Implementing a knowledge management system within an NHS hospital:a case study exploring the roll-out of an Electronic Patient Record (EPR)

This research aims to contribute to understanding the implementation of knowledge management systems (KMS) in the field of health through a case study, leading to theory building and theory extension. We use the concept of the business process approach to knowledge management as a theoretical lens to analyse and explore how a large teaching hospital developed, executed and practically implemented a KMS. A qualitative study was conducted over a 2.5 year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non-participant observation of meetings and documents. The theoretical propositions strategy was used as the overarching approach for data analysis. Our case study provides evidence that true patient centred approaches to supporting care delivery with a KMS benefit from process thinking at both the planning and implementation stages, and an emphasis on the knowledge demands resulting from: the activities along the care pathways; where cross-overs in care occur; and knowledge sharing for the integration of care. The findings also suggest that despite the theoretical awareness of KMS implementation methodologies, the actual execution of such systems requires practice and learning. Flexible, fluid approaches through rehearsal are important and communications strategies should focus heavily on transparency incorporating both structured and unstructured communication methods.

Charting new territory for organizational ethnography:insights from a team-based video ethnography of reinsurance trading in Lloyd’s of London

An increasing interest in “bringing actors back in” and gaining a nuanced understanding of their actions and interactions across a variety of strands in the management literature, has recently helped ethnography to unknown prominence in the field of organizational studies. Yet, calls remain that ethnography should “play a much more central role in the organization and management studies repertoire than it currently does” (Watson, 2011: 202). Ironically, those organizational realities that ethnographers are called to examine have at the same time become less and less amenable to ethnographic study. In this paper, we respond to these calls for innovative ethnographic methods in two ways. First, we report on the practices and ethnographic experiences of conducting a year-long team-based video ethnography of reinsurance trading in Lloyd’s of London. Second, drawing on these experiences, we propose an initial framework for systematizing new approaches to organizational ethnography and visualizing the ways in which they are ‘expanding’ ethnography as it was traditionally practiced.

Climate setting in sourcing teams:developing a measurement scale for team creativity climate

Creative sourcing strategies, designed to extract more value from the supply base, have become a competitive, strategic differentiator. To fuel creativity, companies install sourcing teams that can capitalize on the specialized knowledge and expertise of their employees across the company. This article introduces the concept of a team creativity climate (TCC) - team members' shared perceptions of their joint policies, procedures, and practices with respect to developing creative sourcing strategies – as a means to address the unique challenges associated with a collective, cross-functional approach to develop value-enhancing sourcing strategies. Using a systematic scale development process that validates the proposed concept, the authors confirm its ability to predict sourcing team performance, and suggest some research avenues extending from this concept.

A versenyképesség aktuális kérdései a pénzügyekben - Összefoglaló a pénzügyi kutatócsoport munkájáról = Current issues of competitiveness - Summary on the work of the Finance research team

