Academic journal article Journal of Healthcare Management

Are Real Teams Healthy Teams?

Academic journal article Journal of Healthcare Management

Are Real Teams Healthy Teams?

Article excerpt

EXECUTIVE SUMMARY

This study examines the impact of real-team--as opposed to a team in name only--characteristics (i.e., team boundaries, stability of membership, and task interdependence) on team processes (i.e., team learning and emotional support) and team effectiveness in the long-term care sector. We employed a longitudinal survey in which the real-team characteristics and team processes were rated by team members, and team effectiveness was rated one year later by team members and managers. Our results show that team learning and emotional support are predictors of team effectiveness as rated by team members and managers. They also show that there is no such thing as a real team in the long-term care sector because each real-team characteristic has a different impact on team processes and effectiveness. Whereas one set of real-team characteristics (i.e., stability of membership) is beneficial for healthy team processes and team effectiveness, another set (i.e., team boundaries) has only an indirect effect on team effectiveness via team processes or is even detrimental (i.e., task interdependence). We conclude that more intensive teamwork in the long-term care sector will lead to better outcomes if this teamwork involves increased stability of membership and clarified team boundaries but not if it involves added task interdependency among team members.

INTRODUCTION

Teams are an integral feature of health services delivery in the long-term care (LTC) sector. LTC teams provide supportive services (e.g., health, social, housing, transportation) to clients with intellectual, physical, or cognitive disorders that compromise their ability to live independently (Bodenheimer, 1999). By providing such services, the teams help their clients maintain the best possible quality of life with the greatest possible degree of autonomy, participation, personal fulfillment, and human dignity. Providing LTC is a collective effort; one caregiver cannot provide all of the care needed by a client, and teamwork is believed to improve the quality of care via the exchange of feedback among colleagues. Effective teamwork is becoming even more important because of the increasing demand for LTC services; the growing complexity of care; and the influence of recent labor trends, such as staff turnover and personnel shortages (Harrington, Cassel, Estes, Woolhandler, & Himmelstein, 1991; Sloane and Zimmermann, 2005; WHO, 2000, 2002).

According to Wageman, Hackman, and Lehman (2005), the presence of real-team characteristics increases the likelihood that a team will perform well. Real teams have boundaries that clearly distinguish members from nonmembers, have at least a moderate degree of stability of membership, and include members who function interdependently when working to achieve a common purpose. If team membership is stable and clearly delineated, members work together over a long period of time; they come to trust and know each other well and have the time and opportunity to learn how to collaborate, exchange information, and provide emotional support. Furthermore, if team members work interdependently to achieve a common purpose, they are more likely to see the added value of teamwork than if they approached tasks independently and, therefore, to invest in team processes, including team learning and emotional support (Wageman et al., 2005).

Team stability depends on the amount of turnover in a team and varies among LTC teams. The variation in task interdependency and team delineation depends in part on clients' characteristics (i.e., the severity and complexity of their disorders). However, because LTC teams are highly autonomous and self-managing, they make most care-related decisions on their own and therefore are able to influence their own level of task interdependency. Whereas some teams prefer individual caregivers to deliver everyday care for one designated client (apart from the handoffs between different shifts), making them less task interdependent, other teams prefer to work closely together and share the care delivery for one patient. …

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