Knowledge integration, teamwork and performance in health care

The association of social networks with the job performance of primary health care professionals: the mediating effect of knowledge sharing

Background and aims

Social networks formed through social media platforms have facilitated knowledge sharing among primary health care professionals (PHCPs). However, the impact of these networks on PHCPs' job performance and the mediating role of knowledge sharing remain underexplored. This study aimed to investigate the association between social networks formed via social media and the job performance of PHCPs, and to explore the mediating role of knowledge sharing in this association.

Methods

A cross-sectional survey was carried out among PHCPs in Henan Province, China, involving 655 valid responses. Validated scales measured the key variables, and structural equation modeling (SEM) tested the proposed hypotheses, including the mediating effect of knowledge sharing through bootstrap method. Statistical analysis was performed using SPSS 24.0 and AMOS 24.0.

Results

The degree centrality (β = 0.225; p = 0.001) and network heterogeneity (β = 0.093; p = 0.043) of the social network had a significant direct association with job performance, whereas the direct associations of betweenness centrality and network tie strength with job performance were not significant. Knowledge sharing mediated the relationship between degree centrality (β = 0.147; p = 0.001), network heterogeneity (β = 0.251; p = 0.043), and job performance.

Conclusion

The study revealed the internal mechanisms by which social network characteristics influence PHCPs' job performance, highlighting the mediating role of knowledge sharing. Social networks formed within social media contexts have multifaceted effects on job performance, with knowledge sharing as a critical mediating variable. These findings underscore the importance of leveraging social media for professional networking and knowledge exchange to enhance PHCPs' job performance.

Is knowledge liberating? The role of knowledge behaviors and competition on the workplace happiness of healthcare professionals

PURPOSE

The purpose of this paper is to highlight the joint impact of competitive culture and knowledge behaviors (sharing, hoarding and hiding) on workplace happiness among healthcare professionals. It addresses a literature gap that critiques the development of happiness programs in healthcare that overlook organizational, social and economic dynamics. The study is based on the Social Exchange Theory, the Conservation of Resources Theory and the principles of Positive Psychology.

DESIGN/METHODOLOGY/APPROACH

The study analyzes a linear relationship between variables using a structural equation model and a partial least squares approach. The data are sourced from a survey of 253 healthcare professionals from Portuguese healthcare organizations.

FINDINGS

The data obtained from the model illustrate a positive correlation between competitive culture and knowledge hoarding as well as knowledge hiding. Interestingly, a competitive culture also fosters workplace happiness among healthcare professionals. The complex relationship between knowledge behaviors becomes evident since both knowledge hoarding and sharing positively affected these professionals' workplace happiness. However, no direct impact was found between knowledge hiding and workplace happiness, suggesting that it negatively mediates other variables.

ORIGINALITY/VALUE

This research addresses a previously identified threefold gap. First, it delves into the pressing need to comprehend behaviors that enhance healthcare professionals' workplace satisfaction. Second, it advances studies by empirically examining the varied impacts of knowledge hiding, hoarding and sharing. Finally, it sheds light on the repercussions of knowledge behaviors within an under-explored context - healthcare organizations.

What factors in the workplace enable success in antimicrobial stewardship in paediatric intensive care? An exploration of antimicrobial stewardship excellence through thematic analysis of appreciative inquiry interviews with healthcare staff

OBJECTIVES

Antimicrobial resistance (AMR) is a major global health problem. Efforts to mitigate AMR prioritise antimicrobial stewardship (AMS) interventions. These interventions typically focus on deficiencies in practice and providing negative or normative feedback. This approach may miss opportunities to learn from success. We aimed to identify factors that enable success in AMS practices in the paediatric intensive care unit (PICU) by analysing the data obtained from interviews with staff members who had achieved success in AMS.

DESIGN

Qualitative study design using thematic analysis of appreciative inquiry interviews with healthcare staff.

SETTING

31-bedded PICU in the UK between January 2017 and January 2018.

PARTICIPANTS

71 staff who had achieved success in AMS in the PICU.

RESULTS

Six themes were identified: (1) cultural factors including psychological safety, leadership and positive attitude are important enablers for delivering good clinical care; (2) ergonomic design of the physical environment and ready availability of tools and resources are key elements to support good practice and decision-making; (3) expertise and support from members of the multidisciplinary team contribute to good care delivery; (4) clarity of verbal and written communication is important for sharing mental models and aims of care within the clinical team; (5) a range of intrinsic factors influences the performance of individual HCPs, including organisation skill, fear of failure, response to positive reinforcement and empathetic considerations towards peers; (6) good clinical care is underpinned by a sound domain knowledge, which can be acquired through training, mentorship and experience.

