Joint Problem-Solving orientation, Mutual Value Recognition, and Performance in Fluid Teamwork Environments

INTRODUCTION: Joint problem-solving orientation (JPS) has been identified as a factor that promotes performance in fluid teamwork, but research on this factor remains nascent. This study pushes the frontier of understanding about JPS in fluid teamwork environments by applying the concept to within-organization work and exploring its relationships with performance, mutual value recognition (MVR), and expertise variety (EV). METHODS: This is a longitudinal, survey-based field study within a large United States healthcare organization RESULTS: Our results affirm a moderated mediation model wherein JPS enhances performance, both directly and through MVR; EV serves as a moderator in the JPS-MVR relationship. JPS positively influences MVR, irrespective of whether EV is high or low. When JPS is lower, greater EV is associated with lower MVR, whereas amid high JPS, greater EV is associated with higher MVR, as compared to lower EV. DISCUSSION: Our findings lend further evidence to the value of JPS in fluid teamwork environments for enabling performance, and we document for the first time its relevance for within-organization work. Our results suggest that one vital pathway for JPS to improve performance is through enhancing recognition of the value that others offer, especially in environments where expertise variety is high

Joint problem-solving orientation, mutual value recognition, and performance in fluid teamwork environments

IntroductionJoint problem-solving orientation (JPS) has been identified as a factor that promotes performance in fluid teamwork, but research on this factor remains nascent. This study pushes the frontier of understanding about JPS in fluid teamwork environments by applying the concept to within-organization work and exploring its relationships with performance, mutual value recognition (MVR), and expertise variety (EV).MethodsThis is a longitudinal, survey-based field study within a large United States healthcare organization n = 26,319 (2019 response rate = 87%, 2021 response rate = 80%). The analytic sample represents 1,608 departmental units in both years (e.g., intensive care units and emergency departments). We focus on departmental units in distinct locations as the units within which fluid teamwork occurs in the hospital system setting. Within these units, we measure JPS in 2019 and MVR in 2021, and we capture EV by unit using a count of the number of disciplines present. For a performance measure, we draw on the industry-used measurement of perceived care quality and safety. We conduct moderated mediation analysis testing (1) the main effect of JPS on performance, (2) mediation through MVR, and (3) EV as a moderator.ResultsOur results affirm a moderated mediation model wherein JPS enhances performance, both directly and through MVR; EV serves as a moderator in the JPS-MVR relationship. JPS positively influences MVR, irrespective of whether EV is high or low. When JPS is lower, greater EV is associated with lower MVR, whereas amid high JPS, greater EV is associated with higher MVR, as compared to lower EV.DiscussionOur findings lend further evidence to the value of JPS in fluid teamwork environments for enabling performance, and we document for the first time its relevance for within-organization work. Our results suggest that one vital pathway for JPS to improve performance is through enhancing recognition of the value that others offer, especially in environments where expertise variety is high

Enhancing Gender Equity in Academia: Lessons from the ADVANCE Program

Women are underrepresented in U.S. tenure-track faculty positions, and institutional interventions are key to creating greater gender equality and accessing women’s potential. This study examines the effectiveness of one “transformational” intervention, the ADVANCE Institutional Transformation initiative, implemented at the University of California, Irvine (UCI), in 2001. We compare data on women’s representation in faculty positions before and during the UCI ADVANCE Program (1993–2009) to that of seven other campuses in the University of California system, where no initiatives of this scale were implemented. Using descriptive figures, T tests, and regression analyses, we find that UCI had a higher percentage of women faculty and hired a greater percentage of women during ADVANCE years, but did not retain women at a greater rate. We describe the UCI ADVANCE program and its structure, including its “Equity Advisors,” who we suggest have been important in improving women’s representation among faculty at UCI

Streamlining Care in Crisis: Rapid Creation and Implementation of a Digital Support Tool for COVID-19

