Differing Professional Perspectives on the Interprofessional Collaboration in IPUs: A Mixed-methods Study

Introduction

An important aspect of Value-Based Healthcare (VBHC) is providing the full cycle of care for a specific medical condition through interprofessional collaboration. This requires employees from diverse professional backgrounds to interact, but there is limited knowledge on how professionals perceive such interprofessional collaboration. We aimed to provide insight into how different professionals perceive Integrated Practice Unit (IPU) composition and what factors influence the quality of interprofessional collaboration within IPUs.

Methods

A survey was administered to employees from different professional backgrounds (medical specialists, nurses, allied health professionals, administrative employees) working in IPUs to assess their perception of the composition of their IPU and the quality of the interactions. Subsequently, semi-structured interviews were conducted to gain a deeper understanding of the findings of the survey.

Results

Medical specialists and nurses were most frequently considered to be part of an IPU and indicated that they have high quality interactions. Allied health professionals were less often considered part of the team by all other professional groups and all report low quality interaction with this group. The extent to which a professional group is perceived as a team member depends on their visibility, involvement in the treatment of the patient, and shared interest. Differences in the quality of interprofessional collaboration are influenced by organizational structures, knowledge of each other's expertise, and by ways of communication.

Conclusions

In VBHC, there seems to be a lack of common perception of an IPU's composition and a failure to always achieve high quality interprofessional collaboration. Given the importance of interprofessional collaboration in VBHC, effort should be invested in achieving a shared understanding and improved collaboration.

The ambiguity of "we": Perceptions of teaming in dynamic environments and their implications

In healthcare, organizations increasingly call on clinicians and staff to team up fluidly to deliver integrated services across disciplines and settings. Yet little is known about how clinicians and staff perceive of team membership in healthcare environments where team boundaries are often ambiguous and continually shifting. We draw on the context of primary care in the United States, where fluid multi-disciplinary teamwork is commonly exhorted, to investigate the extent to which clinicians and staff perceive of various roles (e.g., physician, front desk) as members in their teams, and to identify potential implications. Using a survey fielded within 59 clinics (n = 828), we find substantial variation in individuals' perceptions of the roles they consider as team members during an episode of care (e.g., mean team size = 10.60 roles; standard deviation = 5.09). Perceiving more expansive sets of roles as team members exhibits a positive association with performance as measured by care quality (b = 0.02; p < .01) but a curvilinear association with job satisfaction. Separating an individual's perceived core (roles always perceived as part of the team) and periphery (roles sometimes perceived as part of the team), perceiving a larger core is positively associated with performance (b = 0.03 p < .01). In contrast, perceiving a larger periphery is marginally negatively associated with performance (b = -0.02, p < .10). This appears to be driven by divergence from the norm perception of the core, i.e., when individuals attribute to the periphery the roles that are considered by most others to be core. Our findings suggest that individuals viewing the roles they must team with more expansively may generate higher quality output but experience a personal toll. Delivering on the ideal of team-based care in dynamic environments may require helping team members gain clarity about their teammates and implementing policies that attend to job satisfaction as team boundaries shift and expand.

Gender Differences in Responses to Competitive Organization? A Field Experiment on Differences Between STEM and Non-STEM Fields from an Internet-of-Things Platform

Prior research, primarily based on laboratory experiments, suggests that females might be more averse to competition than are males; females might, instead, be more inclined toward collaboration. Were these findings to generalize to working-age men and women across the workforce, there could be profound implications for organizational design and personnel management. We report on a field experiment in which 97,678 adults from a wide range of fields of training and career stages were invited to join a product development platform. Individuals were randomly assigned to treatments framing the opportunity as either involving competitive or collaborative interactions with other participants. Among those outside of science, technology, engineering, and math (STEM) fields, we find differences in the willingness of men and women to participate under competition. Thus, patterns in non-STEM fields conform to the usual claims of gender differences. However, among those in STEM fields, we find no statistical gender differences. Results hold under a series of alternative specifications, controls, and stratified analyses of 17 narrowly defined STEM subfields. The results are also consistent with sorting into fields on the basis of competitiveness, as suggested by prior research, as well as other explanations we discuss. Overall, heterogeneity in competitiveness among women and among men, particularly across fields, appears more striking here than population-wide gender differences.

Funding: This work was supported by Ewing Marion Kauffman Foundation [Grant G00005624].

Supplemental Material: The online appendix is available at https://doi.org/10.1287/orsc.2022.1624 .