CONCLUSION

The insights gained in this study originate from frontline staff who were interviewed about successful work-as-done. This strengths-based approach is an understudied area of healthcare, and therefore offers authentic intelligence which may be leveraged to effect tangible improvement changes. The methodology is not limited to AMS and could be applied to a wide range of healthcare settings.

Research Ready Grant Program (RRGP) protocol: a model for collaborative multidisciplinary practice-research partnerships

Background

Little attention has been given to the process of implementing or evaluating a structured academic–clinician (university–health service) research capacity-building (RCB) model within healthcare settings. We have developed a model for collaborative multidisciplinary practice–research partnerships called the Research Ready Grant Program (RRGP). The RRGP is informed by Cooke’s (BMC Fam Pract 6:44, 2005) RCB framework and principles. The aim of the study outlined in this protocol is to conduct a process and outcome evaluation of the programme. We will explore how the RRGP's structured mentor model contributes to RCB of clinician-led multidisciplinary research teams. We will identify key factors at the organization, team and individual levels that affect research capacity of health professionals working in one regional health service district. This protocol describes the RRGP design and outlines the methods we will employ to evaluate an RCB programme, the RRGP, delivered in a regional health service in Australia.

Methods

The study will adopt an exploratory concurrent mixed-methods approach designed to evaluate the process of implementing an RCB model across one regional hospital and health service. Both quantitative and qualitative data collection methods over a 12-month period will be implemented. Data triangulation will be applied to capture the complex issues associated with implementing collaborative multidisciplinary practice–research partnerships.

Discussion

The RRGP is an innovative RCB model for clinicians in their workplace. It is expected that the programme will facilitate a culture of collaborative multidisciplinary research and strengthen hospital–university partnerships.

Staffing, teamwork and scope of practice: Analysis of the association with patient safety in the context of rehabilitation

Aims

To describe the organization of nursing services (staffing, scope of practice, teamwork) and its association with medication errors and falls, in rehabilitation units.

Background

The healthcare system is greatly impacted by the ageing population and the complexity of care associated with chronic diseases. It is therefore necessary to have enough staff who are using their full scope of practice and who are operating in a favourable working environment. However, these conditions are not always met, which can lead to threats to patient safety.

Design

A correlational descriptive study.

Methods

Staffing data and reported safety incidents were collected by shift from 01 October 2019 until 15 January 2020 in five rehabilitation units. In addition, a total of 75 nursing staff members responded to a missed care and teamwork survey. Descriptive analysis and logistic regression analysis were performed.

Results

The mean staff hours per patient shift was 1.39 (SD = 0.60). The teams reported a global missed care score as ‘rarely missed’ at 1.14 (SD = 0.07) and a moderate teamwork score at 3.36 (SD = 0.58) on a five‐point scale. The safety incidents decreased 10‐fold with a predominance of bachelor compared with technician nurses and decreased by 67% when there was an increase of 1 h of care per patient shift.

Conclusions

This study showed that the organization of nursing services in the observed rehabilitation units is characterized by a moderate staffing intensity, a moderate perception of teamwork level and a relatively low level of missed care. It indicated the key role of the staffing in reducing the risk of occurrence of safety incidents. Future research specific to rehabilitation hospitals are greatly needed to improve patient outcomes in this setting.

Impact

Nurse Managers should consider all the aspects of the organization of nursing services (staffing, scope of practice and teamwork) in their efforts to improve patient safety in rehabilitation settings. A central finding of this study is that the staffing intensity, the proportion of bachelor prepared nurses and the proportion of agency staff were positively associated with a reduction of safety incidents.

Self-evaluating participatory research projects: A content validation of the InSPIRES online impact evaluation tool

Research projects involving science shops and citizen science in their promotion of participatory approaches are flourishing globally. However, an instrument evaluating the impacts of such approaches at different stages of a participatory research processes has yet to be validated. The InSPIRES H2020 project developed an impact evaluation tool for just this purpose, consisting of 64 items that reflect upon the dimensions of knowledge democracy, citizen-led research, participatory dynamics, transformative change, and integrity. In this article, we seek to test the content validity of this tool and to provide recommendations that can ensure its validity. A panel of nine experts was created to evaluate each item as regards the following three criteria: representativeness, relevance, and clarity. The Aiken’s V and Wilson Score methods were used to assess the tool’s content validity based on the experts’ ratings. Experts’ written comments were also reviewed. At the panel level, 75% of the items were considered satisfactory in relation to each of the three validity criteria. However, at the population level, 72% of the items suggested that parts of the tool were not valid and required revision. The main suggestions from the experts pointed to the need to reformulate items in which the separation between science and society appeared reinforced and to develop more items about the gender perspective of a research project. The revised version of the tool should serve as a well-founded, comprehensive evaluation instrument for on-going and future projects whose goal is to self-reflect and compare participatory research processes.

