The quality of teamwork in Child Advocacy Center (CAC) multidisciplinary teams is likely to affect the extent to which the CAC model improves outcomes for children and families. This study examines associations between team functioning and performance in a statewide sample of CAC teams. Multidisciplinary team members (N = 433) from 21 CACs completed measures of affective, behavioral, and cognitive team functioning. Team performance was assessed with three measures: team member ratings of overall performance, ratings of mental health screening/referral frequency, and caregiver satisfaction surveys. Linear mixed models and regression analyses tested associations between team functioning and performance. Affective team functioning (i.e., liking, trust, and respect; psychological safety) and cognitive team functioning (i.e., clear direction) were significantly associated with team members' ratings of overall performance. Behavioral team functioning (i.e., coordination) and cognitive team functioning were significantly associated with mental health screening/referral frequency. Team functioning was not associated with caregiver satisfaction with CAC services. Aspects of team functioning were associated with team members' perceptions of overall performance and mental health screening/referral frequency, but not caregiver satisfaction. Understanding associations between team functioning and performance in multidisciplinary teams can inform efforts to improve service quality in CACs and other team-based service settings.
Child Advocacy , Cognition , Child , Humans , Surveys and Questionnaires , Patient Care Team
BACKGROUND: Children's Advocacy Centers (CACs) use multidisciplinary teams to investigate and respond to maltreatment allegations. CACs play a critical role in connecting children with mental health needs to evidence-based mental health treatment, especially in low-resourced rural areas. Standardized mental health screening and referral protocols can improve CACs' capacity to identify children with mental health needs and encourage treatment engagement. In the team-based context of CACs, teamwork quality is likely to influence implementation processes and outcomes. Implementation strategies that target teams and apply the science of team effectiveness may enhance implementation outcomes in team-based settings. METHODS: We will use Implementation Mapping to develop team-focused implementation strategies to support the implementation of the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), a standardized screening and referral protocol. Team-focused strategies will integrate activities from effective team development interventions. We will pilot team-focused implementation in a cluster-randomized hybrid type 2 effectiveness-implementation trial. Four rural CACs will implement the CPM-PTS after being randomized to either team-focused implementation (n = 2 CACs) or standard implementation (n = 2 CACs). We will assess the feasibility of team-focused implementation and explore between-group differences in hypothesized team-level mechanisms of change and implementation outcomes (implementation aim). We will use a within-group pre-post design to test the effectiveness of the CPM-PTS in increasing caregivers' understanding of their child's mental health needs and caregivers' intentions to initiate mental health services (effectiveness aim). CONCLUSIONS: Targeting multidisciplinary teams is an innovative approach to improving implementation outcomes. This study will be one of the first to test team-focused implementation strategies that integrate effective team development interventions. Results will inform efforts to implement evidence-based practices in team-based service settings. TRIAL REGISTRATION: Clinicaltrials.gov, NCT05679154 . Registered on January 10, 2023.
PURPOSE: Teams play a central role in the implementation of new practices in settings providing team-based care. However, the implementation science literature has paid little attention to potentially important team-level constructs. Aspects of teamwork, including team interdependence, team functioning, and team performance, may affect implementation processes and outcomes. This cross-sectional study tests associations between teamwork and implementation antecedents and outcomes in a statewide initiative to implement a standardized mental health screening/referral protocol in Child Advocacy Centers (CACs). METHODS: Multidisciplinary team members (N = 433) from 21 CACs completed measures of team interdependence; affective, behavioral, and cognitive team functioning; and team performance. Team members also rated the acceptability, appropriateness, and feasibility of the screening/referral protocol and implementation climate. The implementation outcomes of days to adoption and reach were independently assessed with administrative data. Associations between team constructs and implementation antecedents and outcomes were tested with linear mixed models and regression analyses. RESULTS: Team task interdependence was positively associated with implementation climate and reach, and outcome interdependence was negatively correlated with days to adoption. Task and outcome interdependence were not associated with acceptability, appropriateness, or feasibility of the screening/referral protocol. Affective team functioning (i.e., greater liking, trust, and respect) was associated with greater acceptability, appropriateness, and feasibility. Behavioral and cognitive team functioning were not associated with any implementation outcomes in multivariable models. Team performance was positively associated with acceptability, appropriateness, feasibility, and implementation climate; performance was not associated with days to adoption or reach. CONCLUSIONS: We found associations of team interdependence, functioning, and performance with both individual- and center-level implementation outcomes. Implementation strategies targeting teamwork, especially task interdependence, affective functioning, and performance, may contribute to improving implementation outcomes in team-based service settings.
