Impact of Facilitated Behavior Change Strategies on Food Intake Monitoring and Body Weight Measurements in Acute Care: Case Examples From the More-2-Eat Study

BACKGROUND

Assessing and monitoring food intake and body weight of all hospital patients is considered part of "best practice" nutrition care. This study presents case examples describing the impact of behavior change strategies on embedding these 2 monitoring processes in hospitals.

METHODS

Four hospital medical units that participated in the More-2-Eat implementation study to improve nutrition care focused on improving food intake and/or weight monitoring practices. The percentage of admitted patients who received these care practices were tracked through chart audits over 18 months. Implementation progress and behavior change strategies were documented through interviews, focus groups, scorecards, and monthly telephone calls. Case examples are explored using mixed methods.

RESULTS

Of the 4 units, 3 implemented food intake monitoring. One provided food service workers the opportunity to record food intake, with low intake discussed by an interdisciplinary team during bedside rounds (increased from 0% to 97%). Another went from 0% to 61% of patients monitored by introducing a new form ("environmental restructuring") reminding staff to ask patients about low intake. A third unit increased motivation to improve documentation of low intake and improved from 3% to 95%. Two units focused on regularity of body weight measurement. One unit encouraged a team approach and introduced 2 weigh days/week (improved from 14% to 63%), while another increased opportunity by having all patients weighed on Saturdays (improved from 11% to 49%).

CONCLUSION

Difficult-to-change nutrition care practices can be implemented using diverse and ongoing behavior change strategies, staff input, a champion, and an interdisciplinary team.

How oncology teams can be patient-centred? opportunities for theoretical improvement through an empirical examination

BACKGROUND

In the context of interprofessional practice, a patient-centred approach is recommended, which generally means power-sharing, shared decision making and involving patients as part of the health-care team. These aspects, which are essential to "patient-centred" practice, do not appear to be sufficient to illustrate the full richness of this practice.

OBJECTIVE

This article aimed to understand how interprofessional patient-centred (IPPC) practice in oncology teams contributes to creating a more positive experience for patients. Objectives were to (a) describe the IPPC practice of oncology teams using the IPPC Practice Framework; (b) determine the usefulness of this framework; and (c) offer alternative proposals for expanding our understanding of IPPC practice.

DESIGN

A secondary analysis was performed with data from a multicase study designed to explore the effects of interdisciplinary work among oncology teams. Data were provided from six focus groups with professionals (n = 22) and patients diagnosed with cancer (n = 16). An iterative content analysis was performed.

RESULTS

Applying the theoretical framework to data analysis enabled us to distinguish between the IPPC practice of the different teams and structure the data collected in order to show the processes and place them in context. However, it proved to be difficult to describe the central component of the theoretical framework, patient-centred processes. This situation raises new hypotheses for representing practice in a real-life context. An alternative perspective for illustrating IPPC practice is therefore proposed.

CONCLUSION

This study emphasizes the importance of exploring the utility of theoretical frameworks and refining them in order to broaden our understanding of IPPC practice.

Longitudinal Effects of Activity-Based Flexible Office Design on Teamwork

This three-wave longitudinal interview study (time lag: 12 and 18 months) investigates the impact of working in an activity-based flexible office (A-FO) on processes within and across teams (i.e., communication, trust, cohesion, and collaboration) and team management. Based on a new theoretical framework on benefits and risks of A-FOs (A-FO-M; Wohlers and Hertel, 2017), we conducted interviews with 25 employees of an in-house training institute who recently switched from single cell or shared offices to an A-FO. The A-FO consisted of a main open-layout environment without assigned workstations and provided additional working zones appropriate for specific work activities. According to the A-FO-M, A-FO features are expected to alter visibility and proximity of employees compared to office environments with assigned workstations. Altered visibility and proximity, in turn, should be related to team processes, such as communication. The interview material was analyzed using qualitative content analysis. This textual analysis procedure revealed that the interviewees reported that inter-team collaboration improved while working in the A-FO. Reasons that were mentioned for this positive effect were more contact, communication, collaboration possibilities (joint project work), and trusting relationships. However, interviewees also reported negative effects, such as that teamwork suffered due to less communication and cooperation. Along with that, especially ensuring team cohesion and communication among team partners were the most often mentioned challenges for management since team members were spatially dispersed within the office building. Theoretical and practical implications, such as assigning additional team areas to support teamwork, as well as recommendations for future research are discussed.

