Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department: a comparative case study

Authors: Mandus Frykman, Henna Hasson, Åsa Muntlin Athlin, Ulrica von Thiele Schwarz

Published in: BMC Health Services Research | Issue 1/2014

Login to get access

Abstract

Background

While there is strong support for the benefits of working in multi-professional teams in health care, the implementation of multi-professional teamwork is reported to be complex and challenging. Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited. There is a lack of studies focusing on the functions of different behavior change interventions and the mechanisms driving behavior change. In this study, applied behavior analysis is used to analyze the function and impact of different behavior change interventions when implementing multi-professional teamwork.

Methods

A comparative case study design was applied. Two sections of an emergency department implemented multi-professional teamwork involving changes in work processes, aimed at increasing inter-professional collaboration. Behavior change interventions and staff behavior change were studied using observations, interviews and document analysis. Using a hybrid thematic analysis, the behavior change interventions were categorized according to the DCOM® model. The functions of the behavior change interventions were then analyzed using applied behavior analysis.

Results

The two sections used different behavior change interventions, resulting in a large difference in the degree of staff behavior change. The successful section enabled staff performance of teamwork behaviors with a strategy based on ongoing problem-solving and frequent clarification of directions. Managerial feedback initially played an important role in motivating teamwork behaviors. Gradually, as staff started to experience positive outcomes of the intervention, motivation for teamwork behaviors was replaced by positive task-generated feedback.

