Melissa Valentine

Measuring Teamwork in Health Care Settings: A Review of Survey Instruments

Background:Teamwork in health care settings is widely recognized as an important factor in providing high-quality patient care. However, the behaviors that comprise effective teamwork, the organizational factors that support teamwork, and the relationship between teamwork and patient outcomes remain empirical questions in need of rigorous study. Objective:To identify and review survey instruments used to assess dimensions of teamwork so as to facilitate high-quality research on this topic. Research Design:We conducted a systematic review of articles published before September 2012 to identify survey instruments used to measure teamwork and to assess their conceptual content, psychometric validity, and relationships to outcomes of interest. We searched the ISI Web of Knowledge database, and identified relevant articles using the search terms team, teamwork, or collaboration in combination with survey, scale, measure, or questionnaire. Results:We found 39 surveys that measured teamwork. Surveys assessed different dimensions of teamwork. The most commonly assessed dimensions were communication, coordination, and respect. Of the 39 surveys, 10 met all of the criteria for psychometric validity, and 14 showed significant relationships to nonself-report outcomes. Conclusions:Evidence of psychometric validity is lacking for many teamwork survey instruments. However, several psychometrically valid instruments are available. Researchers aiming to advance research on teamwork in health care should consider using or adapting one of these instruments before creating a new one. Because instruments vary considerably in the behavioral processes and emergent states of teamwork that they capture, researchers must carefully evaluate the conceptual consistency between instrument, research question, and context.

Team Scaffolds: How Mesolevel Structures Enable Role-Based Coordination in Temporary Groups

This paper shows how mesolevel structures support effective coordination in temporary groups. Prior research on coordination in temporary groups describes how roles encode individual responsibilities so that coordination between relative strangers is possible. We extend this research by introducing key tenets from team effectiveness research to theorize when role-based coordination might be more or less effective. We develop these ideas in a multimethod study of a hospital emergency department ED redesign. Before the redesign, people coordinated in ad hoc groupings, which provided flexibility because any nurse could work with any doctor, but these groupings were limited in effectiveness because people were not accountable to each other for progress, did not have shared understanding of their work, and faced interpersonal risks when reaching out to other roles. The redesign introduced new mesolevel structures that bounded a set of roles rather than a set of specific individuals, as in a team and gave them collective responsibility for a whole task. We conceptualized the mesolevel structures as team scaffolds and found that they embodied the logic of both role and team structures. The team scaffolds enabled small-group interactions to take the form of an actual team process with team-level prioritizing, updating, and helping, based on newfound accountability, overlapping representations of work, and belonging-despite the lack of stable team composition. Quantitative data revealed changes to the coordination patterns in the ED captured through a two-mode network after the team scaffolds were implemented and showed a 40% improvement in patient throughput time.

Hospital performance, the local economy, and the local workforce: findings from a US National Longitudinal Study.

Blustein and colleagues examine the associations between changes in hospital performance and their local economic resources. Locationally disadvantaged hospitals perform poorly on key indicators, raising concerns that pay-for-performance models may not reduce inequality.

Strained Local And State Government Finances Among Current Realities That Threaten Public Hospitals’ Profitability

This study demonstrates that some safety-net hospitals--those that provide a large share of the care to low-income, uninsured, and Medicaid populations--survived and even thrived before the recent recession. We analyzed the financial performance and governance of 150 hospitals during 2003-07. We found, counterintuitively, that those directly governed by elected officials and in highly competitive markets were more profitable than other safety-net hospitals. They were financially healthy primarily because they obtained subsidies from state and local governments, such as property tax transfers or supplemental Medicaid payments, including disproportionate share payments. However, safety-net hospitals now face a new market reality. The economic downturn, slow recovery, and politics of deficit reduction have eroded the ability of local governments to support the safety net. Many safety-net hospitals have not focused on effective management, cost control, quality improvement, or services that attract insured patients. As a result, and coupled with new uncertainties regarding Medicaid expansion stemming from the recent Supreme Court decision on the Affordable Care Act, many are likely to face increasing financial and competitive pressures that may threaten their survival.

Flash Organizations: Crowdsourcing Complex Work by Structuring Crowds As Organizations

This paper introduces flash organizations: crowds structured like organizations to achieve complex and open-ended goals. Microtask workflows, the dominant crowdsourcing structures today, only enable goals that are so simple and modular that their path can be entirely pre-defined. We present a system that organizes crowd workers into computationally-represented structures inspired by those used in organizations - roles, teams, and hierarchies - which support emergent and adaptive coordination toward open-ended goals. Our system introduces two technical contributions: 1) encoding the crowds division of labor into de-individualized roles, much as movie crews or disaster response teams use roles to support coordination between on-demand workers who have not worked together before; and 2) reconfiguring these structures through a model inspired by version control, enabling continuous adaptation of the work and the division of labor. We report a deployment in which flash organizations successfully carried out open-ended and complex goals previously out of reach for crowdsourcing, including product design, software development, and game production. This research demonstrates digitally networked organizations that flexibly assemble and reassemble themselves from a globally distributed online workforce to accomplish complex work.

