The work is never ending: uncovering teamwork sustainability using realistic evaluation

Area of Science:

• Healthcare Management
• Organizational Behavior
• Applied Behavior Analysis

Background:

• Implementing teamwork in healthcare settings is crucial for improving patient care.
• Sustaining behavior changes after initial interventions remains a significant challenge.
• Understanding the mechanisms behind behavior change sustainability is vital for effective implementation.

Purpose of the Study:

• To investigate the factors influencing the long-term sustainability of teamwork behaviors in an emergency department.
• To analyze the mechanisms of behavior change interventions (BCIs) using the DCOM® framework.
• To explore the interaction between BCIs, context, and sustainability.

Main Methods:

• A realistic evaluation approach was employed, integrating the DCOM® framework (Direction, Competence, Opportunity, Motivation).
• Data were collected through non-participant observation and interviews two and a half years post-implementation.
• Behavioral change mechanisms were categorized to assess their impact on sustainability.

Main Results:

• Teamwork behaviors were not sustained over the two-and-a-half-year period.
• Reduced managerial activities led to decreased direction, opportunity, and motivation among staff.
• Lack of problem-solving resources and unclear team roles created significant barriers to sustained teamwork.

Conclusions:

• Sustaining complex organizational changes in healthcare requires ongoing adaptation and sustained managerial engagement.
• The DCOM® framework, combined with realistic evaluation, provides valuable insights into the behavioral mechanisms affecting intervention sustainability.
• Addressing contextual factors and ensuring clear direction, opportunity, and motivation are critical for long-term behavior change.