A pénzügy kutatócsoport a TÁMOP-4.2.1.B-09/1/KMR-2010-0005 azonosítójú projektjében igen szerteágazó elemzési munkát végzett. Rámutattunk, hogy a különböző szintű gazdasági szereplők megnövekedett tőkeáttétele egyértelműen a rendszerkockázat növekedéséhez vezet, hiszen nő az egyes szereplők csődjének valószínűsége. Ha a tőkeáttételt eltérő mértékben és ütemben korlátozzák az egyes szektorokban, országokban akkor a korlátozást később bevezető szereplők egyértelműen versenyelőnyhöz jutnak. Az egyes pénzügyi intézmények tőkeallokációját vizsgálva kimutattuk, hogy a különféle divíziók közt mindig lehetséges a működés fedezetésül szolgáló tőkét (kockázatot) úgy felosztani, hogy a megállapodás felmondás egyik érintettnek se álljon érdekében. Ezt azonban nem lehet minden szempontból igazságosan megtenni, így egyes üzletágak versenyhátrányba kerülhetnek, ha a konkurens piaci szereplők az adott tevékenységet kevésbé igazságtalanul terhelték meg. Kimutattunk, hogy az egyes nyugdíjpénztárak befektetési tevékenységének eredményességére nagy hatással van a magánnyugdíjpénztárak tevékenységének szabályozása. Ezek a jogszabályok a társadalom hosszú távú versenyképességére vannak hatással. Rámutattunk arra is, hogy a gazdasági válság előtt a hazai bankok sem voltak képesek ügyfeleik kockázatviselő képességét helyesen megítélni, ráadásul jutalékrendszerük nem is tette ebben érdekelté azokat. Számos vizsgálatunk foglalkozott a magyar vállalatok versenyképességének alakulásával is. Megvizsgáltuk a különféle adónemek, árfolyamkockázatok és finanszírozási politikák versenyképességet befolyásoló hatását. Külön kutatás vizsgálta a kamatlábak ingadozásának és az hitelekhez kapcsolódó eszközfedezet meglétének vállalati értékre gyakorolt hatásait. Rámutattunk a nemfizetés növekvő kockázatára, és áttekintettük a lehetséges és a ténylegesen alkalmazott kezelési stratégiákat is. Megvizsgáltuk azt is, hogy a tőzsdei cégek tulajdonosai miként használják ki az osztalékfizetéshez kapcsolódó adóoptimalizálási lehetőségeket. Gyakorlati piaci tapasztalataik alapján az adóelkerülő kereskedést a befektetők a részvények egy jelentős részénél végrehajtják. Külön kutatás foglakozott a szellemi tőke hazai vállalatoknál játszott szerepéről. Ez alapján a cégek a problémát 2009-ben lényegesen magasabb szakértelemmel kezelték, mint öt esztendővel korábban. Rámutattunk arra is, hogy a tulajdonosi háttér lényeges hatást gyakorolhat arra, ahogyan a cégek célrendszerüket felépítik, illetve ahogy az intellektuális javakra tekintenek. _____ The Finance research team has covered a wide range of research fields while taking part at project TÁMOP-4.2.1.B-09/1/KMR-2010-0005. It has been shown that the increasing financial gearing at the different economic actors clearly leads to growth in systematic risk as the probability of bankruptcy climbs upwards. Once the leverage is limited at different levels and at different points in time for the different sectors, countries introducing the limitations later gain clearly a competitive advantage. When investigating the leverage at financial institutions we found that the capital requirement of the operation can always be divided among divisions so that none of them would be better of with cancelling the cooperation. But this cannot be always done fairly from all point of view meaning some of the divisions may face a competitive disadvantage if competitors charge their similar division less unfairly. Research has also shown that the regulation of private pension funds has vital effect on the profitability of the investment activity of the funds. These laws and regulations do not only affect the funds themselves but also the competitiveness of the whole society. We have also fund that Hungarian banks were unable to estimate correctly the risk taking ability of their clients before the economic crisis. On the top of that the bank were not even interested in that due to their commission based income model. We also carried out several research on the competitiveness of the Hungarian firms. The effect of taxes, currency rate risks, and financing policies on competitiveness has been analysed in detail. A separate research project was dedicated to the effect of the interest rate volatility and asset collaterals linked to debts on the value of the firm. The increasing risk of non-payment has been underlined and we also reviewed the adequate management strategies potentially available and used in real life. We also investigated how the shareholders of listed companies use the tax optimising possibilities linked to dividend payments. Based on our findings on the Hungarian markets the owners perform the tax evading trades in case of the most shares. A separate research has been carried out on the role played by intellectual capital. After that the Hungarian companies dealt with the problem in 2009 with far higher proficiency than five years earlier. We also pointed out that the ownership structure has a considerable influence on how firms structure their aims and view their intangible assets.

Vágyott kultúra és reális értékítélet - Tudásmenedzsment-rendszer kiépítésének előfeltétele egy felsőoktatási intézményben (Desired culture and real value judgement – Precondition of development a knowledge management system in a higher education institution)

