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Effects of Similarity-Dissimilarity, Team Cohesion, and Hospital Cross-Functional Team Effectiveness on Organization

Lynn University April 2 nd , 2008. Effects of Similarity-Dissimilarity, Team Cohesion, and Hospital Cross-Functional Team Effectiveness on Organizational Performance. Doctoral Dissertation Defense Hearing Zulfikar Dennis Kalam. CHAPTER I INTRODUCTION TO THE STUDY.

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Effects of Similarity-Dissimilarity, Team Cohesion, and Hospital Cross-Functional Team Effectiveness on Organization

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  1. Lynn UniversityApril 2nd, 2008 Effects of Similarity-Dissimilarity, Team Cohesion, and Hospital Cross-Functional Team Effectiveness on Organizational Performance Doctoral Dissertation Defense Hearing Zulfikar Dennis Kalam

  2. CHAPTER IINTRODUCTION TO THE STUDY Introduction and Background Definitions of Terms Purpose Justification

  3. Introduction and Background • Embedded Cross-Functional Teams • Homogenous (similarity) • Heterogeneous (dissimilarity) • Diversity-Demographics, Occupations • Complex Hospital Organizations • Regulatory Pressure • Competition • Location • Classification

  4. Definitions of Terms • Cross functional team • Work groups, cross-disciplinary, interdisciplinary, multi-disciplinary teams • Hospital Characteristics • Geographic location, tax status, legal classification, and the number of licensed beds • Actual Similarity-Dissimilarity • age, gender, ethnicity, race, occupational title, professional practice areas, practice experience in years, tenure in current hospital

  5. Definitions of Terms • Perceived Dissimilarities • Visible, values, and informational dissimilarities • Perceived Group Openness to Diversity • Visible, values, and informational • Team Cohesion • Feelings about acceptance by fellow team members • Team Outcome Effectiveness • Goals, customers, timeliness, quality, and productivity.

  6. Definitions of Terms • Organizational performance • Average Length of Stay (LOS) (risk adjusted days a patient stays in hospital) • JCAHO survey results for the Management of the Environment of Care • Percent score • Percentile score

  7. Study Purposes • Exploratory (comparative) - differences according to • Actual similarity-dissimilarity • Hospital characteristics • Explanatory (correlational) - explain relationships between • Actual and perceived similarity-dissimilarity, openness to diversity, cohesion, effectiveness, organizational characteristics, and organizational performance

  8. Definition of Terms Tri-County Hospitals CFTs Hospital Characteristics Similarity- Dissimilarity Diversity Effectiveness Cohesion Performance

  9. Justification • Previous Studies Limited in Scope • Growing Issues in Healthcare • Uninsured, HMO’s, Costs, Competition • This Study • Addresses Important Concepts • Increasing Diversity……Effectiveness…Performance • Researchable, Can be Tested, Measurable

  10. CHAPTER IIREVIEW OF LITERATURE THEORETICAL FRAMEWORK RESEARCH QUESTIONS HYPOTHESES

  11. CFTs Multifunctional Multidisciplinary Dissimilarity Organizational Characteristics Team Cohesion Team Effectiveness JCAHO AHCA Diversity Organizational Performance Literature Review

  12. Theoretical Framework

  13. Organizational Characteristics Size, Geography, Type Actual Similarity-Dissimilarity of CFT Visible and Informational H1a H1b H1d Perceived Similarity-Dissimilarity of CFT Visible and Values and Informational H2aH2b H2c H2d CFT Openness to Diversity Visible, Value, and Informational H3 CFT Cohesion H4a H4b H4c H4d H4f Team Effectiveness Goals, Customers, Timeliness, Quality and Productivity H5b H5c H6b H6c Performance of the Organization KPI: Management of the Environment of Care Percentile score KPI: Length of Stay (LOS) --- New hypothesized relationships being tested — Hypothesized relationships tested, but previously tested in the literature Revised Model of CFT diversity, cohesion, team effectiveness, and organizational performance.

  14. CHAPTER IIIRESEARCH METHODS RESEARCH DESIGN POPULATION SAMPLING PLAN PSYCHOMETRIC ANALYSES

  15. Research Design • Quantitative Non-Experimental • Comparative (exploratory) • Explore differences • Correlational (explanatory) • Determine which explanations are best. • On-Line survey • Five parts completed by the respondents

  16. Population • Estimated Target Population • Miami-Dade 4480 • Broward 4200 • Palm Beach 1960 • Total 10640

  17. Accessible Population Source of CFT Members • Professional Contacts 50 • Hospital Web Sites • Physicians 15 • Nurses 20 • Other CFT Members 20 • Professional Associations259 Total 364

  18. Sampling Plan • Purposive and Snowball Sampling Plan • Initial purposive sample included the accessible population • Estimated Sample (see table 3-4) • Initial purposive sample = 364 • Snowball sampling = 1043 CFT • Final data producing sample = 181 • Response rate = 17.4%

  19. S E T T I N G S Palm Beach = 7 Broward = 15 Miami-Dade = 16

  20. Data Producing Sample • Step 1 (actual) • Email sent to initial purposive sample = 241 • Step 2 (estimated) • Snowball sample email sent to 441 • Step 3 (estimated) • Snowball sample email sent to 690 • Produced 206 responses (actual) • Produced 185 valid responses (valid response rate of 27%)

