Purpose The purpose of this paper is to explore possible factors impacting team performance in healthcare, by focusing on information exchange within and across hospital’s boundaries. Design/methodology/approach Through a web-survey and group interviews, the authors collected data on the communication networks of 31 members of four interdisciplinary healthcare teams involved in a system redesign initiative within a large US children’s hospital. The authors mapped their internal and external social networks based on management advice, technical support and knowledge dissemination within and across departments, studying interaction patterns that involved more than 700 actors. The authors then compared team performance and social network metrics such as degree, closeness and betweenness centrality, and computed cross ties and constraint levels for each team. Findings The results indicate that highly effective teams were more inwardly focused and less connected to outside members. Moreover, highly recognized teams communicated frequently but, overall, less intensely than the others. Originality/value Mapping knowledge flows and balancing internal focus and outward connectivity of interdisciplinary teams may help healthcare decision makers in their attempt to achieve high value for patients, families and employees.
This study explored the perceptions of health care providers across the continuum of care as to how effective advance directive arrangements were in assuring compliance with the patients' wishes, as well as their overall satisfaction levels with the process. The health care providers who responded to the survey indicated high levels of overall satisfaction with advance directives, despite low patient completion rates and, most significantly, low confidence levels that surrogate decision making accurately reflected the patient's wishes. A secondary analysis compared the perceptions of health care providers with consumers' reasons for failing to complete advance directives. The need for further education was perceived as a primary need by the health care professionals but not by the consumers. Recommendations for policy initiatives and further research are then presented.
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