The Impact of Organisational Changes on Teamwork in Healthcare: A Systematic Review
Main Article Content
Abstract
Healthcare organisations have to frequently undergo significant reforms, ranging from structural reforms to operational modifications, to address evolving challenges, such as an ageing population, technological advancements, and emerging diseases. These organisational changes significantly affect teamwork in healthcare, which is a critical component for ensuring patient safety, enhancing clinical performance, and maintaining staff satisfaction. The relationship between organisational changes and teamwork is ill-defined. PubMed, Scopus, ProQuest, and Web of Science (WOS) databases were searched for relevant literature on the impact of organisational changes on teamwork processes and outcomes in healthcare settings. Based on predefined selection criteria, 24 studies were considered suitable for inclusion; data from these studies were synthesised using thematic analysis. Three primary themes of organisational changes—organisational restructuring, operational changes, and adaptive response and capacity development—which affected team dynamics in various ways, were identified. Both planned and emergent changes produce mixed effects on teamwork; while planned changes are aimed at improving cooperation and efficiency and minimising negative impacts, they may inadvertently disrupt teamwork. In contrast, emergent changes can encourage resilience and adaptability within teams. Finally, the success of organisational changes in improving teamwork outcomes depends heavily on implementation strategies, contextual factors, and team characteristics. This review highlights the importance of employing established change management frameworks to address the complexities of organisational change. Further research, particularly from low- and middle-income countries, is essential to develop strategies and approaches for establishing effective healthcare teams in diverse settings.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Dattani S, Rodés-Guirao L, Ritchie H, Ortiz-Ospina E, Roser M. Life expectancy. [Internet]. 2023. [Retrieved 2024 Dec 16]. Available at: https://ourworldindata.org/life-expectancy
Johnson A, Nguyen H, Groth M, Wang K, Ng JL. Time to change: a review of organisational culture change in health care organisations. J Organ Eff: People Perform. 2016;3(3):265–288. https://doi.org/10.1108/JOEPP-06-2016-0040
Barry S, Dalton R, Eustace-Cook J. Understanding change in complex health systems - a review of the literature on change management in health and social care 2007-2017. [Internet]. Dublin: Trinity College Dublin; 2018. [Retrieved 2024 Dec 16]. Available at: https://www.tcd.ie/medicine/health_policy_management/research/
Berry JC, Davis JT, Bartman T, Hafer CC, Lieb LM, Khan N, et al. Improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system. J Patient Saf. 2020;16(2):130–136. https://doi.org/10.1097/PTS.0000000000000251
Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open. 2019;9(9):e028280. https://doi.org/10.1136/bmjopen-2018-028280
Daud F, Abd Ghani NF, Abu Zahid SN. Job satisfaction among specialist in Ministry of Health Malaysia and its associated factors. Malays J Public Health Med. 2022;22(3):1–8. https://doi.org/10.37268/MJPHM/VOL.22/NO.3/ART.1177
Daud F, Ponnampalam PK, Mohd Nadzri NFN. Exploratory study on the compensation practices in private hospitals for clinical specialists in Malaysia. IIUM Med J Malays. 2023;22(4):66–73. https://doi.org/10.31436/imjm.v22i4.2287
Robbins SP, Judge TA. Organizational behavior. 18th ed. New York: Pearson Education; 2022.
