Melissa Valentine and Amy Edmondson of Harvard Business School have published an intriguing new working paper about team effectiveness. Valentine and Edmondson explore a concept that they call "team scaffolds" in this paper. The scholars ask the question: "It is increasingly necessary for 24/7 shift operations to include some component of team-based work. But how can organizations support such work among constantly changing groups of people in a setting where stable teams are not feasible?" They examine this question by studying an urban hospital's emergency room. However, the findings apply to other settings in which people often work in unstable/transitory teams.
The scholars begin by pointing out that many organizations cannot design and use stable teams for certain types of work. How then can they make these teams effective, given that the team design literature suggests a certain level of structure and cohesion boosts group performance? Valentine and Edmondson explain that scaffolding proves quite effective in the emergency room setting that they studied. Team scaffolds consist of "a bounded role set with collective responsibility for interdependent tasks." In other words, team roles have been so well-defined that members can step into a role and interact effectively with their peers, even though they haven't worked together as a unit on a regular basis.
The emergency room in the study underwent a major transformation. The ER did not have a team structure prior to the change. Patients were treated in a sequential/linear process with various functions performed by different staff members who did not work as a team. The hospital changed its organization structure, creating what they called "pods" - a physical location with dedicated computers, counters, supplies, beds, and crash rooms. The authors explain:
The pods were each staffed by one attending, one in-charge resident and possibly another resident or intern, and typically three nurses, one of whom was designated the “Pod Lead.” The pods themselves were stable structures that persisted over time, but the staffing of the pods changed constantly. Within some five-hour periods, all of the individuals staffing the pod composition may have turned over completely as a result of shift changes staggered across roles. The nurses, residents, and attendings (collectively called providers) were assigned to a pod at the beginning of each shift. Provider pod assignments were made more-or-less at random, and a provider may have been assigned to a different pod every shift. Their “pod mates” were typically different every shift as well. Education tended to happen within each pod following the redesign, rather than through a department-wide formal rounding process. The attending and resident worked closely together as they cared for patients and informally rounded together several times during the shift, as well as during the shift change between attendings or residents. Note that the pod system connected a clearly defined set of roles (the attending, one or two residents, and three nurses) with collective responsibility for a set of tasks (the patients assigned to the pod) bounded by a shared physical location.
What happened as a result of the structural transformation? Valentine and Edmondson found that patients’ average time in the ER fell by nearly 40% after implementation of the pods. The key, though, is that these pods did not constitute stable teams. However, people worked together quite effectively in these group structures. The authors argue that the well-defined boundaries and roles facilitated effective coordination.