Effects of Similarity-Dissimilarity, Team Cohesion, and Hospital Cross-Functional Team Effectiveness on Organizational Performance

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Effects of Similarity-Dissimilarity, Team
Cohesion, and Hospital Cross-Functional Team
Effectiveness on Organizational Performance
Doctoral Dissertation Defense Hearing Zulfikar
Dennis Kalam

• Lynn UniversityApril 2nd, 2008

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CHAPTER IINTRODUCTION TO THE STUDY

• Introduction and Background
• Definitions of Terms
• Purpose
• Justification

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Introduction and Background

• Embedded Cross-Functional Teams
• Homogenous (similarity)
• Heterogeneous (dissimilarity)
• Diversity-Demographics, Occupations
• Complex Hospital Organizations
• Regulatory Pressure
• Competition
• Location
• Classification

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Definitions of Terms

• Cross functional team
• Work groups, cross-disciplinary,
  interdisciplinary, multi-disciplinary teams
• Hospital Characteristics
• Geographic location, tax status, legal
  classification, and the number of licensed beds
• Actual Similarity-Dissimilarity
• age, gender, ethnicity, race, occupational title,
  professional practice areas, practice experience
  in years, tenure in current hospital

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Definitions of Terms

• Perceived Dissimilarities
• Visible, values, and informational
  dissimilarities
• Perceived Group Openness to Diversity
• Visible, values, and informational
• Team Cohesion
• Feelings about acceptance by fellow team members
• Team Outcome Effectiveness
• Goals, customers, timeliness, quality, and
  productivity.

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Definitions of Terms

• Organizational performance
• Average Length of Stay (LOS) (risk adjusted days
  a patient stays in hospital)
• JCAHO survey results for the Management of the
  Environment of Care
• Percent score
• Percentile score

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Study Purposes

• Exploratory (comparative) - differences according
  to
• Actual similarity-dissimilarity
• Hospital characteristics
• Explanatory (correlational) - explain
  relationships between
• Actual and perceived similarity-dissimilarity,
  openness to diversity, cohesion, effectiveness,
  organizational characteristics, and
  organizational performance

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Definition of Terms
Tri-County Hospitals
CFTs
Hospital Characteristics
Cohesion
Similarity- Dissimilarity
Diversity
Effectiveness
Performance
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Justification

• Previous Studies Limited in Scope
• Growing Issues in Healthcare
• Uninsured, HMOs, Costs, Competition
• This Study
• Addresses Important Concepts
• Increasing DiversityEffectivenessPerformance
• Researchable, Can be Tested, Measurable

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CHAPTER IIREVIEW OF LITERATURE

• THEORETICAL FRAMEWORK RESEARCH QUESTIONS
  HYPOTHESES

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CFTs Multifunctional Multidisciplinary
Dissimilarity
Organizational Characteristics
Team Cohesion
Team Effectiveness
JCAHO AHCA
Diversity
Organizational Performance
Literature Review
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Theoretical Framework
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Revised Model of CFT diversity, cohesion, team
effectiveness, and organizational performance.
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CHAPTER IIIRESEARCH METHODS

• RESEARCH DESIGN
• POPULATION
• SAMPLING PLAN
• PSYCHOMETRIC ANALYSES

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Research Design

• Quantitative Non-Experimental
• Comparative (exploratory)
• Explore differences
• Correlational (explanatory)
• Determine which explanations are best.
• On-Line survey
• Five parts completed by the respondents

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Population

• Estimated Target Population
• Miami-Dade 4480
• Broward 4200
• Palm Beach 1960
• Total 10640

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Accessible Population

• Source of CFT Members
• Professional Contacts 50
• Hospital Web Sites
• Physicians 15
• Nurses 20
• Other CFT Members 20
• Professional Associations 259
• Total 364

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Sampling Plan

• Purposive and Snowball Sampling Plan
• Initial purposive sample included the accessible
  population
• Estimated Sample (see table 3-4)
• Initial purposive sample 364
• Snowball sampling 1043 CFT
• Final data producing sample 181
• Response rate 17.4

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Palm Beach 7
S E T T I N G S
Broward 15
Miami-Dade 16
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Data Producing Sample