The unprecedented COVID-19 pandemic has resulted in rapidly evolving best practices for transmission reduction, diagnosis, and treatment. A regular influx of new information has upended traditionally static hospital protocols, adding additional stress and potential for error to an already overextended system. To help equip frontline emergency clinicians with up-to-date protocols throughout the evolving COVID-19 crisis, our team set out to create a dynamic digital tool that centralized and standardized resources from a broad range of platforms across our hospital. Using a design thinking approach, we rapidly built, tested, and deployed a solution using simple, out-of-the-box web technology that enables clinicians to access the specific information they seek within moments. This platform has been rapidly adopted throughout the emergency department, with up to 70% of clinicians using the digital tool on any given shift and 78.6% of users reporting that they “agree” or “strongly agree” that the platform has affected their management of COVID-19 patients. The tool has also proven easily adaptable, with multiple protocols being updated nearly 20 times over two months without issue. This paper describes our development process, challenges, and results to enable other institutions to replicate this process to ensure consistent, high-quality care for patients as the COVID-19 pandemic continues its unpredictable course

Voice is not enough: A multilevel model of how frontline voice can reach implementation

IssueWhen frontline employees' voice is not heard and their ideas are not implemented, patient care is negatively impacted, and frontline employees are more likely to experience burnout and less likely to engage in subsequent change efforts.Critical theoretical analysisTheory about what happens to voiced ideas during the critical stage after employees voice and before performance outcomes are measured is nascent. We draw on research from organizational behavior, human resource management, and health care management to develop a multilevel model encompassing practices and processes at the individual, team, managerial, and organizational levels that, together, provide a nuanced picture of how voiced ideas reach implementation.Insight/advanceWe offer a multilevel understanding of the practices and processes through which voice leads to implementation; illuminate the importance of thinking temporally about voice to better understand the complex dynamics required for voiced ideas to reach implementation; and highlight factors that help ideas reach implementation, including voicers' personal and interpersonal tactics with colleagues and managers, as well as senior leaders modeling and explaining norms and making voice-related processes and practices transparent.Practice implicationsOur model provides evidence-based strategies for bolstering rejected or ignored ideas, including how voicers (re)articulate ideas, whom they enlist to advance ideas, how they engage peers and managers to improve conditions for intentional experimentation, and how they take advantage of listening structures and other formal mechanisms for voice. Our model also highlights how senior leaders can make change processes and priorities explicit and transparent

Streamlining Care in Crisis: Rapid Creation and Implementation of a Digital Support Tool for COVID-19

The unprecedented COVID-19 pandemic has resulted in rapidly evolving best practices for transmission reduction, diagnosis, and treatment. A regular influx of new information has upended traditionally static hospital protocols, adding additional stress and potential for error to an already overextended system. To help equip frontline emergency clinicians with up-to-date protocols throughout the evolving COVID-19 crisis, our team set out to create a dynamic digital tool that centralized and standardized resources from a broad range of platforms across our hospital. Using a design thinking approach, we rapidly built, tested, and deployed a solution using simple, out-of-the-box web technology that enables clinicians to access the specific information they seek within moments. This platform has been rapidly adopted throughout the emergency department, with up to 70% of clinicians using the digital tool on any given shift and 78.6% of users reporting that they “agree” or “strongly agree” that the platform has affected their management of COVID-19 patients. The tool has also proven easily adaptable, with multiple protocols being updated nearly 20 times over two months without issue. This paper describes our development process, challenges, and results to enable other institutions to replicate this process to ensure consistent, high-quality care for patients as the COVID-19 pandemic continues its unpredictable course

The ambiguity of “we”: Perceptions of teaming in dynamic environments and their implications

In healthcare, organizations increasingly call on clinicians and staff to team up fluidly to deliver integrated services across disciplines and settings. Yet little is known about how clinicians and staff perceive of team membership in healthcare environments where team boundaries are often ambiguous and continually shifting. We draw on the context of primary care in the United States, where fluid multi-disciplinary teamwork is commonly exhorted, to investigate the extent to which clinicians and staff perceive of various roles (e.g., physician, front desk) as members in their teams, and to identify potential implications. Using a survey fielded within 59 clinics (n = 828), we find substantial variation in individuals' perceptions of the roles they consider as team members during an episode of care (e.g., mean team size = 10.60 roles; standard deviation = 5.09). Perceiving more expansive sets of roles as team members exhibits a positive association with performance as measured by care quality (b = 0.02; p <.01) but a curvilinear association with job satisfaction. Separating an individual's perceived core (roles always perceived as part of the team) and periphery (roles sometimes perceived as part of the team), perceiving a larger core is positively associated with performance (b = 0.03 p <.01). In contrast, perceiving a larger periphery is marginally negatively associated with performance (b = −0.02, p <.10). This appears to be driven by divergence from the norm perception of the core, i.e., when individuals attribute to the periphery the roles that are considered by most others to be core. Our findings suggest that individuals viewing the roles they must team with more expansively may generate higher quality output but experience a personal toll. Delivering on the ideal of team-based care in dynamic environments may require helping team members gain clarity about their teammates and implementing policies that attend to job satisfaction as team boundaries shift and expand

