Team-based Structure Research Articles

Single center experience developing sustainable genetics clinical care: a model to address workforce challenges in medical genetics

Purpose of review The national workforce shortage in genetics is being evaluated in order to identify a sustainable solution to the increasing demand for genomic services. An innovative solution to the short term needs is to integrate advanced practice providers (APPs) and embed genetic counselors into both outpatient and inpatient specialty care. Incorporating APPs into a genetic service is not unique in itself, but the method of implementation at Medical College of Wisconsin (MCW) was, at the time, unchartered. Recent findings There are >100 vacancies for board certified medical geneticists across the nation, training programs are not enrolling sufficient trainees to meet demand and more than a third of the current workforce plan to retire within the next 10 years. Summary The integration of advanced practice providers (nurse practitioners, midwives, physician assistants etc.) into both primary and specialty care has been an evolving practice since the mid-1900s and incorporating APPs into a genetic service was not unique in itself but the method of implementation was new at that time. This is a model to successfully develop a clinical practice model around a team-based structure incorporating nurse clinicians, advanced practice providers, genetic counselors, nutritionists, and physicians into an academic clinical genetics practice.

A complete lean system design for team-oriented product development projects

PurposeThe inherent variability on process times and demand are the factors that prevent the efficient application of lean philosophy in multi-project product development (PD) environments. Considering this variability, a hybrid push–pull project control system is developed, and value stream costing (VSC) analysis is performed to reflect the relation between project lead time, capacity and project cost. The assessment of the push/pull project control on lead time improvement and long-term savings on capacity have been aimed with the proposed complete design structure.Design/methodology/approachIn a team-based structure, formed through clustering, push control techniques for planning tasks within cross-functional teams and pull control techniques for planning tasks between cross-functional teams are developed. The final step evaluates the proposed structure through VSC and long-term savings have been pointed out, especially in terms of freed-up capacity. For the validation of the proposed methodology, an office furniture manufacturing firm’s PD department has been considered and the performance of the hybrid system has been observed through simulation experiments and based on the simulation results, the lean system is evaluated by VSC.FindingsThe results of simulation experiments show a superior performance of the proposed hybrid push/pull project control mechanism under different settings of cycle time between projects or shortly project cycle time, dispatching rules within teams and variability levels. The results of the Box-Score (tool to apply VSC) indicate increased capacity in the long term to add extra projects during the planning period with the same project lead time and without additional cost.Research limitations/implicationsAlthough extensive simulation experiments have been performed to quantify the effect of project control structure and positive results have been reported on lead time and cost, the proposed design structure has not been tested in all existing PD environments.Originality/valueTo the best of authors’ knowledge, the quantification of the effect of hybrid project control with VSC is the first attempt to be applied in lean PD projects.

To vanlige digitaliseringsfloker

Når verden endrer seg gir det offentlige virksomheter både muligheter og utfordringer, men også endrede rammebetingelser. For holde seg relevant må de organisere seg slik at de er i takt med brukernes endrede behov og forventninger. Teamorganisering er den mest dynamiske organisasjonsformen vi kjenner. Mange norske virksomheter velger nettopp å bevege seg mot en teambasert organisering for å holde seg relevant for målgruppene og levere verdi. Denne overgangen er et hamskifte, ikke to graders kursendring som preges ofte av noen digitaliseringsfloker. Artikkelen presenterer to typiske floker: målsetting og lederens rolle og ansvar. Abstract in English In an ever-evolving world, public organizations are confronted with continuous shifts in their operating environment. This presents a spectrum of opportunities and challenges. To maintain relevance in this dynamic landscape, it is imperative that these organizations continuously focus on organizational form to meet the evolving needs and expectations of their users. To our knowledge, team organization is the most dynamic organizational form. Recently, aiming to stay relevant and capitalize on the benefits of digitalization has become a strategic choice for many organizations. This move towards team-based structure is not merely an adjustment but a fundamental transformation, essential for harnessing digitalization's full potential. This transition often encounters two "digitalization tangles”: goal setting, and the roles and responsibilities of leaders. Goals must be tailored to the team organization and cannot follow the traditional matrix organization structure. When goals are set along the axes of expertise and delivery, they create competing objectives, which makes it difficult for teams and individuals to prioritize in their daily work. Leadership in a team-based organization requires a paradigm shift. Leaders must pivot from traditional task-focused management to fostering value creation and team success. This necessitates a nuanced understanding and execution of leadership roles, balancing clear direction and goal setting with the autonomy of task execution. Some leaders struggle in this new context, veering towards either absenteeism or micromanagement, both of which hinder the efficacy of team organization. Successful public organizations that leverage the advantages of digitalization through team organization overcome these challenges. They establish clear, non-conflicting goals, and leaders play an active role in facilitating team success, embracing the evolution of their roles with a learning mindset and commitment. Our experience suggests that thriving in a team organization differs fundamentally from traditional matrix or domain-based forms of organizing. It requires a rethinking of fundamental business aspects, including goal setting and leadership roles.

