Key Team Members Research Articles

Overcoming challenges to teamwork in patient-centered medical homes: a qualitative study.

There is emerging consensus that enhanced inter-professional teamwork is necessary for the effective and efficient delivery of primary care, but there is less practical information specific to primary care available to guide practices on how to better work as teams. The purpose of this study was to describe how primary care practices have overcome challenges to providing team-based primary care and the implications for care delivery and policy. Practices for this qualitative study were selected from those recognized as patient-centered medical homes (PCMHs) via the most recent National Committee for Quality Assurance PCMH tool, which included a domain on practice teamwork. Sixty-three respondents, ranging from physicians to front-desk staff, were interviewed from May through December of 2013. Practice respondents came from 27 primary care practices ranging in size, type, geography, and population served. Practices emphasizing teamwork overcame common challenges through the incremental delegation of non-clinical tasks away from physicians. The roles of medical assistants and nurses are expanding to include template-guided information collection from patients prior to the physician office visit as well as many other tasks. The inclusion of staff input in care workflow redesign and the use of data to demonstrate how team care process changes improved patient care were helpful in gaining staff buy-in. Team "huddles" guided by pre-visit planning were reported to assist in role delegation, consistency of information collected from patients, and structured communication among team members. Nurse care managers were found to be important team members in working with patients and their physicians on care plan design and execution. Most practices had not participated in formal teamwork training, but respondents expressed a desire for training for key team members, particularly if they could access it on-site (e.g., via practice coaches or the Internet). Participants who adopted new forms of delegation and care processes using teamwork approaches, and who were supported with resources, system support, and data feedback, reported improved provider satisfaction and productivity. There appears to be a need for more on-site teamwork training.

Using quality improvement to optimise paediatric discharge efficiency

BackgroundBed capacity management is a critical issue facing hospital administrators, and inefficient discharges impact patient flow throughout the hospital. National recommendations include a focus on providing care that is timely...

Critical Success Factors for the Implementation of Integrated Healthcare Information Systems Projects: An Organizational Fit Perspective

Many healthcare reforms are to digitalize and integrate healthcare information systems. However, the disparity of business benefits in having an integrated healthcare information system (IHIS) varies with organizational fit factors. Critical success factors (CSFs) exist for hospitals to implement an IHIS successfully. This study investigated the relationship between the organizational fit and the system success. In addition, we examined the moderating effect of five CSFs -- information systems adjustment, business process adjustment, organizational resistance, top management support, and the capability of key team members – in an IHIS implementation. Fifty-three hospitals that have successfully undertaken IHIS projects participated in this study. We used regression analysis to assess the relationships. The findings of this study provide a roadmap for hospitals to capitalize on the organizational fit and the five critical success factors in order to implement successful IHIS projects.

Procedure of Modular Green Factory Planning to Enhance Collaboration and Decision Making

Planning resource and energy efficient factories is a challenge for present approaches because of the additional knowledge required and because of the high variety of energy efficient measures theoretically available; modularity as promising solution allows case-adaptability and focusing most relevant energy drivers during planning. Planning requires interdisciplinary collaboration and smooth decision making in these modules because different factory elements interact and information needs to be processed. This paper describes the composition and interconnection of Green Factory Planning modules focusing the assignment to planning experts and the management procedure to have higher impact on green performance. A use case shows how planning modules can help identify relevant information and key team members to let them collaboratively find solutions.

"Entrepreneurship, Legitimacy and Online Social Communities: An Empirical Analysis"

We examine how entrepreneurial firms leverage online social networking communities to establish legitimacy. We propose that one measure of a firm’s legitimacy is the size of its online community, and capture an intermediate measure of legitimacy this is associated with credibility. We develop a theoretical model of how entrepreneurial firms grow their online social communities through the use of symbolic actions, and hypothesize about the specific ways that the use of four categories of symbolic actions can facilitate subsequent growth in a firm’s online social community. We empirically test these hypotheses and find that actions that convey product and industry knowledge, and firm achievements are significantly associated with online community growth. This may indicate a form of preferential attachment wherein people want to associate online with firms that they perceive to be knowledgeable and have noteworthy achievements. Our study’s non-significant results for the influence of actions conveying professional organizing and capability of key team members on legitimacy contrasts with the findings from past studies, and thus highlights the importance of differences in the audiences evaluating legitimacy. Contrary to initial expectations, we find that seek opinions has a negative impact on online social community growth.

