Teams in Crisis: The Effect of Team Familiarity on Performance Under Conditions of Crisis and Uncertainty
Alexandra Bray, Rohit B. Sangal† & Marissa King
Research on fluid teams has consistently found a positive relationship between team familiarity and performance, but little empirical research has investigated whether or not these benefits extend to times of crisis and uncertainty. This study examines how team familiarity influences provider decision times in the emergency department, focusing on how its effects vary across different crisis and uncertainty contexts. Using patient and provider data from a large, multi-site emergency department, we construct care team familiarity networks and analyze familiarity's impact on decision-making speed during both low-uncertainty crises (high acuity patient surges) and high-uncertainty crises (early COVID-19 pandemic), as well as under conditions of patient-level task uncertainty. We find that team familiarity consistently reduces provider decision times; familiarity is particularly beneficial during crises. However, across both crisis and non-crisis situations, we find that the positive effects of familiarity are significantly weakened under conditions of high uncertainty. These findings underscore the conditional nature of familiarity's benefits, suggesting that in highly uncertain or novel situations, teams cannot rely solely on past shared experience to maintain performance. Implications for staffing strategies in healthcare and other high-stakes environments highlight the need for organizations to balance the benefits of familiarity with adaptability in the face of uncertainty.
Best Student Paper (Finalist), Academy of Management, 2022
Familiarity, Expertise, and Experience: Team Performance in the Emergency Department
Alexandra Bray & Rohit B. Sangal†
(Job Market Paper)
Health care delivery relies on the coordination of fluid teams with members spanning different roles and specialties. Existing research on team familiarity finds that more familiar health care teams perform better across a variety of contexts; research on team member expertise and experience finds that individual member experience can also improve team performance. However, much of this existing literature focuses on teams consisting of just one role or profession type, and does not consider how familiarity and expertise or experience may interact to affect performance. Using patient and clinician data from a large hospital system’s emergency department, we investigate how the familiarity, expertise, and experience of resident physicians affect the time to disposition decision, a key outcome of emergency department performance. We find that residents’ familiarity has a significantly stronger positive affect on disposition decision time than either attending physicians' or nurses’ familiarity. We also find that this effect is much stronger when the team includes at least one non-expert resident. Finally, we find that the positive effect of resident familiarity weakens as residents gain experience. Together, these findings suggest that team familiarity is most important when teams include inexperienced or non-expert team members.
Outstanding Paper Based on a Dissertation, Academy of Management, 2024
Private Equity Acquisition & Career Trajectories (Data analysis)
with Susan Busch and Marissa King
Teamwork During Transitions of Care (Data collection)
with Dr. Rohit B. Sangal†
Systems-Based Approaches to Improve Patient Safety by Improving Healthcare Worker Safety and Well-Being (Data collection)
with Dr. Edward Melnick† and others
A Scoping Review of Teamwork, Patient Safety, and Clinician Well-Being in the Emergency Department
Suresh K. Pavuluri†, Alexandra Bray, Carolina Diniz Hooper†, Raphael Sherak†, Rohit B. Sangal†, & Edward R. Melnick†
Academic Emergency Medicine (2026)
Emergency departments (EDs) are high-stakes environments where crowding, boarding, and frequent exposure to violence amplify risks to both patients and staff. Conceptual frameworks suggest interdependence between teamwork, well-being, and patient safety, but the empirical basis for these relationships remains underdeveloped. Our objective was to conduct a scoping review examining the intersections between teamwork, patient safety, and well-being in EDs, with the aim of characterizing existing evidence and identifying gaps to inform future research and practice. With a medical librarian, we searched Ovid MEDLINE, PubMed, and CINAHL from inception to 2025 using terms related to emergency services, interprofessional teamwork, burnout, and patient safety. Eligible studies included empirical evaluations of team-based interventions or correlates in ED settings; reviews, protocols, and opinion pieces were excluded. Two reviewers independently screened titles, with disagreements adjudicated through abstract review. Full texts were assessed by a second pair of reviewers. Data were extracted into a standardized template following Arksey and O'Malley's methodological framework.Of 346 studies screened, 16 met inclusion criteria. No study evaluated all three domains simultaneously. Seven studies assessed teamwork–safety relationships using survey or simulation methods and reported associations between stronger teamwork and fewer missed care events, improved safety culture, or enhanced communication. Seven studies examined the teamwork–well-being dyad, finding consistent associations with lower burnout, improved morale, and reduced turnover intentions. Only two studies addressed well-being–safety, reporting negative correlations between job dissatisfaction, poor teamwork climate, and self-reported errors. Evidence supports associations between teamwork, well-being, and patient safety in the ED, but research remains fragmented, methodologically limited, and rarely addresses all three domains together. Across all domains, studies were limited by reliance on self-reported perceptions, heterogeneous measurement instruments, and lack of ED-specific, longitudinal, or controlled designs. Future studies should leverage multi-institutional, ED-specific designs with objective safety outcomes to build a robust evidence base.
