The work is never ending: uncovering teamwork sustainability using realistic evaluation
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 20 March 2017
Abstract
Purpose
The purpose of this paper is to uncover the mechanisms influencing the sustainability of behavior changes following the implementation of teamwork.
Design/methodology/approach
Realistic evaluation was combined with a framework (DCOM®) based on applied behavior analysis to study the sustainability of behavior changes two and a half years after the initial implementation of teamwork at an emergency department. The DCOM® framework was used to categorize the mechanisms of behavior change interventions (BCIs) into the four categories of direction, competence, opportunity, and motivation. Non-participant observation and interview data were used.
Findings
The teamwork behaviors were not sustained. A substantial fallback in managerial activities in combination with a complex context contributed to reduced direction, opportunity, and motivation. Reduced direction made staff members unclear about how and why they should work in teams. Deterioration of opportunity was evident from the lack of problem-solving resources resulting in accumulated barriers to teamwork. Motivation in terms of management support and feedback was reduced.
Practical implications
The implementation of complex organizational changes in complex healthcare contexts requires continuous adaption and managerial activities well beyond the initial implementation period.
Originality/value
By integrating the DCOM® framework with realistic evaluation, this study responds to the call for theoretically based research on behavioral mechanisms that can explain how BCIs interact with context and how this interaction influences sustainability.
Keywords
Acknowledgements
The authors would like to thank all staff and managers who participated in the study. The study was financed by AFA Insurance, Registration No. 100249. Authors’ contributions: UvTS and AMA initiated the TEPPP project and secured ethical approval and funding. MF, UvTS, AMA, HH, and PM jointly conceived the idea for this study. MF, UvTS, and PM performed observations, while MF and PM performed the interviews and the collection of documents. MF performed the literature search in collaboration with PM. MF and PM analyzed the data, and UvTS and AMA reviewed the analyses. MF and PM wrote the initial draft of the manuscript. All authors contributed to the drafting of the manuscript and provided critical revision.
Citation
Frykman, M., von Thiele Schwarz, U., Muntlin Athlin, Å., Hasson, H. and Mazzocato, P. (2017), "The work is never ending: uncovering teamwork sustainability using realistic evaluation", Journal of Health Organization and Management, Vol. 31 No. 1, pp. 64-81. https://doi.org/10.1108/JHOM-01-2016-0020
Publisher
:Emerald Publishing Limited
Copyright © 2017, Emerald Publishing Limited