management model in the healthcare setting: a case …

MANAGEMENT MODEL IN THE HEALTHCARE SETTING: A CASE STUDY

___________________________________

By

PATRICK OWEN CHADD

___________________________________

A DISSERTATION IN PRACTICE

Submitted to the faculty of the Graduate School of Creighton University in Partial

Fulfillment of the Requirements for the degree of Doctor of Education in

Interdisciplinary Leadership

_________________________________

Omaha, NE

November 9, 2015

iii

Abstract

The US healthcare system has been heavily criticized for its disintegrated nature; more

so, it is very much alarming to have reports show that numbers are increasing on the

restorable errors of medical professionals that have led to death or injury. With the

situation in 2015 of the emergency healthcare field, the researcher felt the urgency and

call for finding ways to correct the system protocols and recommend a model that would

promote patient care and quality to a higher degree. Since there have been a growth on

the use of interdisciplinary or dyad management models in the healthcare systems in the

recent years, it was decided to construct the models as the focal points of the current

study. By employing a qualitative thematic analysis on the interviews with eight

physicians and professional managers, the researcher established six major themes and

formed Chadd's Model of Dyad Management that can be utilized to improve the current

practices and protocols in dyad management. It was then found that the key factor in

creating and implementing dyads or triads is the aim of producing the best solutions for

patient care. Participants also strongly believed that the purpose of dyads or triads was to

form better collaboration and to work together as teams. Participants also suggested that

for dyads and triads to be effective, members should have skills to support arguments

with evidence. They also followed protocols such as formal meetings and discussions

before making decisions on their courses of actions requiring a clear communication

between members. Finally, the physicians and managers contended that dyads and triads

may be modified to be more compelling through removal of message noises and thus

solve issues better.

v

Acknowledgements

Over this doctoral journey I have received support and encouragement from a great

number of individuals.

Dr. Isabelle Cherney has been a mentor, advisor, champion and a source of constant

inspiration and motivation. Her guidance has made this a thoughtful and rewarding

journey.

Dr. Cherney - vous avez changé ma vie et de la perspective et je vous remercie de tout

mon cœur.

Dr. Peggy Hawkins, my fantastic advisor has also been integral to my success in this

endeavor and my research would not have been what it is without her invaluable advice

and efforts to help me focus my ideas and thoughts.

Dr. John Hudson, my dissertation chair for his expertise, time, direction and patience as I

worked through my ideas and research to get to where I am today.

I would like to thank my dissertation committee of Dr. John Hudson and Dr. Peggy

Hawkins for their support and counsel over the past year as I moved from several ideas

and topics to a completed study.

My amazing peers in cohorts 13 and 14 who have been on this journey with me from the

beginning; always encouraging, motivating, supporting and pushing when needed to keep

me on track. The writing workshops, cohort dinners and intra-cohort communication via

phone, text, email and facebook have made this experience wholly immersive and

connected for me.

Many thanks to my amazing spouse, Dr. Edward Hamaty who was always encouraging,

understanding and supportive of me through all the years in this program; as I tried to

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juggle work, time away from family and completing my dissertation. But for his

influence, I would not be who and where I am today

Finally, to my parents, Donald J. Chadd and Shizuko Komiya Chadd Matsuzawa who

always believed in me and my abilities; this is for you.

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Table of Contents

Abstract .............................................................................................................................. iii

Acknowledgements ............................................................................................................. v

List of Tables ..................................................................................................................... ix

List of Figures ..................................................................................................................... x

CHAPTER ONE: INTRODUCTION ................................................................................. 1

Background of the Problem ............................................................................................. 1

Purpose of the Study ....................................................................................................... 3

Research Questions ......................................................................................................... 3

Significance of the Study ................................................................................................ 4

Aim of the Study ............................................................................................................. 5

Methodology Overview................................................................................................... 5

Delimitations and Limitations ......................................................................................... 5

Leader’s Role and Responsibility in Relation to the Problem ........................................ 7

Summary ......................................................................................................................... 7

CHAPTER TWO: LITERATURE REVIEW ..................................................................... 9

Introduction ..................................................................................................................... 9

Interdisciplinary Decision making .................................................................................. 9

Interdisciplinary Teamwork in the Healthcare Setting .............................................. 10

Benefits and Drawbacks of the Dyadic Model .......................................................... 12

Competencies for Interdisciplinary Teamwork and Leadership ................................ 13

The Healthcare Setting .................................................................................................. 15

Interdisciplinary Leadership .......................................................................................... 16

Reflections of the Researcher ........................................................................................ 19

Summary ....................................................................................................................... 19

CHAPTER THREE: METHODOLOGY ......................................................................... 21

Purpose of the Study ..................................................................................................... 21

Aim of the Study ........................................................................................................... 21

Research Questions ....................................................................................................... 21

Methodology ................................................................................................................. 22

Participants .................................................................................................................... 23

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Instrumentation.............................................................................................................. 24

Overview of Data Collection ......................................................................................... 25

Procedures ..................................................................................................................... 26

Data Analysis Plan ........................................................................................................ 27

Reliability and Validity ................................................................................................. 28

Ethical Considerations ................................................................................................... 29

Reflective Practices ....................................................................................................... 29

Summary ....................................................................................................................... 30

CHAPTER FOUR: RESULTS ......................................................................................... 31

Introduction ................................................................................................................... 31


Aim of the Study ........................................................................................................... 32

Data Analysis ................................................................................................................ 34

Summary ....................................................................................................................... 69

CHAPTER FIVE: CONCLUSION................................................................................... 71

Introduction ................................................................................................................... 71


Aim of the Study ........................................................................................................... 72

Summary of Findings .................................................................................................... 72

Interpretation of Data .................................................................................................... 75

Limitations .................................................................................................................... 79

Recommendations for Further Research ....................................................................... 80

Implications for Action ................................................................................................. 81

Summary ....................................................................................................................... 83

References ......................................................................................................................... 84

APPENDIX A: Interview Prompts or Questions .............................................................. 87

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List of Tables

Table 1. Backgrounds of Study Participants ..................................................................... 34

Table 2. Factors Considered in Creating and Implementing Dyads/Triads ...................... 35

Table 3. Objectives/Purposes of Dyads/Triads ................................................................. 39

Table 4. Competencies Perceived as Necessary for Members of Dyads/Triads ............... 44

Table 5. Protocols/Procedures for Decision Making Within Dyads/Triads ..................... 52

Table 6. Perceived Advantages/Disadvantages of Dyads/Triads vs. Non-Interdisciplinary Teams ..................................................................................... 58

Table 7. Suggested Areas of Improvement for Dyad/Triad Effectiveness and Efficiency ............................................................................................................ 65

x

List of Figures

Figure 1. Chadd’s Model of Dyad Management……...…………………………………92

MANAGEMENT MODEL IN HEALTHCARE SETTING 1

CHAPTER ONE: INTRODUCTION

Background of the Problem

In a seminal report, the Institute of Medicine described the U.S. healthcare system

as at least ten years behind other high-risk industries with regards to protocols and

practices that ensure safety, which is defined as freedom from accidental injury (Kohn,

Corrigan, & Donaldson, 2000). The report provided examples of patients who died or lost

important limbs and abilities because of medical errors, including drug overdose, drug

mix-up, misdiagnosis, and errors in patient reports and paperwork. The authors also

indicated that the fragmented nature of the U.S. healthcare system increased the

likelihood of incorrect diagnoses due to incomplete or incorrect medical histories

provided by patients. In order to address the issue of significant errors in the U.S.

healthcare system, the authors recommended a comprehensive approach to improving

patient safety. At the core of these recommendations is an emphasis on the roles of

professionals and organizations in collaborating towards improving safety in the U.S.

healthcare system.

Since the release of this report and its recommendations, significant changes have

occurred in the management and protocols of hospitals and health-related institutions.

One such change is the increased use of the dyad or triad model in healthcare

management and decision making (Zismer & Brueggemann, 2010). Simply put, a dyad is

an interdisciplinary team consisting of two individuals of different professions who share

the same goal or mission but have distinct responsibilities and roles that complement one

another, such that efforts are maximized towards achieving objectives (Zismer &

Brueggemann, 2010). For example, in the management of healthcare systems, a doctor of


medicine and a professional manager would take the role of co-managers with distinct

and separate responsibilities that complement each other, such that optimal health care is

provided in their facility. Professional managers in such cases are often nurse managers,

who are nurses who are responsible not only for the conduct and quality of care provided

by nurses within a unit or department, but also for personnel and resource management

within the unit (George & Haag-Heitman, 2011). Another example of a dyad would be a

patient-doctor relationship wherein the patients are provided all necessary information

about their health and the possible courses of action. Then their doctor discusses these

alternatives, and they together make an informed decision on the choice they perceive to

be the best alternative among all others. Consequently, a triadic relationship in such

contexts would be one wherein three individuals with different roles and areas of

expertise collaborate on making better-informed decisions about specific patients,

hospital protocols, and the overall healthcare system.

Numerous forms of dyads and triads have been established and are currently

practiced in healthcare systems for different purposes. This Dissertation in Practice study

focuses on the use of dyads and triads in the management of integrated health systems in

order to minimize preventable adverse errors, to provide more coordinated care, and to

optimize processes while minimizing the cost of procedures. Specifically, the research

was a case study of physicians and professional managers from a selected hospital in

New Jersey who have participated in an interdisciplinary team. Participants were asked to

provide their personal and professional opinions on the use of dyads and triads, especially

on its mechanisms, planning, development, and implementation, necessary competencies

of members, outcomes, its effects on the decision-making process, perceived flaws, and


areas for improvement. The aim of this Dissertation in Practice study is to use the

findings on dyads and triads in the healthcare setting to design a decision-making model

for interdisciplinary teams that can be adapted in different settings.

Purpose of the Study

The purpose of this case study was to explore the experiences and perceptions of

physicians and professional managers on interdisciplinary decision-making teams in a

large healthcare organization. Analysis of their perceptions could be used to develop a

decision-making model that can be adapted in different settings, such as businesses, non-

profit organizations, and academic institutions.

Research Questions

In order to identify optimal ways of using interdisciplinary teams in the healthcare

setting, the design and conduct of this study were guided by the following research

question: What are the perceptions of physicians and professional managers on the use of

interdisciplinary teams or dyads/triads in healthcare management and decision making?

Specifically, data collection focused on answering the following sub-questions:

1. What factors are considered in creating and implementing dyads or triads?

2. What objectives, or for what purposes, are dyads or triads usually created?

3. What competencies are perceived as necessary to effectively and efficiently

function in dyads or triads?

4. What protocols and procedures are followed in decision making within dyads

or triads?

5. What are the perceived advantages and disadvantages of dyads and triads

against non-interdisciplinary teams?


6. What are the perceived areas or facets of dyads or triads that may be modified

to improve effectiveness and efficiency?

Significance of the Study

The management of healthcare provision systems is a complex task primarily

because of long-range services provided and complex relationships among groups of

professionals involved in systems. The U.S. healthcare system has been greatly criticized

for its fragmented nature and significant numbers of preventable errors that have led to

death or injury (Kohn et al., 2000; Maxson et al., 2011). There is a great and urgent need

to modify the current system and develop one that is more robust, integrated, and safe. In

recent years, there has been an increase in the use of interdisciplinary or dyad

management models in healthcare systems. The dyad model allows physicians and

professional managers to share accountability and responsibilities towards improving

quality of care and services and optimizing financial performance without overburdening

patients or incurring large costs for the country (Zismer & Brueggemann, 2010).

However, as each healthcare organization is unique with respect to its size,

organizational members or employees, patients, protocols, and resources, the use of the

dyad management model would also vary accordingly. This Dissertation in Practice study

adds to current literature on dyad management models by providing case-based

information on the perceived advantages of the model, competencies perceived as

necessary for using the model, and the possible applications of the model. Consequently,

the results of the study may help to improve practice by providing empirically-tested,

effective, interdisciplinary decision-making protocols and suggesting areas of

improvement in the design and implementation of dyads. By exploring the use of


interdisciplinary management models in a healthcare system from the perspective of

physicians and professional managers, the study provided more balanced perceptions on

the design and implementation of such models.

Aim of the Study



large healthcare organization. Findings on dyads and triads in the healthcare setting are

expected to aid in developing a decision-making model for interdisciplinary teams that

can be adapted to different settings, such as businesses, non-profit organizations, and

academic institutions.

Methodology Overview

The Dissertation in Practice study used the qualitative case study approach. Data

was collected by conducting individual semi-structured interviews with physicians and

professional managers from a chosen healthcare organization in New Jersey who have

experienced the use of a dyad management model. Additionally, the researcher conducted

a review and analysis of available documents on the organization’s policies and protocols

on the design and implementation of the dyad management model. These documents

provided insight on the procedures followed by dyad teams in setting standards, making

decisions, and managing staff.

Delimitations and Limitations

Limitations are potential weaknesses or problems with the design of the study as

identified by the researcher (Leedy & Ormrod, 2013). As in any instrumental case study,

this study is limited in its generalizability (Creswell, 2013). Additionally, because


participation in the study was voluntary and no compensation was provided to the

participants, they were given the right to withdraw from the study at any time. As such,

the results of the study may not be truly or equally representative of the population of

physicians and professional managers in the hospital.

