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Type: Journal article
Title: Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department: a comparative case study
Author: Frykman, M.
Hasson, H.
Muntlin Athlin, A.
Von Thiele Schwarz, U.
Citation: BMC Health Services Research, 2014; 14(1):218-1-218-13
Publisher: BioMed Central
Issue Date: 2014
ISSN: 1472-6963
Statement of
Mandus Frykman, Henna Hasson, Åsa Muntlin Athlin, and Ulrica von Thiele Schwarz
Abstract: BACKGROUND While there is strong support for the benefits of working in multi-professional teams in health care, the implementation of multi-professional teamwork is reported to be complex and challenging. Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited. There is a lack of studies focusing on the functions of different behavior change interventions and the mechanisms driving behavior change. In this study, applied behavior analysis is used to analyze the function and impact of different behavior change interventions when implementing multi-professional teamwork. METHODS A comparative case study design was applied. Two sections of an emergency department implemented multi-professional teamwork involving changes in work processes, aimed at increasing inter-professional collaboration. Behavior change interventions and staff behavior change were studied using observations, interviews and document analysis. Using a hybrid thematic analysis, the behavior change interventions were categorized according to the DCOM® model. The functions of the behavior change interventions were then analyzed using applied behavior analysis. RESULTS The two sections used different behavior change interventions, resulting in a large difference in the degree of staff behavior change. The successful section enabled staff performance of teamwork behaviors with a strategy based on ongoing problem-solving and frequent clarification of directions. Managerial feedback initially played an important role in motivating teamwork behaviors. Gradually, as staff started to experience positive outcomes of the intervention, motivation for teamwork behaviors was replaced by positive task-generated feedback. CONCLUSIONS The functional perspective of applied behavior analysis offers insight into the behavioral mechanisms that describe how and why behavior change interventions influence staff behavior. The analysis demonstrates how enabling behavior change interventions, managerial feedback and task-related feedback interact in their influence on behavior and have complementary functions during different stages of implementation.
Keywords: Humans; Interdisciplinary Communication; Cooperative Behavior; Internal Medicine; Hospitals, University; Emergency Service, Hospital; Organizational Case Studies; Organizational Innovation; Patient Care Team; Sweden; General Surgery
Rights: © 2014 Frykman et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
RMID: 0030014259
DOI: 10.1186/1472-6963-14-218
Appears in Collections:Nursing publications

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