The dynamics of integration and integrated care: An exploratory study of physician organizations

Background Substantial variation exists in how well health care is integrated, even across similarly structured organizations, yet research about what physician organizations (POs) do that enables or inhibits integrated care is limited. Purpose The aim of this study was to explore the dynamics that enable POs to integrate care. Methodology/Approach We ranked a stratified sample of POs according to patient perceptions of integrated care, as measured in a survey. We interviewed professionals, patients, and family members in 10 higher and 3 lower ranked POs about the process of caring for patients with complex conditions. We derived integration-related themes from the interview data and quantified their prevalence. Using a quasi-statistical approach, we explored relationships among themes and their associations with patient perceptions of integrated care. Results From 6,104 coded references, we derived a set of themes representing integration perspectives, integration engagement mechanisms, and integration failures. POs experienced frequent integration failures. Higher ranked POs experienced these failures less often because of a combination of functional, interpersonal, and stakeholder engagement mechanisms, which appear to complement one another. Integration perspectives, including both people-oriented and systems-oriented mindsets, appear to play a role in generating these integration dynamics. Conclusion Delivering integrated care depends on a PO's ability to limit integration failures, keeping provider attention focused on patients. Building on the attention-based view, we present a framework suggesting that this ability is a function of both integration perspectives and integration engagement mechanisms. Practice Implications POs interested in delivering more integrated care should employ a variety of complementary integration engagement mechanisms and facilitate these efforts by nurturing both people-oriented and system-oriented mindsets among PO decision-makers

Team and leadership factors and their relationship to burnout in emergency medicine during COVID-19: A 3-wave cross-sectional study.

ObjectiveWe examined the relationship of team and leadership attributes with clinician feelings of burnout over time during the corona virus disease 2019 (COVID-19) pandemic.MethodsWe surveyed emergency medicine personnel at 2 California hospitals at 3 time points: July 2020, December 2020, and November 2021. We assessed 3 team and leadership attributes using previously validated psychological scales (joint problem-solving, process clarity, and leader inclusiveness) and burnout using a validated scale. Using logistic regression models we determined the associations between team and leadership attributes and burnout, controlling for covariates.ResultsWe obtained responses from 328, 356, and 260 respondents in waves 1, 2, and 3, respectively (mean response rate&nbsp;=&nbsp;49.52%). The median response for feelings of burnout increased over time (2.0, interquartile range [IQR]&nbsp;=&nbsp;2.0-3.0 in wave 1 to 3.0, IQR&nbsp;=&nbsp;2.0-3.0 in wave 3). At all time points, greater process clarity was associated with lower odds of feeling burnout (odds ratio [OR] [95% confidence interval (CI)&nbsp;=&nbsp;0.36 [0.19, 0.66] in wave 1 to 0.24 [0.10, 0.61] in wave 3). In waves 2 and 3, greater joint problem-solving was associated with lower odds of feeling burnout (OR [95% CI]&nbsp;=&nbsp;0.61 [0.42, 0.89], 0.54 [0.33, 0.88]). Leader inclusiveness was also associated with lower odds of feeling burnout (OR [95% CI]&nbsp;=&nbsp;0.45 [0.27, 0.74] in wave 1 to 0.41 [0.24, 0.69] in wave 3).ConclusionsProcess clarity, joint problem-solving, and leader inclusiveness are associated with less clinician burnout during the COVID-19 pandemic, pointing to potential benefits of focusing on team and leadership factors during crisis. Leader inclusiveness may wane over time, requiring effort to sustain