The delimitations of a study succinctly provide the boundaries and specify the

scope of the study (Leedy & Ormrod, 2013). This study was limited to physicians and

professional managers who were experienced in the dyad management model and were

currently employed in a single chosen healthcare organization in New Jersey. As the

participants were limited to physicians and professional managers, the perceptions of

other healthcare system employees, such as nurses who were not managers, aides, and

laboratory workers, were not represented in this report.

Last, as the researcher has significant experience in the healthcare setting and has

also participated in a number of dyad teams, he has already developed his own

perceptions about the model, its advantages and limitations, and its applications. In other

words, the researcher may have personal bias toward the use of such dyadic teams. In

order to control this bias, the researcher used bracketing, which involved setting aside his

own experiences and perceptions as much as possible in order to gather data and view the

case or phenomenon being studied with a blank or fresh perspective (Creswell, 2013). In

particular, the researcher ensured that questions asked to participants were free of

suggestive words and that the analysis and the final report only represented the responses

of the participants and not the researcher’s own perceptions.


Leader’s Role and Responsibility in Relation to the Problem

This Dissertation in Practice study was designed to explore the experiences and

perceptions of physicians and professional managers on interdisciplinary decision-

making teams in a large healthcare organization. A large part of managing a healthcare

organization is leading subordinates and coordinating with co-managers or co-leaders in

order to provide best services at optimum costs while avoiding errors. As such, part of the

data collection and analysis was to determine the competencies and responsibilities of

both physician and non-physician leaders with interdisciplinary teams, and compare these

outcomes against known theories or models of leadership styles. Such knowledge on

leadership, based on literature and personal experience, allowed the researcher to analyze

and understand the perspectives of the participants better and to explain such rationales

and perceptions against established theories and models in the literature.

Summary

This Dissertation in Practice study was a case study that explored the experiences

and perceptions of physicians and professional managers on interdisciplinary decision-

making teams in a large healthcare organization. Interdisciplinary teams or dyadic

management teams are composed of individuals from different professions or sectors

who have different yet complementary responsibilities and tasks towards reaching a

single list of identified goals. In this study, such dyads were composed of a physician co-

manager and a professional co-manager. The use of such interdisciplinary teams in the

healthcare setting has increased in recent years as a means to improve services, optimize

resources, and minimize preventable errors by improving management and decision

making through the collaboration of co-managers.


The case study was limited to physicians and professional managers with

experience in dyadic management teams and who belonged to a chosen healthcare

organization in New Jersey. Data on the experiences and perceptions of the participants

were collected through individual semistructured interviews and document analyses. The

results of the data analysis were used to develop a general decision-making model for

interdisciplinary teams that can be adapted in different settings, such as businesses, non-



CHAPTER TWO: LITERATURE REVIEW

Introduction

This section provides a clear picture of the current use of interdisciplinary

leadership teams at various levels in healthcare settings. The first subsection provides a

brief review of recent research on the use of interdisciplinary teams in the healthcare

setting in the U.S. and globally. The second subsection presents a comprehensive

understanding of the professional setting of the study, the U.S. healthcare system, in

order for the reader to understand the context of the study. The third subsection provides

a brief description of a leadership theory that is most applicable in the study. The final

subsections provides the researcher’s reflections on the outcomes of the review of

literature, as well as a summary of these outcomes.

Interdisciplinary Decision making

Safety and effectiveness have been prominent issues in the U.S. healthcare setting

in recent years, especially with the release of reports and statistics on the number of

preventable errors that have led to death or injury (Kohn et al., 2000; Maxson et al.,

2011). Numerous strategies and interventions have been put in place in individual

hospitals, as well as the U.S. healthcare industry as a whole, in order to improve

procedures and protocols that ensure the provision of optimum care to patients and the

safety of patients, visitors, and hospital workers (Allen et al., 2015; Maxson et al., 2011).

These strategies often include the use of modified approaches that have been proven to be

effective in ensuring safety and efficiency in other hospitals, healthcare settings, and

industries (Allen et al., 2015; Carayon et al., 2014).


As the provision of efficient and timely healthcare is a task shared among various

professionals, such as doctors of different specializations, nurses, aides, and laboratory

technicians, difficulties often arise when making decisions about the patients’ health and

safety. It follows, then, that the interdisciplinary nature of the hospital setting should be

considered in designing and implementing interventions to improve processes and

protocols in healthcare delivery. For this reason, many of the interventions established in

response to Kohn et al.’s (2000) report on the number of preventable adverse events in

the U.S. involved collaborative planning, design, and execution among the different

professionals in the healthcare setting.

Interdisciplinary Teamwork in the Healthcare Setting

Research and experience has shown that effective collaborative work among

healthcare professionals, most commonly between registered nurses and physicians,

results in lower morbidity and mortality rates, reduced cost of care, and fewer medical

errors (Maxson et al., 2011). Consequently, such effective collaboration can improve job

satisfaction and the retention of nursing staff (Maxson et al., 2011). Collaborative work

between registered nurses, physicians, and other healthcare staff vary in their objectives,

context, scope, and application, and can have their own advantages and weaknesses.

One example of interdisciplinary collaborative work within the healthcare setting

is the surgical team, which typically is comprised of a surgeon, an anesthesiologist, and

an operating room nurse (Walker, Reshamwalla, & Wilson, 2012). In order to improve

safety during surgery, the World Health Organization (WHO) published the surgical

safety checklist, which itemizes all tasks within the three phases of surgical work. The

checklist ideally serves as a tool for effective collaborative work among the members of


the surgical team towards improving surgical outcomes (Walker et al., 2012). However,

studies showed that introducing modifications to established procedures, especially

changes to the safety culture in the operating room, presented significant challenges

(Walker et al., 2012). In general, the greatest challenge in shifting to the use of the

checklist was encouraging all teams and team members to adapt to the checklist culture,

i.e., its procedures and standards (Walker et al., 2012). Research indicated that effective

leadership and open communication among members of the interdisciplinary team were

critical to the successful and effective use of the checklist (Walker et al., 2012).

In a separate study, researchers asked registered nurses and physicians to describe

their perceived barriers to working in interdisciplinary teams wherein the work was

labeled as rapid-response, i.e., urgent critical care expertise provided to the patients’

bedside or wherever needed in the hospital setting (Allen et al., 2015). While nurses

indicated that difficulties arose when they activated the rapid-response team, none of the

physicians surveyed indicated any instances when they believed the nurses had activated

the rapid-response team inappropriately (Allen et al., 2015). This result implied that

nurses may feel certain insecurities about being in a team with doctors, despite their

capacity to do their jobs properly; thus rapid-response team leaders should ensure that all

members of the staff have adequate confidence about their capabilities and decision-

making skills. Both nurses and doctors also indicated that open communication lines

were highly important in ensuring that the proper response was provided in a timely and

efficient manner (Allen et al., 2015).

While interdisciplinary teams between registered nurses and physicians can be

within the context of the operating room or as a rapid-response team that provides urgent


critical care to the patients’ bedside, such interdisciplinary teams may also be present at

management levels. For example, the Fairview Red Wing Health Services in Minnesota

implements the dyad model in management to improve physician and manager

coordination while enhancing clinical and operational outcomes (Baldwin, Dimunation,

& Alexander, 2011). In this dyadic system, a physician department head in each clinical

and medical department within the services coordinated with a nursing lead who was in

charge of operations (Baldwin et al., 2011). Unlike the traditional structure of hospital

services, wherein a medical practice committee oversees the assignment and practice of

physicians and other healthcare providers while also taking charge of administrative

processes, the dyadic system separates such responsibilities to the physician lead and the

nursing lead. Such coordinated division of tasks and responsibilities allows each of the

two leads to focus on their leadership responsibilities without overburdening them, thus

allowing them to perform their clinical tasks adequately. In other words, the dyadic

structure encourages quality, effective care and service, and appropriate behavior

(Baldwin et al., 2011).

Benefits and Drawbacks of the Dyadic Model

Perhaps the most obvious benefit of the dyad model is that it reduces the

traditional “us-them” perspective commonly present in healthcare organizations, wherein

physicians distance themselves from managerial roles and responsibilities and focus only

on their clinical practices. Such a perspective often leads to misunderstandings between

physicians and managers regarding policies, behaviors, and procedures. The dyadic

model addresses this divide in the traditional structure by involving the physicians


throughout the managerial processes while also allowing managers to understand the

circumstances and perspectives of the physicians (Baldwin et al., 2011).

Additionally, the dyad model allows managers and physicians to make more

informed decisions as they bring in different perspectives to viewing a specific problem

or issue to be addressed (Baldwin et al., 2011; Reid Ponte, 2012). This increased

involvement in the decision-making process allows physicians, nurses, and other

members of the healthcare team to better consider alternative courses of action, arrive at a

consensus, and carry out plans with more knowledge, ease, and willingness.

However, dyads or interdisciplinary teams are not without disadvantages. One

obvious drawback of the dyad model is that it creates additional cost for the organization

(Baldwin et al., 2011). Specifically, time and money are needed to educate and train

physicians on managerial techniques and processes, which not only incurs expenses but

also takes them from their practices, i.e., their earning activities. Additionally, the success

of the dyad model is highly contingent on the capabilities of the manager, usually

someone with an MBA, to educate, train, and work with the physicians in the use of the

model. While the managers may be highly knowledgeable and experienced in decision

making and managerial strategies, they may have difficulty working in the unique context

of the hospital setting, as responsibilities, tasks, and authorities are shared between

various individuals in a non-pyramidal structure.

Competencies for Interdisciplinary Teamwork and Leadership

Studies have shown that interdisciplinary teamwork and leadership have led to

improvements in decision making, safety culture, and job satisfaction, both in the

healthcare setting and outside of it (Allen et al., 2015; Tremblay et al., 2014). However,


physicians and nurses cannot simply be recruited to take part in interdisciplinary teams

and be expected to perform managerial tasks and exhibit leadership skills without any

background or training (Walker et al., 2012). Certain skills and competencies, aside from

technical skills required in the profession, are necessary for effective collaborative work,

even more so in effective interdisciplinary collaborative work (Walker et al., 2012). As

members of interdisciplinary teams are often trained differently and may follow

contrasting protocols, difficulties may arise during meetings, planning sessions, and in

decision making. Hence, interdisciplinary team leaders will need to be trained in

interpersonal relations and effective professional communication.

The effective sharing of leadership responsibilities with individuals from other

disciplines and professions requires much work, patience, discipline, trust, and effective

and honest communication (Reid Ponte, 2012; Walker et al., 2012). Continuing

professional education teaches and instills these skills and competencies n

interdisciplinary team leaders (Légaré et al., 2013). While there is already a widespread

use of interdisciplinary leadership teams for shared decision making in healthcare

settings, healthcare organizations and associations have yet to arrive at a unitary,

generally agreed-upon definition of shared decision making (Légaré et al., 2013). This

lack of consensus on definitions has also resulted in a lack of consensus on conceptual

frameworks for training in interdisciplinary leadership and teamwork and in identifying

core competencies needed for shared decision making (Légaré et al., 2013). While no

specific competencies have been identified as necessary precursors for successful

collaborative work, research and experience have shown that there are two broad

categories of competencies that physicians, nurses, and professional managers need for


effective interdisciplinary teamwork (Légaré et al., 2013). These two competencies are

relational competencies and risk communication competencies (Légaré et al., 2013).

Relational competencies refer to the skills and abilities necessary for creating an

environment that is conducive to communication and interaction (Légaré et al., 2013).

These competencies may be used in the professional relationship between the healthcare

providers and patients, as well as among healthcare professionals. Risk communication

competencies refer to the ability to communicate information about health conditions, the

risks of interventions, and prescribed courses of action (Légaré et al., 2013). Clear and

detailed communication about such information is necessary for a team of physicians and

healthcare providers to arrive at a consensus on the best course of action to take in

specific circumstances.

The Healthcare Setting

The healthcare setting is a complex system because of the different professions

involved in the provision of healthcare, the various departments or disciplines within the

medical profession, and the different levels of organizational management. For example,

a typical healthcare organization includes nurses, doctors, laboratory technicians, aides,

and support staff. There are also typically several departments, such as oncology, internal

medicine, ophthalmology, and dermatology, among others. Additionally, a group of

professional managers are responsible for making decisions regarding management, staff

retention, finances, and organizational growth.

In recent years, especially with the publication of the Institute of Medicine’s

report on preventable adverse errors in both private and public hospitals, the U.S.

healthcare system has received significant criticism for its fragmented nature and its lack


of safety (Kohn et al., 2000; Maxson et al., 2011). In response, healthcare organizational

managers and medical organizations have been developing and implementing programs

and modifying organizational operations and management to improve communication,

documentation, and safety (Allen et al., 2105; Baldwin et al., 2011; Maxson et al., 2011;

Walker et al., 2012). One of the most widely-applied interventions is the use of

interdisciplinary leadership at various levels of an organization to improve decision

making regarding the organization, policies, protocols, and procedures.

Interdisciplinary Leadership

Leadership has long been a topic of great interest in academe and in practice

(Lawrence, 2015; Margolis, Rosenberg, Umble, & Chewning, 2013; Reid Ponte, 2012).

