Interactions and Performance in Healthcare
Teams: The Case of AUOP Brest UnitDavide Aloini, Alessandro Stefanini, Peter Gloor, Riccardo Dulmin,Valeria Mininno, Luisa Pellegrini, Elisabetta Benevento, Matteo
Ghilli, Carlo Milli, Marco Nerattini, Gabriella Pellegrini, Marzio
Privato, Manuela Roncella and Carlo Tomassini
Extended Abstract

Most healthcare services are strongly dependent on the patient case, medical
knowledge and clinical evidence. Accordingly, they require a huge coordination
effort in order to guarantee high quality care at affordable costs. Informationsharing, communication, and coordination of multiple actors through internal andexternal processes have in fact a key role for achieving effectiveness, efficiency
and flexibility of such operations. In this aim, clinical activities often rely on
team-based work and involve collaborative features, typical of low or unstructured processes, which have not the same level of predictability of traditional
ones (e.g. clinical procedures, medical treatments, etc). Specifically, theimportance of interaction between physicians, medical staff and patients becomes
ever more important for complex (e.g. Oncology) or chronic conditions where thediagnostic and treatment processes are highly interconnected, multidisciplinaryand difficult to plan in advance. Wagner (2001) shows, for example, how qualityof chronic illness care is affected by productive interactions between practice teamand patients.
Past research has addressed coordination and collaboration issues in healthcare
processes, particularly analyzing the link between team coordination and processeffectiveness and efficiency (Borrill et al., 2000; Grippa et al., 2012). It is
commonly accepted in fact that higher quality and more innovative care occur
when professionals work and learn together, and engage in multidisciplinary
meetings to improve clinical outcomes (Brown, 1982; Bell, 2001; Wagner et al.,
1996; Sexton et al., 2006; Makary et al., 2006; Grippa et al., 2012). Nevertheless,teams and individuals are two fundamental nodes also for achieving efficiency andresilience (i.e. the intrinsic ability of a System to adjust its functioning prior to,during, or following changes) to healthcare systems – both at a macro and at a
micro (patient) level. Teams for instance are engaged in a number of risky
decisions whose success is strongly depending on capabilities characterizing
resilient systems (Hollnagel et al., 2007): 1) the ability to predict something badhappening (e.g. teams assess scenario analysis for patient treatments in
multidisciplinary meetings); 2) the ability to prevent something bad becoming
worse (e.g. teams periodically re-evaluate patients’ condition and plan for changes
during the clinical treatment); and 3) recovery or the ability to recover fromsomething bad once it has happened (e.g. teams flexibly organize internal
resources to provide patients an adequate care in case of crisis).
Thus, understanding team dynamics and their relationships with teamperformance is valuable both for research and practice in order to improve

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operational effectiveness, efficiency and resilience of collaborative activities insuch a context.
In this direction, this study explores team dynamics accordingly to a novelperspective, the lens of microscopic social network, which are directly andquantitatively assessed trough interactions of participants during teamwork. The
work has to be framed in a wider research aiming at improving healthcareorganizations by new organizational strategies, tools and work practices for better
coordination among team participants.
Research question: How much the patterns of interactions within healthcare
teams influence performance of coordination or collaborative activities.
The measure of physical interactions is enabled by the use of sociometricbadges. Sociometric badges are wearable sensors and can directly measure andpredict individual and collective patterns of behavior from unconscious social
signals, identify social affinity among individuals working in the same team, andenhance social interactions by providing feedback to the users of system. The tool
allows researchers to conduct more in depth quantitative analysis of interactions
inside healthcare organizations leading to high level descriptions of humanbehavior in terms of (i) physical activity/human movement, (ii) prosodic speechfeatures (rather than raw audio), (iii) indoor localization, (iv) proximity to otherindividuals, and (v) face-to-face interactions (Olguin-Olguin et al. 2009). The
approach seems particularly valuable for informal coordination mechanisms,
which are hidden to more formal methods and can allow overcoming limitation of
past empirical analysis based on survey data collected by interviews,
questionnaires and reports or direct observation which is up to subjective
evaluation of the observer.
Data were collected during a 8 weeks contiguous period in the Breast Unit of
AUOP, monitoring the activity of about 15 people during cross-functional
meetings hold twice a week for discussing patient cases, decide treatments,
planning the operating rooms and related surgery activities. A total of 15 meetingsand 150 valid observations were gathered (about 50 working hours were recordedby sensors and available for the analysis). Also, through a survey to participants,
we evaluated four main dimensions of performances of the meetings: the efficacy,
the efficiency, the working climate during the meeting, and the overallsatisfaction.
Preliminary results show that greater physical activity and less consistency inthe body movement of team members indicate inhibition of participants and arecorrelated with a worse working climate during the meeting. Evidence alsosuggests that the magnitude and consistency of speaking during the meeting iscorrelated to the perceived results in term of both coordination efficacy andefficiency. Specifically, a high amount of speaking and a low consistency level inspeech of participants worsen the efficacy and efficiency of the meeting as
coordination mechanism. In addition, low consistency jointly with a high volumeof speech is correlated to a lower satisfaction of participants. Finally, as expected,
an increase in proximity of team members seems to increase the perceived
efficacy and efficiency of the meeting.

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