Illusions of team working in health care

Purpose: The ubiquity and value of teams in healthcare are well acknowledged. However, in practice, healthcare teams vary dramatically in their structures and effectiveness in ways that can damage team processes and patient outcomes. The aim of this paper is to highlight these characteristics and to extrapolate several important aspects of teamwork that have a powerful impact on team effectiveness across healthcare contexts. Design/methodology/approach: The paper draws upon the literature from health services management and organisational behaviour to provide an overview of the current science of healthcare teams. Findings: Underpinned by the input-process-output framework of team effectiveness, team composition, team task, and organisational support are viewed as critical inputs that influence key team processes including team objectives, leadership and reflexivity, which in turn impact staff and patient outcomes. Team training interventions and care pathways can facilitate more effective interdisciplinary teamwork. Originality/value: The paper argues that the prevalence of the term "team" in healthcare makes the synthesis and advancement of the scientific understanding of healthcare teams a challenge. Future research therefore needs to better define the fundamental characteristics of teams in studies in order to ensure that findings based on real teams, rather than pseudo-like groups, are accumulated. © Emerald Group Publishing Limited.

Senior management leadership, social support, job design and stressor-to-strain relationships in hospital practice

Purpose: The purpose of this paper is to examine the effect of the quality of senior management leadership on social support and job design, whose main effects on strains, and moderating effects on work stressors-to-strains relationships were assessed. Design/methodology/approach: A survey involving distribution of questionnaires was carried out on a random sample of health care employees in acute hospital practice in the UK. The sample comprised 65,142 respondents. The work stressors tested were quantitative overload and hostile environment, whereas strains were measured through job satisfaction and turnover intentions. Structural equation modelling and moderated regression analyses were used in the analysis. Findings: Quality of senior management leadership explained 75 per cent and 94 per cent of the variance of social support and job design respectively, whereas work stressors explained 51 per cent of the variance of strains. Social support and job design predicted job satisfaction and turnover intentions, as well as moderated significantly the relationships between quantitative workload/hostility and job satisfaction/turnover intentions. Research limitations/implications: The findings are useful to management and to health employees working in acute/specialist hospitals. Further research could be done in other counties to take into account cultural differences and variations in health systems. The limitations included self-reported data and percept-percept bias due to same source data collection. Practical implications: The quality of senior management leaders in hospitals has an impact on the social environment, the support given to health employees, their job design, as well as work stressors and strains perceived. Originality/value: The study argues in favour of effective senior management leadership of hospitals, as well as ensuring adequate support structures and job design. The findings may be useful to health policy makers and human resources managers. © Emerald Group Publishing Limited.

Using the framework method for the analysis of qualitative data in multi-disciplinary health research

Background: The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion. The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary. Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research. © 2013 Gale et al.; licensee BioMed Central Ltd.

The effects of servant leadership on follower performance and well-being:underlying mechanisms, boundary conditions, and the role of training

Based on a review of the servant leadership, well-being, and performance literatures, the first study develops a research model that examines how and under which conditions servant leadership is related to follower performance and well-being alike. Data was collected from 33 leaders and 86 of their followers working in six organizations. Multilevel moderated mediation analyses revealed that servant leadership was indeed related to eudaimonic well-being and lead-er-rated performance via followers’ positive psychological capital, but that the strength and di-rection of the examined relationships depended on organizational policies and practices promot-ing employee health, and in the case of follower performance on a developmental team climate, shedding light on the importance of the context in which servant leadership takes place. In addi-tion, two more research questions resulted from a review of the training literature, namely how and under which conditions servant leadership can be trained, and whether follower performance and well-being follow from servant leadership enhanced by training. We subsequently designed a servant leadership training and conducted a longitudinal field experiment to examine our sec-ond research question. Analyses were based on data from 38 leaders randomly assigned to a training or control condition, and 91 of their followers in 36 teams. Hierarchical linear modeling results showed that the training, which addressed the knowledge of, attitudes towards, and ability to apply servant leadership, positively affected leader and follower perceptions of servant leader-ship, but in the latter case only when leaders strongly identified with their team. These findings provide causal evidence as to how and when servant leadership can be effectively developed. Fi-nally, the research model of Study 1 was replicated in a third study based on 58 followers in 32 teams drawn from the same population used for Study 2, confirming that follower eudaimonic well-being and leader-rated performance follow from developing servant leadership via increases in psychological capital, and thus establishing the directionality of the examined relationships.