Research in this area has mainly focused on leadership theories, best practices, and the

qualities of good leaders. Such work has led to the development of several leadership

theories that describe how leaders lead, how they influence their subordinates, and how

tasks are completed through the use of such methods (Reid Ponte, 2012). These

leadership theories can be applied in various fields and contexts, including politics,

sociology, businesses, and in ethnic groups. Leaders in business organizations are often

educated and trained to become leaders, especially those with Master’s degrees in

business or management. In contrast, doctors or physicians who hold leadership positions

often are not knowledgeable or well-trained in business and management concepts

(Baldwin et al., 2011). Physicians therefore need to increase their organizational

knowledge and managerial skills and use these in combination with their clinical

knowledge when taking leadership roles in healthcare organizations. Additionally, as


physician leaders collaborate regularly with professional managers and other healthcare

professionals, they need to be trained in interdisciplinary leadership.

While there are numerous relevant leadership theories and best practices that may

be related and applied in this study, such as transformational leadership and charismatic

leadership, the most relevant theory is interdisciplinary leadership because of the context

of this study. Interdisciplinary leadership fosters collaborative work through open

communication lines through which leaders or managers in various departments or

professions can share their inputs or ideas regarding an issue, plan, or project (Reid

Ponte, 2012). In the healthcare setting, using the dyad model, triad model, or

interdisciplinary approach also increases the chances that the concerns and opinions of all

departments or professions (e.g., nurses, aides, doctors, and laboratory technicians) are

represented by their group leaders at the management level (Reid Ponte, 2012). Such

equal consideration of all perspectives involved in healthcare provision strengthens and

rationalizes decisions regarding objectives, priorities, resource allocation, and policies.

Typical interdisciplinary teamwork or leadership in healthcare organizations takes

the form of the triad. At the executive level are three co-managers: the chief nursing

officer, chief medical officer, and chief operating officer, i.e., a nurse leader, a physician

leader, and a professional manager (Reid Ponte, 2012). In such a structure, each of these

three members of the triad report to the president or chief executive officer and have

different but complementary tasks and responsibilities (Baldwin et al., 2011; Reid Ponte,

2012). Triads at the executive level brainstorm and collaborate to make decisions

regarding policies, program development, and staffing.


At the service or frontline level, interdisciplinary leadership teams collaborate on

decisions regarding protocols, procedures, and standards (Reid Ponte, 2012). While

interdisciplinary leadership teams at the executive level focus on macro-level planning,

decision making, and implementation, interdisciplinary leadership teams at the service

level make decisions regarding the department and specific patients. For example, dyads

and triads at this level may collaborate on developing new programs and modifying

existing programs, maintaining and monitoring the quality of service, improving quality

of care, and managing finances and other resources.

Although the specific objectives and missions of each interdisciplinary leadership

team vary, there are general principles that guide such collaborative work. First,

interdisciplinary leaders should adhere to a philosophy of inclusion so that all team

members are involved in the planning and decision-making processes and all disciplines

are represented in the final plan (Reid Ponte, 2012). In addition to ensuring the

involvement of all leaders who represent the various disciplines, leaders must also

commit to representing their constituents by considering their opinions and ideas and by

ensuring transparency (Reid Ponte, 2012). However, as differing perspectives can be

expected, leaders should present unbiased opinions and consider the best options

regardless of the discipline of the team member who suggests the most plausible course

of action (Reid Ponte, 2012). Last, to ensure no redundancy in tasks and responsibilities,

interdisciplinary leaders should ensure that each member’s responsibilities are stated

properly and clearly and that each leader understands fully his or her responsibilities and

tasks (Reid Ponte, 2012).


Reflections of the Researcher

The number of preventable adverse events in the country is alarming and warrants

effective and timely intervention. Adverse medical events include ttransfusion errors,

adverse drug events, wrong-site surgery, surgical injuries, avoidable suicides, treatment-

related infections, burns and falls, and even mistaken identity. This review of current

literature on the use of interdisciplinary leadership teams in the healthcare setting to

improve safety and outcomes in the hospital has provided evidence, and along with it

some hope, that preventable adverse events can be minimized. However, the review of

literature has also shown that much research still needs to be done. First, there is a need

to arrive at a concise and generally agreed-upon definition of interdisciplinary decision

making and leadership. This will allow for further work on establishing the necessary

competencies to perform effectively in such positions. When the competencies are

established, it will then be easier to develop continuing education curricula on

interdisciplinary teamwork, interdisciplinary leadership, and interdisciplinary decision

making.

Summary

Chapter 2 provided a review of current literature on the topic or problem

addressed in this study. The review showed that there has been a rise in the use of

interdisciplinary leadership teams at various levels in the healthcare setting to improve

safety and patient outcomes, as well as outcomes for the healthcare providers. Practice

has shown that the use of interdisciplinary teams has its benefits as well as its drawbacks.

Healthcare organizations thus need to design interdisciplinary teams such that they

perform at an optimum level. The review also showed that, while there is no established


list of competencies needed by physicians and other healthcare providers to participate in

interdisciplinary leadership teams, there are general principles (e.g., inclusion,

involvement, and respect for differences) and skills (e.g., communication and group

dynamics) that practitioners have generally agreed upon as contingent to the success of

interdisciplinary leadership teams. Last, the review of literature provided a brief

description of the context of this study, the healthcare setting, and a discussion of

interdisciplinary leadership principles in practice.


CHAPTER THREE: METHODOLOGY




large healthcare organization.

Aim of the Study

The aim of this Dissertation in Practice study was to use the findings on dyads

and triads in the healthcare setting to design a decision-making model for



Research Questions

In order to identify optimal ways of using interdisciplinary teams in the healthcare

setting, the design and conduct of this study were guided by the following research

question: What are the perceptions of physicians and professional managers on the use of


Specifically, data collection focused on answering the following sub-questions:

1. What factors are considered in creating and implementing dyads or triads?

2. What objectives, or for what purposes, are dyads or triads usually created?

3. What competencies are perceived as necessary to effectively and efficiently

function in dyads or triads?

4. What protocols and procedures are followed in decision making within dyads

or triads?


5. What are the perceived advantages and disadvantages of dyads and triads

against non-interdisciplinary teams?

6. What are the perceived areas or facets of dyads or triads that may be modified

to improve effectiveness and efficiency?

Methodology

In this Dissertation in Practice study, the researcher used qualitative methods to

explore the use of interdisciplinary leadership teams in the healthcare setting. The use of

qualitative methodologies involved the use of an interpretive and naturalistic approach,

which allows the researcher to locate himself or herself in the world in order to study,

interpret, and represent a certain facet, event, or phenomenon (Denzin & Lincoln, 2005).

In other words, qualitative research allows the researcher to study things in their natural

settings and to attempt to describe and interpret events or phenomena based on the

meanings people assign to them (Denzin & Lincoln, 2005).

In this study, the researcher has chosen to use the case study methodology or

approach to qualitative research, which is appropriate when the objective of the study is

to understand an issue or problem by exploring and understanding a specific case as an

illustration or representation of the issue (Creswell, 2013). Case study research is

concerned with the exploration of one or more cases within a bounded system as a means

to study or understand a specific issue (Creswell, 2013). For this Dissertation in Practice

study, the issue being studied was the use of interdisciplinary leadership teams, and the

healthcare setting was the bounded system.

The case study methodology was appropriate for exploring the use of

interdisciplinary leadership teams within the chosen system of the healthcare setting


because the aim of this study was to develop a model and to provide a deep

understanding of the issue, and there are clearly identifiable cases within the bounded

system, i.e., specific hospitals or healthcare facilities within the larger healthcare system.

The qualitative data collected were the perceptions and narratives of experiences of

doctors and professional managers who experienced participating in an interdisciplinary

team.

Measures of quality used included member checking, triangulation, and audit

trail. Member checking and triangulation enhanced the study’s credibility while creating

and providing an audit trail to increase the study’s dependability. These measures are

described in later sections of this dissertation.

Participants

In order to conduct this case study, the researcher chose a healthcare organization

in New Jersey that was both appropriate for the study and had dyads in place. First, the

researcher approached the president of the healthcare facility or the director for affairs to

explain the study and to ask for assistance in recruiting participants. Specifically, the

researcher asked the president or the director for referrals to doctors and professional

managers who held leadership positions on interdisciplinary teams in their facility. The

researcher then sent a letter to the suggested individuals. This letter explained the purpose

of the study, the methodology, and the specific details about the participants’ roles,

rights, and expectations. The researcher also indicated his contact information in the letter

so that the prospective participants were able to contact him for inquiries and to confirm

or decline the request to participate in the study.


The prospective participants were given one week to respond to the invitation

letter. After such time, the researcher contacted by phone all prospective participants who

had yet to respond to the letter. Once all prospective participants were contacted, and the

researcher had already recruited at least eight participants from the different professions

(e.g., physicians and professional managers), the researcher scheduled an initial meeting

to debrief all of the study participants. In this initial meeting, the researcher briefly but

concisely explained the roles of the participants, answered any questions they had, and

scheduled the individual interviews. The researcher also asked the participants to provide

him a copy of relevant documents pertinent to the study.

Instrumentation

In order to gather the perspectives and narratives of the experiences of healthcare

professionals and professional managers on the use of interdisciplinary teams in the

healthcare setting, the researcher conducted semi-structured interviews with these

individuals. In order to understand the mechanisms and outcomes of interdisciplinary

leadership teams, the researcher also reviewed and analyzed documents and records on

the use of such teams. The researcher analyzed data gathered from the interviews, along

with the documents and records, in order to see which events or circumstances may have

caused or influenced the professionals’ perspectives and experiences. Triangulation, or

the use of multiple sources of data in a single study, is critical in case study research, as it

confirms and completes the collected data (Houghton, Casey, Shaw, & Murphy, 2013).

This process subsequently enhances the credibility of the study (Houghton et al., 2013).


Overview of Data Collection

The issue explored in this Dissertation in Practice study was the use of

interdisciplinary leadership teams in the healthcare setting. In order to explore this issue,

the researcher gathered data from doctors and professional managers who had

experienced participating in an interdisciplinary team. As interdisciplinary leadership

teams were composed of professionals and individuals from different fields or

professions, it was important to gather the perspectives of these different groups of

individuals to better understand the issue. In healthcare settings, interdisciplinary teams

are usually dyads of a doctor and a professional manager or triads consisting of a doctor,

a registered nurse, and a professional manager. Hence, it was important to gather the

perspectives of healthcare professionals and professional managers in order to create a

deeper and more complete understanding of the use of interdisciplinary leadership teams.

The researcher inquired about these individuals’ personal opinions and

professional perspectives on the use of interdisciplinary leadership teams, as well as

reviewed and analyzed documents and records related to, and which emerged out of, such

teamwork. Throughout the data collection and analysis, the researcher maintained a

research journal wherein specific steps taken and procedures followed were noted for

documentation. This process allowed the researcher subsequently to reflect on decisions

that informed the procedures of the study. The journal also helped the researcher to create

an audit trail when writing the final study report. An audit trail is a comprehensive and

chronologically arranged set of notes on the context of the study, the provenance of the

data gathered, and the rationale for methodological decisions, especially data analysis

(Houghton et al., 2013). Including an audit trail in the final report of the study allows


readers to better understand or discern the researcher’s interpretations and

methodological decisions, thereby increasing the study’s dependability (Houghton et al.,

2013).

Procedures

There were a total of three meetings with the study participants. The first meeting

was between the researcher and the participants as a group. This meeting served as a

debriefing meeting wherein the researcher introduced the study and explained the

participants’ roles, responsibilities, rights, and expectations. The researcher discussed

with the participants their preferred schedules for the semi-structured interviews.

The second meeting consisted of the individual, semi-structured interviews. As it

was expected that the participants had very rigid schedules, they indicated their preferred

dates and times for the individual interviews. These interviews took place in the

participants’ offices within the healthcare facility, where privacy and a professional

atmosphere was expected. The interviews typically lasted for about an hour and a half to

two hours. It was at this point that it was very critical for the researcher to uphold

bracketing, or epoche, wherein the researcher or analyst sets aside his own experiences

and perceptions as much as possible in order to gather data and view the case or

phenomenon being studied with a blank or fresh perspective (Creswell, 2013).

As the interviews were semi-structured, the researcher followed the interview

guide (see Appendix A); however, the participants were allowed some leeway to discuss

other matters as they deemed them relevant to the study. The participants also brought to

the interview copies of any documents they may have possessed regarding their

experience working in interdisciplinary leadership teams. Such documents included


minutes of meetings, project and program documentation, memos and letters, and final

reports.

The third meeting was also one-on-one between the researcher and the participant.

The purpose of this meeting was for member checking, which is the process wherein

participants verify the transcriptions of their own interviews (Koelsch, 2013). In this

meeting, the participants were allowed to modify or delete certain parts of their responses

during their interviews. This step ensured that the researcher had indeed gathered data

and understood the participants’ perceptions and experiences based on their own

accounts.

Data Analysis Plan

In line with typical case study research, it was important to analyze the data from

both data gathering procedures (interviews and document analysis) together and in

chronological order, such that the individual perceptions were related to events within the

case (Creswell, 2013). Hence, the first step in data analysis was to lay out the timeline of

events from the creation of the interdisciplinary team until the time of data collection.