Acceptance rate of clinical pharmacists' recommendations-an ongoing journey for integration.

Introduction: Multidisciplinary expert team collaboration in the clinical setting, which includes clinical pharmacist involvement can facilitate significant improvements in outcomes and optimize patient management by preventing drug-related problems (DRP). This type of collaboration is particularly valuable in patients with multi-morbidity and polypharmacy such as diabetic foot patients. Evidence regarding the successful integration of a new clinical pharmacist, without previous experience into a unit is still scarce. Therefore, this study aimed to describe and evaluate the actual successful integration process of the clinical pharmacist into a diabetic foot unit by measuring the change in recommendation acceptance rate over time. Methods: A prospective, exploratory treatment effectiveness study based on the recommendation acceptance rate of a new clinical pharmacist introduced into the diabetic foot unit was conducted over a 9- month period. The clinical pharmacist identified medical and drug-related problems (DRP) or any discrepancies in the prescribing and administration of medications. Each identified DRP was documented and formulated as a recommendation by the clinical pharmacist. The main outcome measure was the acceptance rate of recommendations over time. Results: A total of 86 patients, of which 67% were men, averagely aged 66.5 (SD 11.8) years were evaluated. Calculated BMI was 30.2 (SD 6.2). The average number of medical diagnoses was 8.9 (SD3.2), and 11.1 (SD 3.7) prescribed drugs for each patient. Cardiovascular disease was presented by 95% (n = 82) of the patients and 33% of them (n = 28) had uncontrolled hyperglycemia. Averagely, 3.3 (SD 1.9) DRPs were identified pre patient. The efficacy-related DRP recommendation acceptance rate increased over the study period from 37.8% in the first 4months to 79.4% after a period of 4.75months. Safety-related DRP recommendation acceptance rate increased from 56% to 67.6%. Conclusion: Improved clinical outcomes and optimized pharmacologic patient management may be achieved by the successful integration of a clinical pharmacist into the team. This study provides evidence of the increasing recommendation acceptance rate of integrated, pharmacist-driven comprehensive medication management in an unexperienced unit. To overcome challenges, team members should collaborate to fully integrate the clinical pharmacist into the team-based structure and utilize proper strategies to minimize and transcend barriers.

International Cleft-Care Organizations in the United States: A Systematized Review