Mach M, Abrantes ACM, Soler C. Teamwork in healthcare management. In: Firstenberg MS, Stawicki SP, editors. Teamwork in healthcare. London: IntechOpen Ltd.; 2021. https://doi.org/10.5772/intechopen.96826
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71
Hong Q, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, et al. 2018. Mixed methods appraisal tool (MMAT), version 2018. Canadian Intellectual Property Office, Industry Canada; 2018. http://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/127916259/MMAT_2018_criteria-manual_2018-08-01_ENG.pdf
Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x
Mash BJ, Mayers P, Conradie H, Orayn A, Kuiper M, Marais J. How to manage organisational change and create practice teams: experiences of a South African primary care health centre. Educ Health. 2008;21(2):132. https://doi.org/10.4103/1357-6283.101573
Gotlib Conn L, Oandasan IF, Creede C, Jakubovicz D, Wilson L. Creating sustainable change in the interprofessional academic family practice setting: an appreciative inquiry approach. J Res Interprof Pract Educ. 2010;1(3). https://doi.org/10.22230/jripe.2010v1n3a29
MacKinnon K, Butcher DL, Bruce A. Working to full scope: the reorganization of nursing work in two Canadian community hospitals. Glob Qual Nurs Res. 2018;5. https://doi.org/10.1177/2333393617753905
Rogers L, De Brún A, McAuliffe E. Exploring healthcare staff narratives to gain an in-depth understanding of changing multidisciplinary team power dynamics during the COVID-19 pandemic. BMC Health Serv Res. 2023;23(1):419. https://doi.org/10.1186/s12913-023-09406-7
Ballangrud R, Aase K, Vifladt A. Longitudinal team training program in a Norwegian surgical ward: a qualitative study of nurses’ and physicians’ experiences with implementation. BMC Health Serv Res. 2021;21(1):725. https://doi.org/10.1186/s12913-021-06732-6
Pulido-Fuentes M, Palmar-Santos AM, Flores-Martos JA, Cipriano-Crespo C, Rubio LA, González LA, et al. Internal dynamics within primary care teams in two Spanish regions during the COVID-19 pandemic: a qualitative study. BMC Prim Care. 2022;23(1):64. https://doi.org/10.1186/s12875-022-01674-2
Maun A, Engström M, Frantz A, Brämberg EB, Thorn J. Effective teamwork in primary healthcare through a structured patient-sorting system - a qualitative study on staff members’ conceptions. BMC Fam Pract. 2014;15(1):189. https://doi.org/10.1186/s12875-014-0189-2
Huby G, Guthrie B, Grant S, Watkins F, Checkland K, McDonald R, et al. Whither British general practice after the 2004 GMS contract? stories and realities of change in four UK general practices. J Health Organ Manag. 2008;22(1):63–78. https://doi.org/10.1108/14777260810862416
Nutt K, Keville S. ‘… you kind of frantically go from one thing to the next and there isn’t any time for thinking any more’: a reflection on the impact of organisational change on relatedness in multidisciplinary teams. Reflective Pract. 2016;17(2):221–232. https://doi.org/10.1080/14623943.2016.1159552
Rodriquez J. Doing more with less: intensive care and the logic of flexible teamwork. In: Vallas S, editor. Emerging conceptions of work, management and the labor market. Leeds, UK: Emerald Publishing Limited; 2017. pp. 117–140. https://doi.org/10.1108/S0277-283320170000030006
Cain CL. Agency and change in healthcare organizations: workers’ attempts to navigate multiple logics in hospice care. J Health Soc Behav. 2019;60(1):3–17. https://doi.org/10.1177/0022146518825379
Rajan A, Wind A, Saghatchian M, Thonon F, Boomsma F, van Harten WH. Staff perceptions of change resulting from participation in a European cancer accreditation programme: a snapshot from eight cancer centres. ecancermedicalscience. 2015;9. https://doi.org/10.3332/ecancer.2015.547
Allen S, Chiarella M, Homer CSE. Lessons learned from measuring safety culture: an Australian case study. Midwifery. 2010;26(5):497–503. https://doi.org/10.1016/j.midw.2010.07.002
Clay-Williams R, Plumb J, Luscombe GM, Hawke C, Dalton H, Shannon G, et al. Improving teamwork and patient outcomes with daily structured interdisciplinary bedside rounds: a multimethod evaluation. J Hosp Med. 2018;13(5):311–317. https://doi.org/10.12788/jhm.2850
