Thesis: Exploring Adaptive Capacity in Hospital Teams - A Multiple Case Study.
Birte Fagerdal's PhD was a Qualitative case study, undertaken at the PhD program in Health Sciences at the SHARE centre, University of Stavanger.
Birte Fagerdal thesis is a qualitative multiple case study, investigating how resilience is enabled in healthcare by studying adaptive capacity in different types of hospital teams in Norway. The PhD project was part of a large international program called “Resilience in Healthcare” (RIH), an international study with several work packages (WP) This PhD was part og WP5; “Multilevel influences on resilient healthcare”. The study aimed at adding knowledge of how resilience is enabled in diverse healthcare systems by examining adaptive capacities in hospital teams in six countries (England, The Netherlands, Australia, Switzerland, Japan, and Norway). More specifically it aimed to identify how team, organisational and national healthcare system factors support or hinder the ability of teams to adapt to variability and change [2]. This PhD study was the Norwegian case.
The study was designed as a multilevel case study of two included cases with four subunits in each case. A case was defined as a hospital with four different types of teams. The case study included observational studies of everyday work in the different types of teams, looking at types of demands, capacity and adaptations experienced by the teams. Following the observation, interviews with team members and their leaders were undertaken.
The result from this thesis identified several multilevel factors influencing adaptive capacity in hospital teams. The study shows how the front-line leaders contribute in several ways and provide a significant role for their team’s adaptive capacity. Their knowledge of everyday work and handling of risk were vital for the teams. Furthermore, they strive to be good role models and build a positive supportive culture within the teams, as this is perceived to be crucial for adaptive capacity.
Various team factors influenced their adaptive capacity. Competence, experience, and knowledge were vital and a key enabler for learning in the teams. In addition, various resources such as technology and tools, guidelines and procedures were important. The key findings regarding the teams nonetheless concerned how relationships between team members and a positive, supportive culture enabled adaptive capacity.
System level actors provided the teams with various resources to direct and enable their everyday work. These governing regulations influenced how the teams were organised and prioritized their work. However, the system level actors are responsible for the entire health service and must contribute general regulations without knowing exactly what every day work looks like in the sharp end of healthcare. Therefore, the teams’ ability to negotiate and align these system level requirements to their own diverse contexts was significant for their adaptive capacity.
The thesis demonstrates that clinical observation of frail older patients is multifaceted, and that competence improvement is difficult. Prior to the competence program, clinical observation had a low priority and vital signs were rarely measured to detect early deterioration of frail older patients. The competence improvement programme was experienced as important by most homecare professionals, yet the belonging learning tools were applied differently in the two homecare settings. In some situations, such as with patient falls and new patients, the competence program changed professionals’ clinical observation, nevertheless, their situation awareness of patients’ deterioration was still insufficient. The program was sustained by regular activities integrated into the homecare work routines, but it was also challenged by organisational issues such as sick leave, turnover, and busy work plans. As such, the implementation of the competence improvement programme was influenced by the programme itself, the professionals, the organisation, and the external context.
Birte Fagerdal have recently started a Postdoc position at SHARE, University of Stavanger where she is involved in the EU project S4R. In addition, she has a position at Haukeland university Hospital where she is project manager for developing a competence program for nurses working in cancer care.
Supervisors
Main supervisor:
Professor Siri Wiig, University of Stavanger
Co-supervisor:
Veslemøy Guise, associate professor, SHARE, University of Stavanger
Hilda Bø Lyng, associate professor, SHARE, University of Stavanger
Professor Janet E. Anderson, Monash University, Melbourne Australia