• Step 1 (actual)
• Email sent to initial purposive sample 241
• Step 2 (estimated)
• Snowball sample email sent to 441
• Step 3 (estimated)
• Snowball sample email sent to 690
• Produced 206 responses (actual)
• Produced 185 valid responses (valid response rate
  of 27)

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Instrumentation

• Part 1 Actual Similarity-Dissimilarity
• 10 items, demographics
• Part 2 Perceived Dissimilarity
• 6 item scale, 3 subscales
• Part 3 Perceived Group Openness to Diversity
• 6 item scale, 3 subscales
• Part 4 Team Cohesion
• 5 items scale, unidimensional
• Part 5 Team Outcome Effectiveness
• 26 item, 5 subscales

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Procedures

• Obtained permission to use scales
• Designed online survey
• IRB approval
• Invitation e-mails sent BCC
• Voluntary participation
• Responses anonymous
• 10-15 minutes to complete
• No IP addresses tracked
• Data encryption

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Evaluation of Strengths and Weaknesses

• Internal Validity
• Strength
• Good estimates of reliability for scales
• Ecological strength
• Rigorous statistical procedures
• Weaknesses
• Small sample size
• Non-experimental, (lack of randomization,
  controls)

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Evaluation of Strengths and Weaknesses

• External Validity
• Strengths
• Included the entire accessible population
• Data collection in natural setting
• Weaknesses
• Non Random Snowball Sampling introduces sampling
  bias

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Methods of Data Analysis

• Research Question 1
• Descriptive statistics
• Research Question 2
• Independent t-tests and ANOVA with Tukeys post
  hoc comparison compared differences according to
  actual similarity-dissimilarity
• Research Question 3
• Chi square and ANOVA with Tukeys post hoc
  comparison compared differences according to
  hospital organizational characteristics

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Hypothesis Testing

• Explanatory (Correlational) Design
• Hierarchical Multiple Regression Method
• Step 1 Eta correlations for categorical
  variables
• Step 2 If significant, dummy variables created
  Step 3 Pearson r for significant and trend dummy
  variables, ratio variables, and interval
  variables.
• Step 4 Hierarchical regression entered from
  strongest to weakest

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CHAPTER IVRESULTS

• Data Producing Sample
• Validity and Reliability of the Measurement
  Scales
• Research Questions
• Hypotheses Testing

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Summary of Psychometric Analyses

• Construct Validity
• Exploratory Factor Analysis
• Reliability Analysis
• Coefficient Alphas
• Convergent and Divergent Validity
• Pearson r

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Part 1 Actual Similarity-Dissimilarity

• Ten Items
• Gender, Race, Ethnicity
• Educational Level, Occupational Level,
  Professional Practice Area
• Age in Years, Years of Practice in Profession
• Tenure at Hospital, Hospital of Employment

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Part 2 Perceived Similarity-Dissimilarity scale

• Six items, 5-point semantic differential scale
• This Study (n185)
• Validity Scale modified after exploratory factor
  analysis supported 2 subscales with factor
  loadings ranging from .599 to .919
• 1. Visible (two items)
• 2. Values and Informational (four items)
• Reliability Cronbachs alphas for the subscales
  of visible (.960) Values and informational
  (.921)

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Part 3 Perceived Group Openness to Diversity
scale

• Six items, 5-point semantic differential scale
• This Study (n185)
• Validity Exploratory factor analysis supported 3
  subscales with loadings ranging from .572 to .876
• Reliability Corrected item-total correlation
  scores ranged from .706 to .872.

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Part 5 Team Outcome Effectiveness

• 26 Item, 7-point inaccurate-accurate rating scale
• This Study (n185)
• Scale modified after 2nd exploratory factor
  analysis
• Validity
• 26 items retained in four factors to produce 4
  subscales with loadings of
• Goals .759 to .820 Customers .641 to .763
  Timeliness .549 to .691 Quality and
  Productivity .534 to 744
• Reliability
• Total scale coefficient alpha .973.
• Corrected item-total correlation scores ranged
  from .878 to .971.

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Part 4 Team Cohesion

• Five items, 5-point semantic differential scale
• This Study (n185)
• Validity - exploratory factor analysis
• Unidimensional structure supported
• Factor loadings ranged from .900 to .959
• Reliability
• Total scale coefficient alpha .961.
• Corrected item-total correlation scores ranged
  from .847 to .934.