Conclusions

The functional perspective of applied behavior analysis offers insight into the behavioral mechanisms that describe how and why behavior change interventions influence staff behavior. The analysis demonstrates how enabling behavior change interventions, managerial feedback and task-related feedback interact in their influence on behavior and have complementary functions during different stages of implementation.
Appendix
Available only for authorised users
Literature
1.
Borrill CS, Carletta J, Carter A, Dawson JF, Garrod S, Rees A, Richards A, Shapiro D, West MA: The Effectiveness of Health Care Teams in the National Health Service. 2000, Birmingham: University of Aston
2.
Institute of Medicine: To err is Human: Building a Safer Health System. 2000, Washington, DC: The National Academy Press
3.
Porter ME, Lee TH: The strategy that will fix health care. Harv Bus Rev. 2013, 91: 50-70.
4.
Havig A, Skogstad A, Veenstra M, Romoren T: Real teams and their effect on the quality of care in nursing homes. BMC Health Serv Res. 2013, 13: 499-10.1186/1472-6963-13-499.CrossRefPubMedPubMedCentral
5.
Svensk Sjuksköterskeförening och Svenska Läkaresällskapet: Teamarbete & Förbättringskunskap - två Kärnkompetenser för god och Säker Vård. 2013, Solna: Svensk Sjuksköterskeförening och Svenska Läkaresällskapet
6.
Statens beredning för medicinsk utvärdering (SBU): Triage och Flödesprocesser på Akutmottagningen. En Systematisk Litteraturöversikt (SBU-Rapport nr 197). 2010, Stockholm: Statens beredning för medicinsk utvärdering
7.
Sorbero ME, Farley DO, Mattke S, Lovejoy SL: Outcome Measures for Effective Teamwork in Inpatient Care: Final Report. 2008, RAND Corporation
8.
Wensing M, Wollersheim H, Grol R: Organizational interventions to implement improvements in patient care: a structured review of reviews. Implement Sci. 2006, 1: 2-10.1186/1748-5908-1-2.CrossRefPubMedPubMedCentral
9.
Zwarenstein M, Goldman J, Reeves S: Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2009, 1-29. CD000072, 3
10.
Morey JC, Simon R, Jay GD, Wears RL, Salisbury M, Dukes KA, Berns SD: Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res. 2002, 37: 1553-1581. 10.1111/1475-6773.01104.CrossRefPubMedPubMedCentral
11.
Salas E, Almeida SA, Salisbury M, King H, Lazzara EH, Lyons R, Wilson KA, Almeida PA, McQuillan R: What are the critical success factors for team training in health care?. Jt Comm J Qual Patient Saf. 2009, 35: 398-405.PubMed
12.
Baker DP, Day R, Salas E: Teamwork as an essential component of high-reliability organizations. Health Serv Res. 2006, 41: 1576-1598. 10.1111/j.1475-6773.2006.00566.x.CrossRefPubMedPubMedCentral
13.
Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ. 1998, 317: 465-468. 10.1136/bmj.317.7156.465.CrossRefPubMedPubMedCentral
14.
Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman A, O’Brien MA: Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001, 39: II2-II45.CrossRefPubMed
15.
Oxman AD, Thomson MA, Davis DA, Haynes RB: No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ. 1995, 153: 1423-1431.PubMedPubMedCentral
16.
Grimshaw J, Eccles M, Thomas R, MacLennan G, Ramsay C, Fraser C, Vale L: Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966–1998. J Gen Intern Med. 2006, 21 (Suppl 2): 14-20.
17.
18.
Michie S, Fixsen D, Grimshaw J, Eccles M: Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci. 2009, 4: 40-10.1186/1748-5908-4-40.CrossRefPubMedPubMedCentral
19.
Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005, 58: 107-112. 10.1016/j.jclinepi.2004.09.002.CrossRefPubMed
20.
Davies P, Walker AE, Grimshaw JM: A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implement Sci. 2010, 5: 14-10.1186/1748-5908-5-14.CrossRefPubMedPubMedCentral
21.
Johnston M, Dixon D: Current issues and new directions in psychology and health: what happened to behaviour in the decade of behaviour?. Psychol Health. 2008, 23: 509-513. 10.1080/08870440701816728.CrossRefPubMed
22.
Øvretveit J: Understanding and improving patient safety: the psychological, social and cultural dimensions. J Health Organ Manag. 2009, 23: 581-596. 10.1108/14777260911001617.CrossRefPubMed
23.
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004, 8: 1-72. iii-ivCrossRef
24.
Grimshaw J: Conference excerpt: living long-term with HIV. Focus. 2001, 16: 7-8.PubMed
25.
French S, Green S, O’Connor D, McKenzie J, Francis J, Michie S, Buchbinder R, Schattner P, Spike N, Grimshaw J: Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the theoretical domains framework. Implement Sci. 2012, 7: 38-10.1186/1748-5908-7-38.CrossRefPubMedPubMedCentral
26.
Michie S, van Stralen MM, West R: The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011, 6: 42-10.1186/1748-5908-6-42.CrossRefPubMedPubMedCentral
27.
Skinner B: Contingencies of Reinforcement: A Theoretical Analysis. 1969, New York: Appleton
28.
29.
30.
Rummler GA: Serious Performance Consulting According to Rummler. 2007, New York: John Wiley & Sons
31.
Braksick LW: Unlock Behavior, Unleash Profits: Developing Leadership Behavior That Drives Profitability in Your Organization. 2007, New York: McGraw-Hill
32.
Gilbert TF: Human Competence: Engineering Worthy Performance. 1978, New York: McGraw-Hill
33.
Stajkovic AD, Luthans F: A meta-analysis of the effects of organizational behavior modification on task performance, 1975–95. Acad Manage J. 1997, 40: 1122-1149. 10.2307/256929.CrossRef
34.
Anderson CM, Kincaid D: Applying behavior analysis to school violence and discipline problems: Schoolwide positive behavior support. Behav Anal. 2005, 28: 49-63.PubMedPubMedCentral
35.
Butler AC, Chapman JE, Forman EM, Beck AT: The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006, 26: 17-31. 10.1016/j.cpr.2005.07.003.CrossRefPubMed
36.
Johnson J, Dakens L, Edwards P, Morse N: SwitchPoints: Culture Change on the Fast Track to Business Success. 2008, Hoboken: John Wiley & Sons
37.
Grol R, Wensing M: What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust. 2004, 180: S57-S60.PubMed
38.
Davis DA, Thomson MA, Oxman AD, Haynes RB: Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995, 274: 700-705. 10.1001/jama.1995.03530090032018.CrossRefPubMed
39.
Solomon DH, Hashimoto H, Daltroy L, Liang MH: Techniques to improve physicians’ use of diagnostic tests: a new conceptual framework. JAMA. 1998, 280: 2020-2027. 10.1001/jama.280.23.2020.CrossRefPubMed