Then, the researcher identified and described the members of the known teams, the

objectives of the teams, the programs and projects of each team, and the tasks and

responsibilities of each of the members. Much of this information was extracted from the

review of the documents provided by the participants.

Next, the researcher incorporated the responses of the participants during the

interviews into the timeline. Specifically, narrated experiences and shared perceptions

and opinions were related to the specific team and specific event to which they refer. This

allowed the researcher to better understand the circumstances that led to such responses


from the participants. The researcher then analyzed the timeline by identifying events that

led to positive opinions and successful outcomes, as well as events that led to negative

opinions and unsuccessful outcomes.

Throughout the data collection and analysis, the researcher identified and noted

instances wherein the participants exhibited leadership qualities and managerial skills.

Physicians in leadership roles are often untrained for such positions; hence, it was

expected that the professional managers were more adept at using managerial skills and

applying leadership theories. During the interviews, the participants were asked to reflect

upon or analyze their own participation and the participation of others and describe

whether they thought leadership qualities were applied in certain circumstances.

Reliability and Trustworthiness

Through the development of the methodology and specific procedures for this

Dissertation in Practice study, the researcher has realized the difficulties of conducting a

qualitative study, especially one conducted in a setting that was already very familiar to

the researcher. This difficulty arose when, no matter how hard the researcher tried, there

was some level of bias in the conduct of the study as a result of the researcher’s own

experiences in the same facility and knowledge about the professions and about

leadership skills, qualities, and theories. Having realized this, the researcher decided to

exert even more effort and be more conscious about specific instances wherein personal

bias may have hindered his professionalism, and he subsequently took measures to

address this problem. Additionally, the researcher took the time to reflect after each

interview and throughout the data analysis process in order to recognize instances of bias

and prejudice and to resolve them.


Ethical Considerations

Because the personal opinions, perceptions, and professional experiences of

individuals were involved in the conduct of this study, it was important to protect the

identity of the participants throughout data collection and analysis, as well as in the final

product. In order to ensure the personal comfort of the participants, they were allowed to

refrain from responding to questions they did not feel comfortable answering, and they

were provided the right to withdraw from the study at any time. In order to protect the

participants’ identities, the researcher took measures to ensure that no one was able to

identify specific participants’ contribution or participation in the study. The participants

were referred to by a code in the audio recordings of their interviews, the transcriptions of

their interviews, and in the documents that they provided. The participants were also

referred to by code in the final, written dissertation. Last, the audio recordings and

transcriptions were kept in a safe and secure location known only to the researcher and

his adviser, where they will be stored for up to five years from the conduct of the study,

after which such data will be destroyed. Additionally, the researcher went through the

IRB at Creighton University and had permission from the institution as well.

Reflective Practices

In order to document the entire experience of writing and conducting this study,

the researcher kept a journal wherein all interview transcripts, interview analysis, notes,

ideas, and reflections were written down for documentation and future reflection. The

researcher also noted his reflections and perceptions about each of the interviews after

each concluded. The researcher also noted contextual descriptions in this notebook to

provide background and circumstantial information that may have influenced the


researcher’s opinions, thoughts, and perceptions at the time of writing. Such contextual

descriptions included the weather, current events, and the researcher’s other

commitments and personal events and experiences.

Summary

The purpose of the Dissertation in Practice study was to explore the experiences

and perceptions of physicians and professional managers on interdisciplinary decision-

making teams in a large healthcare organization. This was conducted through a single

case study. The researcher gathered data from physicians and professional managers who

had experience with participating in an interdisciplinary leadership team. Data were

gathered through individual, semi-structured interviews and document analysis. The data

were analyzed and presented as a chronology of events that included specific information

about the interdisciplinary teams, their objectives, programs, and projects, the individuals

involved and their specific tasks and responsibilities, the outcomes of the teams and their

projects, and the perceptions of the participants regarding the entire endeavor.

Subsequently, the researcher identified events that led to positive opinions and successful

outcomes, as well as events that led to negative opinions and unsuccessful outcomes.


CHAPTER FOUR: RESULTS

Introduction

Chapter 4 presents the results from the thematic analysis of the interviews with

healthcare professionals from a healthcare organization. The purpose of the study was to

explore the experiences and perceptions of physicians and professional managers on

interdisciplinary decision-making teams in a large healthcare organization. The

researcher also wanted to extract meanings and themes directly from the perceptions and

experiences of the healthcare professionals about the dyad management model and its

effectiveness in the healthcare setting. The computer software program NVivo10 by QSR

was also employed to aid in the organization and systematic coding of the responses of

the participants. The researcher addressed the main research question of the study, which

was: What are the perceptions of physicians and professional managers on the use of


The following research sub-questions were the focus of the study:

Research Sub-question 1. What factors are considered in creating and

implementing dyads or triads?

Research Sub-question 2. What objectives, or for what purposes, are dyads or

triads usually created?

Research Sub-question 3. What competencies are perceived as necessary to

effectively and efficiently function in dyads or triads?

Research Sub-question 4. What protocols and procedures are followed in

decision making within dyads or triads?


Research Sub-question 5. What are the perceived advantages and disadvantages

of dyads and triads against non-interdisciplinary teams?

Research Sub-question 6. What are the perceived areas or facets of dyads or

triads that may be modified to improve effectiveness and efficiency?





Aim of the Study





Servant Leadership

The healthcare organization used for the study was a major healthcare provider in

New Jersey. It is a $750 million business enterprise and one of the largest employers in

its geographical area, with more than 5,200 employees and 600 physicians on its payroll.

As the region’s provider of health and wellness services, this organization’s goal is to be

the best in five business areas – Best People in the Workplace, Best Customer

Experience, Best Quality, Best Growth, and Best Financial Performance.

The organization understood that, to achieve those goals, it had to build an

engaged and committed internal culture. Creating an engaged workforce plays a large

part in that effort, and the organization ensures that its employees understand how their


individual efforts contribute to the achievement of organizational goals. A second

important factor in this organization’s success is its leadership team’s commitment to the

principles of Servant Leadership. All of the organization’s managers go through a 33-

week experiential course on Servant Leadership, which involves classroom activities and

training in 360-degree feedback.

Dyad Decision Making Model

The dyad decision-making model is based on an interprofessional approach to

shared decision making (SDM), and this SDM model assumes that at least two healthcare

professionals from different professions collaborate to achieve SDM with the patients,

either concurrently or sequentially (Légaré et al., 2011). The organization where the

study was conducted takes this model and adjusts it into one where two leaders, one

clinical and one from the administrative position, make the decisions.

The dyads are all composed of one male member and one female member. One of

the members of the dyad is a physician with clinical expertise and experience. The other

member of the dyad is generally an associate vice president and has both an MBA and

training in Servant Leadership. All of the dyad members are experienced leaders and

subject matter experts in their respective areas of expertise.

Description of the Sample

Eight participants were recruited for the study from different departments in the

healthcare organization. Interviews with eight physicians and professional managers on

the use of interdisciplinary teams or dyads/triads in healthcare management and decision

making were conducted to gather their perceptions and experiences. Table 1 describes the

backgrounds of the eight participants.


Table 1 Backgrounds of the Study Participants Participant Background Participant 1 Chairman of Emergency Services Participant 2 Service and Satellite Emergency Department Participant 3 Clinical Nurse (Private and Public Practice) Participant 4 Neurosciences, Administration, and Quality Manager Participant 5 Chairman of Critical Care Participant 6 Assistant Vice President of Nursing Participant 7 Medical Director for Hospital Medicine and Chief of the

Medicine Service Line Participant 8 Assistant Vice President for Medicine and Pharmacy Service

Lines

Data Analysis

The researcher performed a qualitative thematic analysis on the participant

interviews. The thematic analysis of the interviews allowed for the discovery of the major

findings and themes that address the main research question, as well as the six research

sub-questions of this study. Creswell (2003) explained that the qualitative thematic

analysis approach provides the foundation for meaningful “descriptions of the

phenomenon” to be established using the clustered codes and themes from the data (as

cited in Wolhuter & de Wet, 2014, p. 64). The researcher then followed the steps reported

by Attride (2001), where the responses of the physicians and professional managers were

analyzed by: (1) “familiarizing with the data; (2) conducting the initial coding; (3)

searching for themes; (4) reviewing of themes; (5) defining and labelling of themes; and

(6) developing of thematic networks” or relationships from the clustered responses (as

cited in Issa, Isaias, & Kommers, 2013, p. 219). In the presentation of findings, the

clustered themes that received the most number of occurrences are considered as the

major findings, and those that followed are the themes of the study or the other


significant perceptions and experiences. In the next section, the verbatim texts from the

interviews are also included for better understanding of the findings.

Presentation of Findings

Major Finding 1: To Produce the Best Solutions for Patient Care

The first major finding that emerged was the factor for producing the best

solutions for patient care. This was based on the first research question, which was the

factor in creating and implementing dyads or triads. The first major finding received five

occurrences from the responses of the eight participants, or 63% of the total sample

population. Table 2 contains the major finding and other themes discovered from the data

analysis that addressed the first research question of this study.

Table 2 Factors Considered in Creating and Implementing Dyads/Triads

Major Finding and Theme Number of

Occurrences Percentage of Occurrences

Major finding 1: To produce the best solutions for patient care

5 63%

Theme 1: Aligning the overall vision of the hospital or campus

4 50%

Overall, the first major finding was the factor of wanting to produce the best

solutions for patient care. The researcher considered this finding as one of the six most

significant findings of the study. Participant 1 stated that one factor in creating and

implementing dyads is coming up with the best ideas and solutions for the patient:

There is no hierarchy at all. We are, you know, considered equivalent to each

other when we’re trying to discuss or, you know, come up with an idea or a

solution to a problem, and any protocols that we would develop to put into place


for our team to use would also include input from the key stakeholders in those.

So it would be the physician leadership and the nursing leadership all coming

together, identifying what the problem or issue is, and then coming up with all the

potential solutions and then sorting through those solutions and then picking what

the group believes is the best solution to start with.

Participant 2 echoed how another factor is a focus on improving the patient care:

You know, it is a hard question when you’re describing yourself and you think

about it. Um, I, I truly want to be a partner with, um, whoever I’m working with.

I’m truly there trying to advance emergency nursing and, and improving the care.

So I, I do want to be a partner and, um, I’m flexible. I would say I’m very

flexible, 98% of the time.

Participant 4 shared how the main factor considered in establishing the dyad care

is improving the services and developing the best quality care for patients:

In today’s healthcare system, you cannot successfully run as an organization

without having a dyad approach. You 100% need physician engagement

paralleled with your administrators in order to have, you know, an optimal

organization running because o- one can't function without the other. You need

that clinical expertise, you need that engagement for, I mean I could go on and on

and on but for m- almost every single reason from the cost standpoint, you know,

from billing, from quality of care, from strategic planning and, you know, adding

in new services. If you, you're going to fail if you don’t have physician

engagement. It’s that’s the new strategy that you’re going to see everywhere

today, you have to have that buy-in position so I, I know there are some hospitals


out there that are very corporate heavy, C-suite heavy as we say where it’s very,

very, you know, y- you’re being, and I have nothing against, you know, there’s a

lot of MBAers, a lot of MBAers out there...

Participant 6 shared that dyads were formed to develop the best and safest patient

care that they could provide:

Well in, in healthcare we’re fortunate enough that we do go to the evidence. We

go to the evidence, and then if we wonder… take time as a factor. We’ll look for

further evidence around success even in time, to set reasonable goals to not be

you know, not approach it out of emotion, not approach it out of any, you know,

different perspective other than for safe patient care and the evidence that governs

that. I think that helps us keep our decisions very uh… I don’t know, we’ve made

some really good ones.

Participant 7 stated how the United States has the most expensive healthcare, and

thus it is right to provide the patients with the best care that they could give:

What you see is this line right here is the United States. We have the most

expensive healthcare in the world, period. Okay. So that should equate to we get

the best bang for the buck. This is a subsequent piece of information. It talks

about life expectancy at first. So even though we are the most expensive

healthcare in the world, we don’t live nearly as long as some of those on average

that are a lot cheaper.

The first and only theme that followed the major finding was the factor of

aligning the overall vision of the hospital or campus. The theme received four

occurrences, or 50% of the total sample population. Participant 3 shared that the model


has been beneficial, since it helps the hospital align its vision:

I think overall if I... If you put me on the spot right now, I think it is a beneficial

model. I’m actually glad that AtlantiCare is moving towards that model. It helps

to balance and align the vision, if there’s vision. I think to help lay out, you know,

the strategy and again, if it’s working, if everything is working and kicking all of

the cylinders together, alignment, strategy, vision and the balance of clinical and

admin, it’s a slam dunk model. It’s a great model.

Participant 5 shared how they create dyads to agree and align the vision of the

organization in the end:

I think since most of us go into the dyad knowing that we need to agree to agree,

we work together to work out the process. And sometimes as in with my first

dyad partner, that’s sitting down and having some very frank and… and honest

conversations about this makes me uncomfortable or I think you’re being too

much of a… a heavy person here or me saying I think you’re not dealing directly

with the issue and you’re being too kind and not holding people responsible

enough until we… sort of an iteration process where in the beginning there were

lots of those conversations and an honest attempt by both of us to move closer to

the middle.

