A new study involving a US hospital emergency department has found that teams with separate roles are less effective than teams with overlapping roles.
Organizations have long relied on predefined roles (e.g., a nurse and a doctor in medicine) as cornerstones of coordination that provide team members with clarity about what they and their teammates are expected to know and do, the study authors said. However, the increase in “fluid participation” – frequent changes in team membership and the composition of available skills – poses new challenges to these traditional coordination mechanisms.
Changes in membership can result in teams having less cohesive or more overlapping roles – that is, a set of roles with more different or overlapping capabilities. The researchers examined the possibility that experiencing separate team roles hinders the flexible coordination necessary for performance in the volatile context of an emergency department.
The study, published in Limits in psychologywas conducted by researchers from Carnegie Mellon University, the Brazilian School of Public and Business Administration, Waseda University and Nanyang Technological University.
“To adapt to volatile environments, many organizations in the 1980s began organizing their work into teams to help the organization respond quickly to changing needs,” said Anna Mayo, assistant professor of organizational behavior at Carnegie’s Heinz College Mellon, the book’s co-author, is a study.
“However, organizational teams are increasingly more unstable than before. Due in part to increasing specialization and technological advances, team membership today is often in flux as experts come and go and people juggle work on multiple teams at once. This makes it difficult to coordinate as boundaries around who is “on” the team and workflows become more dynamic and harder to discern.”
In this study, researchers examined data from nearly 350 teams working in a 12-bed emergency department at a medium-sized suburban hospital in the United States in 2011. Data included hospital scheduling records, patient health records, and surveys completed by attending physicians.
The researchers analyzed two types of teams: The more connected role sets included an attending physician, a nurse, and an average of seven nurses. Missing from teams with less connected roles was the nurse role, whose skills overlap with both nurses and physicians. This absence was believed to reduce the degree of flexibility a team could exercise.
Less connected role sets were associated with lower team effectiveness in terms of longer ED stays and more patients handed off during shift change. This was true after accounting for other possible explanations such as the total manpower available to the team and the time of day. However, the cognitive versatility – or ability to be flexible in thinking style – of a team’s attending physician – who is considered a strategic core member – could alter this effect. Teams with a more cognitively diverse physician provided more efficient care overall and had fewer negative impacts from working with less connected roles compared to teams with less cognitively diverse attending physicians. These results remained even after controlling for other physician characteristics such as experience.
“Role-based organizational systems are a powerful tool for coordination because they provide a clear understanding of what each individual can do and how team members’ work should fit together,” said Brandy Aven, associate professor of organizational theory and strategy. and entrepreneurship at Carnegie Mellon’s Tepper School of Business, who co-authored the study.
“In our study, we highlighted that roles with more overlap in the tasks they can perform can lead to redundancy, which is crucial for adaptation by allowing members to support each other and so on to create a structural mechanism for a certain flexibility. However, without this structural flexibility, cognitive flexibility can be crucial.”
Among the limitations of the study, the authors note that their work is correlational and does not address the causal effects of role structures or cognitive diversity. Furthermore, they were unable to observe the coordination behavior that they suspect explains the relationship between caregiving effectiveness and both role structures and cognitive flexibility.
Anita Williams Woolley, professor of organizational behavior and theory at Carnegie Mellon’s Tepper School of Business, co-author of the study, said: “As the formal organizational structures that once supported coordination disappear, insights from psychology and organizational behavior point to individual team characteristics . “Members as a potential source of flexibility that can strengthen team coordination in dynamic environments.”