Help in finding the right balance:leadership, work-family balance and employee outcomes

Although much research has examined employees’ experience of the work-family interface, its conceptualization has been rather problematic, ranging from work and family as mutually constraining through to mutually enriching and, more recently, to work-family balance (WFB). Building on Greenhaus and Allen’s (2011) conceptualization of WFB as comprising satisfaction and effectiveness components, I proposed and tested a model of he antecedents and outcomes of WFB. Based on work-family border theory, I hypothesised that family-supportive supervisor behaviours (FSSB) facilitate WFB and hat the relationship is stronger when the organisation also offers formal support (availability of family-friendly practices (FFPs); enhancement effect). Furthermore, I integrated the leadership and work-family interface literatures by proposing authentic eadership as an antecedent of FSSB. Based on role accumulation theories, I proposed life satisfaction and health as outcomes of WFB satisfaction and WFB effectiveness and job performance as an outcome of only WFB effectiveness. I tested my hypotheses with individual-level data in Study 1 (two waves of data; employees from Germany and the UK) and nested data (individuals nested in teams; two waves of data; employee and supervisor ratings; Germany and the UK) in Study 2. The obtained findings largely supported the hypothesized model and showed that both authentic leadership (Study 1) and team authentic leadership (Study 2) predicted FSSB which, in turn, increased WFB satisfaction and WFB effectiveness. Contrary to my prediction, both studies revealed that FSSB and (team) availability of FFPs compensated for each other, only impacting WFB satisfaction/effectiveness if the other form of family support was not available. Furthermore, both components were positively related to life satisfaction and health, while WFB effectiveness was only related to self-rated performance (Study 1) and not supervisor-rated performance (Study 2). Lastly, the serial moderated mediation model hat tested the conditional indirect effect of (team) authentic leadership on the outcomes received mixed support.

Leadership and organisational outcomes in healthcare

This research examined to what extent and how leadership is related to organisational outcomes in healthcare. Based on the Job Demands-Resource model, a set of hypotheses was developed, which predicted that the effect of leadership on healthcare outcomes would be mediated by job design, employee engagement, work pressure, opportunity for involvement, and work-life balance. The research focused on the National Health Service (NHS) in England, and examined the relationships between senior leadership, first line supervisory leadership and outcomes. Three years of data (2008 – 2010) were gathered from four data sources: the NHS National Staff Survey, the NHS Inpatient Survey, the NHS Electronic Record, and the NHS Information Centre. The data were drawn from 390 healthcare organisations and over 285,000 staff annually for each of the three years. Parallel mediation regressions modelled both cross sectional and longitudinal designs. The findings revealed strong relationships between senior leadership and supervisor support respectively and job design, engagement, opportunity for involvement, and work-life balance, while senior leadership was also associated with work pressure. Except for job design, there were significant relationships between the mediating variables and the outcomes of patient satisfaction, employee job satisfaction, absenteeism, and turnover. Relative importance analysis showed that senior leadership accounted for significantly more variance in relationships with outcomes than supervisor support in the majority of models tested. Results are discussed in relation to theoretical and practical contributions. They suggest that leadership plays a significant role in organisational outcomes in healthcare and that previous research may have underestimated how influential senior leaders may be in relation to these outcomes. Moreover, the research suggests that leaders in healthcare may influence outcomes by the way they manage the work pressure, engagement, opportunity for involvement and work-life balance of those they lead.

A frame analysis of the leadership styles of dental and medical school deans

The purpose of this study was to determine how dental and medical school deans perceived their own leadership styles and how many management/leadership perspectives they used when approaching a problem. A descriptive and correlational study was conducted which examined the leadership orientations or "frames" utilized by these deans. Four frames--the structural, the human resource, the political, and the symbolic--emerged from leadership studies which described the behavior of leaders in organizational actions and problem solving.^ Employing the repeated measures ANCOVA, it was found that there were no significant interactions between type of dean and perceptions or perspectives. However, the main effects of both leadership style perceptions and the use of perspectives were significant. This indicated that over the total sample of deans, both perceptions and perspectives were used differently; the deans perceived themselves and used perspectives the highest for the human resource frame and the lowest for the political frame. Also, dental deans' mean use overall of the four perspective frames was higher than the medical deans. In addition to the ANCOVA, t-tests performed on perceptions revealed that the deans perceived the frames differently in three human resource items. Pearson's correlations indicated that for the combined sample of deans, significant negative correlations existed when the human resource or symbolic frame was compared to the structural frame. All of the deans used multiple frames, allowing them to re-frame or combine frames according to the situation. ^

Successful and sustained leadership: A case study of a Jesuit high school president