Participant 6 echoed the importance of leaders coming together to reach the vision

and mission of the organization:

And so for me, I do believe we are reaping the benefits of seeing the two partners,

the two leaders come together, have the shared vision, mission, the goal, the

purpose and stay the course. We may be redirected, the time, the climate, the


work, the resources may, you know, put us on a different path, but we do have

that common bond between us that we come back to the work

Participant 8 emphasized the reasons for creating and implementing dyads:

In a line of care, you know, I mean we have our values, which are really at the

heart of the organization. So it's a very team oriented, very, goal, high goal

oriented, visionary type of organization. So you know, in terms of what matters,

you know, it’s outcomes, it's results, you know, and so there’s a strong thread of

responsibility, accountability, built in there. But we also are a serving leader

organization, so while we're not Jesuit or religious based, and in fact we have

probably more diversity in this organization.

Major Finding 2: Working Together as a Team

The second major finding that emerged was the purpose and objective of working

together as a team. The second major finding was discovered based on the second

research sub-question of the study, which was the objectives or purposes for which dyads

or triads usually are created. The finding received five occurrences, or 63% of the total

sample population. Table 3 contains the second major finding and other themes

discovered from the analysis, which address the second research sub-question of the

study.

Table 3

Objectives/Purposes of Dyads/Triads

Major Finding and Themes Number of


Major finding 2: Working together as a team

5 63%

Theme 1: Goal of optimal care for patients

3 38%


The researcher considers the second major finding, which was the goal of

working together as a team, as one of the six most vital findings of the study. Participant

2 stated that one important objective upon creation of the dyad is that everybody has to

work together as a team to produce the best outcomes and results: “Everybody has got to

get on board.” Participant 3 stated how one objective upon the creating of dyads is to

work together equally, as a team:

Yeah. Exactly. There was no, um, one upping of each other. One would, you

know, back off on if a clinical question came up, the administrative person would

defer to the clinical person, the clinical person would defer on the administrative

question to the administrator. So, there was respect of each other’s, you know,

um, expertise. And they had buy-in from the seniors so they got it done. Um, so

that’s where I’ve seen that work extremely well, and they both had mutual support

for their goal.

Just like a bad marriage, you know, and then you’re like trying to figure

out, you know, relationship dynamics.

Participant 5 shared the different goals and procedures that her dyad teams practice:

It is. In the first dyad with the AVP that resides in the other facility, decisions are

2 thumbs up decision. There is… we don’t leave the meeting until we both agree

on a course of action. In the more informal one, what will often happen is a

decision is made by one or the other of the dyad leaders bounce off of the

respective partner and it’s a yay or a nay. Generally speaking it’s a yay without a

whole of discussion because it’s somewhat of a logical process. In the third one


decision are made generally by me and this is one… the sepsis work but then

assessed for efficiency, practicality, doability by the other dyad partners so it’s

more of a veto vote than a governing vote.

Participant 6 compared working in dyads as a marriage in which the teams should

agree to reach and achieve the best care for their patients:

I have remembered reading the article where, again, it’s this marriage, it’s this

partnership and I thought what’s in between us so that it’s never the blame. You

don’t, you never blame each other. You don’t get to walk away because the bond

you have is the patient, first and foremost, and the organization. So the dyad in

my opinion truly is that marriage and it is about co-submission. It is about no

matter what, at the end of the day getting along because there is a patient and

there is the organization. So that’s how I see it.

Participant 8 also emphasized the importance of having an effective model for

teams:

I think the dyad model is effective. I think that it, it asses some structure that

previously you had to connect, you know what I mean? So if I on my own, as the

pharmacy executive, needed to impact something relative to the hospital doctors, I

can’t even think about the steps I’d have to take. But now it’s assed.

The first and only theme that followed the second major finding was the goal of

optimal care for patients. The theme received three occurrences, or 38% of the total

sample population. Participant 1 shared the importance of having the goal of optimal care

for patients or quality service that the patients deserve:


We discuss what, and make sure that the, the nursing and the physician, goals and

objectives are, you know, aligned, so that, you know, again, that’s, that’s the basis

and, and the ultimate, sort of what’s the word I wanna use? The ultimate goal is,

you know, for optimal patient care. So that’s sort of the great equalizer of while

the influences and the, you know, the, the ability to a chain, attain those goals

maybe, you know, coming from different directions, at the end of the day, the,

you know, the question that, you know, is the thing that levels the playing field is,

well, what is, what is it that's gonna best serve the patient? [The patient care is

always the core.]

Participant 4 stated that the main goal of the dyad approach is to provide the

lowest cost with the best optimal care and outcome:

So, pretty much everything and anything we do, we take the dyad approach to…

and that combined, you know, both administrator and physician because that’s the

only way you can effectively run the service line. With, you know, our goal is,

obviously, you know, lowest cost with optimal patient care and outcome, so the

only way to succeed as best we can with that is, is doing the dyad approach. So,

we meet on a daily basis. We check in. We have a neurosciences steering

committee meeting, which is ran by myself and the physician lead as my support

for that. We also are on clinical effectiveness teams together as well and those

meet monthly. Again, same thing as far as reducing costs and continuing to

provide optimal patient care. So you have to have that really, really strong

personality, not confrontational but to speak up.


Participant 7 explained the goal of the dyads as delivery of quality healthcare to

the patients:

That’s why you have a dyad relationship in this type of a setting and a service line

setting because if I just operated on cost, I take every patient to the operating

room necessarily or unnecessarily. We know how that turned out just recently

with the oncologist in Michigan. I mean, that was his model. He got paid for it

and he’s in jail now but the reality is that isn’t what healthcare is about. So it’s…

it’s balancing the scope of the industry to accomplish that Triple Aim. You have

to deliver quality. It has to be done efficiently. I can’t bring people into the

hospital anymore for… for, you know 10 days to run tests and run more tests. It’s

probably focused and then keeping the customer at the center.

Major Finding 3: Ability to Support Arguments with Evidence

The third major finding that emerged was the ability to support arguments with

evidence. The third major theme was gathered from the third research sub-question,

which was the competencies perceived as necessary to effectively and efficiently function

in dyads or triads. The third chief finding received five occurrences, or 63% of the total

sample population. Table 4 contains the third major finding and other themes discovered

from the analysis, addressing the third research sub-question of the study.


Table 4

Competencies Perceived as Necessary for Members of Dyads/Triads



Major finding 3: Ability to support arguments with evidence

5 63%

Theme 1: Good communicators 4 50% Theme 2: Flexibility in working with

others 3 38%

Theme 3: Formal education and experience

2 25%

Theme 4: Strong personalities to convince buy-in

2 25%

Theme 5: Positive mentality 1 13% Theme 6: Credible reputation 1 13%

Overall, the researcher considers the third major finding, which was having the

ability to support arguments with evidence, as one of the six most important findings of

the study. Participant 2 also suggested how the members should be able to present and

back up their arguments with concrete data:

You always have to have data to back up your argument. I mean nobody will

listen to you without the data.

You have to have it, or else you’re just spinning your wheels. What’s very

helpful is the individual report cards. So every physician has a report card. Um,

we haven’t gotten to that point with nursing. But every physician has a report

card, and so we know how many patients they see. We know how many studies

they ordered, the over-utilizers, the under-utilizers.


Participant 4 explained the importance of dyad members being able to support

their arguments or having evidence-based claims:

I’ll give you an example, we were you know, questioned on our neurotransfer

process and we were told that, you know, it was not working. Our team, our dyad,

protocol that our dyad, we had put together was not working. And it’s very

simple, we always ask people why, give us facts not emotions. I always say I

don't want me e-mails to ever be emotions... Everything is factual. Everything is

fact-based.

Participant 5 also described the importance of having the skill set for data analysis:

My personal leadership quality is in skills. I think of… revolve around the fact

that I’m very good at data analysis. I can pick out patterns from the noise very

easily and very rapidly. I can assess whether or not data is sound pretty quickly

and one of our problems has been the inability to get good pure data. Across all

my dyads that has been a challenge and I have had to work with different software

systems, different report writers and different purveyors of the data to finally get

information that we can rely on. And that’s probably one of the best things that I

brought to my team is the assurance that when we’re looking at numbers, they re-

reflect the reality of the situation.

Participant 6 again highlighted the importance of having concrete evidence to

support their proposals:

You know, fortunately in healthcare you always go to your evidence. So you find

out quickly who else is doing what, what the evidence shows we should be doing.

Now let’s look at the data, what are we doing and where are the gaps and let’s go


correct. That, which was really pretty much our approach to it. So we kind of…

there were times where just our relationship could be strained due to the others on

the team straining, but certainly it was always united we stand. We never outright

had that dialogue. I think we just perceived it from each other, just knowing

leadership. I think we both have a strong background in understanding effective

leadership. And so we would go in the room and we would be united, but the team

really had to do a lot of relationship building and learning and communicating.

The first theme that followed the third major finding was the competency of being

good communicators. The finding received four occurrences, or 50% of the total sample

population. Participant 1 stated the importance of the members being good

communicators, where they can communicate about the best care that they can provide to

their patients:

And, and that, the best form or the best success that I found in negotiation is good

communication. So, you know, having, again, the, the patient care as the, you

know, as the, you know, the core focus, that helps to re-orient, you know,

conversations and meetings. When they start to get a little bit down into the weeds

of opinion and maybe prior experience, or projected, you know, outcomes, and we

can say, “Well, let's deal with the here and now” and let’s deal with the

equipment, the resources that we have available to try and achieve this goal with

what we have or if we need to attain something, how do we work together and get

some economy of scale and the latter voice to be able to attain what that resource

is by saying it’s not just one of the two entities, but it’s both entities that feel that

this is really important to try and get done.


Participant 3 shared how vital it is to have members of the dyad who know how to

communicate and respect the opinions of one another:

Here’s the con of the dyad model is when you have two, you know, when you

have two leaders who are both excellent leaders but have two different ways of

thinking about the outcome or ways to get to the outcome or don’t agree or, you

know, are not aligned about even the outcome itself. “Why are we doing what

we're doing? I don't think we should do A. We should do B.” It’s I think the

communication then... If you don’t have alignment, the communication is either

good communication but they’re not communicating key things or there’s poor

communication because now we’re not getting along because so we, we’re not

aligned.

Participant 7 stated that one important competency is being able to communicate

the objectives of the task clearly:

Communicating objectives. The first part is to … What are the objectives? What

are you trying to accomplish by the decision that you’re making, is the decision

you’re making going to work to stabilize the program and everything that we

work on is a model that I kind of put forward that our job in this dyad relationship

is to keep the ship afloat and moving forward. We’re trying to get our team from

point A to point B and we’re trying to keep that ship afloat despite the fact that

every day somebody is drilling a hole into the bottom of the ship and they ship is

sinking. And we have to, you know… We have to keep that ship afloat and what’s

what we talked about with our leadership team too.


Participant 8 also shared an experience of how she communicates with her dyad

partner:

So the site directors, I meet with Tony constantly. Like we’re in constant

communication. In fact, he calls me his work wife. And I’m like, “Really? That’s

a bad thing.” But like, there’s nothing for me to be riding home for, from work at.

I’m thinking I’m done, phone will ring, “Hi, it’s me just checking in.” It’s like,

who do you need to check in with?

The second theme that followed the third major finding was the competency of

flexibility in working with others. The finding received three occurrences, or 38% of the

total sample population. Participant 2 shared how another competency is the flexibility to

work with others:

You know, it is a hard question when you’re describing yourself and you think

about it. I truly want to be a partner with whoever I’m working with. I’m truly

there trying to advance emergency nursing and, and improving the care. So I, I do

want to be a partner and, um, I’m flexible. I, I would say I’m very flexible, um,

98% of the time.

Participant 3 added that members of the dyads should also know how to balance

their work among each other:

Yeah. I agree with that. I, and I think there are still sharing. I think everyone is

trying to get along and say... They’re trying to play to their strengths, you know,

Hey, “Do you feel passionate about that? Or you go to that, you wanna take that

one?” Okay. Well, then next time something circles back, I’ll take it or ... I, I


think between all the dyads I have worked with, there is a sense of fairness that

they do try to equally balance themselves.

Participant 4 shared that one competency of her team is being able to balance their

work effectively:

No, we balance each other because Ed is very particular on especially when it

comes to data and information, as he was just saying. So I complement that by,

you know, maybe taking it a step further in, in terms of, you know, God, I don’t

know how to say this politically correct, this is hard.

The third theme that followed the third major finding was the competency of

having formal education and experience. The finding received two occurrences, or 25%

of the total sample population. Participant 1 stated the equal importance of educational

and experience competencies:

I think they’re very similarly aligned. You know, I think that she comes with,

some, both formal education and some, you know, years of experience. So the

combination of those two, I think, really, you know, they complement each other.

And that’s what I found in myself as well. So then you can take those, you know,

complementary attributes and say, “Here’s the commonalities from what we’ve

learned experientially and here's the commonalities from what we’ve learned from

formal education and this is the way that we can sort of enhance each other's

experience and education to achieve a higher goal.”

Participant 7 simply shared that: “Experience is probably the number 1 thing. I’m

a more senior physician. I’ve been doing this for 20 years as a physician but I was an

army officer before that.”