Evaluation of the "partnership care model" on quality of life and activity of daily living in stroke patients: A randomized clinical trial

BACKGROUND

Stroke is a widespread chronic disease which remains a serious problem for public health and is the cause of major disability and death in adults. Despite valuable efforts, these patients still need new care programs for recovery and rehabilitation.

AIM

The aim of this study is to determine the effect of the partnership care model (PCM) on quality of life (QOL) and activities of daily living (ADL) in stroke participants.

METHOD

The study is a randomized clinical trial carried out in an educational and therapeutic center in 2019. Sixty-seven participants (allocated randomly in intervention and control groups) with cerebrovascular accident who had hospitalization histories were selected. Data collection instruments were the Stroke-Specific QOL scale and Lawton questionnaires. The care plan was developed and implemented for the intervention group after evaluating and recording basic information including demographic variables, care needs, and problems identified in the first PCM-based stage. Ethics approval was obtained from the University / Regional Research Ethics Committee (IR.NIMAD.REC.1397.236).

RESULTS

The results show that the mean scores of the QOL significantly increased after the intervention in the intervention group (before = 130.80; 3 months = 172.19; 6 months = 205.29) compared to the control group (before = 150; 3 months = 144.86; 6 months = 160.66). Also, the mean scores of the ADL significantly increased after the intervention in the intervention group (before = 1.96; 3 months = 3.64; 6 months = 4.87) compared to the control group (p < .05). The effect size is equal to 0.501 and 0.245 for QOL and ADL, respectively.

CONCLUSION

The findings show that the care program based on a PCM recovered the QOL and ADL of stroke participants more than other interventions.

The Development and Effectiveness of Combining Case-Based Online Lecture and Simulation Programs to Facilitate Interprofessional Function Care Training in Nursing Homes

The aim of this study was to (1) develop a case-based combination of online lectures and simulations for function-focused care by nursing home interdisciplinary caregivers and (2) evaluate participants' increasing shared team and task knowledge by surrogate measures of team process and team performance. The study comprised the following steps: (1) the design of a learning module using a shared understanding of function-focused care as a shared mental model; (2) the establishment of two computer programs for online lectures and simulations using cases involving older adults with disabilities; and (3) testing the educational programs using a repeated-measures design. Participants were 61 interdisciplinary caregivers from seven nursing homes in four regions. Data from participants' team process and team performance were collected pre test, post online lecture, and post simulation. Repeated-measures analysis of variance showed that the mean scores for scales of "transactive memory system," "knowledge sharing and utilization," "team outcomes," "motivation for learning transfer," "self-efficacy," "interpersonal understanding," "proactivity in problem solving," and "function-focused care knowledge" differed significantly between the time points. The results indicate that a case-based program of a combination of online lectures and simulations elicits significant improvements in participants' team process and team performance.

Influential Factors of Knowledge Sharing of Multinational E-Health Service Based on 24HrKF

In order to solve the problem of cross-time and cross-regional medical collaboration and distributed knowledge sharing across patients and medical teams for 24 hours a day in the context of global resource allocation, a new 24HrKF e-health service model is proposed and a key knowledge model of 24HrKF e-health team knowledge sharing is established based on existing research results combined with 24HrKF distributed team characteristics. Finally, the questionnaire data of 338 multinational medical team members are used to verify the impact of key factors on the knowledge sharing of medical teams. The results shows that factors such as information and communication technology, the hospital's cultural characteristics, cross-cultural communication, medical knowledge and skills, and trust all have a significantly positive impact on knowledge sharing among team members especially information and communication technology and medical knowledge and skills. However, the degree of time-span separation across time zones has no significant effect on the knowledge sharing among team members.

Developing a sociocultural framework of compliance: an exploration of factors related to the use of early warning systems among acute care clinicians

Background

Early warning systems (EWS) are most effective when clinicians monitor patients’ vital signs and comply with the recommended escalation of care protocols once deterioration is recognised.

Objectives

To explore sociocultural factors influencing acute care clinicians’ compliance with an early warning system commonly used in Queensland public hospitals in Australia.

Methods

This interpretative qualitative study utilised inductive thematic analysis to analyse data collected from semi-structured interviews conducted with 30 acute care clinicians from Queensland, Australia.