Fr. Marcelino García, S.J. has been the president of Belen Jesuit Preparatory School for 25 years. The longevity and success of his tenure is an exemplary case of effective leadership and provided significant insight into what constitutes effective school leadership. The target population for this case study consisted of the school’s 7 administrators, 90 faculty members, 10 English-speaking staff members, and 3 key informants. Data were collected using Bolman and Deal’s (1997) Leadership Orientation Survey along with the Jesuit Secondary Education Administration’s (1994) Administrative Leadership Profile Survey (ALPS). Data collected from the surveys were analyzed using the SPSS, version 10. The study also included data collected from focus interviews with Fr. García and six other significant members of the school community. The interviews were approximately 1-hour individual interviews that employed a semi-structured guide. A concurrent triangulation method was used that directly compared the results from these data collection methods. This was done by looking at the data as a whole and in parts. The parts were internal (faculty, administrators, and staff) and external (parents, alumni, and the superior of the Jesuit community) sectors. The comparison of the findings was then examined in terms of each research question. Analysis of the data revealed that while Fr. García’s predominant leadership style reflected the typical Bolman and Deal characteristics associated with the political frame, his leadership demonstrates access to all four frames. Research has found a correlation between multiple frame use and successful leadership. Relatedly, Fr. García’s capacity to approach his administration from various perspectives is indicative of success. In addition, from the perspective of Jesuit education, an analysis of Fr. García’s leadership indicated recurring themes that contributed to the school’s organizational health. The results of this study provide an extensive analysis of the administration of a unique leader. An analysis of Fr. García’s leadership style from two perspectives gives fresh insight into sustained and successful leadership.

Use of the DACUM process in the identification and verification of competencies for the medical administrative assistant

Medicine has changed in recent years. Medicare will all of its rules and regulations, worker's compensation laws, managed care and the trend toward more and larger group practices all contributed to the creation of an extremely structured regulatory environment which in turn demanded highly trained medical administrative assistants.^ The researcher noted three primary problems in the identification of competencies for the medical administrative assistant position: A lack of curricula, diverse roles, and a complex environment which has undergone radical change in recent years and will continue to evolve. Therefore, the purposes of the study were to use the DACUM process to develop a relevant list of competencies required by the medical administrative assistant practicing in physicians' offices in South Florida; determine the rank order of importance of each competency using a scale of one to five; cross-validate the DACUM group scores with a second population who did not participate in the DACUM process; and establish a basis for a curriculum framework for an occupational program.^ The DACUM process of curriculum development was selected because it seemed best suited to the need to develop a list of competencies for an occupation for which no programs existed. A panel of expert medical office administrative staff was selected to attend a 2-day workshop to describe their jobs in great detail. The panel, led by a trained facilitator, listed major duties and the respective tasks of their job. Brainstorming techniques were used to develop a consensus.^ Based upon the DACUM workshop, a survey was developed listing the 8 major duties and 71 tasks identified by the panel. The survey was mailed to the DACUM group and a second, larger population who did not participate in the DACUM. The survey results from the two groups were then compared. The non-DACUM group validated all but 3 of the 71 tasks listed by the DACUM panel. Because the three tasks were rated by the second group as at least "somewhat important" and rated "very important" by the DACUM group, the researcher recommended the inclusion of all 71 tasks in program development for this occupation. ^

The effectiveness of a conceptually-based health and wellness course in developing health related factors, exercise self-efficacy and knowledge of health issues and exercise performance among diverse college students

The purpose of the study was to investigate the physiological and psychological benefits provided by a self-selected health and wellness course on a racially and ethnically diverse student population. It was designed to determine if students from a 2-year Hispanic serving institution (HIS) from a large metropolitan area would enhance their capacity to perform physical activities, increase their knowledge of health topics and raise their exercise self-efficacy after completing a course that included educational and activity components for a period of 16 weeks. A total of 185 students voluntarily agreed to participate in the study. An experimental group was selected from six sections of a health and wellness course, and a comparison group from students in a student life skills course. All participants were given anthropometric tests of physical fitness, a knowledge test, and an exercise self-efficacy scale was given at the beginning and at the conclusion of the semester. An ANCOVA analyses with the pretest scores being the covariate and the dependent variable being the difference score, indicated a significant improvement of the experimental group in five of the seven anthropometric tests over the comparison group. In addition, the experimental group increased in two of the three sections of the exercise self-efficacy scale indicating greater confidence to participate in physical activities in spite of barriers over the comparison group. The experimental group also increased in knowledge of health related topics over the comparison group at the .05 significance level. Results indicated beneficial outcomes gained by students enrolled in a 16-week health and wellness course. The study has several implications for practitioners, faculty members, educational policy makers and researchers in terms of implementation of strategies to promote healthy behaviors in college students and, to encourage them to engage in regular physical activities throughout their college years.