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Joint Problem-Solving in Fluid Health Care Teams
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Author: Michaela Kerrissey, Harvard U.
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In health care, teams working on process innovation often consist of people from different organizational groups who fluidly shift on and off the team. This research employs multiple methods to discover what factors enable teamwork in such a challenging team context. I studied fourteen teams that crossed organizations to design and implement a new patient referral and reporting process. All teams studied confronted challenges of cross-boundary communication and shifting membership. Some fared better than others. This appeared to be related to a group factor that I call a joint problem-solving orientation, describing the extent to which team members viewed problems as shared and solutions as requiring co-production. To further explore this concept, I collected survey data from a sample of 299 cross-organization teams to measure joint problem-solving orientation, document its variation, assess its reliability and discriminant validity as a construct, and explore its relationship to team effectiveness. This research contributes empirically- grounded insights to the emerging literature on dynamic forms of teamwork and to health care literature on process innovation and care integration. It surfaces joint problem-solving orientation as a measurable and actionable concept for use in future research and practice.
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Paper is No Longer Available Online: Please contact the author(s).
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Organized to Cooperate: Logics and Professional Collaboration in an Italian Medical Home
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Author: Marco Bottura, EDC Paris Business School
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Professional collaborations are influenced by Institutional logics and jurisdictional struggles at play in the specific healthcare system, especially in times of organizational change. I investigate professional collaborations pattern in an experimental medical home set up in Italy between 2013 and 2015. For this study, I conducted 36 semi-structured interviews corroborated by direct observations. My results highlight how today’s efficiency-oriented PSFs integrate instances of the former professional logics and other context-specific logics, creating an organizational-specific “mix” that guides interactions at the inter-professional level, helping to define or re- define collaborations inside these peculiar organizational forms.
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Paper is No Longer Available Online: Please contact the author(s).
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An Accountability Account? The Diverse Outcomes of Perceived Personal and Team Accountability
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Author: Anat Drach-Zahavy, U. of Haifa
Author: Marina Leonenko, Clalit Health Services
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Background: Despite the importance attributed to accountability in healthcare professionals' education and practice, empirical research lags well behind. Accountability has typically been studied as a personal or organizational characteristic. Few studies, if any, have focused on meso-level models of accountability: namely on the concomitant examination of personal and organizational accountability. Consequently, accountability research has shown mixed evidence: whereas several studies showed beneficial effects of accountability for performance, safety, and nurses’ satisfaction, other studies showed negative effects. Objective: To develop and test a meso-level model of accountability, proposing that the joint effects of personal and team (ward) accountability are distinctively linked to professionals’ performance, voice, loyalty, and neglect behaviors. Design: A cross-sectional nested design, where nurses were nested in wards. Participants: 148 nurses from 15 different wards. Data collection: Data were collected with validated questionnaires. Nurses’ performance was assessed by information gathered from patients’ medical records. Results: Findings from polynomic regression analysis demonstrated that performance scores were highest under the expected joint quadratic effects of high personal and high team accountability compared with the alternative combinations of personal and team accountability. Voice behaviors were highest under the joint effects of high personal and low team accountability compared with the alternative combinations of personal and team accountability; loyalty was higher as personal accountability decreased, whereas team accountability was not linked to it; and neglect behaviors were highest as the quadratic effects of personal and team accountability decreased. Discussion and conclusions: The findings support a meso-level integrative model of accountability, which stresses the idea that accountability grows within a context. In other words, personal accountability is not a sufficient predictor of outcomes. On the contrary, outcomes depend critically upon the level of team accountability, and only the combination (fit or misfit) of personal and organizational accountability can be distinctively linked to performance exit, voice, loyalty, or neglect behaviors. The implications of these findings for policy makers and nursing managers are discussed.
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Paper is No Longer Available Online: Please contact the author(s).
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Laminated Uncertainties and Teams
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Author: Issac Lim, U. of Oxford
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Teams in organization are de facto units that formulate plans and strategies for organizations. Conceivably, they encounter large number of uncertainties in the process of accomplishing their task on a day- to-day basis. Yet, we know very little about the implications of different types of uncertainty on teams. In this paper, I use real- life case narratives of two crises – the Boston Marathon Bombing and the Bristol Royal Infirmary Inquiry – as sources of inspiration and stimulation to develop a laminated approach to conceptualizing uncertainty. I borrow ideas from complexity science to disentangle the multifaceted concept of uncertainty.
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Paper is No Longer Available Online: Please contact the author(s).
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Coordinating through Dialogical Presentation Practices
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Author: Wadih Renno, McGill U.
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Coordinating in organizations is not an easy endeavor. Research has identified a wide variety of formal and informal coordinating mechanisms that support organizational work (Faraj & Xiao, 2006; Okhuysen & Bechky, 2009), yet we still know little about how coordinating is achieved in practice. This manuscript introduces posits dialogical presentation practices (DPP) as a fundamental element of coordinating processes. Framing the discussion within the setting on a Neonatal Intensive Care Unit, I show how DPPs and processes incorporating them allow individuals to build a common understanding of the past, project it in the future, and delineate actions in the process to connect the two. Through this process, individuals make themselves accountable for past action and update predictability, either by confirming current practices that work, or by learning from discrepancies, and updating or changing practices. Through their practices, they thus construct the conditions for coordination (common understanding, accountability, and predictability, Okhuysen & Bechky, 2009).
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Paper is No Longer Available Online: Please contact the author(s).
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