Palliative care teams and organisational capability

Doctors’ functional leadership in psychiatric healthcare teams – a reversible leadership logic

Purpose

– The purpose of this paper was to study how psychiatric doctors practise leadership in multidisciplinary healthcare teams. The paper seeks to answer the question: How do psychiatric doctors lead multidisciplinary teams during treatment conferences?

Design/methodology/approach

– Six psychiatric teams were studied at a university hospital. Each team was observed over a period of 18 months, and data were collected during four years (2008-2011). Data were collected through interviews with doctors (n = 19) and observations (n = 30) of doctors’ work in multidisciplinary psychiatric teams.

Findings

– Doctors in a multidisciplinary team use either self-imposed or involuntary leadership style. Oscillating between these two extremes was a strategy for handling the internal tensions of the team.

Research limitations/implications

– The study was a case study, performed during treatment conferences at psychiatric wards in a university hospital. This limitation means that there is cause for some caution in generalising the results.

Practical implications

– The results are useful for understanding leadership in multidisciplinary medical teams. By understanding the reversible logic of leadership, cooperation and knowledge sharing can be gained, which means that a situation of mere peaceful coexistence can be avoided. Understanding the importance of the informal contract makes it possible to switch leadership among team members. A reversible leadership with an informal contract makes the team less vulnerable. The team’s professionals can thus easily handle difficult situations and internal tensions, facilitating leadership and management of multidisciplinary teams.

Originality/value

– Doctors in multidisciplinary psychiatric teams use reversible leadership logic.

Organizational groupings and performance in project-based organizations

Purpose

– This study aims to empirically evaluate the impact of interorganizational groupings on corporate performance in project-based organizations.

Design/methodology/approach

– The study develops and tests a theoretical model whereby groupings include project team, community of practice (CoP), community of interest (CoI), and knowledge network (KN). Organizational performance is supported on financial, process, internal, and cultural aspects. Based on a questionnaire, data was obtained from a sample of 142 companies in North America. The measurement model was tested and confirmed by using structural equation modeling (SEM).

Findings

– The results confirm the positive effects of knowledge networks and communities of interest. However, the impact of project teams turned out to be negative, and communities of practice were not shown to affect corporate performance. Additionally, the results underscore the importance of organizational networks in creating conditions favorable to a firm's success.

Practical implications

– It was verified that knowledge networks and communities of interest affect the measures of organizational performance, including financial, process, internal, and cultural performance. This is useful for researchers and executives looking for appropriate outcomes through the implementation of knowledge management initiatives. Furthermore, this study provides a starting point for further research on the role of inter- and intraorganizational networks in project-based organizations.

Originality/value

– This study claims that a key to performance for project-based organizations is development and management of organizational networks in the form of knowledge networks and communities of interest.

Organisational culture and change: implementing person-centred care

PURPOSE

The purpose of this paper is to explore the connection between organisational cultures and the employee's resistance to change at five hospital wards in Western Sweden. Staff had experienced extensive change during a research project implementing person-centred care (PCC) for patients with chronic heart failure.

DESIGN/METHODOLOGY/APPROACH

Surveys were sent out to 170 nurses. The survey included two instruments--the Organisational Values Questionnaire (OVQ) and the Resistance to Change Scale (RTC).

FINDINGS

The results indicate that a culture with a dominating focus on social competence decreases "routine seeking behaviour", i.e. tendencies to uphold stable routines and a reluctance to give up old habits. The results indicate that a culture of flexibility, cohesion and trust negatively covariate with the overall need for a stable and well-defined framework.

PRACTICAL IMPLICATIONS

An instrument that pinpoints the conditions of a particular healthcare setting can improve the results of a change project. Managers can use instruments such as the ones used in this study to investigate and plan for change processes.

ORIGINALITY/VALUE

Earlier studies of organisational culture and its impact on the performance of healthcare organisations have often investigated culture at the highest level of the organisation. In this study, the culture of the production units--i.e. the health workers in different hospital wards--was described. Hospital wards develop their own culture and the cultures of different wards are mirrored in the hospital.

Synchronous work: myth or reality? A critical study of teams in health and medical care

RATIONALE, AIMS AND OBJECTIVES

In this article, ideal conceptions about teamwork are tested. The research question posed is: How are teams in psychiatry formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while the parallel work mode is a transitional form between group and team.

METHODS

Three psychiatric outpatient teams at a university hospital specialist clinic were studied. Data were collected through 25 personal interviews and 82 hours of observations. The data collection was carried out over 18 months (2008-2009).

RESULTS

Results show: (1) that the three theoretical distinctions between group and team need to be supplemented with two intermediate forms, semiparallel and semisynchronous teamwork; and (2) that teamwork is not characterized by striving towards a synchronous ideal but instead is marked by an adaptive interaction between sequential, parallel and synchronous working modes.

CONCLUSIONS

The article points to a new intermediate stage between group and team. This intermediate stage is called semiparallel teamwork. The study shows that practical teamwork is not characterized by a synchronous ideal, but rather is about how to adaptively find acceptable solutions to a series of practical problems. The study emphasizes the importance of the team varying between different working modes, so-called semisystematics.

The 20-minute team--a critical case study from the emergency room

RATIONALE

In this article, the difference between team and group is tested empirically. The research question posed is How are teams formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while parallel cooperation is a transition between group and team.

METHODS

To answer the question, a longitudinal case study has been made of a trauma team at a university hospital. Data have been collected through interviews and direct observations. Altogether the work of the trauma team has been studied for a period of 5 years (2002-2006).

RESULTS

The results indicate that two factors are of central importance for the creation of a team. The first is related to its management and the other to the forms of cooperation. To allow for a team to act rapidly and to reduce friction between different members, clear leadership is required.

CONCLUSIONS

The studied team developed cooperation with synchronous elements but never attained a level that corresponds to idealized conceptions of teams. This is used as a basis for challenging ideas that teams are harmonious and free from conflicts and that cooperation takes place without friction.