BACKGROUND: Healthcare and human services increasingly rely on teams of individuals to deliver services. Implementation of evidence-based practices and other innovations in these settings requires teams to work together to change processes and behaviors. Accordingly, team functioning may be a key determinant of implementation outcomes. This systematic review will identify and summarize empirical research examining associations between team functioning and implementation outcomes in healthcare and human service settings. METHODS: We will conduct a comprehensive search of bibliographic databases (e.g., MEDLINE, PsycINFO, CINAHL, ERIC) for articles published from January 2000 or later. We will include peer-reviewed empirical articles and conference abstracts using quantitative, qualitative, or mixed methods. We will include experimental or observational studies that report on the implementation of an innovation in a healthcare or human service setting and examine associations between team functioning and implementation outcomes. Implementation outcomes of interest are acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. Two reviewers will independently screen all titles/abstracts, review full-text articles, and extract data from included articles. We will use the Mixed Methods Appraisal Tool to assess methodological quality/bias and conduct a narrative synthesis without meta-analysis. DISCUSSION: Understanding how team functioning influences implementation outcomes will contribute to our understanding of team-level barriers and facilitators of change. The results of this systematic review will inform efforts to implement evidence-based practices in team-based service settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020220168.
Delivery of Health Care , Health Facilities , Evidence-Based Practice , Humans , Meta-Analysis as Topic , Systematic Reviews as Topic
Rationale: Psychological safety is the condition by which members of an organization feel safe to voice concerns and take risks. Although psychological safety is an important determinant of team performance, little is known about its role in the intensive care unit (ICU). Objectives: To identify the factors associated with psychological safety and the potential influence of psychological safety on team performance in critical care. Methods: We performed daily surveys of healthcare providers in 12 ICUs within an integrated health system over a 2-week period. Survey domains included psychological safety, leader familiarity, leader inclusiveness, role clarity, job strain, and teamwork. These data were linked to daily performance on lung-protective ventilation and spontaneous breathing trials. We used regression models to examine the antecedents of psychological safety as well as the influence of psychological safety on both perceived teamwork and actual performance. Results: We received 553 responses from 270 unique providers. At the individual provider level, higher leader inclusiveness (adjusted ß = 0.32; 95% confidence interval [CI], 0.24 to 0.41) and lower job strain (adjusted ß = -0.07, 95% CI, -0.13 to -0.02) were independently associated with greater psychological safety. Higher psychological safety was independently associated with greater perception of teamwork (adjusted ß = 0.30; 95% CI, 0.25 to 0.36). There was no association between team psychological safety and performance on either spontaneous breathing trials (incident rate ratio for each 1-unit change in team psychological safety, 0.85; 95% CI, 0.81 to 1.10) or lung-protective ventilation (incident rate ratio, 0.77; 95% CI, 0.57 to 1.04). Conclusions: Psychological safety is associated with several modifiable factors in the ICU but is not associated with actual use of evidence-based practices.