Introduction: Although there are several international cleft-care organizations, there are variations in how these organizations are structured. The purpose of this paper was to analyze international cleft-care organizations based out of the United States. We provided an analysis of each, with a specific focus on team structure, funding, location, and model of care. Methods: A systematized review was conducted using PubMed using specific MeSH terms and related keywords. Organizations screened had to have the following inclusion criteria: (1) be based out of the United States (2) have a valid web presence. Results: Nineteen unique international cleft-care organizations were identified in the database search. Most international cleft-care organizations included in this review had originally started with the vertical model and, over time, adopted a diagonal approach including a team-based structure, resulting in an increased need for volunteers. Most organizations reviewed in this paper also demonstrated expansion of care beyond cleft lip and/or palate treatment. The cost of trip per volunteer was variable. The number of trips per year ranged from a minimum of one trip per year to a maximum of 150 trips. Conclusion: Throughout the analysis of each international cleft-care organization, a common theme of sustainability and self-sufficiency was present. The data compiled in this manuscript enables critical appraisal of various cleft-care organizations, comparison of different models of care, and provides insight on engaging in international cleft-care initiatives.

Capability improvement measures of the public sector for implementation of building information modeling in construction projects

Abstract This study examines the capability improvement measures of the public sector client for enhancing the implementation of building information modeling (BIM) in construction project delivery. The study adopted a quantitative descriptive analysis based on primary data obtained through a structured questionnaire. A total of 198 valid questionnaires obtained from construction professionals within public sector organizations in Lagos State, Nigeria, provided primary quantitative data for the assessment. Data collected were analyzed using descriptive and inferential statistics. The findings indicated the measures to enhance the capacity of the public sector for BIM implementation including the following: team-based structure and recruitment of adequate number of staff (with mean score [MS] = 3.66), government support and involvement (MS = 3.64), government policies, adoption of process open to innovation, and investment in equipment and technology (MS = 3.60) had been considerably entrenched. However, measures that resulted in improved efficiency were limited to the following: reward system for performance (MS = 3.81), government policies, and education and training of staff (MS = 3.74), government support and involvement (MS = 3.73), and clear job description (MS = 3.71). Most of the measures with high level of impact were not necessarily those that are frequently used. On this basis, the public sector needs to differ from the status quo by adopting improvement measures that are appropriate for enhancing its capabilities for BIM in project delivery. The findings indicate implications that could enable the public sector to adjust and make necessary policies in a bid to improve BIM implementation in project delivery.

A Team-Based Roadmap for Healthcare Change in a Turbulent Environment: a Longitudinal Study of a Not-for-Profit Hospital Transitioning into a for-Profit Organization

This longitudinal research describes how a 50-person management staff, led by a committed chief executive officer (CEO), was able to successfully implement a team-based structure and strategy to achieve a radical change from a non-profit hospital to a for-profit organization over a 12-year period. Many of the issues addressed and practical steps taken to establish a team-based leadership model for the new organizational template are described. Organization development models, diagnosis, intervention, and specific practices to bring about a successful transition are discussed. Seven principles are presented that contain “The Lessons Learned” from the longitudinal organizational systemic change intervention.

Implementing a New Service Line Model to Support Growth and Serve Patients.

Many healthcare organizations are reinvesting in clinical service lines to differentiate themselves, standardize evidence-based care, and add value. Typically, service line structures are built around hospital-based procedures and are accountable solely to local operations. That can be a blueprint for missed growth and lost value.Banner Health, based in Phoenix, Arizona, with operations in six southwestern states, has pivoted to a systemwide service line strategy to foster growth and support value-based care. Service lines are now organized to maximize both revenue and quality across the continuum of care, to the benefit of both the system and its patients. The new, team-based structure allows Banner Health to respond nimbly to changes in the healthcare environment because it is based on the ways patients access the system. In 2021, just two years into this complex transition, the results have demonstrated that this service line model can achieve measurable benefits that include growth; improved financial performance, safety, and clinical outcomes; and increased collaboration in value-based payment models-all helping the system to realize its mission of making healthcare easier so that life can be better for our patients.