The fourth theme that followed the third major finding was the competency of

having and developing strong personalities to encourage buy-in. The finding received two

occurrences, or 25% of the total sample population. Participant 4 highlighted that another

competency would be having strong personalities to encourage buy-in from stakeholders:

With just our overall decision making when we roll something out. I think we’re

very successful because, personalities. You have to be thick-skinned in -

especially when you don’t have jurisdiction and you have to mandate something

over people who you don't have jurisdiction. You have to be almost like a car

salesman with the neuroscience’s service line, truly. Because you have to, you

have to have the strong personality for the mandated p- parts, like I said, with the

joint commission and the state, and then with the things that technically aren’t

mandated but you want to put, implement in place because it’s the best for the

growth of the service line, that’s where you kind of have to be that car salesman.

Participant 5 echoed how one of her competencies is being able to convince other

stakeholders to support their decisions and potential approaches:

My other skill is that I have the ability to get other people to rally around the

cause by first being a role model and modelling the actions that I’m asking them

to do, but also to be able to assist them in overcoming whatever barriers they

have. So my role is to remove barrier… systemic barriers in the healthcare

system.

The fifth theme that followed the third major finding was the competency of

having a positive mentality. The finding received just one occurrence, or 13% of the total

sample population. Participant 1 highlighted the importance of having a “win-win


mentality,” where both members of the dyad have positive outlooks of their end-goal:

I think the ultimate, the one key thing is, is always having a win-win, you know,

mentality. So how can, you know, what I need to happen on my side be a win and

how can the other side of the dyad have a win so that at the end of the day, we’re

gonna be able to trickle all of these down to those that we lead and the mantra will

be, “Well, this is a win for us and this is a win for you.” Therefore, you know, the

buy-in is gonna be a lot, you know, a lot more positive, I think it’s a really… and

in order to get there, it has to be the art of negotiation, you know.

Finally, the sixth theme that followed the third major finding was the competency

of having a credible reputation. The finding again received just one occurrence, or 13%

of the total sample population. Participant 4 stated that they have established their

credibility in the industry, making it easier to implement their approaches as a dyad:

And in 2014, in last year, we actually won an award, the presidential award for

one of our protocols, which was announced, you know, from the president of the

hospital in front of every person that may have bought in… Well it was a huge,

huge presidential award for a large protocol that we initiated as a dyad. Which at

that point, everybody was like, all right, they know what they’re doing. They’re,

they’ve got credibility.

Major Finding 4: Formal Meetings and Discussions

The fourth major finding that emerged was based on the fourth research sub-

question, which was that the protocols and procedures are followed in decision making

within dyads or triads. The researcher discovered that formal meetings and discussions

were the most-employed protocol by the interviewed participants when participating in


dyads or triads. The major finding received seven occurrences, or 88% of the total sample

population. Table 5 contains the fourth major finding and other themes discovered from

the analysis, addressing the fourth research sub-question of the study.

Table 5 Protocols/Procedures for Decision Making Within Dyads/Triads



Major finding 4: Formal meetings and discussions

7 88%

Theme 1: Professional decision making from members

3 38%

Theme 2: Openness to accept the general consent

1 13%

Theme 3: Following a top-down structure

1 13%

Overall, the fourth major finding was performing formal meetings and discussions

as part of the organization’s protocols and procedures. The researcher considers this to be

one of the six most significant findings of the study. Participant 1 stated that there are

also formal meetings and discussions conducted to discuss the patient’s condition and

status: “Usually there’s minutes that are taken and then the minutes get distributed after

the meeting. It’s all written as opposed to any type of recorded, you know, rehash of what

happened at the meeting.” Participant 2 shared that another formal protocol is having the

meetings and discussions with the committee:

Yes, so on a, on a formal basis, uh, minutes are taken and then minutes are shared

with the committee… uh, the group, the group. And I’m, I’m using the sepsis one

because that’s probably the best one. It’s that, um, he reports. He takes the

information and he shares it with the different physician groups, the critical care


group, the med-surg group. He will go to department meetings. He will go to, uh,

the residents’ grand rounds so he takes at that side.

Then I take the information and we, we’re constantly sharing, you know,

presentations so that it’s always the same message, uh, because you’ve got to

have consistency. And so then I take it to the AVPs then I take it to, uh, my

departments. It’s taken, it’s taken to the manager forum. So it’s a, it’s a whole

cascade. It goes down. Issues come up.

Participant 3 echoed that they also conduct regular meetings with the organizational and

structural committees:

If it’s a formal committee, there are... There are organizational committees and

structure committees that are requirements to- for the state. Those will have, um,

committee chairs or co-chairs, meet- meeting minutes and agendas will be taken.

Meaning participants, follow up an action item. So, those things that have to be

documented or documented. Um, there might be other project work and other,

um, committees or, um, initiatives that are going on internally that are also, you

know, requiring that level of structure.

Participant 4 described that the dyad approach has the protocol of conducting

formal meetings and discussions:

So, pretty much everything and anything we do, we take the dyad approach to and

that combined, you know, both administrator and physician because that’s the

only way you can effectively run the service line. With, you know, our goal is,

obviously, you know, lowest cost with optimal patient care and outcome, so the

only way to succeed as best we can with that is, is doing the dyad approach. So,


we meet, on a daily basis. We check in. we have a neurosciences steering

committee meeting, which is ran by myself and the physician lead as my support

for that. We also are on clinical effectiveness teams together as well and those

meet monthly. Again, same thing as far as reducing costs and continuing to

provide optimal patient care. Having to space practice and guidelines and things

like that, and we meet in preparation for those bi-weekly as well, so we have

check-ins bi-weekly for those meetings. Protocol, so every single policy and

protocol for the neuroscience's service line we developed as a dyad, it comes from

the administrative team, myself and the physician, all clinical operations.

Participant 5 added that having formal meetings allow the dyads to create and

plan their course of actions:

My second dyad partner is one of the AVPs of nursing at the other facility from

the one in which I do my main clinical work. She and I meet on a formal basis

every 2 weeks in her office setting. And generally one of us will produce an

agenda. Sometimes it’s her, sometimes it’s me because that work is very

prescribed and we… it is also the oldest of the bodies of work and therefore it is

developed or coalesced into a couple of phases or the phases that we started with,

that we’ve accomplished the phases that are ongoing maintenance work and then

there’s the… the phase of continued improvement where different initiatives

coming up that we are trying to move forward.

That’s the most formal of the arrangements. And our protocol for working

and that arrangement is generally that we will vet the ideas to each other first,

anticipate what possible reactions we could have and then plan a combined


strategy to overcome those reactions. It’s actually very tactical, very formal and

very deliberate.

Participant 7 also stated that they have both formal and informal protocols, but

lean more on the formal side with regular presentations and reports:

Formal structure, we have a report out that we do, with our senior leadership team

on a periodic basis, myself and Sandy Garrett will actually report out on those

things whether… Like this past June, we reported out to the board, on the

medicine service line and, I put together a PowerPoint presentation and we talked

about our mission, our vision. We talked about, how we’ve operationalized

things. We talked about staffing and then we’ve talked about some of the

outcomes.

The first theme that followed the fourth major finding was the important protocol

of following a professional decision making from members. The theme received three

occurrences, or 38% of the total sample population. Participant 1 stated that members of

the dyad should be professional, especially in making their decisions with regard to the

quality of care of patients:

I think it tends to be, overall, it’s always very professional. I mean that’s one of

the… We have sort of a, a set of rules of engagement that I, you know, that I put

into place with the meetings. So it’s usually we follow Robert’s rules. You know,

everyone has to be treated with respect and only one person talks at a time as

opposed to, you know, over them.

So there’s always that professional level that we start with, and then,

certainly, we don’t want to have, you know, the group think model where


everybody just says yes. So we encourage cordial and professional dialogue and

then at the end of, you know, that dialogue, then we’ll call for, you know, a

motion, and then that motion will be seconded and then ultimately, you know,

will be voted upon and that there’ll be a tally of votes. And then the expectation is

regardless of what your position was on the given topic, once it’s decided upon,

then the… all of the leadership team will back whatever the decision was of the

group.

Participant 5 shared that building professional relationships helps in creating valid

decisions:

So with the one partner, the VP partner where we have this… the standard set

every 2 week meeting, that meeting is generally in her office at the other campus

pretty much like clockwork. For the dyad partner, with him I’ve had the ongoing

professional relationship for the last couple of years. Those meetings it… it’s sort

of a running meeting or on a daily basis in communication and in email. No set

formal times for the meetings.

Participant 8 added that the outcomes depend on the professionalism aspect of the

business:

The outcomes, you know. Re-admission, length of stay, mortality, all the DRGs.

You know, we of course have an ACO, so we want to keep business here. So the

amount of referrals, a line of care first, transitions of care is so important. So you

get credit for that, demonstrating you did a hand off with the primary care, we

drive everything through evidence.


The second theme that followed the fourth major finding was the openness to

accept the general consent. The theme received just one occurrence, or 13% of the total

sample population. Participant 2 shared that another protocol is being open to the

opinions and general consent of the members: “There’s a common ground of where this

is where we’re going to make it happen and work. So I’m giving, you're giving, and it,

it’s effective for everyone.”

The third theme that followed the fourth major finding was following a top-down

structure. The theme received just one occurrence, or 13% of the total sample population.

Participant 3 stated that in their hospital or organization, they follow or employ a top-

down structure for the dyads:

We have some of our team’s service lines are starting to form more dyad models.

Not all areas have true dyads in the sense that there’s an admin and a clinical dyad

team, um, as a equal. There are, um... There are, uh, clinical leaders who report to

the next level, up, who are admins. Still that structure exist but if your definition

of a dyad is two, two people who are in parallel or equal standing with each other,

not all of the services are like that.

So, I’m still working with people that are, you know, still kind of a top-up,

top-down structure, as well as some of our service lines that are in a dyad type of

form- format. And since we know, with our upcoming merger with Geisinger, that

they are in a dyad. I think some of that transition here started to occur where

we’re starting to put ourselves into more of a dyad model.

Major Finding 5: Good Communication Between Members

The fifth major finding was based on the fifth research sub-question of the study,


which was the perceived advantages and disadvantages of dyads and triads against non-

interdisciplinary teams. The researcher found that the main advantage of the dyads or

triads is the good communication between members. The finding received four

occurrences, or 50% of the total sample population. Table 6 contains the fifth major

finding and other themes discovered from the analysis, addressing the fifth research sub-

question of the study.

Table 6 Perceived Advantages/Disadvantages of Dyads/Triads vs. Non-Interdisciplinary Teams



Major finding 5: Good communication between members

4 50%

Theme 1: Opportunity to work with professionals with diverse experiences

3 38%

Theme 2: Transparency when making decisions

2 25%

Theme 3: Presence of respect and trust between members

1 13%

Theme 4: Working with physicians who dislike cookbook medicine

1 13%

Theme 5: Weak data collection skills 1 13% Theme 6: Weakness in implementing

fast-paced protocol 1 13%

Overall, the fifth major theme was the good communication between members.

The researcher considers this to be one of the six most vital findings of the study. The

fifth major finding can also be related to one of the most significant competencies

according to 50% of the participants, which was the need for the members of dyads and

triads to be good communicators. Participant 1 stated that one advantage of the use of

dyads and triads is the good communication that members practice:


Yes. So it’s probably all of those. So we do always communicate beforehand prior

to a meeting. So it’s always good to have a meeting before the meeting so that

you know what you're gonna say during the meeting. And then sometimes things

are communicated in a combined meeting, and sometimes, probably more often,

they’re communicated in separate meetings, but the message, it’s always agreed

upon, has to be the same in both meetings, because we’re familiar enough that

even though there are separate meetings, at the end of that meeting, there’s gonna

be the post-meeting where the two participant meet, the participants at the

different meetings are gonna get together and, and compare notes as well, so.

Participant 3 contended the importance of having good working communication

processes with the members:

So, here’s the con of the dyad model is when you have two you know, when you

have two leaders who are both excellent leaders but have two different ways of

thinking about the outcome or ways to get to the outcome or don’t agree or, you

know, are not aligned about even the outcome itself. “Why are we doing what

we’re doing? I don’t think we should do A. We should do B.” It’s, I think the

communication then... If you don’t have alignment, the communication is either

good communication but they’re not communicating key things or there’s poor

communication because now we're not getting along because so we, we’re not

aligned.

Participant 6 emphasized the significance of communication between the dyad

members and teams:


So we were dysfunctional in the beginning and it came down to just basic good

business sense, communication, communication, communication. We needed to

assess basically everyone on our team, even from the different disciplines. Their

attitude towards the team, towards the work, towards each other and then just

really, communicate a lot and have a lot of face time. So, and transparency. You

know, open, honest and very structured. Very strategic touch points to continually

be together and have the work discussed and seek feedback and input, etc.

Communication, communication.

Participant 8 shared the system of communication that they employ:

Well for him and I, I’m usually the note taker, but it’s more around continuing to

evolve the strategy. It’s not for purpose of communicating out unless it’s

something like what I just described. Now that four buckets of work, we have to

communicate that out. Part of the plan is how are we going to regroup and when?

