Contextual influences on adaptation in four types of hospital teams: An ethnographic study

Abstract

Background: Healthcare quality and safety efforts increasingly focus on understanding how complex systems adapt to maintain operations during disruptions. This paper explores team adaptation within hospitals, examining how different types of teams respond to misalignments between demand and capacity.

Aim: To explore whether different types of teams experience different types of demand capacity misalignments, and whether and how teams differ in how they adapt. The overall goal was to identify whether and how different types of teams might have different requirements to support their adaptive capacity and system resilience.

Methods: This study used ethnographic observations to collect data from five wards in a large London hospital: two surgical wards, an older adult ward, a critical care unit, and the Acute Assessment Unit (AAU) specifically designed to expedite patient flow from the Emergency Department. A typology of hospital teams and the CARE Model 2.0 framework were used to analyse misalignments and adaptations.

Results: All team types experienced misalignments, but their adaptations in response to misalignments varied. Team design, structure, and membership influenced adaptation strategies. Structural and satellite teams, with stable membership, had fewer misalignments and coordinated adaptations effectively. Hybrid teams, with both stable and unstable members, were more vulnerable due to their fragmented interactions. Coordinating teams, integrating representatives from multiple areas, faced challenges due to conflicting priorities and information changes.

Conclusions: Different hospital teams adapt in different ways to misalignments. Team features influence adaptation strategies. Designing and supporting adaptive teams is crucial for improving healthcare quality and safety. Future research should focus on adaptive teamwork and explore interventions to enhance team adaptive capacity.