Understanding helping behaviors in an interprofessional surgical team: How do members engage?

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Highlights

  • Helping engagement, both the provision and receipt of help, is a complex and socially mediated process.

  • There are specific aspects held internally by the individual that encourage engagement in helping behaviors, but there are also contextual elements that influence helping engagement.

  • Helping engagement in the represented professions was influenced by power and hierarchy, although that influence varied as their interpretations varied.

  • Co-located space suggests that the close proximity of IP team members may offer some assistance with respect to the engagement in helping behaviors, but does not remove all barriers to help-seeking.

  • Participants described help as a type of currency that was accrued and exchanged within the IP team.

Abstract

Objective

In surgical environments, work must be flexible, allowing practitioners to seek help when required. How surgeons navigate the complexity of interprofessional teams and collaborative care whilst attending to their own knowledge/skill gaps can be difficult. This study aims to understand helping behaviours in interprofessional surgical teams.

Design

Thirteen semi-structured interviews with participants were completed. Data collection and inductive analysis were conducted iteratively using thematic analysis.

Results

We found several intersecting features that influenced helping engagement. Work context, including nested and cross-sectional identities, physical and hierarchical environments, diversity, support for risk-taking and innovation and perceptions of a “speak up” culture shaped the way helping scenarios were approached. Intrinsic attributes influenced decisions to dis/engage. When united, these features shaped how helping behaviours became enacted.

Conclusion

If we desire to create surgical teams that deliver quality care, we must consider not only individual attributes but the context in which teams are situated.

Introduction

The ability to effectively seek and provide help is at the core of highly functional teams. In medicine, this important feature of teamwork sits in tension with a culture that has traditionally valued independence and autonomy. While recent research has brought attention to the social nature of help seeking in individual clinicians, little is known about helping behaviors in interdisciplinary clinical teams. In particular, what is absent from the literature is an understanding of how the complex team setting influences team help seeking and help provision practices. Without this understanding, efforts to improve team collaboration will be compromised.

The nature of interprofessional (IP) work is complex. Many highly trained and skilled professionals, each with their own professional priorities and goals, must collectively navigate a patient’s clinical course. Within these IP teams, there are explicit and implicit power and hierarchical structures that profoundly impact the ways in which members of the team collaborate and ultimately deliver care.1 Recognition of these tensions isn’t enough to reduce or eliminate their impact and consequently, they put IP team collaboration at risk.2

Previous work in the educational, psychology and organizational behavior literature has examined helping behavior as an individualist construct, focusing on traits an individual may possess that predispose them to helping engagement.3,4 Research in the business and organizational science literature at the team level suggests that engagement in helping behaviors helps to increase the overall expertise of the team, as well as foster innovation, knowledge production, and shared understanding5,6,.7 Work by Bamberger3 addressed gaps in the literature by attending to the antecedents and consequences of help-seeking within the business workplace and found that helping engagement was driven by a combination of individual, problem-related and organizational factors. Within health care specifically, engagement in helping behaviors has the potential to impact both quality and safety of patient care.8 Lee9 highlighted that helping behavior is at its highest when the helper is an equal status peer, as the individual is less motivated by the acquisition and maintenance of power. Previous research by Novick10 has brought to light the rationale intraoperative surgeons use when asking for help including the need for technical or skill-based expertise, decision making assistance including the validation of action plans or obtaining a second opinion, or providing complementary expertise, moral support or political cover. However, help-seeking can be face-threatening: Novick10 described surgeons’ continuous compromise between seeking help to ensure patient safety, while attempting to maintain practice autonomy and decisive action. Often, junior surgeons seek help from more seasoned colleagues to provide judgement as well as decision-making reassurance whereas more experienced surgeons are likely to turn to their novice counterparts for technical assistance and equipment expertise. These findings highlight why individual surgeons may engage in help requests but yet, little attention within the broader literature has been paid to how the team context influences helping engagement. Moreover, there is a lack of health care specific research that addresses the ways in which the IP team impacts helping behaviors of the team members. Addressing this specific gap is important because previous work has highlighted the positive impact of working in a health care team, including enhanced organizational effectiveness and patient care11 and interpersonal and interprofessional interactions.12,13 Previous work has not, however, sufficiently examined how work context impacts helping engagement. To that end, we sought to understand how members of an IP surgical team engaged in helping behaviors.

Section snippets

Setting and procedures

This research was conducted at a large North American academic institution and received ethical approval from the Western University institutional review board. The surgical group we engaged with was purposefully selected, as the research team anticipated they represented a small yet highly functional, innovative and collaborative cohort with co-located office space and a dedicated operating room team. The core team was comprised of four surgeons, four physicians, seven registered nurses, and

Results

We identified two elements that shaped the way team members within the IP team engaged in helping behaviors. First, an individual’s work context, including their nested and cross-cutting identities,22 as well as the physical space individuals inhabited, shaped the way participants approached helping scenarios. Nested or embedded identities refer to the multiple social identities individuals may hold within an organization such as surgeon, department chair, site chief, etc., whereas

Discussion

The concept of helping has historically been examined in the context of the individual23 or in homogeneous groups,24 but not in complex teams, such as IP teams. Yet complex teams are the reality in today’s healthcare landscape. Our results suggest that helping engagement is a complex and socially mediated process. Building upon the findings of Novick,10 our work suggests helping, both the provision and receipt, is largely influenced by an individual’s work context including their nested

Funding

This work was supported by PSI Foundation’s Health Research Grant in Health Systems Research [2018].

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