Is there pre-work that we need to do before that, and then you know, get Cynthia

to make a calendar, invite all these people, and then when we get in the meeting

we usually do a, a little song and dance thing. That’s interesting. We kind of

haven’t figured that out. Like some time, you know, maybe we should talk that

over, but we work really well together and we get these little, “Eh,” awkwardness,

it’s like, eh, so what, you know? But like, for example, we’ll get in the meeting,

and God forbid a senior leader is there.

The first theme that followed the fifth major finding was the advantage of having

the opportunity to work with professionals with diverse experiences. The theme received

three occurrences, or 38% of the total sample population. Participant 2 stated that one


advantage is having the opportunity to work with other physicians:

I think that we’re probably going to be doing a lot more projects, definitely using

that dyad approach. I’m thrilled with that because that gives me the opportunity to

work with, other physicians on the inpatient side or even maybe even potentially

outpatient, to improve care. Where it doesn’t work, the only thing I could think of

where it might not work is if you get two personalities that just can’t find a

common ground. And, if you’ve got that then you’ve got some leadership issues.

Participant 5 shared how one advantage is being able to work with professionals

who have diverse skills and experiences:

I know my tools and I know to solve my problems. The other person has their

tools and how to solve their problems but the problem is generally a hybrid

problem and therefore it requires a hybrid skill set to solve. Being paired with an

administrator as a clinician there’s the… the delivery of healthcare side of it

which we both share but from different perspectives. My dyad partners are all

nurses. As a physician I bring my physician perspective to it. They bring their

nursing perspective to it which is valuable. They’re also all MBA administrators

so they bring their MBA training and their administrative expertise to the problem

which is a great.

Participant 7 provided how the dyads allow professionals to work with another,

who can complement and harmonize the strengths and weaknesses of one another:

Everyone has weaknesses and, you know, every dyad is gonna have weaknesses. I

think the strength of the dyad is to recognize what those weaknesses are and then

to compliment what the needs are to keep the ship afloat moving forward. So if I


had weaknesses, yes, absolutely I have weaknesses. You know, at times, I could

be too nice and I could be a dangerous fault. Now, you would think that would be

just the opposite from a West Pointer or retired army is but it’s I’m not in the

army anymore.

The second theme that followed the fifth major finding was the advantage of

transparency when making decisions. The theme received two occurrences, or 25% of the

total sample population. Participant 2 shared that another advantage is the transparency

upon making a decision:

It makes it successful in the fact that it, that all levels that are agreeing upon a

decision and that is being shared so that, you know… And, and there’s not this

backdoor, issues going on where somebody is trying to change it, so. We’re

transparent, very transparent. That’s why it also is successful, why it doesn’t fail

and why it is successful.

Participant 6 shared that transparency is achieved when consensus in decision is

gathered:

We do consensus, so you um… We will put something out for feedback, we’ll

solicit responses via email or in face to face meetings. We’ll circle back, we’ll

discuss those, we’ll vet them and there are times where it can be supported or

there’s times where you have to make an executive decision and just say that’s,

that’s not something we can do. It really does need to be this. But then we do have

the responsibility. We are also practicing serving leadership. So you do want to,

you know, that’s about meeting needs versus wants and respect is one of our core

values. So to circle back to your group and at minimum provide the rationale as to


why the decision, even if it was executive, why it needed to be made, you know,

an executive decision had to be made. That’s pretty much how we do it.

The third theme that followed the fifth major finding was the advantage of having

the presence of respect and trust between members. The theme received just one

occurrence, or 13% of the total sample population. Participant 2 shared that an advantage

is the transparency upon making a decision:

It makes it successful in the fact that it, that all levels that are agreeing upon a

decision and that is being shared so that, you know… And, and there’s not this

backdoor, issues going on where somebody is trying to change it, so. We’re

transparent, very transparent. That’s why it also is successful, why it doesn’t fail

and why it is successful.

Participant 6 shared that transparency is achieved when consensus in decision is

gathered:

We do consensus… We will put something out for feedback, we’ll solicit

responses via email or in face to face meetings. We’ll circle back, we’ll discuss

those, we’ll vet them and there are times where it can be supported or there’s

times where you have to make an executive decision and just say that’s, that’s not

something we can do. It really does need to be this. But then we do have the

responsibility. We are also practicing serving leadership. So you do want to, you

know, that’s about meeting needs versus wants and respect is one of our core

values. So to circle back to your group and at minimum provide the rationale as to

why the decision, even if it was executive, why it needed to be made, you know,

an executive decision had to be made. That’s pretty much how we do it.


The fourth theme that followed the fifth major finding was the disadvantage of

working with physicians who dislike “cookbook medicine.” The theme received just one

occurrence, or 13% of the total sample population. Participant 2 admitted that it is

difficult to work with physicians who claimed to dislike following strict guidelines: “You

know, when you're working with physicians, they really don’t like to function and do the

cookbook medicine.”

The fifth theme that followed the fifth major finding was the disadvantage of

having weak data collection skills. The theme received just one occurrence, or 13% of the

total sample population. Participant 2 stated that data collection by the members is a

weakness, and their skills need to be improved for better outcomes: “It’s data collection.

It is a huge weakness. You have to have the ability to get accurate reports, and it has to

behave. The same information…”

Finally, the sixth theme that followed the fifth major finding was the disadvantage

of the weakness in implementing fast-paced protocol. The theme received just one

occurrence, or 13% of the total sample population. Participant 4 admitted that they have a

disadvantage in implementing a fast-paced protocol:

So that was very challenging because we were instituting kind of, or

implementing a really fast-paced protocol. And initially it was, you know, the, it

was challenging because they, not gave push back, r- good resistance.

Making sure that, you know, we were considering everything and we

recently just rolled out another fast-paced protocol in the ED that involves in the

field with EMS and it was the same thing. We worked with the EMS dyad, their

administrators, their medical director and again it was just the same thing of


coming to the table and identifying, you know, safety concerns and things like

that.

Major Finding 6: Removal of Message Noises to Solve the Issues Better

The sixth and last major finding that was established was the perceived areas or

facets of dyads or triads that may be modified to improve effectiveness and efficiency.

The researcher discovered that the teams should learn how to remove message noises to

solve the issues better and with better efficiency. The last major finding received three

occurrences, or 38% of the total sample population. Table 7 contains the sixth major

finding and other themes discovered from the analysis, addressing the sixth research sub-

question of the study.

Table 7 Suggested Areas of Improvement for Dyad/Triad Effectiveness and Efficiency



Major finding 6: Removal of message noises to solve the issues better

3 38%

Theme 1: Pushing down of leadership distribution

2 25%

Theme 2: Development of data collection skills

1 13%

Theme 3: Development of servant leadership

1 13%

Theme 4: Instituting a fast-paced protocol

1 13%

Theme 5: Developing new methods for innovation

1 13%

Overall, the last major finding was the removal of message noises to better solve

the issues. The researcher considers this to be one of the six most significant findings of


the study. Participant 1 stated how the members could improve in fighting the “message

noise,” or the external factors that affect the communication of the solutions for the

patients:

To be able to say, “All right, you know, I’m getting the message and, and, you

know, all the noise, you know, which both sides would hear.” Not the physical

noise, obviously, but in that whole communication paradigm is, you know, the, all

the confounding variables, all of the naysayers, all of you know, the outside

influences and antagonists to a given situation, are all part of the processing, you

know, of discussing the issue. But at the end of the day, it’s when we agree to

agree or, you know, we have to ultimately agree to agree that to affect the change,

but up until that point, we can agree to disagree on certain elements. But at the

end of the day, we agree on what the overall final concept is gonna be.

Participant 6 echoed how teams could work better if they know how to fight

against factors that hinder their plans:

Very challenging and lo and behold, you know, it did prove, the physicians

proved right. The data was inaccurate, but that’s where you go over to your

serving leader and you be transparent and you mumble and you accept full

responsibility. So all of these things kind of… you know, that’s where the

leadership piece is so, so important to the dyad and because they, the team knew,

okay, okay. And they, they moved on and beyond it much easier than we ever

would have anticipated because you were honest and no one’s going to fault for

being honest. They’re going to fault you for insisting something’s right when it’s

not.


Participant 7 also shared how approaching the problem more efficiently should be

followed and improved going forward:

How we approach those problems is what is the most important thing and, you

know, having the skill set to get around those problems and, you know, move

beyond those problems, it’s really what’s important and that’s what the dyad

relationship does. The other thing is sometimes when I’m talking, I’m not

listening. My dyad might be listening and vice versa.

The first theme that emerged was the improvement through pushing down of

leadership distribution. The theme received two occurrences, or 25% of the total sample

population. Participant 2 also advised that the hospital should consider pushing down the

leadership training to the managers and directors so that they can be groomed as future

leaders for the benefit of the patients:

Personally, I, I think that we need to push it down. That the directors are not as

involved, they could be as well as the managers. It would be very beneficial, uh,

not only for the patients but for the organization but also for leadership

development and this is where you see, who are those people, managers and

directors that we need to groom to make that next step? And, um, keep pushing it

down.

Participant 8 echoed that the organization should start developing new leaders who can

lead the company in the future:

Now the formal ones I think, and I talked about the site directors and I didn’t say

anything I wanted to say, that we recently recruited them. They've been in place

maybe a month at the most, and now we want to develop them. Really identify,


and I was just thinking... Let me just show you this. This is the kind of stuff I do.

Now we're having this meeting, right? Here's everything I need to talk about.

The second theme that emerged was improvement through the development of

data collection skills. The theme received just one occurrence, or 13% of the total sample

population. Participant 2 again suggested another method of effectiveness, which was the

development of skills of the members in data collection or gathering accurate data: “It’s

data collection. You have to have the ability to get accurate reports, and it has to behave.”

The third theme that emerged was the improvement through the development of

servant leadership. The theme received just one occurrence, or 13% of the total sample

population. Participant 3 stated that they have started to train their leaders to acquire

knowledge and skills on servant leadership: “Yeah. So, interestingly, we just got a new

kinda set of tools. Our organization is sending their leaders to... We’ve, we’ve been on a

servant leadership...”

The fourth theme that emerged was the improvement by instituting a fast-paced

protocol. This theme received just one occurrence, or 13% of the total sample population.

Participant 4 determined that one challenge for them is instituting a fast-paced protocol

which can be developed along the way: “So that was very challenging because we were

instituting kind of, or implementing a really fast-paced protocol. And initially it was, you

know, the, it was challenging because they, not gave push back, good resistance.”

The fifth theme that emerged was the improvement by developing new methods

for innovation. This theme received just one occurrence, or 13% of the total sample

population. Participant 5 admitted that the tenured leaders should be open to innovation

and develop new and better ways to reach their goals:


My weakness in that relationship is that I’m sometimes too sure that I know what

to do because we… I’ve been doing it for 32 years and I’m not as open to her

innovative ways of handling the problem as I should be. Likewise sometimes her

wanting to make everything perfect out of the gate on the first go around delays

implementation and she needs to learn that get it up and running and make the

course corrections as necessary because you’ll get to the end faster than trying to

put out the perfect finished product of the gate.

Summary

Chapter 4 presented the findings from the thematic analysis of the interviews.

Through the analysis, the researcher was able to address the main research question,

which was: What are the perceptions of physicians and professional managers on the use

of interdisciplinary teams or dyads/triads in healthcare management and decision

making? The researcher discovered six major themes, which addressed the main research

question and research sub-questions of the study. It was then found that the key factor in

creating and implementing dyads or triads is the goal of producing the best solutions for

patient care. Meanwhile, participants also believed that the main purpose for which dyads

or triads are usually created was to develop collaboration and to work together as a team.

Participants found that, for dyads and triads to be effective, members should have the

ability to support arguments with evidence. They also followed protocols and practices,

such as formal meetings and discussions, before making final decisions on their courses

of action, which implies good communication and understanding between members,

another important aspect of the implementation of dyads and triads. Finally, the

physicians and managers strongly believed that the dyads and triads may be modified to


be more effective through the removal of message noises to solve the issues better.

Chapter 5 will discuss further the effectiveness of dyads or triads in relation to the

literature, as well as the recommendations, implications, and conclusions of the study.


CHAPTER FIVE: CONCLUSION

Introduction

Chapter 5 presents an in-depth discussion of the findings from the previous

chapter, based on the results of the analysis of the interviews with the healthcare

managers and professionals. The purpose of this study was to explore the experiences and

perceptions of physicians and professional managers on interdisciplinary decision-

making teams in a large healthcare organization. Through the thematic analysis of the

participant interviews, six main findings were established, as well as several other themes

that pertain to the main research question and the sub-questions of the study. The main

research question was: What are the perceptions of physicians and professional managers

on the use of interdisciplinary teams or dyads/triads in healthcare management and

decision making? The following research sub-questions were the focus of the study:

Research Sub-question 1. What factors are considered in creating and

implementing dyads or triads?

Research Sub-question 2. What objectives, or for what purposes, are dyads or

triads usually created?

Research Sub-question 3. What competencies are perceived as necessary to

effectively and efficiently function in dyads or triads?

Research Sub-question 4. What protocols and procedures are followed in

decision making within dyads or triads?

Research Sub-question 5. What are the perceived advantages and disadvantages

of dyads and triads against non-interdisciplinary teams?


Research Sub-question 6. What are the perceived areas or facets of dyads or

triads that may be modified to improve effectiveness and efficiency?

