Reframing implementation as an organisational behaviour problem: Inside a teamwork improvement intervention
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 21 September 2015
Abstract
Purpose
The purpose of this paper is to report on a process evaluation of a randomised controlled trial (RCT) intervention study that tested the effectiveness of classroom- and simulation-based crew resource management courses, alone and in combination, and identifies organisational barriers and facilitators to implementation of team training programmes in healthcare.
Design/methodology/approach
The RCT design consisted of a before and after study with a team training intervention. Quantitative data were gathered on utility and affective reactions to training, and on teamwork knowledge, attitudes, and behaviours of the learners. A sample of participants was interviewed at the conclusion of the study. Interview responses were analysed, alongside qualitative elements of the classroom course critique, to search for evidence, context, and facilitation clues to the implementation process.
Findings
The RCT method provided scientifically robust data that supported the benefits of classroom training. Qualitative data identified a number of facilitators to implementation of team training, and shed light on some of the ways that learning was diffused throughout the organisation. Barriers to successful implementation were also identified, including hospital time and resource constraints and poor organisational communication.
Originality/value
Quantitative randomised methods have intermittently been used to evaluate team training interventions in healthcare. Despite two decades of team training trials, however, the authors do not know as well as the authors would like what goes on inside the “black box” of such RCTs. While results are usually centred on outcomes, this study also provides insight into the context and mechanisms associated with those outcomes and identifies barriers and facilitators to successful intervention implementation.
Keywords
Acknowledgements
Ethics approval for the research was granted by the Hunter New England Area Health Service Human Research Ethics Committee (HNEHREC Reference Nos: 08/HNE/262 and 08/08/20/5.19) and the University of New South Wales Human Research Ethics Committee (HREC Reference No. 08274).
The authors would like to acknowledge healthcare professional and administrative staff and instructors at the Hunter New England Skills and Simulation Centre, who provided a valuable contribution to the conduct of this research. The authors also acknowledge the other members of the research team: Dr Cate McIntosh and Dr Ross Kerridge.
This research was partially supported under a University of New South Wales scholarship and by the National Health and Medical Research Council (NHMRC) Program Grant No. 568612 and the Australian Research Council Discovery Grant No. DP0986493.
Citation
Clay-Williams, R. and Braithwaite, J. (2015), "Reframing implementation as an organisational behaviour problem: Inside a teamwork improvement intervention", Journal of Health Organization and Management, Vol. 29 No. 6, pp. 670-683. https://doi.org/10.1108/JHOM-11-2013-0254
Publisher
:Emerald Group Publishing Limited
Copyright © 2015, Emerald Group Publishing Limited