The Partial Teammate: Managing Informal Collaborations in Contemporary Health Care Teams

Health care teams have grown more complex and their boundaries less clear over time, leaving much of care delivery to informal collaborations between “partial” teammates – those who roles are ambiguous and informal, but who may participate substantially in care delivery. This dissertation investigates the challenges that informal members of contemporary health care teams present, and strategies for managing these roles effectively. Each paper addresses a particular role on the boundary of the traditional health care team: medical assistants working in primary care teams, medical device sales representatives providing technical assistance to surgeons, and patients using technology that could enhance their participation in care. In Chapter 1 — with Alyna Chien, Joanna Veazey Brooks, Antoinette Peters, and Sara Singer — we used semi-structured interviews to explore thirty medical assistants’ (MAs') experiences in primary care offices transitioning to team-based care. MAs reported stronger relationships with colleagues, more involvement with patients, a sense of ownership, and a sense of efficacy with team-based care. This work sheds light on how teams are expected to impact primary care delivery and when they are likely to be effective. In Chapter Two — with Rob Huckman and Neal Chen — we used data from the orthopedic surgery setting to examine the impact on operative time of having medical device sales representatives physically present during a procedure. While we found no device rep effect on average, procedures took longer when a surgeon and device rep were very new to working together. This finding supports prior research on team familiarity across organizational boundaries, and has practical implications for hospital managers weighing the tradeoffs inherent Dissertation advisor: Robert S. Huckman Bethany Sheridan iv in industry-provided technical assistance services. In Chapter Three — with Josh Gray, Anna Zink, Amy Edmondson, and Julia AdlerMilstein — we used a detailed longitudinal dataset to understand the role of provider organizations in patients’ use of an online portal. Although prior research has focused largely on patient demographic characteristics, we looked at how practices actually used portals. We found that the extent to which they used portals to communicate proactively with patients – the rate at which they posted labs/images and sent messages to their enrolled patients – was an important predictor of whether patients adopted the portal and how frequently they used it. We also found wide variation at the practice level in how often providers/staff engaged in these activities, resulting in extensive cross-practice variation in patient utilization. These findings call for a reconceptualization of portals as two-way tools, with more focus on the provider side, and provide guidance for provider organizations looking to use them effectively. Together, these studies help advance our understanding of the challenges and opportunities that teams with unclear boundaries face in managing roles on the periphery. They also inform health care practice by providing insights into how delivery organizations can manage informal collaborations most effectively.