How staff experience teamwork challenges in a new organizational structure

Is a bio-psychosocial approach model possible at the first level of health services in the Democratic Republic of Congo? An organizational analysis of six health centers in South Kivu

BACKGROUND

The health system, in the Democratic Republic of Congo, is expected to move towards a more people-centered form of healthcare provision by implementing a biopsychosocial (BPS) approach. It's then important to examine how change is possible in providing healthcare at the first line of care. This study aims to analyze the organizational capacity of health centers to implement a BPS approach in the first line of care.

METHODS

A mixed descriptive and analytical study was conducted from November 2017 to February 2018. Six health centers from four Health Zones (South Kivu, Democratic Republic of Congo) were selected for this study. An organizational analysis of six health centers based on 15 organizational capacities using the Context and Capabilities for Integrating Care (CCIC) as a theoretical framework was conducted. Data were collected through observation, document review, and individual interviews with key stakeholders. The annual utilization rate of curative services was analyzed using trends for the six health centers. The organizational analysis presented three categories (Basic Structures, People and values, and Key Processes).

RESULT

This research describes three components in the organization of health services on a biopsychosocial model (Basic Structures, People and values, and Key processes). The current functioning of health centers in South Kivu shows strengths in the Basic Structures component. The health centers have physical characteristics and resources (financial, human) capable of operating health services. Weaknesses were noted in organizational governance through sharing of patient experience, valuing patient needs in Organizational/Network Culture, and Focus on Patient Centeredness & Engagement as well as partnering with other patient care channels.

CONCLUSION

This study highlighted the predisposition of health centers to implement a BPS approach to their organizational capacities. The study highlights how national policies could regulate the organization of health services on the front line by relying more on the culture of teamwork in the care structures and focusing on the needs of the patients. Paying particular attention to the values of the agents and specific key processes could enable the implementation of the BPS approach at the health center level.

Authentic Leadership and Innovation: The Mediating Role of Affective and Cognitive Integration, and Engagement in Work Teams

This study explores the relationship between authentic leadership and innovation at the team level of analysis. The proposed research model outlines the intervention of three mediating variables: cognitive integration, affective integration, and work engagement. Data were collected from 32 organizations (132 teams) ascribed to the so-called digital ecosystem, an organizational context in which the needs for authentic leadership and innovation seem to be integral to the firm’s performance to succeed in the marketplace. The research supported the presence of a positive relationship between authentic leadership and innovation in work teams. Additionally, affective integration and engagement were found to mediate the relationship between the dependent and the independent variables. Cognitive integration, however, did not manifest any mediating effect. Theoretically, these findings support the consideration of authentic leadership as a job resource that is able to enhance the organizational outcomes, according to the Job Demand and Resources Model.

Collaboration Structures in COVID-19 Critical Care: Retrospective Network Analysis Study

Background

Few intensive care unit (ICU) staffing studies have examined the collaboration structures of health care workers (HCWs). Knowledge about how HCWs are connected to the care of critically ill patients with COVID-19 is important for characterizing the relationships among team structures, care quality, and patient safety.

Objective

We aimed to discover differences in the teamwork structures of COVID-19 critical care by comparing HCW collaborations in the management of critically ill patients with and without COVID-19.

Methods

In this retrospective study, we used network analysis methods to analyze the electronic health records (EHRs) of 76 critically ill patients (with COVID-19: n=38; without COVID-19: n=38) who were admitted to a large academic medical center, and to learn about HCW collaboration. We used the EHRs of adult patients who were admitted to the COVID-19 ICU at the Vanderbilt University Medical Center (Nashville, Tennessee, United States) between March 17, 2020, and May 31, 2020. We matched each patient according to age, gender, and their length of stay. Patients without COVID-19 were admitted to the medical ICU between December 1, 2019, and February 29, 2020. We used two sociometrics—eigencentrality and betweenness—to quantify HCWs’ statuses in networks. Eigencentrality characterizes the degree to which an HCW is a core person in collaboration structures. Betweenness centrality refers to whether an HCW lies on the path of other HCWs who are not directly connected. This sociometric was used to characterize HCWs’ broad skill sets. We measured patient staffing intensity in terms of the number of HCWs who interacted with patients’ EHRs. We assessed the statistical differences in the core and betweenness statuses of HCWs and the patient staffing intensities of COVID-19 and non–COVID-19 critical care, by using Mann-Whitney U tests and reporting 95% CIs.

Results

HCWs in COVID-19 critical care were more likely to frequently work with each other (eigencentrality: median 0.096) than those in non–COVID-19 critical care (eigencentrality: median 0.057; P<.001). Internal medicine physicians in COVID-19 critical care had higher core statuses than those in non–COVID-19 critical care (P=.001). Nurse practitioners in COVID-19 care had higher betweenness statuses than those in non–COVID-19 care (P<.001). Compared to HCWs in non–COVID-19 settings, the EHRs of critically ill patients with COVID-19 were used by a larger number of internal medicine nurse practitioners (P<.001), cardiovascular nurses (P<.001), and surgical ICU nurses (P=.002) and a smaller number of resident physicians (P<.001).

Conclusions

Network analysis methodologies and data on EHR use provide a novel method for learning about differences in collaboration structures between COVID-19 and non–COVID-19 critical care. Health care organizations can use this information to learn about the novel changes that the COVID-19 pandemic has imposed on collaboration structures in urgent care.

Working separately but together: appraising virtual project team challenges

Purpose

This paper aims to extend the extant knowledge on virtual teams by examining the challenges of virtual project teams in organisations in Nigeria.

Design/methodology/approach

Data were collected through semi-structured interviews. Totally, 20 interviews were recorded, transcribed and analysed. Validity and reliability were achieved by first assessing the plausibility in terms of already existing knowledge on some of the virtual project team issues identified by participants.

Findings

The findings from this study confirmed the growing relevance of virtual project teams in highly competitive global business environments. It emerged that some of the challenges identified in the study had some level of congruence with those previously identified from similar studies from other geographical locations. The findings also suggested that challenges in virtual project teams can be linked to the organisation, the project team and the virtual environment or even a combination of all.

Practical implications

The present study corroborates the position that managing virtual project teams requires additional efforts to attain their objectives through effective communications and the adoption of appropriate technology.

Originality/value

The originality of this study lies in its exploration of virtual project team challenges in a sub-Saharan Africa country (Nigeria). By identifying the challenges associated with virtual project teams, stakeholders will be better able to successfully establish and manage virtual project teams better.