Intensive Care Units , Patient Care Team , Health Personnel , Humans , Surveys and Questionnaires
Often, the senders and receivers of scientific communication have different knowledge bases. While such communication is essential for solving the complex social and technological problems that affect multiple stakeholders, a diversity of knowledge among communicators can create representational gaps (rGaps). rGaps occur when senders make assumptions that receivers do not, creating conflict over the meaning and value of the information communicated. Such conflict could, if managed, promote learning and innovation as communicators reconcile their assumptions. More often, however, rGaps cause conflict to transform from a debate that informs to an argument that divides. Managing rGap conflict so that it does not degrade communication requires relationship building to mitigate the negative by-products of persistent conflict while maintaining appropriate levels of cognitive distinctiveness among diverse stakeholders. Thus, we provide a framework for identifying and leveraging rGaps through managed conflict so that communication between those with different perspectives builds rather than burns bridges.
Intensive care units (ICUs) provide care to the most severely ill hospitalized patients. Although ICUs increasingly rely on interprofessional teams to provide critical care, little about actual teamwork in this context is well understood. The ICU team is typically comprised of physicians or intensivists, clinical pharmacists, respiratory therapists, dieticians, bedside nurses, clinical psychologists, and clinicians-in-training. ICU teams are distinguished from other health care teams in that they are low in temporal stability, which can impede important team dynamics. Furthermore, ICU teams must work in physically and emotionally challenging environments. Our review of the literature reveals the importance of information sharing and decision-making processes, and identifies potential barriers to successful team performance, including the lack of effective conflict management and the presence of multiple and sometimes conflicting goals. Key knowledge gaps about ICU teams include the need for more actionable data linking ICU team structure to team functioning and patient-, family-, ICU-, and hospital-level outcomes. In particular, research is needed to better delineate and define the ICU team, identify additional psychosocial phenomena that impact ICU team performance, and address varying and often competing indicators of ICU team effectiveness as a multivariate and multilevel problem that requires better understanding of the independent effects and interdependencies between nested elements (i.e., hospitals, ICUs, and ICU teams). Ultimately, efforts to advance team-based care are essential for improving ICU performance, but more work is needed to develop actionable interventions that ensure that critically ill patients receive the best care possible. (PsycINFO Database Record
Cooperative Behavior , Critical Care/organization & administration , Group Processes , Intensive Care Units/organization & administration , Interprofessional Relations , Patient Care Team/organization & administration , Humans
Scholars have assumed that the presence of negative emotions during task conflict implies the absence of positive emotions. However, emotions researchers have shown that positive and negative emotions are not 2 ends of a bipolar continuum; rather, they represent 2 separate, orthogonal dimensions. Drawing on affective events theory, we develop and test hypotheses about the effects of task conflict on positive emotions and job satisfaction. To this end, we distinguish among the frequency, intensity, and information gained from task conflict. Using field data from 232 employees in a long-term health care organization, we find that more frequent mild task conflict expression engenders more information acquisition, but more frequent intense task conflict expression hinders it. Because of the information gains from mild task conflict expression, employees feel more active, energized, interested, and excited, and these positive active emotions increase job satisfaction. The information gained during task conflict, however, is not always energizing: It depends on the extent to which the behavioral context involves active learning and whether the conflict is cross-functional. We discuss theoretical implications for conflict, emotions, and job satisfaction in organizations.
