Person:

Valentine, Melissa A

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 non-self-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.

In this dissertation, I integrate research on role-based coordination with concepts adapted from the team effectiveness literature to theorize how minimal team structures support effective coordination when people do not work together regularly. I argue that role-based coordination among relative strangers can be interpersonally challenging and propose that team scaffolds (minimal team structures that bound groups of roles rather than groups of individuals) may provide occupants with a temporary shared in-group that facilitates interaction. I develop and test these ideas in a multi-method, multi-site field study of a new work structure, called pods, that were implemented in many hospital emergency departments (EDs) and were sometimes designed to function as team scaffolds.

Background: Pay-for-performance is an increasingly popular approach to improving health care quality, and the US government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and improve performance) likely depends on local resources. In this study, we quantify the association between hospital performance and local economic and human resources, and describe possible implications of pay-for-performance for socioeconomic equity. Methods and Findings: We applied county-level measures of local economic and workforce resources to a national sample of US hospitals (n = 2,705), during the period 2004–2007. We analyzed performance for two common cardiac conditions (acute myocardial infarction [AMI] and heart failure [HF]), using process-of-care measures from the Hospital Quality Alliance [HQA], and isolated temporal trends and the contributions of individual resource dimensions on performance, using multivariable mixed models. Performance scores were translated into net scores for hospitals using the Performance Assessment Model, which has been suggested as a basis for reimbursement under Medicare’s ‘‘Value-Based Purchasing’’ program. Our analyses showed that hospital performance is substantially associated with local economic and workforce resources. For example, for HF in 2004, hospitals located in counties with longstanding poverty had mean HQA composite scores of 73.0, compared with a mean of 84.1 for hospitals in counties without longstanding poverty (p,0.001). Hospitals located in counties in the lowest quartile with respect to college graduates in the workforce had mean HQA composite scores of 76.7, compared with a mean of 86.2 for hospitals in the highest quartile (p,0.001). Performance on AMI measures showed similar patterns. Performance improved generally over the study period. Nevertheless, by 2007—4 years after public reporting began—hospitals in locationally disadvantaged areas still lagged behind their locationally advantaged counterparts. This lag translated into substantially lower net scores under the Performance Assessment Model for hospital reimbursement. Conclusions: Hospital performance on clinical process measures is associated with the quantity and quality of local economic and human resources. Medicare’s hospital pay-for-performance program may exacerbate inequalities across regions, if implemented as currently proposed. Policymakers in the US and beyond may need to take into consideration the balance between greater efficiency through pay-for-performance and socioeconomic equity.

Individuals on the periphery of organizational knowledge sharing networks, due to inexperience, location, or lack of social capital, may struggle to access useful knowledge at work. An electronic knowledge repository (KR) has the potential to help peripheral individuals gain access to valuable knowledge because a KR is universally and constantly available and can be used without social interaction. However, for it to serve this equalizing function, those on the periphery of the organization must actually use it, possibly overcoming barriers to doing so. In this paper, we develop a multi-level model of knowledge use in teams and show that individuals whose experience and position already provide them access to vital knowledge use a KR more frequently than individuals on the organizational periphery. We argue that this occurs because the KR – despite its appearance of equivalent accessibility to all – is actually more accessible to central than peripheral players due to their greater experience and access to colleagues. Thus, KR use is not driven primarily by the need to overcome limited access to other knowledge sources. Rather KR use is enabled when actors know how to reap value from the KR, which ironically improves with increasing access to other sources of knowledge. Implications for both team effectiveness and knowledge management research are offered. We conclude that KRs are unlikely to serve as a knowledge equalizer without intervention.