Huddler: Convening Stable and Familiar Crowd Teams Despite Unpredictable Availability

Distributed, parallel crowd workers can accomplish simple tasks through workflows, but teams of collaborating crowd workers are necessary for complex goals. Unfortunately, a fundamental condition for effective teams -- familiarity with other members -- stands in contrast to crowd works flexible, on-demand nature. We enable effective crowd teams with Huddler, a system for workers to assemble familiar teams even under unpredictable availability and strict time constraints. Huddler utilizes a dynamic programming algorithm to optimize for highly familiar teammates when individual availability is unknown. We first present a field experiment that demonstrates the value of familiarity for crowd teams: familiar crowd teams doubled the performance of ad-hoc (unfamiliar) teams on a collaborative task. We then report a two-week field deployment wherein Huddler enabled crowd workers to convene highly familiar teams in 18 minutes on average. This research advances the goal of supporting long-term, team-based collaborations without sacrificing the flexibility of crowd work.

Renegotiating Spheres of Obligation: The Role of Hierarchy in Organizational Learning

To achieve organization-wide goals, sometimes multiple local groups must synchronize their learning activities. This paper uses an ethnographic study of a cancer treatment center to develop theory on organizational learning by identifying a process that helped synchronize learning across many local and interdependent groups by taking advantage of hierarchy. Change agents—in this case, consultants—identified the managers of the various groups that would need to change for an organization-wide goal to be achieved, and they met with each manager to renegotiate his or her formal obligations. Through the renegotiation process, the managers came to better understand the organization-wide goal, and the change agents better understood each group’s work. After the managers understood and accepted their renegotiated obligations, they changed how they administered resources and expectations in their groups, and the members of their respective groups adapted their practices in response. This process illustrates how the obligations associated with hierarchical positions can be renegotiated in ways that develop improved understanding and, when changed, can shape local activities to favor new goals.

Inequality in Knowledge Repository Use in Scaling Service Operations

This paper develops and tests a multi-level model that links individual and team experience with knowledge sourcing (specifically, knowledge repository (KR) use). Prior research theorizes that experienced workers source more than inexperienced workers because they have stronger information processing capabilities that motivate their search. Other research, however, suggests that teams source less as they gain experience because they develop and perpetuate set ways of thinking about problems. Which effect dominates the sourcing behavior of individuals working in teams? We argue that individual knowledge-sourcing behavior is shaped by both individual and team attributes and we provide an empirical test of new theory. Specifically we suggest that both individual capabilities and team average experience influence team member knowledge sourcing, and argue that there is an interaction between individual and team experience (meaning rookies and veterans working on inexperienced or experienced teams will be influenced differently). We find empirical support for this model. Team experience does not affect veteran team member knowledge sourcing, unless the team is very experienced; then, veterans slow their KR use. Rookies are more influenced by team composition: when working on teams with too little experience, too much experience, or a disparity of experience, rookie KR sourcing is limited. Yet on moderately experienced teams, rookies use almost on par with veterans. Importantly, limited KR use by highly experienced teams does not appear to be a savvy choice for exploiting team resources: KR use predicts team performance and the effect is not moderated by team experience.

Collaboration among Highly Autonomous Professionals: Costs, Benefits, and Future Research Directions

Abstract Purpose This chapter examines collaboration among highly autonomous, powerful, professional peers to explain why the benefits of teamwork that scholars typically find in traditional teams may not apply. The chapter analyzes the perspectives of individual professionals to show that, in this setting, collaboration is often seen as more costly than rewarding for the individuals involved. It presents a conceptual framework exploring this paradox and suggests directions for future research to elaborate an underlying theory. Methodology/approach The chapter draws on extensive qualitative data from surveys and interviews in three professional service firms, including a top 100 global law firm, a boutique executive search firm, and a large, US-based commercial advisory firm. Findings are married integrated with organizational theory to develop testable propositions for future research. Findings Because senior professionals collaborate with peers who have the autonomy to choose to work collectively or independently, power and authority are not means to create a team or make it effective. Findings show how professionals interpret the relative costs and benefits of collaboration, and suggest that in most cases, senior professionals will not attempt it or give it up before collaborations can reap important benefits. Thus, short-term costs prevent opportunities to experience longer term benefits for many professionals. Yet, some professionals have figured out how to use “instrumental collaboration” to shift the balance in their favor. The chapter’s conceptual framework uses a longitudinal perspective to resolve this seeming paradox. Research implications The chapter presents a nascent theory of instrumental collaboration, including five testable hypotheses, an emergent conceptual framework, and suggestions for specific future research directions.

In Search of the Dream Team: Temporally Constrained Multi-Armed Bandits for Identifying Effective Team Structures

Team structures---roles, norms, and interaction patterns---define how teams work. HCI researchers have theorized ideal team structures and built systems nudging teams towards them, such as those increasing turn-taking, deliberation, and knowledge distribution. However, organizational behavior research argues against the existence of universally ideal structures. Teams are diverse and excel under different structures: while one team might flourish under hierarchical leadership and a critical culture, another will flounder. In this paper, we present DreamTeam: a system that explores a large space of possible team structures to identify effective structures for each team based on observable feedback. To avoid overwhelming teams with too many changes, DreamTeam introduces multi-armed bandits with temporal constraints: an algorithm that manages the timing of exploration--exploitation trade-offs across multiple bandits simultaneously. A field experiment demonstrated that DreamTeam teams outperformed self-managing teams by 38%, manager-led teams by 46%, and teams with unconstrained bandits by 41%. This research advances computation as a powerful partner in establishing effective teamwork.