Chapter 2 Getting everyone on the same page

In designing, implementing, and evaluating organizational interventions, program logic plays a central role as it outlines the core components of the intervention and links them to both proximal and distal outcomes. Also, central in the design, implementation, and evaluation of organizational interventions is the engagement of stakeholders across the organization (employees, managers, and specialists). Concrete tools are lacking for stakeholders to be engaged in the design of interventions and in defining criteria that can guide evaluation. This chapter outlines a structured process – the cocreated program logic (COP) process – for how organizational stakeholders can be involved in defining intervention goals and activities and thus forming the program logic together with interventionists (researchers or consultants). The program logic can then be used to guide the evaluation of the organizational intervention. The authors present two cases illustrating how the COP process has been used in their reserach. The chapter ends with lessons learned

Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work

<p>Abstract</p> <p>Objective</p> <p>Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors.</p> <p>Methods</p> <p>The study was set in a Swedish university hospital ED during the initial phase of implementation of teamwork. The intervention focused on changing the environment and redesigning the work process to enable teamwork. Each team was responsible for entire care episodes, i.e. from patient arrival to discharge from the ED. Data was collected through 3 days of observations structured around an observation scheme. Behavior analysis was used to pinpoint key teamwork behaviors for consistent implementation of teamwork and to analyze the contingencies that decreased or increased the likelihood of these behaviors.</p> <p>Results</p> <p>We found a great discrepancy between the planned and the observed teamwork processes. 60% of the 44 team patients observed were handled solely by the appointed team members. Only 36% of the observed patient care processes started according to the description in the planned teamwork process, that is, with taking patient history together. Beside this behavior, meeting in a defined team room and communicating with team members were shown to be essential for the consistent implementation of teamwork. Factors that decreased the likelihood of these key behaviors included waiting for other team members or having trouble locating each other. Getting work done without delay and having an overview of the patient care process increased team behaviors. Moreover, explicit instructions on when team members should interact and communicate increased adherence to the planned process.</p> <p>Conclusions</p> <p>This study illustrates how behavior analysis can be used to understand discrepancies between planned and observed behaviors. By examining the contextual conditions that may influence behaviors, improvements in implementation strategies can be suggested. Thereby, the adherence to a planned intervention can be improved, and/or revisions of the intervention be suggested.</p

Are We All in the Same Boat? The Role of Perceptual Distance in Organizational Health Interventions

The study investigates how agreement between leaders' and their team's perceptions influence intervention outcomes in a leadership-training intervention aimed at improving organizational learning. Agreement, i.e. perceptual distance was calculated for the organizational learning dimensions at baseline. Changes in the dimensions from pre-intervention to post-intervention were evaluated using polynomial regression analysis with response surface analysis. The general pattern of the results indicated that the organizational learning improved when leaders and their teams agreed on the level of organizational learning prior to the intervention. The improvement was greatest when the leader's and the team's perceptions at baseline were aligned and high rather than aligned and low. The least beneficial scenario was when the leader's perceptions were higher than the team's perceptions. These results give insights into the importance of comparing leaders' and their team's perceptions in intervention research. Polynomial regression analyses with response surface methodology allow three-dimensional examination of relationship between two predictor variables and an outcome. This contributes with knowledge on how combination of predictor variables may affect outcome and allows studies of potential non-linearity relating to the outcome. Future studies could use these methods in process evaluation of interventions

Leading well is a matter of resources : leader vigour and peer support augments the relationship between transformational leadership and burnout

Although studies suggest that transformational leaders play an important role in employee health and well-being, the relationship between transformational leadership and employee burnout remains unclear. One reason may be that moderators may play an important role. Building on conservation of resources theory, we examined if leaders’ perceptions of internal and external resources in terms of vigour and peer support augmented the relationship between transformational leadership and employee burnout in a sample of municipality workers and their leaders in Sweden (N = 217). Multilevel analyses over two time points revealed that both vigour and peer support enhance this relationship, such that when leaders experience high levels of vigour or peer support, the negative relationship between transformational leadership behaviours and employee burnout was strengthened. Our findings suggest that both personal and contextual resources may help leaders to better engage in transformational leadership, which is important in order to protect employees from burning out

Using kaizen to improve employee well-being: Results from two organizational intervention studies

Participatory intervention approaches that are embedded in existing organizational structures may improve the efficiency and effectiveness of organizational interventions, but concrete tools are lacking. In the present paper, we use a realist evaluation approach to explore the role of kaizen, a lean tool for participatory continuous improvement, in improving employee wellbeing in two cluster-randomized, controlled participatory intervention studies. Case 1 is from the Danish Postal Service where kaizen boards were used to implement action plans. The results of multi-group structural equation modeling showed that kaizen served as a mechanism that increased the level of awareness of and capacity to manage psychosocial issues, which in turn predicted increased job satisfaction and mental health. Case 2 is from a regional hospital in Sweden that integrated occupational health processes with a pre-existing kaizen system. Multi-group structural equation modeling revealed that, in the intervention group, kaizen work predicted better integration of organizational and employee objectives after 12 months, which in turn predicted increased job satisfaction and decreased discomfort at 24 months. The findings suggest that participatory and structured problem-solving approaches that are familiar and visual to employees can facilitate organizational interventions

No leader is an island : contextual antecedents to line managers’ constructive and destructive leadership during an organizational intervention

