Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care

Background: Acute hospital general medicine services care for ageing complex patients, using the skills of a range of health-care providers. Evidence suggests that comprehensive early assessment and discharge planning may improve efficiency and outcomes of care in older medical patients. Aim: To enhance assessment, communication, care and discharge planning by restructuring consistent, patient-centred multidisciplinary teams in a general medicine service. Methods: Prospective controlled trial enrolling 1538 consecutive medical inpatients. Intervention units with additional allied health staff formed consistent multidisciplinary teams aligned with inpatient admitting units rather than wards; implemented improved communication processes for early information collection and sharing between disciplines; and specified shared explicit discharge goals. Control units continued traditional, referral-based multidisciplinary models with existing staffing levels. Results: Access to allied health services was significantly enhanced. There was a trend to reduced index length of stay in the intervention units (7.3 days vs 7.8 days in control units, P = 0.18), with no change in 6-month readmissions. in-hospital mortality was reduced from 6.4 to 3.9% (P = 0.03); less patients experienced functional decline in hospital (P = 0.04) and patients' ratings of health status improved (P = 0.02). Additional staffing costs were balanced by potential bed-day savings. Conclusion: This model of enhanced multidisciplinary inpatient care has provided sustainable efficiency gains for the hospital and improved patient outcomes.

Virtual teams and group member dissimilarity - Consequences for the development of trust

The consequences of demographic dissimilarity for group trust in work teams was examined in a virtual (computer-mediated) and a face-to-face (FTF) environment. Demographic dissimilarity (based on age, gender, country of birth, enrolled degree) was predicted to be negatively associated with group trust in the FTF environment but not in the computer-mediated environment. Participants worked in small groups on a creative task for 3 consecutive days. In the computer-mediated environment, participants worked on the task for an hour per day. In the FTF environment, participants worked on the task for 20 minutes per day. Partial support was found for the effectiveness of computer-mediated groups in reducing the negative consequences of dissimilarity. Age dissimilarity was negatively related to trust in FTF groups but not in computer-mediated groups. Birthplace dissimilarity was positively related to trust in computer-mediated groups. Implications for the successful management of virtual teams are discussed.

Exploring the impact of perceived LMX variability within work teams

According to Leader-Member Exchange (LMX) theory, leaders develop different quaUt}' reladonships with the employees they supervise. To date, Utde research has invesdgated the impact of such differendadon by the leader on workplace outcomes. The current research proposes a novel way to capture the extent of LMX variabiUt}' within a single work team, and subsequently investigates the impact of perceived LMX variability on workplace outcomes. Across multiple employed samples, participants reported poorer team relations (as indicated by low team cohesion and high conflict) when they perceived LMX variability to be high. Perceptions of poor team relations further impacted negatively upon individual affect variables. The findings suggest that leaders may need to exercise caution when developing different quality relationships amongst individuals within the same work team.

Transformational leadership within virtual teams: Examining the mediating influence of trust and role clarity for performance and knowledge sharing

Virtual teams differ from tradidonal, co-located teams in that they primarily communicate via informadon technolog}' such as email, video conferencing and web based coUaboradve environments rather than in a face-to-face medium. There has been a lack of empirical research into the influence that leadership has within virtual teams upon key outcomes such as performance and knowledge sharing. This paper examines antecedents of knowledge sharing and performance, namely role clarit)' and trust in a team leader. We predicted that transformadonal leadership would posidvely influence both performance and knowledge sharing within virtual teams. We also h^'pothesised that trust in a leader and role clarit)' would mediate both the associadon between transformadonal leadership and performance as well as the associadon between transformadonal leadership and knowledge sharing within virtual teams. Data was collected from a public sector organisadon using virtual teams, Pardcipants responded to a self-report quesdonnaire. Supervisor radngs of performance and knowledge sharing were also obtained. In general we found support for a posidve reladonship between transformadonal leadership and performance and knowledge sharing within virtual teams. Using mediated muldple regression, we found support for the mediadng role of trust in the leader and role clarit}' between transformadonal leadership and performance and knowledge sharing. Implicadons of the results are provided.

Intergroup processes in intragroup contexts: The roles of group status, group identification and communication in diverse work teams

The present research examines employee identification and communication in organisations. In Study 1, 2229 soldiers from a military organisation completed measures of perceived status and strength of identification with their unit, employment category and their brigade. As predicted, the status of a key organisational group influenced reactions to different organisational groups: full-time soldiers evaluated their work unit and the organisation as being lower in status and identified less strongly with both of these groups than part-time soldiers. The second study extended these findings to a different research context: a large psychiatric hospital undergoing downsizing and restructuring. Surprisingly, there were no differences in survivors' and victims' levels of identification with organisational groups. Instead, and consistent with Study 1, there was evidence to suggest that employees adjusted their patterns of identification and perceptions of group status through a compensatory mechanism that maximised opportunities for selfenhancement and positive distinctiveness. In the third study, employees from a public hospital (N = 142) rated communication from double ingroup members (same work unit/same occupational group) more favourably than communication from partial group members (same work unit/different occupational group). These results are considered in terms of their practical implications for identity management in organisations.