The Effectiveness of Community Mental Health Teams in Relation to Team Cohesion, Authentic Leadership and Size of the Team: A study in the North West of Ireland

Community Mental Health Teams (CMHTs) are increasingly being considered effective models of recovery focused care, however their effectiveness and factors that may affect it have not fully evaluated. Cross-sectional study in Ireland included 106 members from 8 CMHTs. We examined CMHT's effectiveness and the effects of authentic leadership, team cohesion, team members' experience and team tenure on effectiveness, by administering the Team Effectiveness Scale, Authentic Leadership Questionnaire, and Organizational Cohesion Scale. Data on demographics, discipline, years of experience, tenure in the same team, full or partial membership, and number of team members were collected. Results from multilevel regression analysis indicated significant association (p < 0.05) between effectiveness of CMHTs and factors including team cohesion, authentic leadership, size of the team and full membership. Therefore, to increase CMHTs effectiveness, interventions are needed to those areas: a switch to make leadership styles more authentic, to improve team cohesion, smaller team size and full membership.

The Effect of Role-Based Product Representations on Individual and Team Coordination Practices: A Field Study of a Globally Distributed New Product Development Team

The investigation of the appealing indication that a modular product architecture is best associated to a loosely coupled organizational structure—that is, the mirroring hypothesis—has produced contradictory evidence, especially in the dynamic and ambiguous context of new product development. By integrating modularity theory and product-representation theories, we investigate how individual agency affects coordination in teams developing modular products. We conducted a field study of Flower-Net, a globally distributed team in a major IT company, engaged with the development of a modular software using agile practices. Our grounded model shows that, whereas top managers defined the product as modular and coordinated work accordingly, individuals developed different representations of the product’s architecture and conflicting individual coordination practices. We traced the individual development of product architecture representations back to the individual interpretations of organizational roles as more or less “segmented.” Conflicting individual practices, associated to different role-based product representations, were not addressed by the team—that developed a state of illusory concordance—and impaired the functioning of the team. This study contributes to the literature on modularity and the mirroring hypothesis by proposing individual role-based representations as an underexplored level of analysis for the matching between product and organizational modularity (Mirroring Hypothesis II). It also contributes to the debate on how representations affect team coordination, by detailing how role-based product representations can influence team members’ divergence and sustain illusory concordance.

The challenges of working with “real” teams: Introduction to the second installment

We introduce the next two papers in our running special section on the challenges studying modern teams—those that may not have identifiable boundaries, stable membership, or members who belong only to that single team. Our perspective is that many of the assumptions about teams themselves are no longer correct, so rather than further exploiting our traditional approaches, the field should explore new or different ways to analyze the team experience. Thus, in these special sections, we present theoretical arguments made based on disciplined imagination and actual experience for why such new approaches are credible. This installment presents two papers that should enrich researchers’ sophistication in their ontological assumptions about teams. They are excellent complements to each other, as both are about questions of meaning and both have clear methodological implications for research design, but one zooms in to the nature of teams and the other zooms out to the nature of knowledge itself.

The challenges of working with “real” teams: Challenges, needs, and opportunities

Teams are ubiquitous in organizations, yet work contexts now make traditional teams—those that have identifiable boundaries, stable membership, and members who belong only to that single team—a rarity. Teamwork has evolved along with work itself, making the traditional means of studying and validating team experiences (e.g., agreement statistics) inadequate. Yet it is not merely that current measures are antiquated, many of the assumptions about teams themselves are no longer correct. We felt that rather than simply trying to further exploit our traditional approaches to studying teams, the field should explore new or different ways to capture the team experience. New ideas about how to study teams will necessarily start out as theoretical—arguments made based on disciplined imagination and actual experience for why such new approaches are credible. If those who study new forms of teams can then validate these theories, then such new approaches expand the field’s capabilities. Thus, over the next few issues of OPR, we will be featuring papers that present new stances on how to study real teams. Such papers will provide arguments as to why these approaches are legitimate and necessary, to hopefully help bring these new approaches to future empirical work on teams in the real world.

Multiple Team Membership: An Integrative Review

With many employees operating in a multiteam environment, multiple team membership (MTM) has become a critical topic across a number of disciplines. Although MTM research is often regarded as being in its beginning stages, there has been a recent uptick of research. An integration of the literature at this phase allows scholars to see the most pressing challenges and begin to identify general insights to move research forward effectively. Accordingly, this review contributes to the literature through drawing meaningful connections regarding MTM between disciplines and providing nascent opportunities for future research. The final review includes 44 articles that directly examine MTM. These articles are supplemented by the project and management literatures to elaborate upon the theoretical bases and findings of these articles.