Results

This study identified that individuals and teams approached compliance with EWS in the context of 1) the use of EWS for patient monitoring; and 2) the use of EWS for the escalation of patient care. Individual and team compliance with monitoring and escalation processes is facilitated by intra and inter-professional factors such as acceptance and support, clear instruction, inter-disciplinary collaboration and good communication. Noncompliance with EWS can be attributed to intra and inter-professional hierarchy and poor communication.

Conclusions

The overarching organisational context including the hospital’s embedded quality improvement and administrative protocols (training, resources and staffing) impact hospital-wide culture and influence clinicians’ and teams’ compliance or non-compliance with early warning system’s monitoring and escalation processes. Successful adoption of EWS relies on effective and meaningful interactions among multidisciplinary staff.

Relationships Among Structures, Team Processes, and Outcomes for Service Users in Quebec Mental Health Service Networks

Background:

Few studies have identified and compared profiles of mental health service networks (MHSN) in terms of structures, processes, and outcomes, based on cluster analyses and perceptions of team managers, MH professionals and service users. This study assessed these associations in Quebec metropolitan, urban and semi-urban MHSN.

Methods:

A framework adapted from the Donabedian model guided data management, and cluster analyses were used to identify categories. Study participants included team managers (n = 45), MH professionals (n = 311) and service users (n = 327).

Results:

For all three MHSN, a common outcome category emerged: service users with complex MH problems and negative outcomes. The Metropolitan network reported two categories for structures (specialized MH teams, primary care MH teams) and processes (senior medical professional, psychosocial professionals), and outcomes (middle-age men with positive outcomes, older women with few MH problems). The Urban and Semi-urban networks revealed one category for structures (all teams) and service user (young service users with drug disorders), but two for processes (psychosocial professionals: urban, all professionals: semi-urban).

Conclusion:

The Metropolitan MHSN showed greater heterogeneity regarding structures and team processes than the other two MHSN. Service user outcomes were largely associated with clinical characteristics, regardless of network configurations for structures and team processes.

Medical knowledge integration and "systems medicine": Needs, ambitions, limitations and options

Medicine today is an extremely heterogeneous field of knowledge, based on clinical observations and action knowledge and on data from the biological, behavioral and social sciences. We hypothesize at first that medicine suffers from a disciplinary hyper-diversity compared to the level of conceptual interdisciplinary integration. With the claim to "understand" and cure diseases, currently with the label "Systems Medicine" new forms of molecular medicine promise a general new bottom-up directed precise, personalized, predictive, preventive, translational, participatory, etc. medicine. Our second hypothesis rejects this claim because of conceptual, methodological and theoretical weaknesses. In contrary, this is our third hypothesis; we suggest that top-down organismic systems medicine, related to general system theory, opens better options for an integrative scientific understanding of processes of health and disease.

Collaborative governance as a policy strategy in healthcare

Purpose

The purpose of this paper is to examine the enactment of collaborative governance as a policy strategy in healthcare – in particular its effects in coordinating multiple collaborative initiatives dedicated to improve the performance of health organizations. It studies overarching governance mechanisms that serve as platforms at a meta-level between policy and frontline practice.

Design/methodology/approach

Four collaborative governance arrangements dedicated to improve health outcomes in the Netherlands are analyzed in a comparative case-study design, based on extensive document analysis (n=121) and interviews (n=56) with key stakeholders in the field, including the Dutch Ministry of Health, health organizations and other actors.

Findings

The studied policy-based governance mechanisms for the coordination of multiple micro-level collaborative initiatives function partly as platforms in bringing actors and resources together successfully. They do so, by fostering evolvability (the capacity to generate diversity in emergent ways) in relation to goal-setting and intermediation between actors. Yet, they marginalize open access to participants through high selectivity and deliberate exclusion strategies for certain actors, contrary to a platform logic of action.

Research limitations/implications

While the collaborative governance literature focuses on these dimensions as independent elements, findings reveal both trade-offs and interdependencies between studied dimensions of coordination associated with platforms, that need to be negotiated and managed.

Practical implications

Selectivity and exclusion in collaborative arrangements may negatively affect relational bonds and ties between actors, which challenges the application of collaborative governance as a policy strategy in pursuit of health objectives.

Originality/value

Responding to recent calls in the literature, this study applies ideas from public administration to the field of health organization and management to avert failures in the translation of policy ambitions into health practice.

An ethnographic study comparing approaches to inter-professional knowledge sharing and learning in discharge planning and care transitions

PURPOSE

The purpose of this paper is to investigate how three communication interventions commonly used during discharge planning and care transitions enable inter-professional knowledge sharing and learning as a foundation for more integrated working. These interventions include information communication systems, dedicated discharge planning roles and group-based planning activities.

