. The views expressed are those of the authors
and not necessarily those of the NHS, the NIHR or the Department of Health and
Social Care.


  • patient-centred care
  • qualitative research
  • quality improvement
  • teamwork


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