Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department: a comparative case study

Abstract

BackgroundWhile there is strong support for the benefits of working in multi-professional teams in health care, the implementation of multi-professional teamwork is reported to be complex and challenging. Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited. There is a lack of studies focusing on the functions of different behavior change interventions and the mechanisms driving behavior change. In this study, applied behavior analysis is used to analyze the function and impact of different behavior change interventions when implementing multi-professional teamwork.MethodsA comparative case study design was applied. Two sections of an emergency department implemented multi-professional teamwork involving changes in work processes, aimed at increasing inter-professional collaboration. Behavior change interventions and staff behavior change were studied using observations, interviews and document analysis. Using a hybrid thematic analysis, the behavior change interventions were categorized according to the DCOM® model. The functions of the behavior change interventions were then analyzed using applied behavior analysis.ResultsThe two sections used different behavior change interventions, resulting in a large difference in the degree of staff behavior change. The successful section enabled staff performance of teamwork behaviors with a strategy based on ongoing problem-solving and frequent clarification of directions. Managerial feedback initially played an important role in motivating teamwork behaviors. Gradually, as staff started to experience positive outcomes of the intervention, motivation for teamwork behaviors was replaced by positive task-generated feedback.ConclusionsThe functional perspective of applied behavior analysis offers insight into the behavioral mechanisms that describe how and why behavior change interventions influence staff behavior. The analysis demonstrates how enabling behavior change interventions, managerial feedback and task-related feedback interact in their influence on behavior and have complementary functions during different stages of implementation.

The Need for Dual Openness to Change: A Longitudinal Study Evaluating the Impact of Employees’ Openness to Organizational Change Content and Process on Intervention Outcomes

“…Even if it were possible to find stable organizations for an intervention study, the results from such an intervention would likely have limited generalizability (i.e., external validity) (Griffiths, A., 1999) as organizations, not least in healthcare and residential care for older people, face continuous changes. Therefore, it could be argued that instead of trying to avoid concurrent changes, there is a need for researchers to be aware of how concurrent changes may influence outcomes and to integrate concurrent changes in the planned intervention and in evaluation frameworks (Frykman, Hasson, Athlin, & von Thiele Schwarz, 2014;Nielsen, Taris, et al, 2010). By planning for potential changes in advance and monitoring the discrete context during the intervention, potential threats of concurrent changes that may hinder intervention implementation can be detected and activities to avoid them can be undertaken (Frykman et al, 2014).…”

“…Therefore, it could be argued that instead of trying to avoid concurrent changes, there is a need for researchers to be aware of how concurrent changes may influence outcomes and to integrate concurrent changes in the planned intervention and in evaluation frameworks (Frykman, Hasson, Athlin, & von Thiele Schwarz, 2014;Nielsen, Taris, et al, 2010). By planning for potential changes in advance and monitoring the discrete context during the intervention, potential threats of concurrent changes that may hinder intervention implementation can be detected and activities to avoid them can be undertaken (Frykman et al, 2014). Actions that could be used to avoid this are likely to differ depending on the type of change (e.g., changes in management, concurrent projects, or restructuring or downsizing) and should be investigated in further studies.…”

“…However, as the intervention proceeds, these expectations are likely to be replaced with actual outcome experiences. Actual experiences of positive outcomes have been identified as important for long-term motivation and sustained behavior change (Frykman et al, 2014). The low-fidelity departments had most likely not experienced positive initial effects since the intervention had not yet been implemented.…”

A systematic review of empirical studies examining mechanisms of implementation in health

“…Three studies utilized a comparative case study design incorporating a combination of interviews, Numbering is used to denote match variables across models; not all models tested the same sets of variables focus groups, observation, and document review, whereas two studies employed a cross-sectional descriptive design. Although three of the five studies reported their analytic design was informed by a theory or previously established model, only one study included an interview guide in which items were explicitly linked to theory [19]. All qualitative studies explored relations between multiple ecological levels, drawing connections between intra and interpersonal behavioral constructs and organization or system level change.…”

Employees' and line managers' active involvement in participatory organizational interventions: Examining direct, reversed, and reciprocal effects on well‐being

“…Thus far, the support provided by line managers during implementations of participatory organizational interventions has mainly been examined after the intervention, on the same measurement occasion as intervention outcomes (Nielsen & Randall, ), thus offering limited information on temporal aspects. One exception is a study investigating what affected the intervention process of a teamwork intervention (Frykman, Hasson, Athlin, & Thiele Schwarz, ). The study showed that line managers had a central motivating role during the active intervention phase, whereas their support was less important once teamwork had become an established daily practice, because by that time, task‐related feedback had become a more important motivator.…”