Pengujian Dampak Sistem Insentif Dan Orientasi Kognitif Terhadap Kinerja Kelompok: Studi Di Indonesia

This study aims to find out individual’s performance based on their cognitive orientation towards incentive system. This study refers to a previous study (Naranjo-Gil et al., 2012) that tested similarly that the study was conducted in Indonesia which has a different culture with the previous research’s origin country. This study used case study method with college student respondent that had economics background. The results of this study revealed that some conclusions. First, individual behavior in completing tasks tends to match with their cognitive orientation. Second, there was a difference between individualism cognitive orientation when they given to team-based structure incentive system. Third, there are differences in collectivism cognitive orientation groups when they given to an individual-based structure incentive system. The most appropriate incentive system used to improve the group performance which respect to the cognitive orientation group members is the team-based incentive system.

A Project-Based, Resident-Led Quality Improvement Curriculum Within a Pediatric Continuity Clinic.

Participation in quality improvement (QI) projects is required of pediatric residents, and evidence-based medicine has highlighted the importance of providing residents with experiential practice in this realm. Embedding QI projects within a continuity clinic provides residents an opportunity for meaningful involvement in QI efforts. A QI curriculum was implemented within a pediatric residency program that included an introductory lecture on QI principles and participation in resident-led, team-based QI projects at an outpatient clinic. Residents designed, implemented, and analyzed projects beginning in their intern year. Projects operated on an accelerated, 6-month time frame, allowing residents to complete multiple projects over the course of their residency. Resident QI knowledge was assessed before and after an introductory lecture with the Quality Improvement Knowledge Application Tool (QIKAT). Resident feedback was solicited 1 year following curriculum implementation via anonymous online surveys. Residents completed four QI projects that produced meaningful improvements in clinic processes and patient care. QIKAT scores significantly increased after the introductory lecture. Residents reported that the curriculum afforded them increased confidence to implement plan-do-study-act cycles and improve patient care in their future practices. Qualitative feedback highlighted the team-based structure, participation in multiple projects, and visible direct impacts on patient care as strengths of the curriculum. Increased involvement of clinic staff, scheduling concerns, and improved communication were areas for improvement. Our model for integrating resident-led QI projects into an ambulatory clinic rotation is feasible and has been well received by residents and impactful on clinic processes and care.

Team based labour assignment methodology for new product development projects

This study explores the organizational aspects of new product development projects and proposes a new team-based labour assignment methodology. The proposed hierarchical methodology focusses on the project value stream and aims to shorten lead time through waste reduction. Lean product development tools, such as clustering and design structure matrix tools, are integrated with the methodology. A detailed real-life case study is presented and the proposed methodology is evaluated using discrete event simulation. Experiment results show that the proposed methodology and team-based structure provide superior lead time performance when compared to conventional organizational setting. This study contributes to existing literature by presenting evidence of the effect of teams on NPD lead time performance.

PC-FACS

PC-FACS

Transactive Memory System Coordination Mechanisms in Organizations

This article integrates the organizational coordination and transactive memory system (TMS) literatures and provides an empirical study on organizational TMS coordination mechanisms. The study findings, based on 60 interviews in a Japanese manufacturing company, show that organization design (team-based structure, small unit size), human resource management (HRM) practices (recruitment and selection, training, promotion, and reward systems and performance evaluations), and relational interactions (roles, routines) coordinate organizational TMSs. Organization design and HRM practices as more formal coordination mechanisms also support and provide continuity to relational interactions. Contributing to the organizational TMS literature in which employees are described to form TMSs through informal, face-to-face interactions, the findings provide evidence of formal and informal coordination mechanisms and suggest that team-based structures without reinforcing vertical mechanisms are insufficient to coordinate organizational TMSs.

Rates of Medical Errors and Preventable Adverse Events Among Hospitalized Children Following Implementation of Resident Handoff Bundle: Starmer A, Sectish, T, Simon D, et al. JAMA 2013;310:2262–70.

Handoffs between outgoing teams to oncoming teams can lead to medical errors through miscommunication. This study sought to determine if a handoff bundle reduces adverse events and medical errors among hospitalized patients. The prospective intervention study included 1255 admissions on two inpatient units at a children's hospital. A resident handoff bundle was compared to preintervention data. The bundle included standardized communication, handoff training, a verbal mnemonic, and a new team-based structure plus a computerized handoff tool in one of the hospital units.