40.
SAGE Publications I: Case Study as a Methodological Approach. Encyclopedia of Case Study Research. SAGE Publications, Inc. 2010, Thousand Oaks, CA: SAGE Publications, Inc
41.
Mazzocato P, Hvitfeldt Forsberg H, von Thiele SU: Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work. Scand J Trauma Resusc Emerg Med. 2011, 19: 1-8. 10.1186/1757-7241-19-1.CrossRef
42.
Muntlin Athlin A, von Thiele SU, Farrohknia N: Effects of multidisciplinary teamwork on lead times and patient flow in the emergency department: a longitudinal interventional cohort study. Scand J Trauma Resusc Emerg Med. 2013, 21: 76-10.1186/1757-7241-21-76.CrossRefPubMedPubMedCentral
43.
Langley GJ, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP: The Improvement Guide: A Practical Approach to Enhancing Organizational Performance 2nd Edition. 2009, San Francisco: Jossey-Bass
44.
Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S: A conceptual framework for implementation fidelity. Implement Sci. 2007, 2: 40-10.1186/1748-5908-2-40.CrossRefPubMedPubMedCentral
45.
Hasson H, Blomberg S, Duner A: Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care. Implement Sci. 2012, 7: 23-10.1186/1748-5908-7-23.CrossRefPubMedPubMedCentral
46.
Coleman JS: Relational analysis - the study of social organizations with survey methods. Hum Organ. 1958, 17: 28-36.CrossRef
47.
Fereday J, Muir-Cochrane E: Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Method. 2008, 5: 80-92.
48.
Schilling J: On the pragmatics of qualitative assessment - designing the process for content analysis. Eur J Psychol Assess. 2006, 22: 28-37. 10.1027/1015-5759.22.1.28.CrossRef
49.
Boyatzis RE: Transforming Qualitative Information: Thematic Analysis and Code Development. 1998, Thousand Oaks: Sage Publications
50.
51.
Self DR, Armenakis AA, Schraeder M: Organizational change content, process, and context: a simultaneous analysis of employee reactions. J Change Manage. 2007, 7: 211-229. 10.1080/14697010701461129.CrossRef
52.
Kotter JP: Leading change - Why transformation efforts fail. Harv Bus Rev. 1995, 73: 59-67.
53.
Holt DT, Armenakis AA, Feild HS, Harris SG: Readiness for organizational change the systematic development of a scale. J Appl Behav Sci. 2007, 43: 232-255. 10.1177/0021886306295295.CrossRef
54.
Bandura A: Self-Efficacy: The Exercise of Control. 1997, New York: Freeman
55.
Komaki JL, Collins RL, Penn P: The role of performance antecedents and consequences in work motivation. J Appl Psychol. 1982, 67: 334-340.CrossRef
56.
Komaki J: Emergence of the operant model of effective supervision or How an operant conditioner got hooked on leadership. Leadersh Org Dev J. 1994, 15: 27-32.CrossRef
57.
Stirman SW, Kimberly J, Cook N, Calloway A, Castro F, Charns M: The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci. 2012, 7: 17-10.1186/1748-5908-7-17.CrossRef
58.
Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N: Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010, 3: 1-63. CD005470
59.
Bhuiyan N, Baghel A: An overview of continuous improvement: from the past to the present. Manage Decis. 2005, 43: 761-771. 10.1108/00251740510597761.CrossRef
60.
Kluger AN, DeNisi A: The effects of feedback interventions on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol Bull. 1996, 119: 254-284.CrossRef
61.
Kivimaki M, Voutilainen P, Koskinen P: Job enrichment, work motivation, and job satisfaction in hospital wards: testing the job characteristics model. J Nurs Manag. 1995, 3: 87-91. 10.1111/j.1365-2834.1995.tb00086.x.CrossRefPubMed
62.
Gagne M, Deci EL: Self-determination theory and work motivation. J Org Behav. 2005, 26: 331-362. 10.1002/job.322.CrossRef
63.
Latham GP, Pinder CC: Work motivation theory and research at the dawn of the twenty-first century. Annu Rev Psychol. 2005, 56: 485-516. 10.1146/annurev.psych.55.090902.142105.CrossRefPubMed
64.
Skinner B: Science and Human Behavior. 1953, New York: Macmillan
65.
Kanfer R, Chen G, Pritchard RD: Work Motivation: Past, Present and Future. 2008, New York: Taylor & Francis
66.
Ryan RM, Deci EL: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000, 55: 68-78.CrossRefPubMed
67.
Kozlowski SWJ, Gully SM, Salas E, Cannon-Bowers JA: Team leadership and development: theory, principles, and guidelines for training leaders and teams. Advances in Interdisciplinary Studies of Work Teams: Team Leadership, Vol 3. Edited by: Beyerlein MM, Johnson DA, Beyerlein ST. 1996, US: Elsevier Science/JAI Press, 253-291.
68.
Powers W: Behavior: The Control of Perception. 1973, Chicago: Aldine Transaction
69.
Kilbourne AM, Neumann MS, Pincus HA, Bauer MS, Stall R: Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implement Sci. 2007, 2: 42-10.1186/1748-5908-2-42.CrossRefPubMedPubMedCentral
70.
Walt G, Shiffman J, Schneider H, Murray SF, Brugha R, Gilson L: ‘Doing’ health policy analysis: methodological and conceptual reflections and challenges. Health Policy Plan. 2008, 23: 308-317. 10.1093/heapol/czn024.CrossRefPubMedPubMedCentral
71.
Lincoln YS, Guba EG: Naturalistic Inquiry. 1985, Newbury Park: SAGE Publications
Metadata
Title
Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department: a comparative case study
Authors
Mandus Frykman
Henna Hasson
Åsa Muntlin Athlin
Ulrica von Thiele Schwarz
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-14-218

Other articles of this Issue 1/2014

BMC Health Services Research 1/2014 Go to the issue

Research article

Video-confidence: a qualitative exploration of videoconferencing for psychiatric emergencies

Research article

Costs associated with febrile neutropenia in solid tumor and lymphoma patients – an observational study in Singapore

Research article

Frontline health workers as brokers: provider perceptions, experiences and mitigating strategies to improve access to essential medicines in South Africa

Research article

Effects of patient health literacy, patient engagement and a system-level health literacy attribute on patient-reported outcomes: a representative statewide survey

Research article

People with limiting long-term conditions report poorer experiences and more problems with hospital care

Research article

Patient-reported measurement of time to diagnosis in cancer: development of the Cancer Symptom Interval Measure (C-SIM) and randomised controlled trial of method of delivery