What makes er teams efficient? A multi-level exploration of environmental, team, and member characteristics

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WHAT MAKES ER TEAMS EFFICIENT?

A MULTI-LEVEL EXPLORATION OF ENVIRONMENTAL, TEAM, AND MEMBER CHARACTERISTICS

PLEASE DO NOT CIRCULATE OR CITE WITHOUT PERMISSION

Ishani Aggarwal

Brazilian School of Public and Business Administration

Toshio Murase

Roosevelt University

Evelyn Zhang

Carnegie Mellon University

Brandy Aven

Carnegie Mellon University

Anita Woolley

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Emergency Room Teams

•

Widely recognized in the patient safety literature that many adverse

events in healthcare originate from flawed teamwork rather than from

a lack of clinical skills

(Burtscher, Wacker, Grote, & Manser, 2010; Kohn, Corrigan, & Donaldson, 2002; Manser, 2009; Risser et al., 1999; Rosen et al., 2008).

•

Even highly trained teams vary considerably in their effectiveness and

many teams perform inadequately in such situations

(Carbine, Finer, Knodel, & Rich, 2000; Marsch et al., 2005; Stachowski, Kaplan, & Waller, 2009; Tschan et al., 2006).

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•

Form of action teams that work in turbulent and uncertain environments,

under extreme time pressure

•

Team efficiency is a key indicator of successful performance

•

Environments where the importance of coordination, communication,

and knowledge integration for efficient fast action are heightened

because previously relied-upon strategies and routines may no longer

be appropriate

(Homan, Buengeler, Eckhoff, van Ginkel, & Voelpel, 2015; Sung & Choi, 2012; Thomas-Hunt & Phillips, 2003)

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Environmental Factors

•

Environmental factors are characteristics of the external environment

in which the organization is embedded, such as industry

characteristics and turbulence, and are likely to have a huge impact

on team outcomes (Cohen & Bailey, 1997).

•

Difficult environmental conditions are likely to be one of the major

factors explaining variance in the performance of ER teams since

these teams are tightly linked to the task environment.

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Environmental Factors

• Environmental factors in the ER include:

•

severity of patient condition

•

the number of beds occupied at the time a patient is being treated

•

the severity of all the patients in the ER at the time a patient is

admitted

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Hypothesis 1

Environmental difficulty Team efficiency

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-Team- and Member-related Factors

•

Why do some teams perform better than others in similar

environmental conditions?

•

Most models of team performance are based on one of two implicit

assumptions

• all team members perform the same role in a team or

• all of the team roles have the same impact on team performance.

•

Yet, the first assumption is typically not true, as teams often possess

differentiated role structures

(Belbin, 1993; Mumford, Campion, & Morgeson, 2006; Mumford, Van Iddekinge, Morgeson, & Campion, 2008)

•

Strategic core is defined as the role or roles on a team that

• encounter more of the problems that need to be overcome in the team • have a greater exposure to the tasks that the team is performing

• are more central to the workflow of the team

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Team- and Member-related Factors

• In an ER setting, doctors arguably hold strategically core

roles since they

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oversee the treatment of each patient

•

make decisions about the treatment course, and seek outside

counsel if necessary

•

provide instructions to the rest of the ER team (such as nurses, ER

technicians, counselors) on the plan of action

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Team factor: Team member experience with

strategically core members

• Teams´ experience in working together as a team reduces patient

procedure time and increases team performance (Reagans, Argote, & Brooks, 2005);

• Improvement in coordination that is a result of working together over time is one of the main explanatory mechanisms

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Team factor: Team member experience with

strategically core members

• Since strategically-core members hold an important role in a team, one factor that will influence coordination, is the team´s experience in working with the strategically core members.

• The importance of team experience with strategically core members will be especially reflected when the environmental difficulty is high.

• i.e. in teams where members have experiential proximity with strategically core members there will be increased coordination, which will allow for the teams to be efficient even with increasing environmental difficulty.

• On the other hand, when much time has elapsed from having worked together with a strategically core member, coordination will hugely suffer, which will be reflected in decreased team efficiency especially when

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Hypothesis 2

Environmental difficulty

Team efficiency

Amount of time elapsed from working together with core team members

In teams where less time has elapsed, the relationship between

environmental difficulty and team efficiency will be less negative than in teams with more elapsed time.

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Team-member factor: Cognitive versatility of

strategically core members

•

Research has demonstrated that certain member

characteristics (e.g., cognitive ability) exhibit greater influence

on team effectiveness when possessed by strategically core

role holders

(Humphrey et al., 2009; Summers, Humphrey, & Ferris, 2012).

•

Supports the theory that it matters where these characteristics

reside in the team

(Humphrey et al., 2009).

