Explication and testing of the structural component of the transtheoretical integration model

Abstract

The purpose of this research was to develop and empirically test the structural component of the Transtheoretical Integration Model (TIM). TIM contains four stages, environment, sociotechnical system, integration, and goals, and uses a systems perspective to propose constructs and relationships congruent with team-based contexts in acute care environments. The framework extends previous work by reconceptualizing patient care unit structures consistent with current environments. The sample consisted of 16 medical surgical units drawn from four hospitals in the Southwestern United States. Participants included 411 multidisciplinary team members employed on the sampled units. The majority of participants were registered nurses and unlicensed care personnel. Measures used in this research were adapted from instruments previously used in non-acute care settings. Data were collected through self-report and hospital administrative databases. Psychometric properties of all but three scales (Hierarchical Culture, Rational Culture, and Task Type) exhibited evidence of validity as group measures. TIM proposed that Workgroup Design moderated by Group and Developmental Cultures would lead to Positive Intra-Team Process and Negative Intra-Team Process, which in turn would lead to effective patient outcomes (decreased Falls with Injury) and efficient organizational outcomes (lower Costs and shorter Lengths of Stay). TIM further proposed that Work Technology moderated the relationship between the two Intra-Team Process constructs and Outcome variables. Neither moderator entered the model, but Group and Developmental Culture directly predicted a reduction in Falls (Group Culture) and increased Costs (Developmental Culture). Workgroup Design predicted Positive and Negative Intra-Team Process, which predicted increased Length of Stay. Neither mediator variable predicted Patient Falls or Costs. Based on these preliminary findings, multidisciplinary teams did not have any effect on reducing Patient Falls or lowering Costs. Negative Intra-Team Process did predict increased Length of Stay, as did Positive Intra-Team Process. Workgroup Design indirectly predicted increased Length of Stay through its relationship with Positive Intra-Team Process and Negative Intra-Team Process. Further research should evaluate the influence of TIM's environment stage on other model stages and evaluate the stability of these findings in a larger sample.