HA510 Unit 5 Transfer Center Team Development Case Example

Passed From Person to Person: A Team Development Case on a Composite Health System's Transfer Center, Diagnosing a Seventy-Four-Minute Call-to-Acceptance Time Through the Big Five Model of Teamwork and Proposing How It Could Become a Team

[Student Name]

Purdue University Global

HA510: Organizational Development in Health Care

Unit 5 Team Development Case

[Instructor Name]

[Date]

The system, the team and the thirty traced transfers are composite and bracketed; quoted moments are illustrative and attributed to roles.

Background

Ten months ago the system chartered a transfer center at the regional medical center. The team as chartered: four transfer nurses on rotation, a bed placement coordinator, a transport coordinator, the hospitalist on call for the week and, on the other end of the line, whichever emergency physician is calling from a small hospital. The members rarely meet; the hospitalist changes weekly.

The Evidence

The writer traced [30] transfer calls from the small hospitals over six weeks, using call recordings, the transfer log and the bed board. Median call to acceptance: [74] minutes. Median number of hand-offs per call: [four]. In [eleven] calls, the emergency physician repeated the patient's story to three or more people.

The Big Five

Salas and colleagues argued that effective teams share five core behaviors, held together by three coordinating mechanisms: a common picture of the task, messages confirmed when received, and trust among members (Salas et al., 2005). Each behavior is scored below against the traced calls:

1. Team leadership: weak. The charter names the transfer nurse as coordinator, but in practice no one has authority over the hospitalist's decision or the bed coordinator's queue. Moment: "I'm just the nurse; you'll need to talk to the hospitalist."

2. Mutual performance monitoring: weak. No one sees the whole call; each member sees only their part.

3. Backup behavior: absent. When the hospitalist was in a procedure for [40] minutes, no one else could accept.

4. Adaptability: moderate. Transport adjusts well to weather and distance.

5. Team orientation: weak. Members describe themselves by department, not as the transfer team.

Coordinating mechanisms: no shared mental model of what a complete transfer request contains; communication is open-loop, with information passed on but not confirmed; trust between the regional center and small hospital physicians is low. Six people touch every transfer, but none of them sees the whole call, so the team behaves like a relay with no anchor leg.

Stage of Development

In Tuckman's terms, the team never fully formed: members were assigned but never met to agree on roles and norms (Tuckman, 1965). Its conflicts, such as hospitalists questioning whether transfers are needed, play out on calls with outside physicians rather than inside the team.

Development Plan

1. Leadership: give the transfer nurse on duty authority to set up a three-way call with the hospitalist within ten minutes and to escalate if the hospitalist is unavailable.

2. Shared mental model: a one-page transfer request template, built with small hospital emergency physicians, so the story is told once.

3. Closed-loop communication: the transfer nurse repeats back the plan to the calling physician before ending the call.

4. Backup behavior: a backup hospitalist named each day to accept when the primary is unavailable.

5. Team orientation: a monthly thirty-minute huddle of transfer nurses, bed and transport coordinators and that month's hospitalists, with a small hospital physician invited.

6. Trust: small hospital emergency physicians visit the transfer center once a quarter; transfer nurses spend a shift at a small hospital each year.

What a Good Transfer Would Look Like

A small hospital emergency physician calls at 02:10 about a patient with a suspected bowel obstruction. The transfer nurse answers, takes the story on the template and sets up a three-way call with the hospitalist within ten minutes. The hospitalist accepts or asks one focused question. The bed coordinator, listening on the line, names a bed, and transport is dispatched. The nurse repeats the plan back. Total time: about [25] minutes, one telling of the story.

Measures

Median call to acceptance; number of hand-offs per call; share of calls where the story is repeated; small hospital physician ratings of transfer calls, collected quarterly.

Psychological Safety

Transfer nurses said they hesitate to push hospitalists for decisions. Teams learn and improve when members feel safe to speak up (Edmondson, 1999), so the huddle should be led by the transfer nurse manager, with explicit permission for nurses to raise delays.

Who Owns the Plan

The director of patient flow sponsors the plan; the transfer nurse manager leads it; the chief medical officer secures hospitalist participation. Small hospital emergency physicians are consulted on the template.

Limits

Thirty calls over six weeks may not capture seasonal patterns. Recordings capture words, not tone or context. Calls from the regional center's own emergency department were not traced and may follow a different path.

Conclusion

The transfer center is a group of people working on the same calls, not yet a team. Strengthening leadership, building a shared model of a transfer, closing communication loops and naming backup would let it act as one.

References

Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383. https://doi.org/10.2307/2666999

Salas, E., Sims, D. E., & Burke, C. S. (2005). Is there a "Big Five" in teamwork? Small Group Research, 36(5), 555-599. https://doi.org/10.1177/1046496405277134

Tuckman, B. W. (1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384-399. https://doi.org/10.1037/h0022100