DESIGN/METHODOLOGY/APPROACH

A two-year ethnographic study was carried out across two regional health and care systems in the English National Health Service, focussing on the discharge of stroke and hip fracture patients. Data collection involved in-depth observations and 213 semi-structured interviews.

FINDINGS

Information systems (e.g. e-records) represent a relatively stable conduit for routine and standardised forms of syntactic information exchange that can "bridge" time-space knowledge boundaries. Specialist discharge roles (e.g. discharge coordinators) support personalised and dynamic forms of "semantic" knowledge sharing that can "broker" epistemic and cultural boundaries. Group-based activities (e.g. team meetings) provide a basis for more direct "pragmatic" knowledge translation that can support inter-professional "bonding" at the cultural and organisational level, but where inclusion factors complicate exchange.

RESEARCH LIMITATIONS/IMPLICATIONS

The study offers analysis of how professional boundaries complicate discharge planning and care transition, and the potential for different communication interventions to support knowledge sharing and learning.

ORIGINALITY/VALUE

The paper builds upon existing research on inter-professional collaboration and patient safety by focussing on the problems of communication and coordination in the context of discharge planning and care transitions. It suggests that care systems should look to develop multiple complementary approaches to inter-professional communication that offer opportunities for dynamic knowledge sharing and learning.

Piloting and evaluating feasibility of a training program to improve patient safety for inter-professional inpatient care teams - study protocol of a cluster randomized controlled trial

Background

Improving patient safety is a major goal in healthcare systems worldwide. There are several international training programs to improve patient safety, but they are often focused on single topics and professions. Therefore, one inter-professional training program for inpatient care teams, which combines key areas of patient safety (Teamwork, Error management and Patient involvement), was developed by our research group. In the present study we aim to (1) pilot this training program by comparing two different training formats (e-learning only versus blended learning) with a waiting control group and (2) evaluate the feasibility of the intervention.

Methods and analysis

(1) To pilot the intervention a cluster randomized controlled trial will be performed at three study sites. Therefore, an e-learning group and a blended learning group will be compared to a waiting control group at three points of assessment; (2) The feasibility of the intervention will be evaluated using qualitative methods. We will conduct problem-focused individual interviews as part of the post-intervention measurement in order to collect information on acceptance, implementation, promoting factors and barriers from the staffs’ perspective.

Discussion

The study puts forth a training program which has the potential to improve patient safety in inpatient care. Members of inter-professional inpatient care teams can receive systematic training in three competencies which are central to patient safety management. Thus, we expect the greatest improvement in staff Safety-related behavior regarding Teamwork, Error management and Patient involvement as well as Subjectively perceived patient safety in the blended learning group. In addition, the development of an optimal implementation strategy can foster implementation of the intervention in healthcare practice. Consequently, the intervention could be used continuously and comprehensively for advanced training of hospital staff.

Trial registration

The study has been registered in the German Register of Clinical Trials (DRKS-ID: DRKS00012818). Registered on August 8, 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3448-7) contains supplementary material, which is available to authorized users.

Critical reflection on the role of theater nurses in a multidisciplinary team for perioperative care in China

Objective

The aim of this article is to reflect on the role of theater nurses in a multidisciplinary team, understand the factors that have influenced theater nurses’ practice, and improve the authors’ clinical practice ultimately.

Methods

The author used Smyth’s model to guide the process of reflection on the practice issue. Critical reflection, critical emancipatory theory, reflexivity, and critical social theory were used to help the author analyze the factors that have affected theater nurses’ practice in the organization.

Results

There are gaps between the espoused and enacted theories. A theater nurse’s practice is determined by multiple factors, such as political, structural, social, historical, cultural issues, and so on. The hierarchy of the health context could hinder possible changes in theater nurses’ practice. To better understand our practice and implement transformation, we should shape a supportive environment, bear in mind the practice motto of “patient-centered” care, and improve our knowledge and reflection skills.

Conclusions

Reflection plays a significant role in the advancing of practice among theater nurses and needs to be combined with clinical practice. To provide the best service of care to perioperative patients, a theater nurse should have an insightful understanding of the factors that have influenced her/his behaviors historically, socially, and culturally. By improving their critical reflection skills, practitioners could gain knowledge from experience.

Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation

PURPOSE

Poor coordination may impede delivery of the Awakening, Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle. Developing a shared mental model (SMM), where all team members are on the same page, may support coordination.

MATERIALS AND METHODS

We administered a survey at the 2016 MHA Keystone Center ICU workshop. We measured different components of SMMs using five items from a validated survey, each on a 5-point Likert scale (strongly agree-strongly disagree). We measured self-reported routine ABCDE implementation using a single item 4-point Likert scale (ABCDE is routine-Made no steps to implement ABCDE). We examined the relationship between SMMs and routine ABCDE implementation using logistic regression, adjusting for confounders.