Quest for the Best Performance Feedback: Toward a Theory of Performance Feedback in Group Settings

For employees in organizations, performance feedback is important. Even though huge amounts of studies have been conducted, two conundrums, changing nature of team-based structure in current organi...

Small-Team Active Learning in an Integrated Pharmacokinetics Course Series

To implement a pharmacokinetics curriculum that used small-team active learning and assess students' perceptions. The course design and delivery were based on delivery of Student Team lecture followed by concept reinforcement through problem-based learning sessions. Course faculty members facilitated classroom and problem-based learning discussions to promote an active-learning environment. An anonymous survey instrument was administered to students prior to and following completion of the pharmacokinetics course. Students reported a significant decrease in anxiety from 67% to 44% related to working in small teams upon completion of the course. However, students maintained negative perceptions related to peer teaching, with 80% of students reporting anxiety related to receipt of course information from peers. The course had a positive impact on students' ability to apply concepts to case-based scenarios, but little impact on their perceived ability to identify and critically evaluate new material and present that material to their peer team. The team-based structure defined herein for delivery of a pharmacokinetics curriculum offers students a tangible method to increase their comfort and confidence in the application of pharmacokinetic concepts in therapy.

Team-based structure within department increases training opportunities for junior trainees

Team-based structure within department increases training opportunities for junior trainees

The Influence of Teams, Supervisors and Organizations on Healthcare Practitioners' Abilities to Practise Ethically

Healthcare practitioners make many important ethical decisions in their day-to-day practices. Questions arising in daily practice require practitioners to make prudent, balanced and good decisions, which are most effectively made interpersonally and reflectively. It is commonly assumed that the team-based structure of healthcare delivery can provide practitioners with the support needed to address ethical questions in their practice, especially if the team involves multidisciplinary collaboration. A phenomenological study was conducted in which the impact of the team and the larger organization on practitioners' experiences of dealing with moral challenges was uncovered. Various mental healthcare professionals shared their experiences of ethically challenging situations in their practices and described the ways in which their teammates and supervisors affected how they faced these troubling situations. These findings allow us to see that there is considerable room for healthcare managers, many of whom are nurses, to facilitate supportive, ethical environments for healthcare professionals. An understanding of the essential experience of practising ethically allows for an appreciation of the significance of the team's role in supporting it and enables healthcare managers to target support for ethical healthcare work.

Assessment of Teams and Teamwork in the University of Maryland Libraries

Teams play an important role in the University of Maryland (UM) Libraries. Since 1998, teams and collaborative teamwork have become the way librarians address the myriad of issues affecting the needs of UM’s faculty, students, and staff. There has been much change in the UM Libraries over the past nine years, and the development is ongoing. Understanding how change takes place and whether the appropriate strategies to support these changes are implemented are vital to the libraries’ success. Assessment of any change process must be conducted to gauge improvement in reaching the desired organizational goals. One assessment tool, the Individual- Team-Organization (ITO) Survey, has been used to measure library staff perceptions in the teambased structure. The ongoing use of the ITO Survey has helped the UM Libraries better understand the challenges of and solutions to building a culture of continuous learning among librarians and staff. Given the widespread use of teams and teamwork in academic libraries, there is much to be gained by understanding their cohesion.

Discursive Struggle and the Ambiguous World of HRD

The problem and the solution. In this article, the author draws on a discourse perspective to explore the role of the human resource development (HRD) function in shaping organizational change within a large manufacturing firm moving toward a flatter team-based organizational structure. In support of an emerging “critical” strand of HRD, the author gives special consideration to how HRD specialists worked with colleagues from the personnel function to strategically draw on a complex mix of discursive constructions to promote a supportive learning environment and enhanced worker participation.Treating language as social practice, the author shows how this ability to act strategically was shaped by a variety of discursive practices at corporate level and beyond.