WORKING AT THE TOP OF THEIR CAPABILITIES: HOW TEAMWORK SUPPORT ATTENUATES LEADER ROLE CONFLICT.

Objective: To understand whether team member support reduces team leader stress. Method: In Phase 1, we used hierarchical linear modeling with survey data and administrative records from 45 Veterans Health Administration teams (73 providers and 228 associated members) to investigate how teamwork support mitigates leader stress. In Phase 2, we adopted a parallel/simultaneous mixed methods design, utilizing open- and closed-ended responses from 267 additional Veterans Health Administration providers. With the mixed methods design we first analyzed open-ended responses using directed content analysis and hypothesis coding. Next, we transformed our codes into counts and compared them with closed-ended responses to understand whether teamwork support allows leaders to engage in work aligned with their qualifications. Results: As predicted, providers' role conflict corresponded with decreased performance under low teamwork support, but this negative relationship was attenuated with high teamwork support as such support allows leaders to focus on tasks they are uniquely qualified to perform. Conclusions: These findings emphasize the facilitative nature of teams in supporting leaders: followers provide teamwork support that helps leaders navigate role conflict by allowing leaders to work on tasks consistent with their qualifications.

Key High-efficiency Practices of Emergency Department Providers: A Mixed-methods Study.

OBJECTIVE: The objective of this study was to determine specific provider practices associated with high provider efficiency in community emergency departments (EDs). METHODS: A mixed-methods study design was utilized to identify key behaviors associated with efficiency. Stage 1 was a convenience sample of 16 participants (ED medical directors, nurses, advanced practice providers, and physicians) identified provider efficiency behaviors during semistructured interviews. Ninety-nine behaviors were identified and distilled by a group of three ED clinicians into 18 themes. Stage 2 was an observational study of 35 providers was performed in four (30,000- to 55,000-visit) community EDs during two 4-hour periods and recorded in minute-by-minute observation logs. In Stage 3, each behavior or practice from Stage 1 was assigned a score within each observation period. Behaviors were tested for association with provider efficiency (relative value units/hour) using linear univariate generalized estimating equations with an identity link, clustered on ED site. RESULTS: Five ED provider practices were found to be positively associated with efficiency: average patient load, using name of team member, conversations with health care team, visits to patient rooms, and running the board. Two behaviors, "inefficiency practices," demonstrated significant negative correlations: non-work-related tasks and documentation on patients no longer in the ED. CONCLUSIONS: Average patient load, running the board, conversations with team member, and using names of team members are associated with enhanced provider productivity. Identification of behaviors associated with efficiency can be utilized by medical directors, clinicians, and trainees to improve personal efficiency or counsel team members.

The content of the message matters: The differential effects of promotive and prohibitive team voice on team productivity and safety performance gains.

We propose that it is important to take the content of team voice into account when examining its impact on team processes and outcomes. Drawing on regulatory focus theory (Higgins, 1997), we argue that promotive team voice and prohibitive team voice help teams achieve distinct collective outcomes-that is, team productivity performance gains and team safety performance gains, respectively. Further, we identify mechanisms through which promotive and prohibitive team voices uniquely influence team outcomes as well as boundary conditions for such influences. In data collected from 88 production teams, we found that promotive team voice had a positive association with team productivity performance gains. By contrast, prohibitive team voice had a positive association with team safety performance gains. The relationship between promotive team voice and team productivity performance gains was mediated by team innovation, and the relationship between prohibitive team voice and team safety performance gains was mediated by team monitoring. In addition, the indirect effect of prohibitive team voice on team safety performance gains via team monitoring was stronger when prior team safety performance was lower. We discuss the theoretical and practical implications of these findings. (PsycINFO Database Record