RESULTS

Among the 206 (75%) responses, 157 (84%) reported using the ABCDE bundle and 80 (51% of 157) reported routine use. When clinicians agreed it was difficult to predict team members' behaviors, the odds of reporting routine ABCDE implementation significantly decreased [0.26 (0.10-0.66)]. Other SMM components related to knowing team members' skills, access to information, team adaptability, and team help behavior, were not significantly associated with the outcome.

CONCLUSION

Increasing awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles like ABCDE.

Relationship between team culture and team performance through lens of knowledge sharing and team emotional intelligence

Purpose

The purpose of this study is to investigate the relationship between team culture and team performance through the mediating role of knowledge sharing and team emotional intelligence.

Design/methodology/approach

The study advocated that team culture influences the knowledge sharing behavior of team members and the development of emotional intelligence skill at the team level. Further, it is hypothesized that knowledge sharing and team emotional intelligence positively influence team performance. By adopting a quantitative research design, data were gathered by using a survey questionnaire from 535 respondents representing 95 teams working in private health-care institutions.

Findings

The findings significantly indicated that knowledge sharing and team emotional intelligence influence team working. Furthermore, this study confirms the strong association between team culture and team performance through the lens of knowledge sharing and team emotional intelligence.

Practical implications

This investigation offers observational proof to health-care services to familiarize workers with the ability of emotional intelligence and urge them to share knowledge for enhanced team performance. The study provides in-depth understanding to managers and leaders in health-care institutions to decentralize culture at the team level for endorsement of knowledge sharing behavior.

Originality/value

This is amongst one of the initial studies investigating team members making a pool of knowledge to realize potential gains enormously and influenced by the emotional intelligence. Team culture set a platform to share knowledge which is considered one of the principal execution conduct essential for accomplishing and managing team adequacy in a sensitive health-care environment.

Work-related variables associated with perceptions of recovery-oriented care among Quebec mental health professionals

BACKGROUND

Provider working conditions are important in mental health service delivery.

AIMS

To identify variables associated with perceived recovery-oriented care among mental health professionals.

METHOD

A total of 315 mental health professionals and 41 managers across four Quebec service networks completed questionnaires. Univariate and multilevel mixed-effects linear regressions for bivariate and multivariate analyses were performed using independent variables from the input-mediator-output-input model and recovery-oriented care.

RESULTS

Recovery-oriented care related to: working in primary care or out-patient mental health services, team support, team interdependence, prevalence of individuals with suicide ideation, knowledge-sharing, team reflexivity, trust, vision (a subset of team climate), belief in multidisciplinary collaboration and frequency of interaction with other organisations.

CONCLUSIONS

Optimising team processes (for example knowledge-sharing) and emergent states (for example trust) may enhance recovery-oriented care. Adequate financial and other resources, stable team composition, training on recovery best practices and use of standardised assessment tools should be promoted, while strengthening primary care and interactions with other organisations.

DECLARATION OF INTEREST

None.

Multilevel moderation analysis of change perception on change commitment

Purpose

In implementing evolutionary or revolutionary change, considering people-related issues is critical. Based on the shared mental model (SMM) and occupational stress theory, the purpose of this paper is to clarify the relationship between change perception and change commitment by investigating the moderating effect of organizational-level SMM and individual-level work stress.

Design/methodology/approach

This research tested the direct cross-level effect of change perception on change commitment, and the cross-level moderation analysis. The data collected from small and medium-sized enterprises in Taiwan, and sampled 1,201 employees in 267 firms.

Findings

Change perception would relate positively to change commitment. Moreover, the SMM positively moderated the relationship between change perception and change commitment. In addition, a significant negative-moderated relationship is found. There is a positive relationship between change perception and change commitment at low level of work stress. However, there is the opposite effect when work stress is high.

Originality/value

The generally understanding of the employees’ attitudes and behaviors in organizational change, especially to investigate the moderating factors at cross-level analysis is limited. The results provide a basis for successful employees’ change commitment, and the authors propose that both organizational- and individual-level moderating effects need to be considered.

