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Pulling Together and Pulling Apart: Influences of Convergence and Divergence on Distributed Healthcare Teams

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Title: Pulling Together and Pulling Apart: Influences of Convergence and Divergence on Distributed Healthcare Teams
Language: English
Authors: Lingard, L., Sue-Chue-Lam, C., Tait, G. R., Bates, J., Shadd, J., Schulz, V., Arnold, Malcolm, Burge, Fr, Burnett, Samuel, Harkness, Karen, Kimel, Gil, LaDonna, Kori, Lowery, Donna, Marshall, Denise, McDougall, Allan, McKelvie, Robert, Nimmon, Laura, Smith, Stuart, Strachan, Patricia, Ward, Donna
Source: Advances in Health Sciences Education. Dec 2017 22(5):1085-1099.
Availability: Springer. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: service-ny@springer.com; Web site: http://www.springerlink.com
Peer Reviewed: Y
Page Count: 15
Publication Date: 2017
Document Type: Journal Articles
Reports - Research
Descriptors: Health Services, Allied Health Occupations Education, Teamwork, Systems Approach, Health Personnel, Constructivism (Learning), Grounded Theory, Competence, Patients, Interviews, Heart Disorders, Chronic Illness
DOI: 10.1007/s10459-016-9741-2
ISSN: 1382-4996
Abstract: Effective healthcare requires both competent individuals and competent teams. With this recognition, health professions education is grappling with how to factor team competence into training and assessment strategies. These efforts are impeded, however, by the absence of a sophisticated understanding of the "the relationship between" competent individuals and competent teams. Using data from a constructivist grounded theory study of team-based healthcare for patients with advanced heart failure, this paper explores the relationship between individual team members' perceived goals, understandings, values and routines and the collective competence of the team. Individual interviews with index patients and their healthcare team members formed Team Sampling Units (TSUs). Thirty-seven TSUs consisting of 183 interviews were iteratively analysed for patterns of convergence and divergence in an inductive process informed by complex adaptive systems theory. Convergence and divergence were identifiable on all teams, regularly co-occurred on the same team, and involved recurring themes. Convergence and divergence had nonlinear relationships to the team's collective functioning. Convergence could foster either shared action or collective paralysis; divergence could foster problematic incoherence or productive disruption. These findings advance our understanding of the complex relationship between the individual and the collective on a healthcare team, and they challenge conventional narratives of healthcare teamwork which derive largely from acute care settings and emphasize the importance of common goals and shared mental models. Complex adaptive systems theory helps us to understand the implications of these insights for healthcare teams' delivery of care for the complex, chronically ill.
Abstractor: As Provided
Number of References: 36
Entry Date: 2017
Accession Number: EJ1159267
Database: ERIC
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  Data: Pulling Together and Pulling Apart: Influences of Convergence and Divergence on Distributed Healthcare Teams
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  Data: Springer. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: service-ny@springer.com; Web site: http://www.springerlink.com
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  Data: Effective healthcare requires both competent individuals and competent teams. With this recognition, health professions education is grappling with how to factor team competence into training and assessment strategies. These efforts are impeded, however, by the absence of a sophisticated understanding of the "the relationship between" competent individuals and competent teams. Using data from a constructivist grounded theory study of team-based healthcare for patients with advanced heart failure, this paper explores the relationship between individual team members' perceived goals, understandings, values and routines and the collective competence of the team. Individual interviews with index patients and their healthcare team members formed Team Sampling Units (TSUs). Thirty-seven TSUs consisting of 183 interviews were iteratively analysed for patterns of convergence and divergence in an inductive process informed by complex adaptive systems theory. Convergence and divergence were identifiable on all teams, regularly co-occurred on the same team, and involved recurring themes. Convergence and divergence had nonlinear relationships to the team's collective functioning. Convergence could foster either shared action or collective paralysis; divergence could foster problematic incoherence or productive disruption. These findings advance our understanding of the complex relationship between the individual and the collective on a healthcare team, and they challenge conventional narratives of healthcare teamwork which derive largely from acute care settings and emphasize the importance of common goals and shared mental models. Complex adaptive systems theory helps us to understand the implications of these insights for healthcare teams' delivery of care for the complex, chronically ill.
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