Lynn university april 2 nd 2008
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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

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Lynn university april 2 nd 2008

Lynn UniversityApril 2nd, 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

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


    Lynn university april 2 nd 2008

    CFTs

    Multifunctional

    Multidisciplinary

    Dissimilarity

    Organizational

    Characteristics

    Team

    Cohesion

    Team

    Effectiveness

    JCAHO

    AHCA

    Diversity

    Organizational

    Performance

    Literature Review


    Lynn university april 2 nd 2008

    Theoretical Framework


    Lynn university april 2 nd 2008

    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-Dade4480

      • Broward4200

      • 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%


    Lynn university april 2 nd 2008

    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


    Convergent and divergent validity

    Convergent and Divergent Validity


    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)


    Occupation

    Occupation


    Ethnicity

    Ethnicity


    Education

    Education


    Practice area

    Practice Area


    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?


    Summary of mean scores

    Summary of Mean Scores


    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?


    Percentage of occupation according to hospital size

    Percentage of Occupation According to Hospital Size


    H1 results

    H1 Results


    H2 results

    H2 Results


    H3 results

    H3 Results


    H4 results

    H4 Results


    H5 and h6 results

    H5 and H6 Results


    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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