Dissertation Title： "Team Scaffolds: How Minimal Team Structures Enable Role-based Coordination"In my dissertation, I integrate research on role-based coordination with concepts adapted from the team effectiveness literature to theorize how team scaffolds enable effective coordination among people do not work together regularly. I argue that role-based coordination can be interpersonally challenging and propose that team scaffolds (minimal team structures that bound groups of roles) may provide occupants with a temporary shared in-group that facilitates interaction. I develop and test these ideas in a multi-method, multi-site field study of a new work structure, called pods, that were implemented in many hospital emergency departments during my study period. In some cases, the pods were designed to function as team scaffolds.
In chapter 3 of my dissertation, I report an in-depth case study of team scaffolds in one emergency department (ED) that implemented a pod design. I first adapt network methods to compare coordination patterns before and after team scaffolds were implemented. My results show that the team scaffolds improved performance, in part by reducing the number of partners with whom each role occupant coordinated. Second, I analyze qualitative interview data to theorize the social experience of working in team scaffolds. I find that the new team structures provided a kind of social scaffolding that facilitated group-level coordination between roles. The temporary shared in-group that emerged in the team scaffolds supported a sense of belonging, reduced interpersonal risk, and led individuals to expect account-giving behavior from other roles.
In chapter 4, I extend the findings from the first case study with a cross-case comparison of the pod design at two additional emergency departments (EDs). The pod structures put in place at the comparative field sites achieved some of the conditions (proximity and boundedness) identified at the first ED as helpful for role-based coordination, but did not scaffold group-level coordination within meaningful minimal teams. Instead, interviewees referenced other informal groupings that felt like meaningful teams (e.g., the stable group that worked the night shift, those involved in a resuscitation or co-located nurses helping each other). Qualitative analysis revealed that people associate teamness with the people aligned with and helping with their interests. The way that work was allocated at the two comparative EDs created a misalignment of ownership and interests between nurses and physicians, which undermined the sense that those working together in a pod were in fact a minimal team.
In chapter 5, I conduct a quantitative analysis of pod performance at the three field sites. I consider the effect of the relatively stable resources in each pod (e.g., staff-to-patient ratios) and also the relational patterns that accumulate in each pod (e.g., number of shared patients per dyad within shift) on operational performance and quality. My analysis found no variation between the pods at the first hospital, but significant variation between pods at the other hospitals across staffing patterns, coordination patterns, and performance. Results from an analysis examining pod performance across all hospitals revealed that after controlling for pod and hospital fixed effects and other operational control variables, within-shift shared patients is associated with operational performance, even though lifetime shared patients is not. Altogether, these analyses present important theoretical and practical contributions.
Work teams are becoming less bounded and stable and my dissertation provides insight and evidence on the conditions under which relative strangers can identify as and function as a minimal team. I identify structures and mechanisms that enable teaming among hyper-fluid groups of people, and also demonstrate the importance of aligned ownership of work in how people make sense of teams in their work lives. For managers and leaders in flexible, fast-paced work environments (like EDs), this dissertation theoretically conceptualizes and empirically tests critical design features of supporting team scaffolds.