Facilitating accrual to cancer control and supportive care trials: the clinical research associate perspective.

BackgroundAccrual to Cancer Control and Supportive Care (CCL) studies can be challenging. Our objective was to identify facilitators and perceived barriers to successful Children’s Oncology Group (COG) CCL accrual from the clinical research associate (CRA) perspective.MethodsA survey was developed that focused on the following features from the institutional perspective: (1) Components of successful accrual; (2) Barriers to accrual; (3) Institutional changes that could enhance accrual; and (4) How COG could facilitate accrual. The survey was distributed to the lead CRA at each COG site with at least 2 CCL accruals within the previous year. The written responses were classified into themes and sub-themes.Results57 sites in the United States (n = 52) and Canada (n = 5) were contacted; 34 (60%) responded. The four major themes were: (1) Staff presence and dynamics; (2) Logistics including adequate numbers of eligible patients; (3) Interests and priorities; and (4) Resources. Suggestions for improvement began at the study design/conception stage, and included ongoing training/support and increased reimbursement or credit for successful CCL enrollment.ConclusionsThe comments resulted in suggestions to facilitate CCL trials in the future. Soliciting input from key team members in the clinical trials process is important to maximizing accrual rates.

Application of team role theory to construction design teams

Teams are the primary unit of working in the construction industry, and thus the performance of an industry can be improved when team performance is improved. Therefore, managers in the field should be well aware of good team-working practices for successful forming and managing of teams within construction industry and many authors in the field have pointed out this as a necessity. Team composition is a key factor in influencing team performance; when considering the team composition, it is relevant to take into account the different roles which the members play and the way they interact with one another. Team roles of the members can be used as a tool for the team to have effective execution of their work, effective management of their relationships with its environment and also to maintain the team's strength in meeting social needs of individuals who form the team. The design team being a major and most prominent sub-team will have an impact on project success; the applicability of team role concept in construction design teams will be beneficial to its clients, project managers, team members and, finally, for the project and construction industry as a whole. According to Belbin's team role theory, when a team is more balanced in terms of the spread of naturally occurring team roles, it tends to be high performing. This study explored the existence of team roles and their effect to team performance in construction design teams. To explore this research problem, three case studies of in-house design teams which were involved in building construction projects with separated procurement arrangement were conducted in Sri Lanka. Team roles of the design team members were assessed using the Belbin Team Role Self Perception Inventory, while semi-structured interviews were conducted with the key design team members as well as team selectors. The findings revealed that individuals are assigned to design teams considering their functional roles rather than team roles. But, team members naturally adopted team roles in a way that it suits their functional role, project requirements and team setting under which they operate, in most of the situations. Team performance was affected by several complex factors. Hence, even though there seems to be an effect from team role balance to team performance, it could not be isolated and figured out. Despite this limitation, this study offers implications particularly to design team selectors such as clients and their project managers on application of team role theory in construction context.

Team Consensus Concerning Important Outcomes for Augmentative and Alternative Communication Assistive Technologies: A Pilot Study

Obstacles to assistive device outcome measurement include a lack of consensus about which outcomes should be evaluated. This article reports a case study of the use of a structured consensus-building approach called Technique for Research of Information by Animation of a Group of Experts (TRIAGE) to develop agreement among key professional team members with regard to outcome measurement. We also describe the changes in key professional team members’ perspectives on outcome measurement over time. Initially, participants expressed preferences for the measurement of about 33 different outcomes. Subsequent discussions and the TRIAGE process led to the choice of the five most important outcomes. Our case study provides evidence that professional team consensus could successfully be reached through the individual reflections and group sharing proposed by the TRIAGE technique. Future research directions include the development of strategies to give prominence to the opinions of individuals who use augmentative and alternative communication (AAC) in the identification of important outcomes, and for aggregating and interpreting data gathered at local, regional, or national levels.