Running too far ahead? Towards a broader understanding of mindfulness in organisations

Current workplace mindfulness research and interventions assume that teaching mindfulness will have beneficial effects for people and organizations. While research shows that mindfulness trainings may increase resilience of working adults, assuming that mindfulness will have independent effects on outcomes at different levels of an organization is not well grounded. We assert that mindfulness training would, however, be beneficial for organizations when tailored to that context and shaped by an understanding of organizational theory and practice. We also envisage mindfulness as a beneficial property of teams, organizations and the individuals who constitute them. To close the evidence gap we propose building multi-level models of mindfulness in organizations, broadening training programs, and developing a novel competency framework for teachers in this context.

Cultural Disposition Influences in Workgroups: A Motivational Systems Theory of Group Involvement Perspective

Modern organizations often involve workgroup members who have different cultural heritage. This article provides an examination of how different cultural dimensions (e.g., uncertainty avoidance, individualism–collectivism) influence the ways that workgroups and their members respond to situations that involve threats and rewards. The threats and rewards activate distinct response patterns that are associated with a motivational systems theory of group involvement. Based on this theoretical foundation, a cultural dispositions approach is applied to reveal how culture could impact the ways group members respond (cognitively, affectively, motivationally) to situations that involve varying degrees of threats or rewards. This focus on cultural dispositions locates this article in the larger theoretical context of persons within situations that account for complexities of threat and reward cues as well as groups, organizations, and cultures. Consequently, this article has broad implications to the scientific and applied science communities interested in multicultural workgroups.

The effect of charismatic leadership on coordinated teamwork: a study in Turkey

Purpose

The purpose of this paper is to investigate the effect of behavioral dimensions constituting the essence of charismatic leadership (CL) on coordinated teamwork (CTW).

Design/methodology/approach

Data were collected from 113 members among 20 ad hoc project teams formed by specialists and assistant specialists employed in a public institution. Simple linear and multiple regression models were employed to analyze the effect of CL on CTW.

Findings

The behavioral dimensions of CL, which include possessing a strategic vision and articulation skill, sensitivity to the environment and sensitivity to member needs, were found to have a significant and positive effect on CTW, while the personal risk and unconventional behavior dispositions of a leader were found to render no significant effect on CTW.

Research limitations/implications

Having tested the effect of CL behaviors on CTW, this particular model provides salient implications in clarifying which CL behaviors particularly render a significant effect on CTW and the consequential effectiveness of teamwork. Nevertheless, there is a need for longitudinal studies conducted in a range of different sectors and institutions.

Originality/value

The originality of this empirical study is that it advances the grasp of the relationship between CTW and the behavioral factors of CL.

Team Science, Justice, and the Co-Production of Knowledge

Science increasingly consists of interdisciplinary team-based research to address complex social, biomedical, public health, and global challenges through a practice known as team science. In this article, I discuss the added value of team science, including participatory team science, for generating scientific knowledge. Participatory team science involves the inclusion of public stakeholders on science teams as co-producers of knowledge. I also discuss how constructivism offers a common philosophical foundation for both community psychology and team science, and how this foundation aligns well with contemporary developments in science that emphasize the co-production of knowledge. I conclude with a discussion of how the co-production of knowledge in team science can promote justice.

Autonomous team members’ expectations for top-leader involvement

Purpose

The purpose of this paper is to examine incongruities between autonomous team members’ expectations for top-leader involvement with teams and their perceptions of top-leader involvement actually encountered in their own team experiences.

Design/methodology/approach

Interview feedback was sought from three participants from each of six autonomous teams to capture explanations of their lived experiences from team participation. Transcribed data were examined through thematic analysis, from which patterned responses and meanings relevant to the research inquiry were identified.