A tudásmenedzsment-rendszerek kiépítése és működtetése egyre népszerűbb vállalati cél. A legnagyobb igyekezet ellenére is kudarccal végződhet egy ilyen változás megvalósítása, ha a szükséges feltételek nélkül próbálkozunk ezzel a beavatkozással a szervezet életében. Az egyik legfontosabb előfeltétel a bizalomra, közös tanulásra, fejlődésre épülő, nyitott szervezeti kultúra, mely a tanulószervezeti jellemzőkkel írható le. A szerzők kutatásukban arra voltak kíváncsiak, milyen elképzeléseik, vágyaik vannak a felsőoktatásban oktató kollégáknak az ideálisnak nevezett szervezeti kultúráról. Ezeket az elképzeléseket egy külső tanácsadó cég által végzett kérdőíves felmérésen alapuló vizsgálat segítségével tudták meg, melynek kiértékelésére a circumplex-módszer szolgált. Az eredményeket összevetették a tanulószervezeti jellemzőkkel, vizsgálva azt a hipotézist, miszerint az oktató kollégák tudat alatt is olyan ideális szervezetet képzelnek el, mely a tanulószervezeti kultúra jellemzőivel azonos. _________ To create and to operate a knowledge management system is becoming a more and more popular target of the companies. Realizing the changes above can result in a failure – in spite of the biggest will – if organizations lack certain prerequisites which are necessary in companies’ lives. One of the most important prerequisites is organizational culture which can be characterized by confidence, common learning, development and open atmosphere. This is called a learning organizational culture. In their research the authors would have liked to know what kind of dreams the colleagues have about their own organizational culture. They achieve these results from an investigation with questionnaires which were realized by an advisory team. To evaluating the results of this investigation circumplex method was used. These results were compared with the characteristics of learning organization to confirm our hypothesis. According to this idea colleagues have the same images about their successful organization as the characteristics of learning organizations.

Team diversity and leadership: Tests of model of process and direct effects

A model was tested to examine relationships among leadership behaviors, team diversity, and team process measures with team performance and satisfaction at both the team and leader-member levels of analysis. Relationships between leadership behavior and team demographic and cognitive diversity were hypothesized to have both direct effects on organizational outcomes as well as indirect effects through team processes. Leader member differences were investigated to determine the effects of leader-member diversity leader-member exchange quality, individual effectiveness and satisfaction.^ Leadership had little direct effect on team performance, but several strong positive indirect effects through team processes. Demographic Diversity had no impact on team processes, directly impacted only one performance measure, and moderated the leadership to team process relationship.^ Cognitive Diversity had a number of direct and indirect effects on team performance, the net effects uniformly positive, and did not moderate the leadership to team process relationship.^ In sum, the team model suggests a complex combination of leadership behaviors positively impacting team processes, demographic diversity having little impact on team process or performance, cognitive diversity having a positive net impact impact, and team processes having mixed effects on team outcomes.^ At the leader-member level, leadership behaviors were a strong predictor of Leader-Member Exchange (LMX) quality. Leader-member demographic and cognitive dissimilarity were each predictors of LMX quality, but failed to moderate the leader behavior to LMX quality relationship. LMX quality was strongly and positively related to self reported effectiveness and satisfaction.^ The study makes several contributions to the literature. First, it explicitly links leadership and team diversity. Second, demographic and cognitive diversity are conceptualized as distinct and multi-faceted constructs. Third, a methodology for creating an index of categorical demographic and interval cognitive measures is provided so that diversity can be measured in a holistic conjoint fashion. Fourth, the study simultaneously investigates the impact of diversity at the team and leader-member levels of analyses. Fifth, insights into the moderating impact of different forms of team diversity on the leadership to team process relationship are provided. Sixth, this study incorporates a wide range of objective and independent measures to provide a 360$\sp\circ$ assessment of team performance. ^

The effects of the outdoor experiential ropes course on perceived team performance

The purpose of this quasi-experimental study was to explore the perceived effects of the Ropes Course on the performance of intact work teams. The dependent variable, team performance, was measured by the Team Performance Assessment, a 20 question inventory. The Ropes Course, the independent variable, was an outdoor experiential training program presently marketed as a highly effective team building training program. Issues the team addressed in the highly emotional and physical environment were purported to transfer back to the work environment and act as a catalyst for change The Ropes Course in this study consisted of a day long series of outdoor mental, emotional and physical exercises addressing the issues of goal-setting, role expectations, accountability, trust, respect, communication, problem-solving and decision-making. The 68 subjects, 37 in the treatment group and 31 in the control were employees of a large international financial institution. They were not chosen by random selection. The work teams' managers recognized a need to improve team morale, performance and functioning due to corporate reengineering and downsizing resulting in team members' job losses. Control teams were partially matched to the treatment teams on the basis of professional composition and similar job descriptions. The pretest of the Team Performance Assessment was given the morning of the Ropes Course treatment and the posttest was given three to five weeks later. The control teams received the pretests and posttests at about the same time intervals at their work location but received no Ropes Course treatment. The treatment teams' scores and the control teams' scores were statistically compared using the Multivariate Analysis of Variance (MANOVA) and the Multivariate Analysis of Covariance (MANCOVA) at the .05 level of significance. The statistical analysis revealed a significant difference between the control and experimental teams after the team building Ropes Course training as measured by the Team Performance Assessment (Gilbert, 1996). ^