Improvement of time to develop treatment plan at a specialized sarcoma center.

127 Background: Treatment of new patients at the MD Anderson Sarcoma Medical Oncology Clinic can take up to 1 to 2 weeks from their initial consultation depending on the information available for review. Treatment delays can result in poor patient outcomes, adversely affecting the quality of care provided. There are numerous processes involved in the development of a treatment plan that could be improved to reduce the time to finalization of treatment plan. Methods: We undertook a quality improvement project involving key clinic and administrative team members. We performed detailed process mapping and developed a cause and effect diagram to identify and prioritize opportunities for improvement. We measured the time in hours from the patient’s initial appointment to finalization of a treatment plan. Baseline data (before process improvement implementation) was collected retrospectively through chart review. Post-implementation data was collected prospectively. For process improvement, we focused on two deficiencies that were regarded as the key causes of delay to develop a finalized treatment plan (1) insufficient data for decision making at the time of new patient visit, and (2) delays in obtaining diagnostic imaging. Results: Due to insufficient data for decision-making available at the time of initial consultation, the median time to develop a treatment plan is 72 hours. After initiating process improvement, the median time to develop a treatment plan decreased to approximately 7 hours. Conclusions: Improving the quality of data available for the medical oncologist prior to initial consultation greatly enhances the rapid development of finalized treatment plan. Availability of an early treatment plan improves patient outcomes, diminishes patient anxiety, and decreases the costs incurred by the patient awaiting a treatment plan at a specialized oncology clinic.

Management of a Large Qualitative Data Set: Establishing Trustworthiness of the Data

Health services research is multifaceted and impacted by the multiple contexts and stakeholders involved. Hence, large data sets are necessary to fully understand the complex phenomena (e.g., scope of nursing practice) being studied. The management of these large data sets can lead to numerous challenges in establishing trustworthiness of the study. This article reports on strategies utilized in data collection and analysis of a large qualitative study to establish trustworthiness. Specific strategies undertaken by the research team included training of interviewers and coders, variation in participant recruitment, consistency in data collection, completion of data cleaning, development of a conceptual framework for analysis, consistency in coding through regular communication and meetings between coders and key research team members, use of N6™ software to organize data, and creation of a comprehensive audit trail with internal and external audits. Finally, we make eight recommendations that will help ensure rigour for studies with large qualitative data sets: organization of the study by a single person; thorough documentation of the data collection and analysis process; attention to timelines; the use of an iterative process for data collection and analysis; internal and external audits; regular communication among the research team; adequate resources for timely completion; and time for reflection and diversion. Following these steps will enable researchers to complete a rigorous, qualitative research study when faced with large data sets to answer complex health services research questions.

What's in store: Lessons from implementing CCS

Carbon dioxide capture and storage (CCS) has been identified as a key technology for mitigating carbon emissions. However, CCS is still very much at a developmental stage and the full-scale projects required to test the technology have proven difficult to implement, with lack of societal acceptance considered a key contributing factor to this delay. This paper reports on a study that explored practices for effective communication, engagement strategies and activities in the context of five detailed CCS project case studies. The cases studied included Barendrecht, The Netherlands; Carson, USA; FutureGen, USA; ZeroGen, Australia; and the CO2CRC Otway project, Australia. Comparative analysis of these cases identified a series of factors including: the extent to which key government and project team members are aligned; deployment of communications experts as part of the project team from the outset; consideration of the social context; the degree of flexibility in the project; and competition involving community self-selection. The research team designated these “critical success factors” that, when present, seemed to enhance the effectiveness of best practices in engagement and contribute to successful project deployment in some cases. The paper proposes that project developers need to consider ways to maximise these critical factors as part of their project planning and implementation process. It also discusses best practices in stakeholder communication and engagement activities applicable to CCS projects.