Bentley M, Freeman T, Baum F, Javanparast S. Interprofessional teamwork in comprehensive primary healthcare services: findings from a mixed methods study. J Interprof Care. 2018;32(3):274–283. https://doi.org/10.1080/13561820.2017.1401986
Milton J, Gillespie BM, Åberg D, Erichsen Andersson A, Oxelmark L. Interprofessional teamwork before and after organizational change in a tertiary emergency department: an observational study. J Interprof Care. 2023;37(2):300–311. https://doi.org/10.1080/13561820.2022.2065250
Pandhi N, Kraft S, Berkson S, Davis S, Kamnetz S, Koslov S, et al. Developing primary care teams prepared to improve quality: a mixed-methods evaluation and lessons learned from implementing a microsystems approach. BMC Health Serv Res. 2018;18(1):847. https://doi.org/10.1186/s12913-018-3650-4
Vifladt A, Simonsen BO, Lydersen S, Farup PG. Changes in patient safety culture after restructuring of intensive care units: two cross-sectional studies. Intensive Crit Care Nurs. 2016;32:58–65. https://doi.org/10.1016/j.iccn.2015.06.004
Martinussen M, Kaiser S, Adolfsen F, Patras J, Richardsen AM. Reorganisation of healthcare services for children and families: improving collaboration, service quality, and worker well-being. J Interprof Care. 2017;31(4):487–496. https://doi.org/10.1080/13561820.2017.1316249
Milton J, Chaboyer W, Åberg ND, Andersson AE, Oxelmark L. Safety attitudes and working climate after organizational change in a major emergency department in Sweden. Int Emerg Nurs. 2020;53:100830. https://doi.org/10.1016/j.ienj.2020.100830
Grace SM, Rich J, Chin W, Rodriguez HP. Implementing interdisciplinary teams does not necessarily improve primary care practice climate. Am J Med Qual. 2016;31(1):5–11. https://doi.org/10.1177/1062860614550333
Hefner JL, Hilligoss B, Knupp A, Bournique J, Sullivan J, Adkins E, et al. Cultural transformation after implementation of crew resource management: is it really possible? Am J Med Qual. 2017;32(4):384–390. https://doi.org/10.1177/1062860616655424
Cummings G, Hayduk L, Estabrooks C. Mitigating the impact of hospital restructuring on nurses: the responsibility of emotionally intelligent leadership. Nurs Res. 2005;54(1):2–12. https://doi.org/10.1097/00006199-200501000-00002
Gulliver P, Towell D, Peck E. Staff morale in the merger of mental health and social care organizations in England. J Psychiatr Ment Health Nurs. 2003;10(1):101–107. https://doi.org/10.1046/j.1365-2850.2003.00544.x
Hackman JR. The design of work teams. In: Lorsch J, editor. Handbook of organizational behavior. Denver, CO: Prentice Hall; 1987. pp. 315–342.
Rogelberg SG (editor). The SAGE encyclopedia of industrial and organizational psychology. 2nd ed. Thousand Oaks, CA: SAGE Publications; 2016.
Ilgen DR, Hollenbeck JR, Johnson M, Jundt D. Teams in organizations: from input-process-output models to IMOI models. Annu Rev Psychol. 2005;56(1):517–543. https://doi.org/10.1146/annurev.psych.56.091103.070250
Mathieu JE, Hollenbeck JR, van Knippenberg D, Ilgen DR. A century of work teams in the. J Appl Psychol. 2017;102(3):452–467. https://doi.org/10.1037/apl0000128
Daud F, Siti Norbani A, Azimatun N, Nik Azlan NM. Work Performance and its Influencing Factors Among Support Staff in Hospital Mersing, Johor. Med Health. 2020;15(2):47–55. https://doi.org/10.17576/MH.2020.1502.07
Harrison R, Fischer S, Walpola RL, Chauhan A, Babalola T, Mears S, et al. Where do models for change management, improvement and implementation meet? a systematic review of the applications of change management models in healthcare. J Healthc Leadersh. 2021;13:85–108. https://doi.org/10.2147/JHL.S289176
Varkey P, Antonio K. Change management for effective quality improvement: a primer. Am J Med Qual. 2010;25(4):268–273. https://doi.org/10.1177/1062860610361625
Kotter JP. Leading change. Boston, MA: Harvard Business School Press; 1996.
Hayes J. The theory and practice of change management. 6th ed. London: Bloomsbury Publishing; 2022.