Resolving Rivalries and Realigning Goals: Challenges of Clinical and Research Multiteam Systems

Abstract

This article describes the care processes for a 64-year-old man with newly diagnosed advanced non-small-cell lung cancer who was enrolled in a first-line clinical trial of a new immunotherapy regimen. The case highlights the concept of multiteam systems in cancer clinical research and clinical care. Because clinical research represents a highly dynamic entity-with studies frequently opening, closing, and undergoing modifications-concerted efforts of multiple teams are needed to respond to these changes while continuing to provide consistent, high-level care and timely, accurate clinical data. The case illustrates typical challenges of multiteam care processes. Compared with clinical tasks that are routinely performed by single teams, multiple-team care greatly increases the demands for communication, collaboration, cohesion, and coordination among team members. As the case illustrates, the described research team and clinical team are separated, resulting in suboptimal function. Individual team members interact predominantly with members of their own team. A considerable number of team members lack regular interaction with anyone outside their team. Accompanying this separation, the teams enact rivalries that impede collaboration. The teams have misaligned goals and competing priorities that create competition. Collective identity and cohesion across the two teams are low. Research team and clinical team members have limited knowledge of the roles and work of individuals outside their team. Recommendations to increase trust and collaboration are provided. Clinical providers and researchers may incorporate these themes into development and evaluation of multiteam systems, multidisciplinary teams, and cross-functional teams within their own institutions.

An integration team’s diagnosing of context, spanning boundaries and creating psychological safety within a multiteam system

“…This would result in negative multiteam system performance, or failure to achieve a common superordinate goal. This suggests that the direct relationship between a climate of psychological safety and building trust and mutual respect positively impacts multiteam system performance (Gerber et al, 2016). This study therefore proposes that the integration team members' creation of a climate of psychological safety positively impacts trusting relationships between component teams and with the integration team within a multiteam system.…”

“…Furthermore, a climate of trust, due to psychological safety is an important enabler for successful interdependent relationships (Weaver, 2016). Since an integration team positively impacts multiteam system coordination and interdependence towards achieving a common superordinate goal, it is proposed that the creation of a climate of psychological safety by an integration team aids in building trust, further enhancing multiteam system performance (Gerber et al, 2016). For there to be an element of trust and a cohesive working relationship among component team members, individuals need to feel psychologically safe and that their contributions are valued and taken seriously (Gerber et al, 2016).…”

“…Since an integration team positively impacts multiteam system coordination and interdependence towards achieving a common superordinate goal, it is proposed that the creation of a climate of psychological safety by an integration team aids in building trust, further enhancing multiteam system performance (Gerber et al, 2016). For there to be an element of trust and a cohesive working relationship among component team members, individuals need to feel psychologically safe and that their contributions are valued and taken seriously (Gerber et al, 2016). This study therefore included items that point to how safe respondents feel that their suggestions are taken seriously and that their integration team is open to their ideas and suggestions.…”

“…This cross-sectional study proposes that the measure of multiteam performance is the strength of the trust relationship among component teams within the multiteam system, leading to the achievement of a common superordinate goal. Figure 1 above illustrates the direct relationships between diagnosing context, boundary spanning and creating a climate of psychological safety, which contribute to a trusting relationship, which ultimately positively impacts multiteam system performance (Gerber et al, 2016 ;Luciano et al, 2018;Millikin et al, 2010), which in turn stimulate the achievement of a common superordinate goal (Davison et al, 2012). In Figure 1 the highlighted section is the focus of this study, which is the impact of diagnosing context, boundary spanning and creating a climate of psychological safety on trusting relationships in the multiteam system.…”

The relationship between Indigenous and allopathic health practitioners in Africa and its implications for collaboration: a qualitative synthesis

“…In addition to power struggles, we found that the symptoms of power differentials -that of distrust, disrespect, rivalry and lack of mutual understanding -are themselves barriers to collaboration [61,89,[92][93][94]. Lack of respect and trust prevent collaboration by hampering communication and causing assertiveness to be perceived as threatening [61].…”