Task, team and technology integration in the paediatric cardiac operating room

One of the most potentially valuable paradigms for improving safety in surgery is known as human factors. However, the main use of this approach has been largely limited to aviation-style teamwork training. In this paper two case studies are presented that illustrate the complex interactions between team, task and technology in paediatric cardiac surgery. Both illustrate primarily how the technological co-ordination of the perfusion task is shared amongst the three key team members. The first case study presents two approaches to going onto cardio-pulmonary bypass, one of which demonstrates a range of key risks. The second presents the transcripts of a case of mild exsanguinations that was quickly recovered from. This case illustrates both the complexity of error and the importance of task-based communications for error capture and recovery. The discussion argues for a broader approach to teamwork considerations in the OR.

From PALSA PLUS to PALM PLUS: adapting and developing a South African guideline and training intervention to better integrate HIV/AIDS care with primary care in rural health centers in Malawi

BackgroundOnly about one-third of eligible HIV/AIDS patients receive anti-retroviral treatment (ART). Decentralizing treatment is crucial to wider and more equitable access, but key obstacles are a shortage of trained healthcare workers (HCW) and challenges integrating HIV/AIDS care with other primary care. This report describes the development of a guideline and training program (PALM PLUS) designed to integrate HIV/AIDS care with other primary care in Malawi. PALM PLUS was adapted from PALSA PLUS, developed in South Africa, and targets middle-cadre HCWs (clinical officers, nurses, and medical assistants). We adapted it to align with Malawi's national treatment protocols, more varied healthcare workforce, and weaker health system infrastructure.Methods/DesignThe international research team included the developers of the PALSA PLUS program, key Malawi-based team members and personnel from national and district level Ministry of Health (MoH), professional associations, and an international non-governmental organization. The PALSA PLUS guideline was extensively revised based on Malawi national disease-specific guidelines. Advice and input was sought from local clinical experts, including middle-cadre personnel, as well as Malawi MoH personnel and representatives of Malawian professional associations.ResultsAn integrated guideline adapted to Malawian protocols for adults with respiratory conditions, HIV/AIDS, tuberculosis, and other primary care conditions was developed. The training program was adapted to Malawi's health system and district-level supervision structure. PALM PLUS is currently being piloted in a cluster-randomized trial in health centers in Malawi (ISRCTN47805230).DiscussionThe PALM PLUS guideline and training intervention targets primary care middle-cadre HCWs with the objective of improving HCW satisfaction and retention, and the quality of patient care. Successful adaptations are feasible, even across health systems as different as those of South Africa and Malawi.

Supply-chain corporate venturing through acquisition: Key management team retention

Acquisitions are often used as a way to engage in corporate venturing. The value of these ventures tends to reside in the knowledge and capabilities of the key management team members who have and maintain key inter-organizational relationships. Because their knowledge and/or relationships may be tacit and therefore difficult to transfer, retaining the key managers in the acquired organization is often a critical issue for the human resource management of the acquiring organization. They are also frequently thought to be critical elements in the future performance in global supply chains and therefore, should be a key concern of human resource management after the acquisition has been culminated. Using a unique dataset of corporate acquisitions in supply-chains, we examine how the development of the psychological contract elements affects retention of critical key global managers. We find that higher retention of the key management team members leads to higher performance after acquisition. We also find that the development of the psychological contract has a positive impact on the retention of key managers with global supply-chain relations.

So Long, Farewell – Sending Patients Home

So Long, Farewell – Sending Patients Home

The problems of using social networks in entrepreneurial resource acquisition

This article identifies and classifies the problems perceived by entrepreneurs when they use social network ties (direct and indirect ties) to acquire resources during the early stages of new venture formation process. On the basis of field interviews with 128 high-tech entrepreneurs in Singapore, the author finds that entrepreneurs have a high level of awareness of the potential problems of social networks, though they rely extensively on network ties. Substantial variations occur across the three dimensions of potential problems (information, influence and solidarity) and three types of resources (financial resources, key team members and lead users). This study offers a more complete understanding of how and why entrepreneurs use social networks and the influence of their use on the entrepreneurial process.

