ویژگی های ساختاری، فرایند، و اثربخشی تیم های متقابل کارکردی در بیمارستان : آزمون مدل I-P-O

Hospitals are served by a variety of different specialists and technicians, including doctors, nurses, pharmacists, medical technicians, radiologists, etc. To provide good healthcare services, teamwork among this workforce is of great importance, and the management of cross-functional teams consisting of specialists and technicians is a significant issue. This study, based on McGrath's Input–Process–Output team theoretical model, explores some essential variables of teams in hospitals, including team structural characteristics, team process, and team effectiveness. Using 109 valid questionnaires samples from 20 hospitals in Taiwan, we explored these three main variables. First, we examined team structural characteristics, in terms of team size, diversity, norms, and cohesion. Second, we divided team process into two factors: members' cooperation and bottom–up communication. Finally, we measured team effectiveness in terms of performance and satisfaction. We found that (1) for team structural characteristics, only team norms affect team effectiveness; (2) team process affects team effectiveness; (3) team norms and team cohesion affect team process; and (4) team process fully mediates between team structural characteristics and satisfaction and mediates partially between team structural characteristics and performance.

Today's businesses strive to create organizational structures that are flexible, efficient, and responsive. Studies have shown that work teams are especially capable of strengthening an organization's problem-solving capabilities, increasing productivity, improving work effectiveness, better utilizing resources, lowering costs, and reducing human resources (Parker, 1990). The team is also an organization's best strategic choice for coping with complex and variable environments (Mohrman, Cohen, & Mohrman, 1995). Hospitals are labor-intensive organizations. As the number of medical technicians increases and healthcare grows more complicated, large hospitals have become one of the most complex institutions in society (Chang, Tan, & Huang, 1996). Since a hospital houses many types of professionals, such as doctors, nurses, pharmacists, medical technicians, radiologists, etc., hospital organizations often use work teams as a way to assure smooth cooperation and improve effectiveness. In recent years, stiff competition in the healthcare industry and rapid changes in government funding policies have put new pressures on hospitals. Given excellent communication and joint decision making, the existence of internal teams with common goals and complementary technical capabilities can enable any hospital to face these challenges with greater ease. Amidst a chaotic healthcare environment and organizational structure divisions, integration of hospital departments has become a critical goal in which hospital teams play an important role. Inspired by organizations' reliance on team-based work structures (Devine, Clayton, Philips, Dunford, & Meiner, 1999), a great deal of research has focused on understanding factors that might explain how and why teams achieve desired outcomes (Turner, 2001). Actual observation of hospitals of all sizes shows that with the exception of the usual medical teams, hospital management tends to neglect the important role played by cross-functional teams. In fact, hospitals are unprepared to manage such teams. This study probes the links among structural characteristics, operations, and effectiveness of hospitals' cross-functional teams with the goal of contributing to team management in hospitals. Many scholars believed Input–Process–Outcome model (I–P–O model) is a good predictive model about team effectiveness (Mathieu, Heffner, Goodwin, Salas, & Cannon-Bowers, 2000). Although I–P–O model was adopted expansively, its utility was still disputed. The degree of utility about I–P–O team model is related to team variables. One of the purposes in this study is to explore the application of I–P–O team model.

