Effective teamwork in health care demands better integration of organizational sciences research with technology development

As patient health needs grow in complexity, health care organizations across the United States are relying on ever larger teams of clinicians to manage care. But coordination and communication within these burgeoning teams has lagged—putting patients at risk for medical mistakes and hampering the training of tomorrow’s clinicians.

That’s the alarm raised by a team of researchers including Christopher G. Myers, a faculty member at Johns Hopkins Carey Business School, in a commentary published in June in The New England Journal of Medicine.

High turnover and labor shortages have also contributed to the current situation, the researchers say. In hospitals today, clinicians who share a patient’s care often have limited, if any, history of working together. And while health care organizations have responded by implementing high-tech communication tools—from messaging apps to electronic medical records—these technological solutions “don’t address the fundamental human challenges involved in fostering effective teamwork, such as managing attention and relationships,” notes Myers, who leads the Center for Innovative Leadership at Carey Business School.

Fixing the situation, the authors contend, requires a deep understanding of human and organizational behavior, “not just more advanced technologies,” and a breaking down of silos. “The findings from decades of research in the organizational sciences and related fields (e.g., human-factors engineering and psychology), which has included rigorous studies of human behavior in health care settings, haven’t been incorporated into most health care research,” they write. “We believe there are promising opportunities for integration across these fields.”

Looking outward for better collaboration

In their commentary Myers and colleagues highlight previous studies they’ve conducted that could point the way forward. In one such project, Anna Mayo of Carnegie Mellon’s Heinz College, lead author of the NEJM article and formerly an assistant professor at Carey Business School, examined cross-boundary collaboration within medical teams at an academic medical center. She found that the least effective teams were inward-focused when conducting their work, excluding others (such as nurses, specialists, pharmacists, and patients and their families) whose input could be valuable in providing high quality care. Even when these teams did reach outside for information, “these inward-focused teams often failed to take the critical step of synthesizing the input they received from these out-of-sight people.” The result of this isolated approach? Backtracking and delays in care for patients.

In contrast, about one quarter of the inpatient teams in the study, which appeared in Administrative Science Quarterly, took a more outward-looking approach, expanding their boundaries as needed to gather input from other clinicians—as well as patients and their families—and to collectively synthesize information before contracting back to the core team to delegate tasks. On the surface, it might appear that this approach is more time-consuming, says Myers. “But taking that time on the front end ends up helping these teams work more efficiently. It’s a ‘go slow to go fast’ strategy,” he says. These clinical care teams completed their medical rounds faster and their patients had shorter lengths of stay in the hospital.

“Learning is a social process”

The current lack of communication and coordination within health care teams also has an adverse impact on training—by “eroding opportunities for learning from others, which is a critical component of teamwork in health care and is necessary for improving care of future patients,” write Myers and colleagues in their NEJM commentary.

In previous research on learning within organizations, Myers has shown the importance of creating spaces for informal conversation or observing others and learning on the job. Specifically, Myers studied the transfer of knowledge among members of air medical transport crews for a study that appeared in Administrative Science Quarterly. Because these crews are constantly being reconfigured, it can be challenging to collaborate and share knowledge through traditional mechanisms. He found that crews have adapted by using storytelling routines during downtime. This swapping of stories offers an informal—and effective—way for team members to share their expertise.

“Learning is a social process and learning by doing things together is critical,” Myers notes. As today’s health care teams become more expansive, fragmented, and transient, he says, health care organizations must make concerted efforts to bring people together so that they have opportunities to develop relationships and learn from one another.

Human-focused harnessing of technology

With a better understanding of the human-focused elements of teamwork within health care, Myers says, researchers can develop more effective technology-based interventions “to track and increase coordination and learning” among health care teams.

In their commentary, he and his colleagues note the potential that artificial intelligence tools hold to improve communication, coordination, and collaboration. For example, AI tools that process conversations in real time could invite input from important team members—such as nurses or patients themselves—who have not contributed to a conversation but probably should. Or AI could identify a clinician from outside the core team whose expertise and input might be particularly valuable to decision-making.

As health care organizations become larger, people work more remotely, and there are more temporary staffers “we don’t always know each other,” says Myers. “AI could be helpful in aiding teams to determine: ‘Where can I find this expertise within our organization?’”

In authoring the NEJM commentary, Myers and his colleagues say their aim is to raise awareness within the medical community to the growing importance of organizational behavior in health care. “Our ability to provide great patient care is as much an organizational issue as it is a clinical issue,” says Myers. “It’s critical that we take steps now—as researchers, developers, and practitioners—to better integrate insights from organizational research into the development of technological support tools.”