Purpose: Line managers can make or break organizational interventions, yet little is known about what makes them turn in either direction. As leadership does not occur in a vacuum it has been suggested that the organizational context plays an important role. Building on the intervention and leadership literature, we examine if span of control and employee readiness for change are related to line managers’ leadership during an organizational intervention. Design: Leadership is studied in terms of intervention-specific constructive, as well as passive and active forms of destructive, leadership behaviors. As a sample, we use employees (N = 172) from 37 groups working at a process industry plant. Multilevel analyses over two time points, with both survey and organizational register data were used to analyze the data. Findings: The results revealed that span of control was negatively related to constructive leadership and positively related to passive destructive leadership during the intervention. Employee readiness for change was positively related to constructive leadership, and negatively related to both passive and active destructive leadership. Practical implications: Our findings suggest that contextual factors need to be assessed and considered if we want line managers to engage in constructive rather than destructive leadership during interventions. Originality/value: The present study is the first to address line managers’ making or breaking of organizational interventions by examining the influence of context on both their destructive and constructive leadership

All by myself: How perceiving organizational constraints when others do not hampers work engagement

Organizational constraints (OCs) represent work conditions that interfere with employees’ performance. Although employees share the same work environment, perceptions of OCs may vary among team members. In this study, we examined employee–teammate perceptual congruence and incongruence regarding three types of OCs (i.e., social, structural, and infrastructure) and the associated consequences for employee work engagement among health care employees from two Spanish hospitals (N = 141). Multilevel polynomial regression with response surface analyses revealed that the perceptual congruence and incongruence effects depended on the type of OCs. Congruence in perceptions was linked with greater work engagement only for social OCs. Incongruence had an effect in cases of social and structural OCs, but not infrastructure OCs: work engagement was worse when an employee rated OCs as higher (i.e., more problematic) than their teammates did. Our findings suggest that the negative effects of OCs are additionally exacerbated by perceptual incongruence with teammates and indicate the need to include social contexts in the study of work environment perceptions

Beyond the individual: A systematic review of the effects of unit-level demands and resources on employee productivity, health, and well-being

Creating sustainable employment—that is, a condition in which employees remain productive but also enjoy good health and well-being—is a challenge for many organizations. Work environment factors are major contributors to these employee outcomes. The job demands–resources model categorizes work environment factors into demands versus resources, which are, respectively, detrimental versus beneficial to employee outcomes. Although conceptualized as workplace factors, these job characteristics have been studied mostly at an individual level. Therefore, their roles at the supraindividual level (i.e., any work-unit level above an individual, such as group or organization) for employee productivity, health, and well-being remains unclear. The aim of this systematic review is to synthesize evidence concerning job resources and job demands at the supraindividual level and their relationships to productivity, health, and work-related well-being. The review covers articles published through December 2018. In total, 202 papers met the inclusion criteria. We found stronger support for the beneficial roles of supraindividual job resources than for the detrimental roles of job demands for productivity and work-related well-being. Regarding health, most of the relationships were found to be nonsignificant. To conclude, this review demonstrates that, at the supraindividual level, the motivational path has received more support than the health impairment path. Based on these findings, we provide recommendations for further research and practice

Integrating a transfer perspective into evaluations of leadership training

Purpose: In previous studies, outcomes of leadership training have varied, with some studies suggesting large effects and others small. Although the transfer of training literature suggests a number of factors that influence training outcomes, this knowledge has seldom been used when evaluating the outcomes of leadership training. The purpose of the present study is therefore to examine how factors related to transfer of training influence outcomes of leadership training. Design: In the present research, follower-rated outcomes of a leadership training programme in Denmark (N = 298) was examined from a transfer of training perspective. Findings: Using Baldwin and Ford’s Transfer of Training Model as a framework, analyses revealed that leaders’ utility reactions (i.e., perception of usefulness) and learning were linked to transfer of training. In addition, leaders’ perceptions of transfer were associated with post-intervention follower-rated transformational leadership and collective self-efficacy. Practical implications: Making sure that leaders find the training useful for their everyday activities (i.e. positive utility reactions) and that they have time to learn the training content is important to enable transfer, and that leaders to use trained skills back at work. Originality: The findings indicate the importance of understanding how leaders’ perception of the training content influence leadership training outcomes, and that these perceptions need to be part of the evaluation of leadership training. In addition, the findings suggest that factors predicting transfer of leadership training differ from other types of training

Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department: a comparative case study

BACKGROUND While there is strong support for the benefits of working in multi-professional teams in health care, the implementation of multi-professional teamwork is reported to be complex and challenging. Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited. There is a lack of studies focusing on the functions of different behavior change interventions and the mechanisms driving behavior change. In this study, applied behavior analysis is used to analyze the function and impact of different behavior change interventions when implementing multi-professional teamwork. METHODS A comparative case study design was applied. Two sections of an emergency department implemented multi-professional teamwork involving changes in work processes, aimed at increasing inter-professional collaboration. Behavior change interventions and staff behavior change were studied using observations, interviews and document analysis. Using a hybrid thematic analysis, the behavior change interventions were categorized according to the DCOM® model. The functions of the behavior change interventions were then analyzed using applied behavior analysis. RESULTS The two sections used different behavior change interventions, resulting in a large difference in the degree of staff behavior change. The successful section enabled staff performance of teamwork behaviors with a strategy based on ongoing problem-solving and frequent clarification of directions. Managerial feedback initially played an important role in motivating teamwork behaviors. Gradually, as staff started to experience positive outcomes of the intervention, motivation for teamwork behaviors was replaced by positive task-generated feedback. CONCLUSIONS The functional perspective of applied behavior analysis offers insight into the behavioral mechanisms that describe how and why behavior change interventions influence staff behavior. The analysis demonstrates how enabling behavior change interventions, managerial feedback and task-related feedback interact in their influence on behavior and have complementary functions during different stages of implementation.Mandus Frykman, Henna Hasson, Åsa Muntlin Athlin, and Ulrica von Thiele Schwar