Findings

To foster a team environment and shape the organizational context to align with autonomous team members’ expectations, organizational leaders should give significant attention to all-inclusive recruitment; frequent, face-to-face communication between themselves and team members; and an unwavering resource allocation.

Originality/value

This study addresses a unique realm of team research in addressing the need for top leaders to understand team members’ expectations for their involvement in shaping an organizational context most conducive to team effectiveness.

Envisioning successful teamwork: An exploratory qualitative study of team processes used by nursing teams in a paediatric hospital unit

AIMS AND OBJECTIVES

To explore how team processes support nursing teams in hospital units during every day work.

BACKGROUND

Due to their close proximity to patients, nurses are central to the process of maintaining patient safety. Globally, changes in models of care delivery by nurses, inclusive of team nursing are being considered.

DESIGN AND METHODS

This qualitative study used purposive sampling in a single hospital and participants were nurses employed to work on a paediatric unit. Data were collected using nonparticipant observation. Thematic analysis was used to analyse and code data to create themes.

RESULTS

Three clear themes emerged. Theme 1: "We are a close knit team"; Behaviours building a successful team - outlines expectations regarding how members are to behave when establishing, nurturing and managing a team. Theme 2: "Onto it"; Ways of interacting with each other - Identifies the expected pattern of relating within the team which contribute to shared understanding and actions. Theme 3: "No point in second guessing"; Maintaining a global view of the unit - focuses on the processes for monitoring and reporting signals that team performance is on course or breaking down and includes accepting responsibility to lead the team and team members having a widespread sensitivity to what needs to happen.

CONCLUSION

Essential to successful teamwork is the interplay and mutuality of team members and team leaders.

RELEVANCE TO CLINICAL PRACTICE

Leadership behaviours exhibited in this study provide useful insights to how informal and shared or distributed leadership of teams may be achieved. Without buy-in from team members, teams may not achieve successful desired outcomes. It is not sufficient for teams to rely on current successful outcomes, as they need to be on the look-out for new ways to ensure that they can anticipate possible risks or threats to the team before harm is done.

A meta-ethnographic review of interprofessional teamwork in hospitals: what it is and why it doesn’t happen more often

Objectives

Although interprofessional teamwork has been shown to improve patient safety, it is not yet routine practice in most hospital settings. There is also a lack of clarity regarding what teamwork actually means, with terms such as collaboration, coordination, networking and knotworking often being used interchangeably. In this study, we analyse 20 years of qualitative research on interprofessional teamwork in hospital settings and examine what it looks like and the factors influencing it.

Methods

The literature search included articles published between 1996 and 2016, and articles were included if they examined interprofessional teamwork within a hospital using qualitative methodology. We used meta-ethnographic analysis of eligible primary studies applying reciprocal translation and line of argument synthesis.

Results

Nineteen articles were included. Interprofessional teamwork was largely absent in acute care and found to be influenced by systems perpetuating power imbalances, organizational practices that interfered with interprofessional interactions, representations of teamwork and leadership.

Conclusions

Future strategies to improve interprofessional practices should include policies and structural changes to develop healthcare systems that facilitate these practices.

One Big Happy Family? Unraveling the Relationship between Shared Perceptions of Team Psychological Contracts, Person-Team Fit and Team Performance

With the knowledge that team work is not always associated with high(er) performance, we draw from the Multi-Level Theory of Psychological Contracts, Person-Environment Fit Theory, and Optimal Distinctiveness Theory to study shared perceptions of psychological contract (PC) breach in relation to shared perceptions of complementary and supplementary fit to explain why some teams perform better than other teams. We collected three repeated survey measures in a sample of 128 respondents across 46 teams. After having made sure that we met all statistical criteria, we aggregated our focal variables to the team-level and analyzed our data by means of a longitudinal three-wave autoregressive moderated-mediation model in which each relationship was one-time lag apart. We found that shared perceptions of PC breach were directly negatively related to team output and negatively related to perceived team member effectiveness through a decrease in shared perceptions of supplementary fit. However, we also demonstrated a beneficial process in that shared perceptions of PC breach were positively related to shared perceptions of complementary fit, which in turn were positively related to team output. Moreover, best team output appeared in teams that could combine high shared perceptions of complementary fit with modest to high shared perceptions of supplementary fit. Overall, our findings seem to indicate that in terms of team output there may be a bright side to perceptions of PC breach and that perceived person-team fit may play an important role in this process.