Agentic Denial: How Athletic Teams Sustain Divergent Structures During Concussion Events

This study reveals how athletic health care teams, embedded within large bureaucratic organizations and complex social systems, negotiate and sustain multiple divergent structures. An iterative analysis of 69 in-depth interviews with National Collegiate Athletic Association (NCAA) Division I athletes’ certified athletic trainers (ATCs) and coaches from four high-contact sports (i.e., women’s lacrosse, men’s wrestling, men’s soccer, and men’s football) revealed that team members coconstructed and negotiated multiple conflicting structures during concussion events. The divergent macro-, meso-, and micro-level structures include (a) formal versus hidden authority structures, (b) prevention versus inevitability discourse, (c) assigned versus enacted roles, and (d) authentic versus inauthentic injury performance. The analysis also revealed how a specific speech act, termed agentic denial, enabled members to obscure their agency within concussion events. Theoretical implications and practical recommendations are discussed.

In or Out? Exploring the Inconsistency and Permeability of Team Boundaries

Despite the fundamental relevance of team boundaries for team research, scholars have rarely explored their origins and characteristics. Instead, team research commonly assumes the existence of formally defined, stable team boundaries. We challenge this assumption by asserting that beyond formal assignment, team members’ individual perceptions of a team’s boundaries are driven by individual-level categorization processes and team-level task dynamism. Building on multiple team members’ mental representations of team boundaries, we propose that team boundaries are likely mutually inconsistent and vary in their degree of permeability. This permeability and inconsistency serve to clarify how membership change and overlap can induce cognitive and emotional spillovers across teams. The proposed conceptual model links the origins of boundary emergence with their characteristics by explaining how membership structure and dynamics drive the characteristics of team boundaries. This account offers a new perspective on how individual perceptions of work affiliations can shape a team’s boundaries.

The dynamic relationship between multiple team membership and individual job performance in knowledge-intensive work

Many employees in modern, knowledge-based organizations are concurrently involved in more than one team at the same time. This study investigated whether a within-person change in such individual multiple team membership (MTM) may precede and may be predicted by changes in an employee's overall job performance. We examined this reciprocal relationship using longitudinal archival data from a large knowledge-intensive organization, comprising 1,875 employees and spanning 5 consecutive years. A latent change score model demonstrated that an increase in an employee's MTM was associated with a subsequent decrease in his or her overall job performance evaluations. By contrast, an increase in job performance was associated with a subsequent increase in an employee's MTM. Moreover, our results indicated that although an increase in an individual employee's MTM initially decreases his or her job performance, in the long run, this increase in MTM was associated with higher job performance. Together, these results suggest a dynamic association between an individual employee's MTM and his or her overall job performance, such that these variables are mutually connected in a highly complex manner over time.

Who is on the primary care team? Professionals' perceptions of the conceptualization of teams and the underlying factors: a mixed-methods study

Background

Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care professionals conceptualize teams and what underlying factors influence their perception of being part of a team. Our research question is: What are primary care professionals’ perceptions of teams and team membership among primary care disciplines and what factors influence their perceptions?

Methods

We conducted a mixed-methods study in the Dutch primary care setting. First, a survey study of 152 professionals representing 12 primary care disciplines was conducted, focusing on their perceptions of which disciplines are part of the team and the degree of relational coordination between professionals from different disciplinary backgrounds. Subsequently, we conducted semi-structured interviews with 32 professionals representing 5 primary care disciplines to gain a deeper understanding of the underlying factors influencing their perceptions and the (mis)alignment between these perceptions.

Results

Misalignments were found between perceptions regarding which disciplines are members of the team and the relational coordination between disciplines. For example, general practitioners were viewed as part of the team by helping assistants, (district) nurses, occupational therapists and geriatric specialized practice nurses, whereas the general practitioners themselves only considered geriatric specialized practice nurses to be part of their team. Professionals perceive multidisciplinary primary care teams as having multiple inner and outer layers. Three factors influence their perception of being part of a team and acting accordingly: a) knowing the people you work with, b) the necessity for knowledge exchange and c) sharing a holistic view of caregiving.

Conclusion

Research and practice should take into account the misalignment between primary care professionals’ perceptions of primary care teams, as our study notes variations in the conceptualization of primary care teams. To enhance teamwork between professionals from different disciplinary backgrounds, professionals acknowledge the importance of three underlying conditions: team familiarity, regular and structured knowledge exchange between all professionals involved in the care process and realizing and believing in the added value for patients of working as a team.

Electronic supplementary material

The online version of this article (10.1186/s12875-017-0685-2) contains supplementary material, which is available to authorized users.