Teams leading teams: Examining the role of leadership in multi-team systems

A major challenge of modern teams lies in the coordination of the efforts not just of individuals within a team, but also of teams whose efforts are ultimately entwined with those of other teams. Despite this fact, much of the research on work teams fails to consider the external dependencies that exist in organizational teams and instead focuses on internal or within team processes. Multi-Team Systems Theory is used as a theoretical framework for understanding teams-of-teams organizational forms (Multi-Team Systems; MTS's); and leadership teams are proposed as one remedy that enable MTS members to dedicate needed resources to intra-team activities while ensuring effective synchronization of between-team activities. Two functions of leader teams were identified: strategy development and coordination facilitation; and a model was developed delineating the effects of the two leader roles on multi-team cognitions, processes, and performance.^ Three hundred eighty-four undergraduate psychology and business students participated in a laboratory simulation that modeled an MTS; each MTS was comprised of three, two-member teams each performing distinct but interdependent components of an F-22 battle simulation task. Two roles of leader teams supported in the literature were manipulated through training in a 2 (strategy training vs. control) x 2 (coordination training vs. control) design. Multivariate analysis of variance (MANOVA) and mediated regression analysis were used to test the study's hypotheses. ^ Results indicate that both training manipulations produced differences in the effectiveness of the intended form of leader behavior. The enhanced leader strategy training resulted in more accurate (but not more similar) MTS mental models, better inter-team coordination, and higher levels of multi-team (but not component team) performance. Moreover, mental model accuracy fully mediated the relationship between leader strategy and inter-team coordination; and inter-team coordination fully mediated the effect of leader strategy on multi-team performance. Leader coordination training led to better inter-team coordination, but not to higher levels of either team or multi-team performance. Mediated Input-Process-Output (I-P-O) relationships were not supported with leader coordination; rather, leader coordination facilitation and inter-team coordination uniquely contributed to component team and multi-team level performance. The implications of these findings and future research directions are also discussed. ^

The influence of gender and ethnic diversity on team effectiveness

Organizations are becoming increasingly diverse as a growing number of women and ethnic minorities enter the workforce. Understanding the influence of diversity is particularly important for organizations that rely on team-based work structures, where individuals must engage in face-to-face interactions more frequently than in other organizational settings. The purpose of this research was to examine the effects of gender and ethnic diversity on team member interactions when performing a highly interdependent task that is both cognitively and behaviorally challenging. Participants were composed of 264 undergraduate students who enrolled in psychology courses at Florida International University and formed 66, 4-person teams. Teams participated in a low fidelity F-22 flight simulation consisting of two aircraft that had to interact in order to be successful. A 2 x 2 design was utilized in which the gender and ethnicity composition of each team was manipulated to form four experimental conditions (same gender/same ethnicity, same gender/mixed ethnicity, mixed gender/same ethnicity, mixed gender/mixed ethnicity). Both ethnic and gender homogeneity in teams resulted in increased interpersonal cohesion. Moreover, coordination fully mediated the relationship between interpersonal cohesion and team performance. Higher levels of interpersonal cohesion enhanced coordination between team members, which ultimately improved performance. Implications of these findings are discussed, as are limitations of the study and suggestions for future research. ^

