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 (HCM), 2024
Teams in Crisis: Team Familiarity and Performance During Crisis Situations
Alexandra Bray, Rohit B. Sangal & Marissa King
(3rd Round R&R at Organization Science)
Research on fluid teams has consistently found a positive relationship between team familiarity and performance in a variety of settings. However, there is little empirical research investigating whether or not these benefits of familiarity extend to times of crisis and uncertainty. Moreover, whether familiarity may be more or less beneficial during different types of crises is unknown. To study this, we collected patient and provider data from the emergency department (ED) of a large hospital from January 2018 through October 2021. In general, team familiarity was significantly associated with reductions in length of stay, a key metric of ED performance. However, team familiarity was less important to performance during crises with high levels of uncertainty. In contrast, during crises with low levels of uncertainty, familiarity was in fact more important to performance. Together, these findings suggest that the benefits of familiarity can be realized during crisis situations, but may be limited during uncertain crises until teams can develop effective coordination mechanisms.
Best Student Paper Award Finalist, Academy of Management (HCM), 2022
Network Cohesion in Emergency Department Teams (Data analysis)
with Dr. Rohit B. Sangal
Teamwork During Transitions of Care (Data analysis)
Artificial Intelligence in the Emergency Department (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
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