This chapter includes the following sections: (a) summary of findings; (b)

interpretation of data; (c) limitations; (d) recommendations; (e) implications; and the (f)

conclusion of the study.





Aim of the Study





Summary of Findings

Through the qualitative thematic analysis on the interviews with the participants,

the researcher discovered six major findings, which all pertain to the main research

question. In addition, themes were formed to support the major findings, as well as

provide a broader and more extensive perspective on the research questions of the study.

Research Sub-question 1

From the analysis, it was discovered that the most important factor in creating and

implementing the dyads or triads was to produce the best solutions for patient care. The

major finding received five occurrences from the eight interviewed participants. Another


vital perception on creating or implementing dyads or triads was alignment of the overall

vision of the hospital or campus. The theme received relatively less occurrences than the

first major finding of the research study.


For the second research sub-question, the researcher discovered that the purpose

of creating dyads revolved around the idea of working together as a team in order to

reach the goal of optimal care for the patients. The participants of the study shared how

teamwork became integral to reaching their goal of providing the best quality of

healthcare to the patients they served. The majority of the interviewed participants shared

these purposes when creating dyads.


For the third research sub-question, the participants shared the different

competencies that they perceived as necessary to function effectively in a dyad/triad. The

researcher found that a majority of the healthcare professionals believed that the most

important competency was the ability to support arguments with evidence. This major

finding received the highest number of occurrences, with five occurrences or 63% of the

total sample population. The major finding was followed by several other needed abilities

and skills for dyads and triads. The participants shared that members should also be good

communicators and that members should have flexibility when working with others.

Participants also suggested that formal education and experience are still required. Strong

member personalities to encourage buy-in from the stakeholders was also vital, and a

positive mentality of achieving better outcomes was seen as effective. Finally, a credible


reputation was also perceived as necessary for members to be efficient while working in

dyads and triads.


There were also various protocols and procedures followed by the participants in

their organization in terms of their decision making within dyads and triads. The

members primarily had regular formal meetings to discuss the goals and outcomes that

they wanted to achieve for the benefit of their departments and organization. Several

other protocols and procedures also emerged. Participants shared that professional

decision making by members was one example of protocols that they followed and saw

as important. Another crucial procedure was being open to accepting the general

consensus of the group to create a more harmonious working environment. Finally,

another shared protocol was to follow a top-down structure in the organization.


The researcher discovered that the main advantage perceived by the participants

upon the employment of dyads and triads was the good communication between

members. Other significant advantages were: (a) having the opportunity to work with

professionals with diverse experiences; (b) the presence of transparency when making

decisions; and (c) the presence of respect and trust between members. Meanwhile, the

disadvantages that the participants observed with the model included: (a) working with

physicians who dislike “cookbook medicine;” (b) members having weak data collection

skills; and (c) an apparent weakness in implementing fast-paced protocol.



Finally, the participants shared suggestions for how the model can be improved or

developed. It was mainly found that the model could be advanced through the removal of

message noises to solve the issues better. Participants also suggested that pushing down

of leadership distribution could help to train and discover the future leaders of the

organization. The organization should also invest in the development of data collection

skills and development of servant leadership in order to have better outcomes from the

model in the future. Instituting a fast-paced protocol was also another aspect that could be

developed. Finally, participants also suggested that new methods for innovation were

required.

Interpretation of Data


The researcher found that different strategies have been shown to be effective in

ensuring safety and efficiency in hospitals, healthcare settings, and industries (Allen et

al., 2015; Carayon et al., 2014). One strategy explored in the current research is the

model of dyads and triads in the healthcare setting. The researcher in this study found that

the healthcare managers believed that the model was formed in order to produce the best

solutions for patient care, which aligns with the mission and vision of the healthcare

organization. Indeed, the findings of the current study coincided with the report in

Chapter 2, which claimed that the dyad model allowed physicians and professional

managers to share accountability and responsibilities for improving the quality of care

and services and optimizing financial performance without overburdening patients or

incurring large costs for the country (Zismer & Brueggemann, 2010). Zismer and


Brueggemann’s (2010) statement was validated in this study by the responses shared by

the participants in Chapter 4 and is discussed further below.


The researcher found how collaboration and teamwork has always been the focus

and objective of the model. Chapter 2 explained that research and experience have shown

that effective collaborative work among healthcare professionals, most commonly

between registered nurses and physicians, results in lower morbidity and mortality rates,

reduced cost of care, and fewer medical errors (Maxson et al., 2011). Subsequently, such

effective collaboration can improve job satisfaction and retention of nursing staff

(Maxson et al., 2011). Indeed, teamwork and collaborative decision making by the

members and stakeholders of the healthcare organization has always been of special

importance to the model. Together with the collaborative team efforts of the members,

the study participants also emphasized the best possible care that they could provide to

the patients. As reported, numerous strategies and interventions have been put in place in

individual hospitals, as well as the U.S. healthcare industry as a whole, in order to

advance procedures and protocols that ensure the provision of optimum care to patients

and the safety of patients, visitors, and hospital workers (Allen et al., 2015; Maxson et al.,

2011). The statements by Allen et al. (2015) and Maxson et al. (2011) strengthen the goal

of the model, which is to provide the most favorable care and quality of health for the

patients seeking their services.


The researcher discovered several competencies needed for effective functioning

in dyads’ or triads’ management model. However, several competencies were highlighted


as crucial to the study, as reported in the earlier chapters. Previous studies have shown

that interdisciplinary teamwork and leadership have led to improvements in decision

making, safety culture, and job satisfaction, both in the healthcare setting and in other

settings (Allen et al., 2015; Tremblay et al., 2014). The current study highlighted and

emphasized the importance of having the education and skills to be able to support and

back up data with concrete evidence to ensure the buy-in of stakeholders. Other effective

qualities as stated by Reid Ponte (2012) and Walker, Reshamwalla, and Wilson (2012)

are patience, discipline, trust, and effective, honest communication. These coincided with

the competencies emphasized by the study participants—especially the abilities to

communicate properly and work effectively with different sets and levels of healthcare

professionals.


The participants in the study shared both the formal and informal protocols

followed by the members of the dyads or triads in the study. Chapter 2 reported how

members of interdisciplinary teams are often trained differently and may follow

contrasting protocols and that difficulties may arise during meetings, planning sessions,

and in decision making. For this reason, interdisciplinary team leaders need to be trained

in interpersonal relations and effective professional communication. Indeed, as

discovered, the participants focused on formal meetings and discussions as part of their

most-practiced protocols upon the creation of the model. These protocols ensure that they

have one common goal and practice constant communication within their teams.



The fifth research sub-question discussed the different advantages and

disadvantages observed by the participants of the study, based on their experiences. As

reported in Chapter 2, according to Baldwin et al. (2011):

Perhaps the most obvious benefit of the dyad model is that it reduces the

traditional “us-them” perspective commonly present in healthcare organizations,

wherein physicians distance themselves from managerial roles and

responsibilities, and focus only on their clinical practice. Such a perspective often

leads to misunderstandings between physicians and managers about policies,

behaviors, and procedures. The dyadic model addresses this divide in the

traditional structure by involving the physicians throughout the managerial

processes while also allowing managers to understand the circumstances and

perspectives of the physicians.

Baldwin et al.’s (2011) finding was also highlighted in the current research study,

wherein the use of the model has allowed good communication, transparent decision

making, and professionalism to emerge.

The dyad model also permits managers and physicians to make more informed

decisions, as they bring in different perspectives of a specific problem or issue to be

addressed (Baldwin et al., 2011; Reid Ponte, 2012). Having experienced and well-trained

professionals come together to create models and decisions that would serve the

healthcare organization and its members best has opened greater opportunities for both

the organization and its stakeholders. Having a diverse group of professionals who can

create informed decisions has increased the involvement of the members in the decision-


making process and has allowed the members of the healthcare team to better consider

alternative courses of action, reach a consensus, and then carry out the plan with more

knowledge, ease, and willingness; these all bring positive results to the organization and

the patients they are serving.


Finally, the sixth research sub-question discussed the ways in which the

development of the dyads and triads can be improved. These mainly focused on the

removal of noises or hindrances in the courses of action of the leaders, as well as the

continuous training and development of the members, as discussed above. In conclusion,

the study participants all agreed that the future of the model lies in the willingness and

ability of the leaders to innovate and use their knowledge to provide the best solutions

and care to the patients they serve.

Limitations

Although the researcher maximized all resources available to complete this

research study, several nuances and inadequacies were still observed. The researcher

found that the lack of data support and the possibility that the participants controlled their

responses were the major limitations of the study. These limitations were:

1. Lack of formal data to support the claims and perceptions shared by the

healthcare managers and professionals; the findings could have included data

from the organization. Concrete statistics and reports could have been added

to strengthen the findings and support the responses of the interviewed

participants.


2. The study participants, as members of a well-respected healthcare

organization, could have controlled their responses, as they may not have

wanted to damage the reputation of the organization. In addition, participants

may not have been comfortable divulging full details of their answers and real

perceptions, as they may have been afraid of being identified through their

responses and were worried about sanctions and consequences that they might

face as a result of the interviews. To address this limitation, the researcher

constantly ensured the participants that their identities were secured and

protected, and that their names would not in any way be divulged in the study.

The researcher used numbers to identify the participants rather than names.

Subsequently, all data gathered both recorded and in print will be kept inside a

vault for a minimum of three years as required by most universities in the

United States, to secure the identities of the participants of the study.

Recommendations for Further Research

Based on the limitations of the study, the researcher recommends the following be

performed by future scholars who plan to conduct a study on the same research topic.

Future studies should:

1. Consider employing a mixed-methodology study, combining both quantitative

and qualitative findings to provide a data-driven study with well-supported

facts and evidence to back up the claims reported in the research findings of

this study. In addition, future studies may also consider incorporating facts

and statistical data provided by the target healthcare organization to reinforce


the statements, perceptions, and experiences shared by interviewed healthcare

professionals and managers.

2. Consider interviewing other groups considered to be stakeholders of the dyads

or triads in order to see different viewpoints on the topic. Interviews with

other stakeholders may allow for the discovery of other important elements

and aspects of the model, coming not just from the tenured healthcare

professionals but also from those who have enough knowledge and experience

with the model. This may be useful, given that the main goal of the model is

the inclusion of each stakeholder in decision making, whether at the

healthcare or the administrative level.

Implications for Action

The researcher believes that this study provides a significant contribution to the

healthcare industry, specifically regarding the dyad management model. Given the lack

of available literature on the dyad management model, the current study provides future

scholars with a perception- and experience-based study in which the findings were

gathered directly from those who had knowledge and experience with the subject. The

current research can also be employed by other healthcare organizations who want to

utilize the dyad model to improve management in their institutions.

This study provides suggestions and ideas for six aspects of dyads/triads: (a) the

factors considered when creating and implementing dyads or triads: (b) the objectives, or

purposes, for which dyads or triads are usually created; (c) the competencies necessary

for members to function effectively and efficiently in dyads or triads; (d) the protocols

and procedures for decision making within dyads or triads; (e) the perceived advantages


and disadvantages of dyads and triads versus non-interdisciplinary teams; and (f) the

perceived areas or facets of dyads or triads that may be modified to improve effectiveness

and efficiency. These aspects shall allow the other healthcare organizations to decide if

the model is suitable for their environments and to prepare themselves for what to expect

upon employment and implementation of the model, given that the current study has laid

out direct experiences and perceptions from healthcare professionals themselves. Figure 1

is the model or framework developed from the researcher’s analysis of the findings,

which the researcher proposes as Chadd’s Model of Dyad Management.

Figure 1. Chadd’s model of dyad management.


Summary

In conclusion, the researcher successfully addressed the main research question

and six sub-questions of the study pertaining to the effectiveness and structure of the

dyad model. Through thematic analysis of the interviews with the participants, the

researcher found that the core reason for creating and implementing the dyad model is to

produce the best solutions for patient care while working together as a team. Healthcare

organizations should note that the core competency that they should require from their

professionals is the ability to support arguments with evidence. In addition, one of the

most important protocols that they should adopt is the use of formal meetings and

discussions to ensure the similarity of the goals and visions of the different teams

involved in the dyad/triad. One advantage of the model is the practice of good

communication between members, which makes it more effective and beneficial to the

organization compared to the other models available. Finally, the removal of message

noises shall allow the model to become fully functional and effective for healthcare

organizations. Therefore, it can be concluded that the employment of the dyad

management model is effective in a healthcare setting due to the ability of the healthcare

professionals and managers to collaborate to achieve the common goal of providing their

patients with optimal care.


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Appendix A

Interview Prompts or Questions

Kindly describe the interdisciplinary team you were part of. (Who were the

participants? What were the objectives?)

Describe you team dynamics and protocols. (How often and where did you meet?

Who took minutes? Etc.)

How would you describe these meetings? Were you comfortable? Did you feel

that there was a general atmosphere of respect and professionalism?

Kindly describe a program or project of your team that presented a challenge for

you.

How did you go about making decisions as a team? Was this a particularly

difficult task?

What are your perceptions regarding the leadership qualities and skills that you

and your teammates exhibited?

What did you perceive that allowed your team to be effective and efficient in its

objectives and processes?

In general, do you think interdisciplinary teams are beneficial in the healthcare

setting? Kindly explain.

management model in the healthcare setting: a case …

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