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Part 6 Organizational Characteristics (n 35)

• Geographic Location
• South Florida counties of Palm Beach, Broward,
  and Miami-Dade
• Hospital Size
• In this study Licensed beds ranged from 200 to
  1498
• Tax Status
• For-profit, not for-profit
• Legal Classification
• Investor owned, government

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Part 7 Organizational Performance

• This study used secondary data
• AHCA
• Average Length of Stay (LOS)
• Adjusted for morbidity
• JCAHO
• Management of the Environment of Care Survey
• Percentile score

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Convergent and Divergent Validity
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Research Question 1

• What are CFT members actual similarity-dissimilar
  ity, perceived similarity-dissimilarity,
  perceived group openness to diversity, team
  cohesion, team outcome effectiveness,
  characteristics of their organizations, and
  organizational performance?

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Gender
(Previous studies had 83 female respondents)
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Occupation
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Ethnicity
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Education
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Practice Area
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Research Question 2

• Are there differences in CFT members
• perceived similarity-dissimilarity, perceived
  group openness to diversity, team cohesion, team
  outcome effectiveness, characteristics of their
  organizations, and performance of their
  organizations according to actual
  similarity-dissimilarity?

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Summary of Mean Scores
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Research Question 3

• Are there differences in CFT members actual
  similarity-dissimilarity, perceived
  similarity-dissimilarity, perceived group
  openness to diversity, team cohesion, team
  outcome effectiveness, and performance of their
  organizations according to organizational
  characteristics of hospitals with existing CFTs
  in south Florida?

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Percentage of Occupation According to Hospital
Size
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H1 Results
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H2 Results
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H3 Results
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H4 Results
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H5 and H6 Results
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CHAPTER VDISCUSSION

• Practical Implications
• Conclusions
• Limitations
• Recommendations for Future Study

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Discussion

• Summary of Findings
• Practical Implications
• Conclusions
• Limitations
• Recommendations for Future Study

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Summary of Findings

• Years in practice showed a negative relationship
  with visible dissimilarity where CFT members with
  more time in their professions felt more visible
  dissimilarity in their teams
• RNs, LPNs and Therapists felt less openness to
  diversity, they may feel less involved in group
  tasks
• Openness to values diversity and informational
  diversity both showed positive relationships with
  team cohesion

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Summary of Findings

• Values and informational similarity-dissimilarity
  showed positive relationships with team cohesion
• As CFT members felt more similarity and more
  openness to diversity, they also felt more
  cohesion
• Cohesion showed positive relationship with all
  team outcome effectiveness subscales and total
  scale
• Visible and values and informational
  similarity-dissimilarity showed negative
  relationship with goals, timeliness, quality and
  productivity, and total scale

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Summary of Findings

• CFT members who felt their teams were more
  cohesive felt their teams were more effective
• CFT members who felt less similarity also felt
  less effectiveness
• Larger non-profits got higher percentile scores
  on surveys
• Smaller hospitals had lower LOS
• The greater the presence of clinical staff the
  lower the LOS

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Practical Implications

• South Florida hospitals may become more diverse
• Trend to continue in terms of growth in diverse
  population entering workforce and seeking health
  services
• Demand for safe healthcare services revolving
  around entire hospital
• Occupational differences
• Demand for skilled healthcare workers will
  continue to create differences
• Team cohesion
• Competition may increase
• Teams will need to be more effective cohesion
  will be critical

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Conclusions

• Administrators, directors, and lower level
  occupations
• Different perceptions about similarity-dissimilari
  ty
• Different perceptions about diversity
• More tenure in practice area leads to more
  perceptions of dissimilarity

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Conclusions

• Teams with more perceptions of similarity are
  perceived as more cohesive
• Teams with more openness to diversity are
  perceived as more cohesive
• Team effectiveness was negatively affected by
  visible, values, and informational diversity
• The less open, the less effective
• The less similar, the less effective

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Limitations

• Non-experimental study
• Sample size not representative of the entire
  population in hospitals in Palm Beach, Broward,
  or Miami-Dade in south Florida
• Modified scales
• Large percentage of unexplained variance

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Recommendations for Future Study

• Focus on occupational differences
• Focus on TQM and BSC
• Focus on team size
• Focus on diversity and cohesion in hospitals