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Teamwork in TQM hospitals: An investigation through case study
Abstract
This study explored teamwork in two hospitals implementing Total Quality Management. Its objectives were to: document and describe the social process of constructing teamwork in the two hospitals and the patterns of interaction that emerged; to compare the experiences of teamwork in the hospitals to the conceptualization of teamwork prescribed by TQM and to compare the experiences of the two hospitals to each other; and to understand how teamwork is interpreted by members of TQM hospitals. A multi-site case design was used; data was collected through participant observation, interviews, and document analysis. Results suggested that quality improvement teams represent a means for creating teamwork in hospitals by providing a forum for members to understand each other's needs, work, and problems through which respect and cooperative relationships emerged. Team leaders played a key role in the construction of teamwork by managing the meaning of teamwork, guiding the work of teams, assuring equal participation and facilitating the establishment of meaningful ground rules and mutually shared objectives. Identified obstacles to teamwork included the lack of physician involvement in team efforts; managers and staff who would not cooperate with team recommendations; the time required to improve work processes; managers who attempted to control a team's work; and leaders who failed to provide clear direction and guidance. In exploring the practice of teamwork outside the boundaries of QIT's, the data revealed that barriers between departments still existed. Management efforts to forge teamwork across functional areas were fragmented. Department heads who promoted teamwork tended to be those who had been involved in QIT's. In both hospitals conflict, distrust and a lack of mutually shared objectives among senior managers was identified by middle managers as antithetical to TQM and an obstacle to building a sense of "all one team" hospital-wide. Recognizing that the hierarchical, departmental structure in hospitals prevents the construction of teamwork across departments and recognizing the ability of quality improvement teams to break down departmental barriers, this study recommends that organizational restructuring be explored for hospitals which might include the management of processes or systems vs. departments and incorporates the team structure.
Subject Area
Health care management|Public health
Recommended Citation
Raimondo, Marianne, "Teamwork in TQM hospitals: An investigation through case study" (1993). Doctoral Dissertations Available from Proquest. AAI9329658.
https://scholarworks.umass.edu/dissertations/AAI9329658