Training Programs in Outcomes Research

Outcomes research is a rapidly evolving field that focuses on the ultimate end-result of health care (patient outcomes). At its core, outcomes research seeks to identify potential deficiencies in the systems of care, and then develop and implement solutions to these problems with the purpose of improving patient outcomes.1,2 Because of its emphasis on patient care, the field of outcomes research is intended for clinicians and other clinically-oriented researchers with keen ability to ask and answer critically important questions that have direct clinical implications. At its best, outcomes research is a multidisciplinary team endeavor. The clinician scientist is a key team member, and it is the training of these investigators that is addressed in this brief overview. Although superb clinical training forms the initial foundation for a future career in outcomes research, the transition from a clinician to an outcomes researcher requires the commitment to acquire the necessary skills, just like in other research fields. Because of its interface with numerous other disciplines (biostatistics, epidemiology, health services research, health economics, behavioral sciences, and health policy), this training is best obtained in a comprehensive program dedicated to the field of outcomes research. The purpose of this review is to briefly outline currently available programs that provide the necessary training in outcomes research. Two critical components of training form the foundation and can help secure a productive career in outcomes research: the commitment to dedicate sufficient time and effort to training, and a training environment that provides the necessary skill set for success. Many successful investigators acquire components of their training through the resources and expertise at their local institutions, using well-established traditional channels such as career development awards (administered by the National Institutes of Health, not-for-profit foundations, and others). However, several structured formal programs have been established, which are designed …

Leveraging informal networks in knowledge management

PurposeThe purpose of this paper is to trace and understand informal knowledge sharing networks for various competencies in project teams. This will help establish a baseline and thereby enable further knowledge management interventions to be outlined.Design/methodology/approachTwo project teams were identified for this study. While one of the teams had a semi‐structured knowledge management system already in place, the other had not adopted any knowledge management practices. The knowledge network analysis was rolled out for both the teams for the competencies that they were working on. This was more of an exploratory study. The results are compared across both the teams and inferences are made on the knowledge networks for the teams.FindingsThe various measures involved in social network analysis can help from a knowledge management perspective to: identify experts; provide indicators to the extent of knowledge sharing for various competencies; and baseline current knowledge management practices in a team.Research limitations/implicationsThis methodology would not be very feasible for large teams with more than 500 people.Practical implicationsThis is a very useful diagnostic tool for managers to know more about the knowledge sharing dynamics in their teams. This may help them design interventions to build the capabilities of key team members along specific knowledge areas.Originality/valueThe paper provides indicators on the capability of the teams and their knowledge repositories based on the interactions between them.

Use of the Decision Case Method of Teaching in a Course on Death and Grief

ABSTRACT As a key professional and essential team member, social workers must be adequately prepared to address the complexities and challenges inherent in palliative, hospice, and bereavement care. Decision case method teaching is one means of exposing students to practice situations they may face and stimulating collaborative decision making in the classroom. This article explores the use of the decision case method in a master's level course on death and dying. The approach was well-accepted by students and a good fit for the university's academic focus on developing critical thinking abilities.

Improving qualifications‐based selection by use of the fuzzy Delphi method

Among prevailing contract‐awarding paradigms, the qualifications‐based selection (QBS) method offers awarding agencies a substantial level of flexibility and multifactored decision‐making capability over traditional cost‐based paradigms (such as competitive bidding). QBS is a process used by owners to select proposers to whom they can award a project contract, based on the proposers' professional qualifications in relation to the specific project parameters. Further to being very suitable for the selection of professional engineering design services, QBS can also be applied for the selection of contractors involved in specialized construction or design‐build projects. In such cases, the procurement method and the selection criteria used are critical decisions involving several key project team members and decision factors, the formulation of which requires complex evaluation methodologies. Within this context, a process is proposed by which the traditional QBS method can be improved via the utilization of a fuzzy Delphi method (FDM), a cross‐mutation of the traditional Delphi method (DM) and fuzzy logic (FL). The method utilizes ‘expert’ appraisals to identify both the factors and their weights in the overall evaluation process through a ‘fuzzy attractiveness ratio’ (FAR) which is used for evaluating the bidders' suitability to task.