Team Primacy Concept-based employee evaluation and job performance

This qualitative case study explored how employees learn from Team Primacy Concept (TPC)-based employee evaluation and how they apply the knowledge in their job performance. Kolb's experiential learning model (1974) served as a conceptual framework for the study to reveal the process of how employees learn from TPC evaluation, namely, how they experience, reflect, conceptualize and act on performance feedback. TPC based evaluation is a form of multirater evaluation that consists of three components: self-feedback, supervisor's feedback, and peer feedback. The distinctive characteristic of TPC based evaluation is the team evaluation component during which the employee's professional performance is discussed by one's peers in a face-to-face team setting, while other forms of multirater evaluation are usually conducted in a confidential and anonymous manner.^ Case study formed the methodological framework. The case was the Southeastern Virginia (SEVA) region of the Institute for Family Centered Services, and the participants were eight employees of the SEVA region. Findings showed that the evaluation process was anxiety producing for employees, especially the process of peer evaluation in a team setting. Preparation was found to be an important phase of TPC evaluation. Overall, the positive feedback delivered in a team setting made team members feel acknowledged. The study participants felt that honesty in providing feedback and openness to hearing challenges were significant prerequisites to the TPC evaluation process. Further, in the planning phase, employees strove to develop goals for themselves that were meaningful. Also, the catalyst for feedback implementation appeared to stem from one's accountability to self and to the client or community. Generally, the participants identified a number of performance improvement goals that they attained during their employment with IFCS, which were supported by their developmental plans.^ In conclusion, the study identified the process by which employees learned from TPC-based employee evaluation and the ways in which they used the knowledge to improve their job performance. Specifically, the study examined how participants felt and what they thought about TPC-based feedback, in what ways they reflected and made meaning of the feedback, and how they used the feedback to improve their job performance.^

Adaptation in knowledge-based teams: An examination of team composition, leader sensegiving, and cognitive, behavioral, and motivational mechanisms

Organizations are increasingly relying on teams to do the work that has traditionally been done by individuals. At the same time, the environments in which these organizations and teams operate have been becoming progressively more complex and uncertain. These trends raise important questions about the factors that enable teams to adapt. In response to these questions, the current study sought to identify the cognitive, behavioral, and motivational processes and emergent states that promote a team's adaptation to unforeseen changes and novel events, and the team compositional characteristics and leadership processes that enabled these processes and emergent states. Two hundred twenty two undergraduate students from a large Southeastern University composed 74 3-person teams, and participated in a computerized decision-making simulation where each team formed the governing body (i.e., Mayor's cabinet) for two separate simulated cities, and made strategic decisions about city operations. Participants were randomly assigned to one of three roles, distributing expertise and creating mutual interdependence. External team leader sensegiving was manipulated through video recorded communications from an external team leader. Results indicate that team cognitive ability, achievement striving, and psychological collectivism, as well as external team leader sensegiving, were all related to the similarity and quality of team members' strategy-focused mental models (cognitive emergent states), and to the amount of information sharing among members (behavioral process). In turn, teams with more similar and higher quality mental models, and who shared greater levels of information, were found to have a greater ability to react and adapt to environmental changes, and to have greater levels of decision-making effectiveness. Results indicate a pattern of relationships consistent with hypotheses, and have important implications for organizations and knowledge-based teams charged with management responsibilities. Organizations should staff teams with the compositional characteristics that enable the development of similar and high quality mental models, and that promote information sharing among teammates. Similarly, organizations which train and develop leaders to engage in sensegiving behaviors enable team adaptability and promote enhanced decision-making effectiveness when faced with unforeseen changes and novel situations.

An agent-based model of team coordination and performance

This research is based on the premises that teams can be designed to optimize its performance, and appropriate team coordination is a significant factor to team outcome performance. Contingency theory argues that the effectiveness of a team depends on the right fit of the team design factors to the particular job at hand. Therefore, organizations need computational tools capable of predict the performance of different configurations of teams. This research created an agent-based model of teams called the Team Coordination Model (TCM). The TCM estimates the coordination load and performance of a team, based on its composition, coordination mechanisms, and job’s structural characteristics. The TCM can be used to determine the team’s design characteristics that most likely lead the team to achieve optimal performance. The TCM is implemented as an agent-based discrete-event simulation application built using JAVA and Cybele Pro agent architecture. The model implements the effect of individual team design factors on team processes, but the resulting performance emerges from the behavior of the agents. These team member agents use decision making, and explicit and implicit mechanisms to coordinate the job. The model validation included the comparison of the TCM’s results with statistics from a real team and with the results predicted by the team performance literature. An illustrative 26-1 fractional factorial experimental design demonstrates the application of the simulation model to the design of a team. The results from the ANOVA analysis have been used to recommend the combination of levels of the experimental factors that optimize the completion time for a team that runs sailboats races. This research main contribution to the team modeling literature is a model capable of simulating teams working on complex job environments. The TCM implements a stochastic job structure model capable of capturing some of the complexity not capture by current models. In a stochastic job structure, the tasks required to complete the job change during the team execution of the job. This research proposed three new types of dependencies between tasks required to model a job as a stochastic structure. These dependencies are conditional sequential, single-conditional sequential, and the merge dependencies.