  21. Instrumentation • Part 1: Actual Similarity-Dissimilarity • 10 items, demographics • Part 2: Perceived Dissimilarity • 6 item scale, 3 subscales • Part 3: Perceived Group Openness to Diversity • 6 item scale, 3 subscales • Part 4: Team Cohesion • 5 items scale, unidimensional • Part 5: Team Outcome Effectiveness • 26 item, 5 subscales

  22. Procedures • Obtained permission to use scales • Designed online survey • IRB approval • Invitation e-mails sent BCC • Voluntary participation • Responses anonymous • 10-15 minutes to complete • No IP addresses tracked • Data encryption

  23. Evaluation of Strengths and Weaknesses • Internal Validity Strength • Good estimates of reliability for scales • Ecological strength • Rigorous statistical procedures Weaknesses • Small sample size • Non-experimental, (lack of randomization, controls)

  24. Evaluation of Strengths and Weaknesses • External Validity Strengths • Included the entire accessible population • Data collection in natural setting Weaknesses • Non Random Snowball Sampling introduces sampling bias

  25. Methods of Data Analysis • Research Question 1 • Descriptive statistics • Research Question 2 • Independent t-tests and ANOVA with Tukey’s post hoc comparison compared differences according to actual similarity-dissimilarity • Research Question 3 • Chi square and ANOVA with Tukey’s post hoc comparison compared differences according to hospital organizational characteristics

  26. Hypothesis Testing • Explanatory (Correlational) Design • Hierarchical Multiple Regression Method • Step 1: Eta correlations for categorical variables • Step 2: If significant, dummy variables created Step 3: Pearson r for significant and trend dummy variables, ratio variables, and interval variables. • Step 4: Hierarchical regression – entered from strongest to weakest

  27. CHAPTER IVRESULTS Data Producing Sample Validity and Reliability of the Measurement Scales Research Questions Hypotheses Testing

  28. Summary of Psychometric Analyses • Construct Validity – • Exploratory Factor Analysis • Reliability Analysis – • Coefficient Alphas • Convergent and Divergent Validity – • Pearson r

  29. Part 1: Actual Similarity-Dissimilarity • Ten Items • Gender, Race, Ethnicity • Educational Level, Occupational Level, Professional Practice Area • Age in Years, Years of Practice in Profession • Tenure at Hospital, Hospital of Employment

  30. Part 2: Perceived Similarity-Dissimilarity scale • Six items, 5-point semantic differential scale • This Study (n=185) • Validity: Scale modified after exploratory factor analysis supported 2 subscales with factor loadings ranging from .599 to .919 • 1. Visible (two items) • 2. Values and Informational (four items) • Reliability:Cronbach’s alphas for the subscales of visible (.960) ; Values and informational (.921)

  31. Part 3: Perceived Group Openness to Diversity scale • Six items, 5-point semantic differential scale • This Study (n=185) • Validity: Exploratory factor analysis supported 3 subscales with loadings ranging from .572 to .876 • Reliability: Corrected item-total correlation scores ranged from .706 to .872.

  32. Part 5: Team Outcome Effectiveness • 26 Item, 7-point inaccurate-accurate rating scale • This Study (n=185) • Scale modified after 2nd exploratory factor analysis • Validity • 26 items retained in four factors to produce 4 subscales with loadings of: • Goals= .759 to .820 Customers = .641 to .763; Timeliness = .549 to .691; Quality and Productivity =.534 to 744 • Reliability • Total scale coefficient alpha .973. • Corrected item-total correlation scores ranged from .878 to .971.

  33. Part 4: Team Cohesion • Five items, 5-point semantic differential scale • This Study (n=185) • Validity - exploratory factor analysis • Unidimensional structure supported • Factor loadings ranged from .900 to .959 • Reliability • Total scale coefficient alpha .961. • Corrected item-total correlation scores ranged from .847 to .934.

  34. Part 6: Organizational Characteristics (n = 35) • Geographic Location • South Florida counties of Palm Beach, Broward, and Miami-Dade • Hospital Size • In this study Licensed beds ranged from 200 to 1498 • Tax Status • For-profit, not for-profit • Legal Classification • Investor owned, government

  35. Part 7: Organizational Performance • This study used secondary data • AHCA • Average Length of Stay (LOS) • Adjusted for morbidity • JCAHO • Management of the Environment of Care Survey • Percentile score

  36. Convergent and Divergent Validity

  37. Research Question 1 What are CFT members’ actual similarity-dissimilarity, perceived similarity-dissimilarity, perceived group openness to diversity, team cohesion, team outcome effectiveness, characteristics of their organizations, and organizational performance?

  38. Gender (Previous studies had 83% female respondents)

  39. Occupation

  40. Ethnicity

  41. Education

  42. Practice Area

  43. Research Question 2 Are there differences in CFT members’ perceived similarity-dissimilarity, perceived group openness to diversity, team cohesion, team outcome effectiveness, characteristics of their organizations, and performance of their organizations according to actual similarity-dissimilarity?

  44. Summary of Mean Scores

  45. Research Question 3 Are there differences in CFT members’ actualsimilarity-dissimilarity, perceived similarity-dissimilarity, perceived group openness to diversity, team cohesion, team outcome effectiveness, and performance of their organizations according to organizational characteristics of hospitals with existing CFTs in south Florida?

  46. Percentage of Occupation According to Hospital Size

  47. H1 Results

  48. H2 Results

  49. H3 Results

  50. H4 Results

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