Team complexity and care coordination for cancer survivors with multiple chronic conditions: a mixed methods study.

PURPOSE: Little is known about the perceptions and experiences of care received from healthcare teams among cancer survivors with multiple chronic conditions (MCCs). METHODS: Cancer survivors completed an online survey (N=441) of which 12 participated in an interview. Team complexity was operationalized based on team size, clinician specialties, and health system affiliation. Kilpatrick's Patient-Perceptions of Team Effectiveness (PTE) questionnaire measured team effectiveness. Constant comparative method was used to identify care coordination challenges and facilitators from interviews. RESULTS: Mean age at cancer diagnosis was 45 years (SD=14), 68% were 5 years from diagnosis, the most common cancer was breast (27%), and two-thirds had two or more pre-diagnosis comorbidities. Sixty percent rated both cancer and other condition(s) as taking priority. Team complexity varied from low (32%), moderate (49%), and high (20%). Eighty percent rated PTE overall as high, with variation by subscales: coordination (85%) and patient-family focus (47%). Higher team complexity was associated with lower PTE overall (p=0.049). Challenges were identified: sequential referrals with no integration across team members; no shared mental model among team; and cancer survivor having to "referee" conflicting care decisions. CONCLUSION: This mixed method study found an inverse relationship between team complexity and PTE-overall, where high-complexity teams had lower team effectiveness. Participants reported issues with the problem-solving abilities of their teams and felt like their contributions were not valued by their care team. IMPLICATIONS FOR CANCER SURVIVORS: Improving team effectiveness offers one way to leverage the expertise of multiple specialties to deliver integrated, patient-centered care for the growing population of cancer survivors with MCC.

Multiteam Systems in Long Duration Exploration Missions: A Qualitative Analysis of Key Characteristics and Challenges.

Given the unprecedented environment of long duration space exploration (LDSE), success simply cannot occur without the coordinated efforts of multiple teams, both in flight and on the ground. These multiteam systems (MTSs) are needed to achieve the complex and dynamic tasks of spaceflight missions that will be longer and more uncertain than any previously experienced. Accordingly, research is limited in terms of how to best coordinate these teams and their dynamics-and in particular, how to best prepare LDSE teams to work across time and space effectively. To begin to address these critical questions systematically, qualitative data was extracted from a series of ten interviews with experts in spaceflight and long duration analog environments. Using thematic analysis techniques, we identified several consistent themes for affective, behavioral, and cognitive elements of teamwork occurring within and between teams. We examine each of these in detail, to identify the dynamics of what is currently known and where research needs to go to provide guidance for spaceflight organizations as well as others attempting to successfully implement MTSs in novel, complex environments.

Organizational science and cybersecurity: abundant opportunities for research at the interface.

Cybersecurity is an ever-present problem for organizations, but organizational science has barely begun to enter the arena of cybersecurity research. As a result, the "human factor" in cybersecurity research is much less studied than its technological counterpart. The current manuscript serves as an introduction and invitation to cybersecurity research by organizational scientists. We define cybersecurity, provide definitions of key cybersecurity constructs relevant to employee behavior, illuminate the unique opportunities available to organizational scientists in the cybersecurity arena (e.g., publication venues that reach new audiences, novel sources of external funding), and provide overall conceptual frameworks of the antecedents of employees' cybersecurity behavior. In so doing, we emphasize both end-users of cybersecurity in organizations and employees focused specifically on cybersecurity work. We provide an expansive agenda for future organizational science research on cybersecurity-and we describe the benefits such research can provide not only to cybersecurity but also to basic research in organizational science itself. We end by providing a list of potential objections to the proposed research along with our responses to these objections. It is our hope that the current manuscript will catalyze research at the interface of organizational science and cybersecurity.

Teamwork competencies for interprofessional cancer care in multiteam systems: A narrative synthesis.

Numerous teamwork competency frameworks are designed for co-located, procedure-driven teams delivering care in acute settings. Little is known about their applicability or evaluation among larger teams-of-teams, known as multiteam systems (MTS), involved in delivering care for complex chronic conditions like cancer. In this review we aimed to identify studies examining teamwork competencies or teamwork competency frameworks developed or tested in healthcare teams, identify the extent to which they have been applied or evaluated in cancer care, and understand their applicability to larger MTSs involved in coordinating cancer care. We identified 107 relevant original articles, consensus statements, and prior systematic reviews published from 2013-2019. Most original papers (n = 96) were intervention studies of inpatient acute care teams (52, 54%). Fifty-eight articles (60%) used existing frameworks to define competency domains. Four original articles and two consensus statements addressed teamwork competencies for cancer care. Few frameworks or interprofessional education (IPE) curricula specifically addressed teamwork among larger, distributed teams or examined competencies necessary to overcome care coordination challenges in cancer care MTSs. Research guiding the development of frameworks and IPE that consider challenges to effective coordination among larger MTSs and studies of their impact on patient and clinical outcomes is essential to optimal, high-quality care.

Information sharing in interteam responses to disaster.

Research demonstrates that information sharing is facilitated by familiarity, and having a common understanding of problems, use of lexicon, and semantic meaning. These factors can be difficult to develop within extreme environments such as disasters as members of the multi-agency system that responds often have limited experience of working together. Public inquiries repeatedly highlight the impact of information sharing difficulties on public safety, but limited academic research has focused on identifying concrete behaviours that facilitate interteam information sharing within such environments. This paper presents a case study of a national disaster response exercise involving 1,000 emergency responders. Data consist of structured observations, recordings of interteam meetings, and interviews with emergency responders. Results of mixed-method analysis indicate that interteam information sharing is delayed by limited situation awareness and poor articulation. Conversely, adopting behaviours that promote common frames for understanding interteam capabilities and information requirements improves information sharing and potentially reduces cognitive effort required to process information. Findings contribute to interteam communication theory by highlighting that in complex, time-constrained environments, having a shared understanding of responsibilities and information requirement is important for minimizing redundant deliberation and improving relevance and speed. PRACTITIONER POINTS: Facilitating the exchange and interpretation of relevant information is important for improving situation assessment, decision-making, and the implementation of appropriate actions for addressing risks.Interteam information sharing can be particularly challenging when teams are comprised of members from across different organizations with different language and cultures that must form ad hoc to rapidly respond to problems in extreme environments.Adopting communication strategies that develop common frames-of-reference can facilitate information sharing and interteam responses to disasters.