The impact of institutional complexity and top management characteristics on executive compensation and firm performance

While most studies take a dyadic view when examining the environmental difference between the home country of a multinational enterprise (MNE) and a particular foreign country, they ignore that an MNE is managing a network of subsidiaries embedded in diverse environments. Additionally, neither the impacts of global environments on top executives nor the effects of top executives’ capabilities to handle institutional complexity are fully explored. Thus, using a three-essay format, this dissertation tried to fill these gaps by addressing the effects of institutional complexity and top management characteristics on top executive compensation and firm performance. ^ Essay 1 investigated the impact of an MNE’s institutional complexity, or the diversity of national institutions facing an MNE’s network of subsidiaries, on the top management team (TMT) compensation. This essay proposed that greater political and cultural complexity leads to not only greater TMT total compensation but also to a greater portion of TMT compensation linked with long-term performance. The arguments are supported in this essay by using an unbalanced panel dataset including 296 U.S. firms with 1,340 observations. ^ Essay 2 explored TMT social capital and its moderating role on value creation and appropriation by the chief executive officer (CEO). Using a sample with 548 U.S. firms and 2,010 observations, it found that greater TMT social capital does facilitate the effects of CEO intellectual capital and social capital on firm growth. Finally, essay 3 examined the performance implications for the fit between managerial information-processing capabilities and institutional complexity. It proposed that institutional complexity is associated with the needs of information-processing. On the other hand, smaller TMT turnover and larger TMT size reflect larger managerial information-processing capabilities. Consequently, superior performance is achieved by the match among institutional complexity, TMT turnover, and TMT size. All hypotheses in essay 3 are supported in a sample of 301 U.S. firms and 1,404 observations. ^ To conclude, this dissertation advances and extends our knowledge on the roles of institutional environments and top executives on firm performance and top executive compensation.^

Appraising Work Group Performance: New Productivity Opportunities in Hospitality Management

In - Appraising Work Group Performance: New Productivity Opportunities in Hospitality Management – a discussion by Mark R. Edwards, Associate Professor, College of Engineering, Arizona State University and Leslie Edwards Cummings, Assistant Professor, College of Hotel Administration University of Nevada, Las Vegas; the authors initially provide: “Employee group performance variation accounts for a significant portion of the degree of productivity in the hotel, motel, and food service sectors of the hospitality industry. The authors discuss TEAMSG, a microcomputer based approach to appraising and interpreting group performance. TEAMSG appraisal allows an organization to profile and to evaluate groups, facilitating the targeting of training and development decisions and interventions, as well as the more equitable distribution of organizational rewards.” “The caliber of employee group performance is a major determinant in an organization's productivity and success within the hotel and food service industries,” Edwards and Cummings say. “Gaining accurate information about the quality of performance of such groups as organizational divisions, individual functional departments, or work groups can be as enlightening...” the authors further reveal. This perspective is especially important not only for strategic human resources planning purposes, but also for diagnosing development needs and for differentially distributing organizational rewards.” The authors will have you know, employee requirements in an unpredictable environment, which is what the hospitality industry largely is, are difficult to quantify. In an effort to measure elements of performance Edwards and Cummings look to TEAMSG, which is an acronym for Team Evaluation and Management System for Groups. They develop the concept. In discussing background for employees, Edwards and Cummings point-out that employees - at the individual level - must often possess and exercise varied skills. In group circumstances employees often work at locations outside of, or move from corporate unit-to-unit, as in the case of a project team. Being able to transcend individual-to-group mentality is imperative. “A solution which addresses the frustration and lack of motivation on the part of the employee is to coach, develop, appraise, and reward employees on the basis of group achievement,” say the authors. “An appraisal, effectively developed and interpreted, has at least three functions,” Edwards and Cummings suggest, and go on to define them. The authors do place a great emphasis on rewards and interventions to bolster the assertion set forth in their thesis statement. Edwards and Cummings warn that individual agendas can threaten, erode, and undermine group performance; there is no - I - in TEAM.

Factors surgical team members perceive influence choices of wearing or not wearing personal protective equipment during operative /invasive procedures

Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.