Ivan Koay MBChB, MRCS, FRNZCUC, MD
Optimal team dynamics play a key role in productivity and enterprise success. The importance of a well-functioning team is evident every day in urgent care centers (UCCs). Increasingly, rapid turnover of UC staff is becoming normative, and changes in team composition can have significant impact on how well a team functions. Whether from daily shift changes or staff joining or leaving the organization, such changes require adaptations both for the loss of old team members and in the efforts to determine appropriate roles when new members join.
Similarly, in many sports organizations, free agency, injuries, trades, and drafts lead to near constant alterations in team composition. There is much that can be learned from how sports teams cope with such changes and applied to UC.
A team’s ability to adapt and continue to function in light of changes in membership has an obvious impact on their collective success—regardless whether the objective involves winning a game or caring for patients. In their recent study, Pasarakonda et al. investigated unexpected events that occur during task execution and specific performance episodes due to sudden changes in team composition.1 The study analyzed English Premier League (EPL) soccer teams’ performances when there were events that disrupted membership. The authors hypothesized that alterations in team composition that were characterized by the loss of a team member would adversely affect team performance and game outcomes. The researchers specifically examined the impact of familiarity—whether team members knew each other or not—on coordination of the team. They also looked to delineate the effects that various types of composition changes (eg, loss of a teammate, substitution, etc.) had on team function and the outcomes of events. Their findings offer important lessons for UC clinicians and administrators on how such disruptions to team dynamics are likely to affect performance.
Team Familiarity and Performance
Team familiarity—defined as the shared experience a team has of working together—has been shown in various sectors to improve performance. When team members have experience handling a variety of situations together, they learn how other members react to different demands and the skill sets and capabilities of their teammates. Team members learn to combine information about a situation at hand—whether that be a seizing patient or a three-goal deficit at halftime—with previous performances, which then provides an intuitive sense for the likely actions of fellow team members.
Over time and with increasing shared experience, teams establish a sense of shared knowledge, which enhances communication. Increases in team familiarity not only results in more profound communal knowledge but also enables complex coordination of responses to familiar patterns. Enhanced levels of familiarity have been connected to higher levels of trust among team members that serve the team well when faced with task disruption. Team familiarity also creates resilience against some of the negative effects of team composition changes.
Team Composition Disruptions
In their study analyzing EPL soccer teams over 3 consecutive seasons, Pasarakonda and colleagues found that the duration of adversity a team experiences as a consequence of losing a team member negatively affected team outcomes. In other words, the longer the team had to work without the dismissed team member, the worse the team functioned. Moreover, teams’ ability to maintain or recover performance after the loss of a teammate was mitigated when another player was substituted in quickly.
This study highlights the fact that when teams lose a member, it appears critical to replace that individual as soon as possible because not doing so seems to have a more profound negative effect on performance. In contrast, when teams were forced to substitute a team member due to injury, teams were able to maintain performance by redistributing their resources and roles adequately, which helps the team conserve its resources. This implies that the loss of a team member is a more harmful form of team composition disruption than the substitution of a team member.
In the UC setting, these findings can inform hiring, staffing, and scheduling decisions. Ensuring that roster gaps are filled as soon as possible—particularly in cases of short notice absences related to illness and the like—would prevent excessive detriment to team function.
For example, operating in a short-staffed capacity when someone calls out sick would likely lead to less optimal function for the team than having an on-call backup member fill in. This may seem obvious, but it is a far too common reality that UC teams are asked by their leadership to maintain unaltered performance when team members are unexpectedly absent.
Transferring Learnings to UC
In most UCCs, there are a variety of staff members with various scopes of practice and skill sets. Effective teamwork among them ensures optimal patient flow. This begins with the “front of the house” reception team and extends to the medical assistants, physician assistants, nurse practitioners, and/or physicians caring for the patients. Other ancillary staff, such as janitorial staff and business administrators, also need to be considered for their role in maintaining an efficient UCC. Managers of organizations should be aware of the downsides that the loss of a team member has on team coordination and performance. As the current labor shortages abound, this is a challenge for many UC organizations.
Suboptimal team performance due to understaffing is not frequently discussed as a source of job-related stress, but it certainly can and does affect job satisfaction. This then can create a vicious cycle of team member departures as team familiarity and function deteriorate and the work becomes increasingly stressful with each subsequent loss of an employee. Appreciating the importance of a functional team and prioritizing retention reduces the likelihood of unexpected resignations and thereby helps organizations avoid the high costs of turnover, such as recruiting, onboarding, and paying premiums for temporary/locums staffing.
Team familiarity was also demonstrated to be an important determinant of a team’s ability to adapt in the study. UC managers and team leaders might consider how familiar team members are with one another when creating schedules. When there is a loss of a team member with no immediate substitute available, UC managers might focus on hiring a replacement who can adapt swiftly. Seeking referrals from a network of qualified candidates who already are familiar with some of the current team members (eg, friends or former colleagues) can also reduce time for team familiarity to resurge.
Teamwork is foundational to optimal UCC performance. UCC administrators who care about throughput, patient experience, and efficiency metrics would be wise to pay attention to the findings of Pasarakonda and colleagues as they pertain to what helps and hampers team function. Creating an environment where the UC team can thrive may not always make sense from a short-term financial perspective, however, it is critical to the long-term success of UCCs and the well-being of the individuals who care for patients every day.
References
- Pasarakonda S, Maynard T, Schmutz J, et. al. How Team Familiarity Mitigates Negative Consequences of Team Composition Disruptions: An Analysis of Premier League Teams Group & Organization Management 2023, Vol. 0(0) 1–56
Download the article PDF: How Changes in Team Composition Affect Performance: What Urgent Care Can Learn from the Sports World