When hospital management assigns employees to participate in cross-functional teams, it usually takes into consideration the nature of the work, its relationship with the team task, and/or whether individuals' positions and professional capabilities can contribute to the team. The size of the team is dictated by the needs of the team task and has no direct bearing on team effectiveness. As hospitals' cross-functional team leaders are usually doctors, who have always played an important role in hospitals as professional organizations, it comes as no surprise that, relatively speaking, the diversity reflected by other members exercises no direct effects on team effectiveness. Team norms had positive effects on team effectiveness, thus showing that the establishment of norms serves to define roles and functions with more clarity. This reduces unnecessary conflicts and improves team effectiveness as well as satisfaction, corroborating Vinokur-Kaplan's (1995) findings of hospital organizations. However, Asian cultures are known to be less individualistic, more collective and hierarchical (Hofstede, 1980), ethnic culture norms seem to influence our samples. Therefore, we infer team norms will affect team effectiveness positively in Chinese society. Also, it could be necessary to study the differences how norms variables affect team effectiveness in Asian and western society. We also found that team cohesion had no significant predictive effects on task performance, consistent with the opinions of Forsyth (1983). This finding may be explained by the possibility that members of highly cohesive teams may enjoy their tasks more than members of less cohesive teams, although this phenomenon may not always translate into higher productivity. Moreover, the team atmosphere resulting from team cohesion improves willingness to cooperate and degree of satisfaction, although highly cohesive teams may have lower degrees of communication, lower cooperation costs (Ouchi, 1980), and may be easily satisfied by meeting communication processes. However, this does not necessarily translate to team satisfaction, in terms of the practicality of meetings' final conclusions and resolutions. The results of our study are consistent with those made by many scholars—that is, a positive team process or positive interactions have positive effects on team effectiveness (Barrick et al., 1998, Campion et al., 1993 and Stewart and Barrick, 2000). Moreover, the results also support McCann and Galbraith's (1981) view that in cross-functional department teams in hospital organizations, a communication and coordination mechanism helps hospitals weather chaotic environments. The results of this study show that team norms exert significant predictive effects on team process. Appropriate team norms are beneficial in steering members and leaders in the same direction, such that the team's interaction becomes smooth and the quality of bottom–up communication is enhanced. Team cohesion affects members' interactions and cooperative behavior (Cosier, 1981 and Schwenk, 1983). At the same time, there is significant correlation between cohesion and communication (Lott & Lott, 1965), and this is consistent with the study's finding that cohesion has positive predictive effects on member cooperation. This study shows that team structural characteristics have direct repercussions on task performance, but only part of this mediating effect is carried out through the team process. However, team structural characteristics fully mediate team attitude (degree of cooperation satisfaction and degree of meeting satisfaction) by means of team process. As communication and cooperation both fall under a team's social-emotive behavior, if one were to probe team effectiveness by means of degree of cooperation satisfaction and degree of meeting satisfaction, then McGrath's I–P–O paradigm (1964) may have an excellent predictive function. If future research includes task behavior in the team process, examinations of the mediating effects of team process between structural characteristics and team effectiveness can become more comprehensive. Furthermore, in team theoretical models, team leaders also serve as a focus of team management studies. In terms of measuring team effectiveness, this study studies the issue from the angle of team leaders' and members' perceptions. Future research might expand this scope by including team supervisors' measures of team effectiveness. Finally, in terms of method of analysis, future research might use the structural equation model to probe the influence pathway of team structural characteristics, process, and effectiveness. In fact, many hospitals have already adopted team structural designs, yet empirical studies focusing on team management in the healthcare industry are few and far between. The relatively broad results of this study have great significance for practical hospital work. First, when hospitals assign leaders and members to teams, they should take into account whether or not suitable professionals are recruited and should consider the assignment's real benefits in terms of attaining team tasks. Hospitals should not be restricted by team size and member diversity issues. Both members' cooperation and bottom–up communication quality have positive influences on team effectiveness. Most healthcare industry team leaders are high-level hospital managers. Thus, it is possible that team members and their leaders may be more than one level apart hierarchically. In such instances, the quality of bottom–up communication becomes even more important. Teams must create an atmosphere of cooperation or communication that enhances the team's decision quality, trust, and practicality. Moreover, as team leaders are mostly doctors, when hospitals promote team education and training, doctor-members must be included. At the very least, this training must be included in doctors' continuing education programs, as it can help improve team effectiveness. The results of this study suggest that team norms are an important pathway for healthcare industry management teams. Hospital teams must establish sound behavioral norms that will lead to normalization and standardization of team tasks, while at the same time promoting smooth team member interactions. In addition, team effectiveness norms must be set up, and performance evaluation systems must be established and implemented to improve effectiveness. More specifically, hospitals must include team management in its motivation and incentives system, such that employees become aware that the hospital emphasizes cross-functional team participation or performance. Such a mechanism will motivate employees to appreciate their participation in teams. Finally, for hospitals to improve team meeting performance and satisfaction, they must avoid discussing issues and problems that can already be solved through existing hospital charters, procedures, or historical experiences. For teams to become truly functional, cross-functional team meetings should focus on issues and agendas requiring team resolution.