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Cognitive Style

• Cognitive Style is a psychological dimension that represents

consistencies in how an individual acquires and processes

information

(Ausburn & Ausburn, 1978; Messick, 1984)

•

Spatial Visualization

•

Object Visualization

•

Verbalization

• Only recently explored in the context of teams

(Aggarwal & Woolley, 2013)

• Individuals can be high on multiple dimensions: cognitively

versatile

(Aggarwal, Molinaro, & Woolley, working paper)

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Team-member factor: Cognitive versatility of

strategically core members

• Team cognitive style versatility is associated with • Improved team coordination

• learning with experience

• reduction in task and process conflict

• Improved team performance in execution and creative tasks • team viability

Aggarwal, Molinaro, & Woolley, in preparation; Schilpzand, Aggarwal, & Martins, in preparation

• The complex nature of ER tasks and the uncertain environment

• necessitate both depth and breadth of perspectives in order to coordinate

• as well as process information effectively

• complex information needs to be quickly and accurately processed, having cognitively versatile core members is also likely to aid in handling the information processing demands more

effectively

• While there is a dearth of research on cognitive style versatility, Cannon-Bowers

et al. (1998) found that the benefits of cross training were greatest under

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Hypothesis 3

Environmental difficulty Team efficiency Cognitive versatility of core team members

In teams where core team members have cognitive style versatility, the relationship between environmental difficulty and team efficiency will be less negative.

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Study

• 12-bed Emergency Room unit of a hospital in the US

• Doctors, nurses, nurse practitioners, and nurse assistants

filled out individual measures

•

Archival data about over a six-month period

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diagnoses and times at which patients were admitted and left the

hospital

•

Employee shift schedules

• 69 employees, who made up 236 teams that treated a

total of 2,203 patients who were admitted for 202 different

diagnoses.

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Measures

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Environmental difficulty.

• The frequency with which a diagnosis occurred. The top three quartiles of occurrence were coded as routine (75% cut-off occurring 58 times or more), while cases in the bottom quartile were coded as non-routine. E.g. abdominal pain versus drug overdose

• The number of patients with non-routine diagnosis who were admitted within 60 minutes before and after each patient was admitted. This 120-minute time window was used to assess the number of patients still waiting or being treated when each patient was admitted.

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Teamwork elapsed time-core.

The numbers of days passed since the

last time each non-core member on the current team worked with a core member were calculated and averaged.

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Cognitive versatility- core.

OSIVQ (Blazhenkova & Kozhevnikov, 2008) to

capture cognitive styles; a categorical variable capturing the core members’ dominance (or a score at or above 75th _{percentile of the entire sample for}

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Measures

•

Team Efficiency. Treatment time; amount of time each patient spent

in the ER standardized by the mean time for that particular diagnosis.

•

Control Variables

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Familiarity. number of shifts that each member had worked on with

every other member prior to the current shift, and averaged the shift

times across all the members on the shift

(Huckman, Staats, & Upton, 2009).

•

Shift size. numbers of members on the shift.

•

Constraint. total number of patients (both routine and non-routine)

who were admitted within 60 minutes before and after each patient

admitted.

•

Routine. As explained previously. Total of 1,411 routine patients and

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Results: Hypothesis 1

Environmental difficulty Team efficiency

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-Treatment Time

Variable Model 1 Model 2 Model 3 Model 4

1 Intercept -.51** _-.48** _-.48** _-.48** 2 Control Constraint -.08** _-.10** _-.10** _-.10** Routine -.07** _-.07** _-.07** _-.07** Shift Size .03 .03 .02 .03 Familiarity -.00 -.00 -.00 -.00 TET-core -.00 -.00 -.00 -.00 TET-noncore .00 .00 .00 .00 CSV-core .01 .01 .01 .01 CSV-noncore -.07 -.09 -.09 -.09 3 H1 ED .04** _.04 _.06** 4 H2 ED x TET-core .00* 5 H3 ED x CSV-core -.07**

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Results: Hypothesis 2

Environmental difficulty

Team efficiency

Amount of time elapsed from working together with core team members

In teams where less time has elapsed, the relationship between

environmental difficulty and team efficiency will be less negative than in teams with more elapsed time.

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Treatment Time

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Low TET core (time-elapsed): teams in which less time has elapsed between non-core members working with core members were less susceptible to increasing treatment time as environmental difficulty increases.

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Results: Hypothesis 3

Environmental difficulty Team efficiency Cognitive versatility of core team members

In teams where core team members demonstrate cognitive style

versatility, the relationship between environmental difficulty and team efficiency will be less negative.

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Treatment Time

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When teams have core members who are cognitively versatile (High CSV score), they are less susceptible to increasing treatment time as environmental difficulty increases that teams whose core members are not cognitively versatile (Low CSV score)