Regional Multiteam Systems in Cancer Care Delivery

Teamwork is essential for addressing many of the challenges that arise in the coordination and delivery of cancer care, especially for the problems that are presented by patients who cross geographic boundaries and enter and exit multiple health care systems at various times during their cancer care journeys. The problem of coordinating the care of patients with cancer is further complicated by the growing number of treatment options and modalities, incompatibilities among the vast variety of technology platforms that have recently been adopted by the health care industry, and competing and misaligned incentives for providers and systems. Here we examine the issue of regional care coordination in cancer through the prism of a real patient journey. This article will synthesize and elaborate on existing knowledge about coordination approaches for complex systems, in particular, in general and cancer care multidisciplinary teams; define elements of coordination derived from organizational psychology and human factors research that are applicable to team-based cancer care delivery; and suggest approaches for improving multidisciplinary team coordination in regional cancer care delivery and avenues for future research. The phenomenon of the mobile, multisystem patient represents a growing challenge in cancer care. Paradoxically, development of high-quality, high-volume centers of excellence and the ease of virtual communication and data sharing by using electronic medical records have introduced significant barriers to effective team-based cancer care. These challenges urgently require solutions.

Use of a Shared Mental Model by a Team Composed of Oncology, Palliative Care, and Supportive Care Clinicians to Facilitate Shared Decision Making in a Patient With Advanced Cancer

Our case describes the efforts of team members drawn from oncology, palliative care, supportive care, and primary care to assist a woman with advanced cancer in accepting care for her psychosocial distress, integrating prognostic information so that she could share in decisions about treatment planning, involving family in her care, and ultimately transitioning to hospice. Team members in our setting included a medical oncologist, oncology nurse practitioner, palliative care nurse practitioner, oncology social worker, and primary care physician. The core members were the patient and her sister. Our team grew organically as a result of patient need and, in doing so, operationalized an explicitly shared understanding of care priorities. We refer to this shared understanding as a shared mental model for care delivery, which enabled our team to jointly set priorities for care through a series of warm handoffs enabled by the team's close proximity within the same clinic. When care providers outside our integrated team became involved in the case, significant communication gaps exposed the difficulty in extending our shared mental model outside the integrated team framework, leading to inefficiencies in care. Integration of this shared understanding for care and close proximity of team members proved to be key components in facilitating treatment of our patient's burdensome cancer-related distress so that she could more effectively participate in treatment decision making that reflected her goals of care.

How staff experience teamwork challenges in a new organizational structure

Purpose

This study aims to explore challenges arising from the development of teamwork in a new organizational structure, based on the experiences of the staff involved.

Design/methodology/approach

An explorative and qualitative approach was used, with individual interviews as the data collection method. These interviews were analyzed using qualitative and interpretative analysis with a modified editing style.

Findings

The results describe how the lack of essential organizational prerequisites for teamwork and the absence of the leadership qualities needed to facilitate teamwork contribute to difficulties in working in a team-orientated way. Shortage of information among the team members and few scheduled meetings signify insufficient coordination within the working team. Without a team leader who can keep things together, read the team members’ needs and support and guide them, team work is difficult to uphold because the members will need to seek support elsewhere. Assumed synergies from working together as team member experts will be thwarted.

Originality/value

This study contributes knowledge about the difficulties in creating team-orientated cooperation in a new organizational structure when leadership as well as structures and processes supporting team work are absent. The challenges described are drawn from the experiences of the staff concerned, providing insights to form a basis for theoretical and practical discussion.