Team performance in the Italian NHS: the role of reflexivity

Purpose The purpose of this paper is twofold: first, to investigate the goodness of the input-process-output (IPO) model in order to evaluate work team performance within the Italian National Health Care System (NHS); and second, to test the mediating role of reflexivity as an overarching process factor between input and output. Design/methodology/approach The Italian version of the Aston Team Performance Inventory was administered to 351 employees working in teams in the Italian NHS. Mediation analyses with latent variables were performed via structural equation modeling (SEM); the significance of total, direct, and indirect effect was tested via bootstrapping. Findings Underpinned by the IPO framework, the results of SEM supported mediational hypotheses. First, the application of the IPO model in the Italian NHS showed adequate fit indices, showing that the process mediates the relationship between input and output factors. Second, reflexivity mediated the relationship between input and output, influencing some aspects of team performance. Practical implications The results provide useful information for HRM policies improving process dimensions of the IPO model via the mediating role of reflexivity as a key role in team performance. Originality/value This study is one of a limited number of studies that applied the IPO model in the Italian NHS. Moreover, no study has yet examined the role of reflexivity as a mediator between input and output factors in the IPO model.

Knowledge integration in One Health policy formulation, implementation and evaluation

The One Health concept covers the interrelationship between human, animal and environmental health and requires multistakeholder collaboration across many cultural, disciplinary, institutional and sectoral boundaries. Yet, the implementation of the One Health approach appears hampered by shortcomings in the global framework for health governance. Knowledge integration approaches, at all stages of policy development, could help to address these shortcomings. The identification of key objectives, the resolving of trade-offs and the creation of a common vision and a common direction can be supported by multicriteria analyses. Evidence-based decision-making and transformation of observations into narratives detailing how situations emerge and might unfold in the future can be achieved by systems thinking. Finally, transdisciplinary approaches can be used both to improve the effectiveness of existing systems and to develop novel networks for collective action. To strengthen One Health governance, we propose that knowledge integration becomes a key feature of all stages in the development of related policies. We suggest several ways in which such integration could be promoted.

Brazilian nursing professionals: leadership to generate positive attitudes and behaviours

PURPOSE

This paper aims to identify the kind of work environment that should be offered by hospital leaders to their nursing staff in Brazil to generate job satisfaction, organizational commitment and organizational citizenship behaviour within their field of expertise.

DESIGN/METHODOLOGY/APPROACH

A survey was applied to 171 nurses and 274 nursing technicians who work at five private hospitals in Brazil. Both factor analysis and regression analysis were used to analyse the study model.

FINDINGS

The results indicate that to stimulate positive behaviours and attitudes among nursing staff, managers should mainly be concerned about establishing a clear and effective communication with their professionals to ensure role clarity, promote a good working environment and encourage relationships based on trust.

RESEARCH LIMITATIONS/IMPLICATIONS

The limitations of the study are absence of the researcher while the questionnaires were filled out and the fact that the sample comprised respondents who made themselves available to participate in the research.

PRACTICAL IMPLICATIONS

This study contributes to elucidate the factors that can promote a good internal climate for nursing staff, assisting hospital leaders to face the huge managerial challenges of managing, retaining and advancing these professionals.

ORIGINALITY/VALUE

The findings contribute to the body of knowledge in leadership among nursing professionals in developing countries. Hospital leaders in Brazil should encourage trusting relationships with nursing professionals through clear, effective and respectful communications, besides investing in team development and promoting a good working environment.

Overcoming counter-knowledge through telemedicine communication technologies

Purpose Knowledge acquired from sources of unverified information such as gossip, partial truths or lies, in this paper it is termed as "counter-knowledge." The purpose of this paper is to explore this topic through an exploration of the links between a Hospital-in-the-Home Units (HHUs) learning process (LP), counter-knowledge, and the utilization of communication technologies. The following two questions are addressed: Does the reduction of counter-knowledge result in the utilization of communication technologies? Does the development of counter-knowledge hinder the LP? Design/methodology/approach This paper examines the relevance of communication technologies to the exploration and exploitation of knowledge for 252 patients of a (HHU) within a Spanish regional hospital. The data collected was analyzed using the PLS-Graph. Findings To HHU managers, this study offers a set of guidelines to assist in their gaining an understanding of the role of counter-knowledge in organizational LPs and the potential contribution of communication technologies. Our findings support the proposition that the negative effects of counter-knowledge can be mitigated by using communication technologies. Originality/value It is argued in this paper that counter-knowledge may play a variety of different roles in the implementation of LPs. Specifically, the assignment of communication technologies to homecare units has given them the means to filter counter-knowledge and prevent users from any possible problems caused by such counter-knowledge.

