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Lynn University April 2 nd , 2008. Effects of Similarity-Dissimilarity, Team Cohesion, and Hospital Cross-Functional Team Effectiveness on Organizational Performance. Doctoral Dissertation Defense Hearing Zulfikar Dennis Kalam. CHAPTER I INTRODUCTION TO THE STUDY.

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lynn university april 2 nd 2008
Lynn UniversityApril 2nd, 2008Effects of Similarity-Dissimilarity, Team Cohesion, and Hospital Cross-Functional Team Effectiveness on Organizational Performance

Doctoral Dissertation Defense Hearing

Zulfikar Dennis Kalam

chapter i introduction to the study

CHAPTER IINTRODUCTION TO THE STUDY

Introduction and Background

Definitions of Terms

Purpose

Justification

introduction and background
Introduction and Background
  • Embedded Cross-Functional Teams
    • Homogenous (similarity)
    • Heterogeneous (dissimilarity)
      • Diversity-Demographics, Occupations
  • Complex Hospital Organizations
    • Regulatory Pressure
    • Competition
    • Location
    • Classification
definitions of terms
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
definitions of terms1
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.
definitions of terms2
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
study purposes
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
definition of terms
Definition of Terms

Tri-County

Hospitals

CFTs

Hospital

Characteristics

Similarity-

Dissimilarity

Diversity

Effectiveness

Cohesion

Performance

justification
Justification
  • Previous Studies Limited in Scope
  • Growing Issues in Healthcare
      • Uninsured, HMO’s, Costs, Competition
  • This Study
    • Addresses Important Concepts
      • Increasing Diversity……Effectiveness…Performance
      • Researchable, Can be Tested, Measurable
chapter ii review of literature

CHAPTER IIREVIEW OF LITERATURE

THEORETICAL FRAMEWORK RESEARCH QUESTIONS HYPOTHESES

slide11

CFTs

Multifunctional

Multidisciplinary

Dissimilarity

Organizational

Characteristics

Team

Cohesion

Team

Effectiveness

JCAHO

AHCA

Diversity

Organizational

Performance

Literature Review

slide13

Organizational Characteristics

Size, Geography, Type

Actual Similarity-Dissimilarity of CFT

Visible and Informational

H1a H1b H1d

Perceived Similarity-Dissimilarity of CFT

Visible and Values and Informational

H2aH2b H2c H2d

CFT Openness to Diversity

Visible, Value, and Informational

H3

CFT Cohesion

H4a H4b H4c H4d H4f

Team Effectiveness

Goals, Customers, Timeliness, Quality and Productivity

H5b H5c

H6b H6c

Performance of the Organization

KPI: Management of the Environment of Care Percentile score

KPI: Length of Stay (LOS)

--- New hypothesized relationships being tested

— Hypothesized relationships tested, but previously tested in the literature

Revised Model of CFT diversity, cohesion, team effectiveness, and organizational performance.

chapter iii research methods

CHAPTER IIIRESEARCH METHODS

RESEARCH DESIGN

POPULATION

SAMPLING PLAN

PSYCHOMETRIC ANALYSES

research design
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
population
Population
  • Estimated Target Population
    • Miami-Dade 4480
    • Broward 4200
    • Palm Beach 1960
  • Total 10640
accessible population
Accessible Population

Source of CFT Members

  • Professional Contacts 50
  • Hospital Web Sites
    • Physicians 15
    • Nurses 20
    • Other CFT Members 20
  • Professional Associations259

Total 364

sampling plan
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%
slide19

S

E

T

T

I

N

G

S

Palm Beach = 7

Broward = 15

Miami-Dade = 16

data producing sample
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%)
instrumentation
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
procedures
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
evaluation of strengths and weaknesses
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)
evaluation of strengths and weaknesses1
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
methods of data analysis
Methods of Data Analysis
  • Research Question 1
    • Descriptive statistics
  • Research Question 2
    • Independent t-tests and ANOVA with Tukey’s post hoc comparison compared differences according to actual similarity-dissimilarity
  • Research Question 3
    • Chi square and ANOVA with Tukey’s post hoc comparison compared differences according to hospital organizational characteristics
hypothesis testing
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
chapter iv results

CHAPTER IVRESULTS

Data Producing Sample

Validity and Reliability of the Measurement Scales

Research Questions

Hypotheses Testing

summary of psychometric analyses
Summary of Psychometric Analyses
  • Construct Validity –
    • Exploratory Factor Analysis
  • Reliability Analysis –
    • Coefficient Alphas
  • Convergent and Divergent Validity –
    • Pearson r
part 1 actual similarity dissimilarity
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
part 2 perceived similarity dissimilarity scale
Part 2: Perceived Similarity-Dissimilarity scale
  • Six items, 5-point semantic differential scale
  • This Study (n=185)
    • 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:Cronbach’s alphas for the subscales of visible (.960) ; Values and informational (.921)
part 3 perceived group openness to diversity scale
Part 3: Perceived Group Openness to Diversity scale
  • Six items, 5-point semantic differential scale
  • This Study (n=185)
    • 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.
part 5 team outcome effectiveness
Part 5: Team Outcome Effectiveness
  • 26 Item, 7-point inaccurate-accurate rating scale
  • This Study (n=185)
  • 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.
part 4 team cohesion
Part 4: Team Cohesion
  • Five items, 5-point semantic differential scale
  • This Study (n=185)
    • 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.
part 6 organizational characteristics n 35
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
part 7 organizational performance
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
research question 1
Research Question 1

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

gender
Gender

(Previous studies had 83% female respondents)

research question 2
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?

research question 3
Research Question 3

Are there differences in CFT members’ actualsimilarity-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?

chapter v discussion

CHAPTER VDISCUSSION

Practical Implications

Conclusions

Limitations

Recommendations for Future Study

discussion
Discussion
  • Summary of Findings
  • Practical Implications
  • Conclusions
  • Limitations
  • Recommendations for Future Study
summary of findings
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
  • RN’s, LPN’s 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
summary of findings1
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
summary of findings2
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
practical implications
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
conclusions
Conclusions
  • Administrators, directors, and lower level occupations
    • Different perceptions about similarity-dissimilarity
    • Different perceptions about diversity
  • More tenure in practice area leads to more perceptions of dissimilarity
conclusions1
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
limitations
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
recommendations for future study
Recommendations for Future Study
  • Focus on occupational differences
  • Focus on TQM and BSC
  • Focus on team size
  • Focus on diversity and cohesion in hospitals
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