PhD defense Hujie Wang - "Team functioning in rural Chinese hospitals"

Sustainable Development Goal 3 of the WHO requires developing countries to strengthen their healthcare workforce to attain universal health coverage. In alignment with this goal, the Chinese government has proposed enhancing teamwork to improve the quality of care in rural Chinese hospitals, particularly in county-level hospitals. Current scientific understanding of team functioning in healthcare is, however, mainly from Western countries. Due to the scant evidence and unique contextual characteristics, we need to advance the understanding of team functioning in rural Chinese hospitals, helping improve teamwork. With this aim, we conducted a systematic literature review, semi-structured interviews (in fifteen county-level hospitals) and cross-sectional surveys (in four county-level hospitals) in rural China. 

This PhD thesis provides novel insights into team functioning, emphasising the importance of contextualising team research. First, we found that deep-level perceived similarity is positively associated with team processes (e.g. speaking up and coordination) and subsequently positively related to perceived quality of care, while surface-level generational diversity does not significantly influence team functioning. These findings highlight the more crucial role of deep-level perceived (dis)similarity rather than surface-level diversity/dissimilarity in team functioning in rural Chinese hospitals. To improve teamwork and the quality of care, hospital management may leverage the benefits of similarity and implement extra interventions to attenuate the disadvantages of dissimilarity/diversity. This is a different human resource management approach from that in many Western hospitals, which prefer to increase diversity and stress the positive impact of workforce diversity. Second, we found that the conventional monodisciplinary mode drove rural Chinese hospitals to implement interventions that focused on redesigning input factors (e.g. changing leaders, changing members’ roles and inviting external experts) to improve teamwork, which is unlike the emphasis on process interventions in Western hospitals. However, introducing multidisciplinary teams in recent years has entailed the implementation of process interventions (e.g. simulation training and continuous process improvement) in rural Chinese hospitals. This change creates opportunities for hospital management to optimise team processes together with redesigning inputs to improve team functioning and the quality of care in these hospitals.