Variables Associated With Perceived Work Role Performance Among Professionals in Multidisciplinary Mental Health Teams Overall and in Primary Care and Specialized Service Teams, Respectively

This study had a dual purpose (1) to identify variables associated with perceived work role performance (WRP) among 315 mental health professionals (MHPs) in Quebec and (2) to compare variables related to WRP in MH primary care teams (PCTs) and specialized service teams (SSTs), respectively. WRP was measured using an adapted version of the work role questionnaire. Variables were organized within five areas: individual characteristics, perceived team attributes, perceived team processes, perceived team emergent states, and geographical and organizational context. Half of the WRP variables were linked to team processes. Knowledge sharing correlated with WRP in both MH PCTs and SSTs. Team attributes had more impact on MH PCTs, while team processes and team emergent states played a larger role among SSTs. The association between WRP and knowledge sharing confirms the need for a systematic training program to promote interdisciplinary collaboration. Integration strategies (e.g., service agreements) could improve collaboration between MH PCTs and SSTs and help MHPs perform more effectively within PCTs.

Referral to an Acute Child and Adolescent Inpatient Unit: The Experiences and Views of Community Mental Health Referrers

Admission to an acute mental health inpatient unit is a significant event for a young person. The interface between inpatient and community teams negotiating the admission and later discharge can be fraught. To understand how to improve the transition between inpatient and community care, we interviewed 48 community clinicians about their experiences of engaging with an acute child and adolescent mental health inpatient unit. Through thematic analysis, we identified management of risk was a central issue. Participants wanted more time in hospital, and more communication and collaboration. They expressed appreciation, but some gave intense descriptions of dissatisfaction. The analysis suggests avenues to improve communication and experience, recognizing the (felt) power differential between inpatient and referring community clinicians. Managing the power dynamics requires inpatient clinicians to use active inquiry to bring forward community clinicians' views and be mindful of the risk of community clinicians experiencing communication as criticism.

Conceptions of patients and their roles in healthcare: Insights from everyday practice and service improvement

PURPOSE

The purpose of this paper is two-fold. First, it sets the context for the special issue by considering conceptions of patients and their roles in service delivery and improvement. Second, it introduces the contributions to the special issue, and identifies thematic resonance.

DESIGN/METHODOLOGY/APPROACH

The paper utilises a literature synthesis and thematic analysis of the special issue submissions. These emanated from the Ninth International Organisational Behaviour in Healthcare Conference, hosted by Copenhagen Business School on behalf of the Learned Society for Studies in Organizing Healthcare.

FINDINGS

The articles evidence a range of perspectives on patients' roles in healthcare. These range from their being subject to, a mobilising focus for, and active participants in service delivery and improvement. Building upon the potential patient roles identified, this editorial develops five "ideal type" patient positions in healthcare delivery and improvement. These recognise that patients' engagement with health care services is influenced both by personal characteristics and circumstances, which affect patients' openness to engaging with health services, as well as the opportunities afforded to patients to engage, by organisations and their employees.

ORIGINALITY/VALUE

The paper explores the relationally embedded nature of patient involvement in healthcare, inherent in the interdependence between patient and providers' roles. The typology aims to prompt discussion regarding the conceptualisation patients' roles in healthcare organisations, and the individual, employee, organisational and contextual factors that may help and hinder their involvement in service delivery and improvement. The authors close by noting four areas meriting further research attention, and potentially useful theoretical lenses.

Evaluation of PCMH Model Adoption on Teamwork and Impact on Patient Access and Safety

Purpose: Each of the participating patient-centered medical home (PCMH) received coaching and participated in learning collaborative for improving teamwork. The objective of the study was to assess the impact of trainings on patient-centered teamwork. Methods: The Teamwork Perception Questionnaire (TPQ) was administered once in spring 2014 and then in fall 2015. The TPQ consists of 35 questions across 5 domains: mutual support, situation monitoring, communication, team structure, and leadership. Based on our objective we compared the frequencies of strongly agree/agree by domain. The difference was tested using chi-square test. We compared the scores on each domain (strongly agree/agree = 1; maximum score = 7) via Wilcoxon rank sum test. Results: The response rate for this survey was n = 29 (80.6%) in spring 2014, and n = 31 (86.1%) in fall 2015. We found that the practice members significantly (P < .05) strongly agreed/agreed more in fall 2015 than spring 2014 for characteristics—“staff relay relevant information in a timely manner” (64.5% vs 83.9%) and “staff follow a standardized method of sharing information when handing off patients” (67.7% vs 90.3%) under communication domain and for characteristic—“staff within my practice share information that enables timely decision making” (74.2% vs 90.3%). However, there was no statistical significant difference observed in the scores for the overall TPQ at the 2 time points. Conclusion: Despite the statistical insignificance, the observations in PCMHs across the spectrum of practices participating in the Maryland Multi-Payer Program demonstrated enhanced teamwork specifically in communication and in leadership. This we believe will continue to result in enhanced patient access to care and safety.