Leadership communication, stress, and burnout among frontline emergency department staff amid the COVID-19 pandemic: A mixed methods approach
Rohit B. Sangal†, Alexandra Bray, Eleanor Reid†, Andrew Ulrich†, Beth Liebhardt†, Arjun K. Venkatesh† & Marissa King
Organizations have a key role to play in supporting healthcare workers (HCWs) and mitigating stress during COVID-19. We aimed to understand whether perceptions of support and communication by local leadership were associated with reduced reports of stress and burnout among frontline HCWs. We conducted cross-sectional surveys embedded within emergency department (ED) workflow during the first wave of COVID-19 from April 9, 2020 to June 15th, 2020 within three EDs of a multisite health system in the Northeast United States. All ED HCWs were administered electronic surveys during shift via text message. We simultaneously conducted 64 qualitative interviews to better characterize and validate survey responses. Primary survey outcomes were levels of work stress and burnout. Over a 10 week study, 327 of 431 (76%) frontline HCWs responded to at least one round of the survey. More useful communication mediated through higher perception of support was significantly associated with lower work stress (B = −0.33, p < 0.001) and burnout (B = −7.84, p < 0.001). A one-point increase on the communication Likert scale was associated with a 9% reduction in stress and a 19% reduction in burnout. Three themes related to effective crisis communication during COVID-19 emerged in interviews: (1) information consolidation prior to dissemination, (2) consistency of communication, and (3) bi-directional communication. This work suggests that effective local leadership communication, characterized by information consolidation, consistency, and bi-directionality, leads to higher perceptions of support and lower stress and burnout among ED frontline workers. As the pandemic continues, these results present an evidence-based framework for leaders to support frontline HCWs through effective crisis communication.
Best Basic Science Award (Nominee), Society for Academic Emergency Medicine, 2021
Work Team Identification Associated with Less Stress and Burnout among Frontline Emergency Department Staff amid the COVID-19 Pandemic
Rohit B. Sangal†, Amy Wrzesniewski, Julia DiBenigno, Eleanor Reid†, Andrew Ulrich†, Beth Liebhardt†, Alexandra Bray, Elisabeth Yang, Eunice Eun, Arjun K. Venkatesh† & Marissa King
The COVID-19 pandemic has exposed front-line healthcare workers to unprecedented risks and stressors threatening both physical and mental health. Prior work in the military has found that team identification, or the sense that one was a part of a team, can help reduce stress and prevent burnout during prolonged stress. We conducted repeated cross-sectional surveys embedded within emergency department workflow to understand whether team identification was associated with reduced reports of stress and burnout among front-line workers. During the 10-week study which spanned the first wave of COVID-19, 327 of 431 (76%) front-line healthcare workers responded to at least one round of the survey. Higher team identification was associated with significantly less work stress (B=−0.60, 95% CI −0.84 to to -0.40, p<0.001) and burnout (B=−12.87, 95% CI −17.73 to -8.02, p<0.001) in cross-sectional analyses. Further evidence of the protective effect of team identification for work stress (B=−0.36, 95% CI −0.76 to 0.05, p=0.09) and burnout (B=−13.25, 95% CI −17.77 to -8.73, p<0.001) was also found in prospective longitudinal evidence. This work suggests work team identification is a key buffering factor against feelings of stress and burnout. Efforts to promote team identification may offer a promising way for leaders to support front-line healthcare workers’ well-being during the COVID-19 pandemic. These results can inform ongoing COVID-19 operational and quality improvement initiatives.
Summarized on Yale Insights, June 2021
Summarized on Yale School of Medicine News, November 2020
†Physician or clinical practitioner collaborator