Conflict, Psychological , Emotions , Interpersonal Relations , Job Satisfaction , Task Performance and Analysis , Adolescent , Adult , Female , Humans , Learning , Male , Young Adult
OBJECTIVE: We sought to develop a reliable and valid tool for measuring teamwork among emergency medical technician (EMT) partnerships. METHODS: We adapted existing scales and developed new items to measure components of teamwork. After recruiting a convenience sample of 39 agencies, we tested a 122-item draft survey tool (EMT-TEAMWORK). We performed a series of exploratory factor analyses (EFAs) and confirmatory factor analysis (CFA) to test reliability and construct validity, describing variation in domain and global scores using descriptive statistics. RESULTS: We received 687 completed surveys. The EFAs identified a nine-factor solution. We labeled these factors 1) Team Orientation, 2) Team Structure & Leadership, 3) Partner Communication, Team Support, & Monitoring, 4) Partner Trust and Shared Mental Models, 5) Partner Adaptability & Back-Up Behavior, 6) Process Conflict, 7) Strong Task Conflict, 8) Mild Task Conflict, and 9) Interpersonal Conflict. We tested a short-form (30-item SF) and long-form (45-item LF) version. The CFAs determined that both the SF and the LF possess positive psychometric properties of reliability and construct validity. The EMT-TEAMWORK-SF has positive internal consistency properties, with a mean Cronbach's alpha coefficient ≥0.70 across all nine factors (mean = 0.84; minimum = 0.78, maximum = 0.94). The mean Cronbach's alpha coefficient for the EMT-TEAMWORK-LF was 0.87 (minimum = 0.79, maximum = 0.94). There was wide variation in weighted scores across all nine factors and the global score for the SF and LF. Mean scores were lowest for the Team Orientation factor (48.1, standard deviation [SD] 21.5, SF; 49.3, SD 19.8, LF) and highest (more positive) for the Interpersonal Conflict factor (87.7, SD 18.1, for both SF and LF). CONCLUSIONS: We developed a reliable and valid survey to evaluate teamwork between EMT partners.
Attitude of Health Personnel , Conflict, Psychological , Emergency Medical Technicians/psychology , Patient Care Team/organization & administration , Adult , Cross-Sectional Studies , Emergency Medical Technicians/organization & administration , Female , Health Care Surveys , Humans , Male , Psychometrics , Reproducibility of Results , Statistics as Topic
Negotiators' social motives (cooperative vs. individualistic) influence their strategic behaviors. In this study, the authors used multilevel modeling and analyses of strategy sequences to test hypotheses regarding how negotiators' social motives and the composition of the group influence group members' negotiation strategies. Four-person groups negotiating a 5-issue mixed-motive decision-making task were videotaped, and the tapes were transcribed and coded. Group composition included 2 homogeneous conditions (all cooperators and all individualists) and 3 heterogeneous conditions (3 cooperators and 1 individualist, 2 cooperators and 2 individualists, 1 cooperator and 3 individualists). Results showed that cooperative negotiators adjusted their use of integrative and distributive strategies in response to the social-motive composition of the group, but individualistic negotiators did not. Results from analyses of strategy sequences showed that cooperators responded more systematically to others' behaviors than did individualists. They also redirected the negotiation depending on group composition.
Conflict, Psychological , Group Processes , Motivation , Negotiating , Social Behavior , Humans
This article examines the effects of the other party's concession behavior on a negotiator's satisfaction and judgments. The timing of the concessions (immediate, gradual, delayed) and the justifications provided by the other party (negotiator skill vs. external constraints) were manipulated using a scenario method (Study 1) and a role-playing experiment (Study 2). Study 1 showed that concession timing influenced valuation of the object and satisfaction with the partner and the outcome. Justifications about why the concession was made interacted with concession timing to influence participants' attributions. Participants' attributions for why the concession was actually made, in turn, had a main effect on satisfaction and judgments of the negotiation. Study 2 replicated some, but not all, of these findings.
Judgment , Negotiating/psychology , Social Behavior , Female , Humans , Male , Personal Satisfaction , Regression Analysis , Social Justice , Social Perception , Time Factors
This study provides a meta-analysis of research on the associations between relationship conflict, task conflict, team performance, and team member satisfaction. Consistent with past theorizing, results revealed strong and negative correlations between relationship conflict, team performance, and team member satisfaction. In contrast to what has been suggested in both academic research and introductory textbooks, however, results also revealed strong and negative (instead of the predicted positive) correlations between task conflict team performance, and team member satisfaction. As predicted, conflict had stronger negative relations with team performance in highly complex (decision making, project, mixed) than in less complex (production) tasks. Finally, task conflict was less negatively related to team performance when task conflict and relationship conflict were weakly, rather than strongly, correlated.
Conflict, Psychological , Cooperative Behavior , Interpersonal Relations , Job Satisfaction , Decision Making , Employee Performance Appraisal , Humans
