This study aimed to examine how allied healthcare professionals as informal leaders can lead reforms to improve patient care on an interprofessional team. With 284 interprofessional team members working in 59 geriatric facilities, our findings demonstrated that informal leaders exhibiting more championship behaviors gained higher innovation success scores. In addition, the champion’s professional tenure and institutional size were both negatively associated with innovation success. We discuss important implications for this understudied issue in interprofessional team research: how a low-status informal leader can direct reform aimed at improving patient care within a healthcare organization.
AustinJ. R. (2013). Making knowledge actionable: Three key translation moments. Journal of Organization Design, 2(3), 29–37. https://doi.org/10.7146/jod.15580
2.
BaldwinD. C.Jr.DaughertyS. R. (2008). Interprofessional conflict and medical errors: Results of a national multi-specialty survey of hospital residents in the US. Journal of Interprofessional Care, 22(6), 573–586. https://doi.org/10.1080/13561820802364740
3.
BellS. T.VilladoA. J.LukasikM. A.BelauL.BriggsA. L. (2011). Getting specific about demographic diversity variable and team performance relationships: A meta-analysis. Journal of Management, 37(3), 709–743. https://doi.org/10.1177/0149206310365001
4.
BindmanA. B.PronovostP. J.AschD. A. (2018). Funding innovation in a learning health care system. The Journal of the American Medical Association, 319(2), 119–120. https://doi.org/10.1001/jama.2017.18205
5.
BraddP.TravagliaJ.HayenA. (2017). Leadership in allied health: A review of the literature. Asia Pacific Journal of Health Management, 12(1), 17–24. https://doi.org/10.24083/apjhm.v12i1.103
6.
BrodyR. A.Touger-DeckerR.RadlerD. R.ParrottJ. S.RachmanS. E.TrostlerN. (2014). A novel approach to oral health assessment training for dietitians in long-term care settings in Israel: A pilot study of changes in knowledge and practice. Topics in Clinical Nutrition, 29(1), 57–68. https://doi.org/10.1097/01.tin.0000443027.06030.a1
7.
BuryT. J.StokesE. K. (2013). A global view of direct access and patient self-referral to physical therapy: Implications for the profession. Physical Therapy, 93(4), 449–459. https://doi.org/10.2522/ptj.20120060
8.
CarmanJ. M.ShortellS. M.FosterR. W.HughesE. F.BoerstlerH.O’BrienJ. L.O’ConnorE. J. (2010). Keys for successful implementation of total quality management in hospitals. Health Care Management Review, 35(4), 283–293. https://doi.org/10.1097/HMR.0b013e3181f5fc4a
9.
CarrierA.ÉthierA.BeaudoinM.HudonA.BédardD.JasminE.VervilleF. (2021). Acting as change agents: Insight into Québec occupational therapists’ current practice. Canadian Journal of Occupational Therapy, 88(2), 173–181. https://doi.org/10.1177/0008417421994367
10.
DornerB.FriedrichE. K. (2018). Position of the academy of nutrition and dietetics: Individualized nutrition approaches for older adults: Long-term care, post-acute care, and other settings. Journal of the Academy of Nutrition and Dietetics, 118(4), 724–735. https://doi.org/10.1016/j.jand.2018.01.022
11.
EdmondsonA. C. (2003). Speaking up in the operating room: How team leaders promote learning in interdisciplinary action teams. Journal of Management Studies, 40(6), 1419–1452. https://doi.org/10.1111/1467-6486.00386
12.
EdmondsonA. C.HarveyJ.-F. (2018). Cross-boundary teaming for innovation: Integrating research on teams and knowledge in organizations. Human Resource Management Review, 28(4), 347–360. https://doi.org/10.1016/j.hrmr.2017.03.002
13.
EliotK. A.KolasaK. M. (2015). The value in interprofessional, collaborative-ready nutrition and dietetics practitioners. Journal of the Academy of Nutrition and Dietetics, 115(10), 1578–1588. https://doi.org/10.1016/j.jand.2015.03.025
14.
FleurkeM.VoskuilD. W.Beneken Genaamd KolmerD. M. (2020). The role of the dietitian in the management of malnutrition in the elderly: A systematic review of current practices. Nutrition & Dietetics, 77(1), 60–75. https://doi.org/10.1111/1747-0080.12546
15.
Flores-SandovalC.SibbaldS.RyanB. L.OrangeJ. B. (2021). Interprofessional team-based geriatric education and training: A review of interventions in Canada. Gerontology & Geriatrics Education, 42(2), 178–195. https://doi.org/10.1080/02701960.2020.1805320
16.
FranckeA. L.SmitM. C.de VeerA. J.MistiaenP. (2008). Factors influencing the implementation of clinical guidelines for health care professionals: A systematic meta-review. BMC Medical Informatics and Decision Making, 8(38), 38. https://doi.org/10.1186/1472-6947-8-38
17.
GoodmanD.HarveyD.CavanaghT.NiemanR. (2018). Implementation of an expanded-scope-of-practice physiotherapist role in a regional hospital emergency department. Rural and Remote Health, 18(2), 1–7. https://doi.org/10.22605/rrh4212
GreenhalghT.RobertG.MacfarlaneF.BateP.KyriakidouO. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581–629. https://doi.org/10.1111/j.0887-378x.2004.00325.x
20.
HallP. (2005). Interprofessional teamwork: Professional cultures as barriers. Journal of Interprofessional Care, 19(Suppl 1), 188–196. https://doi.org/10.1080/13561820500081745
21.
HarrisM. F.AdvocatJ.CrabtreeB. F.LevesqueJ. F.MillerW. L.GunnJ. M.HoggW.ScottC. M.ChaseS. M.HalmaL.RussellG. M. (2016). Interprofessional teamwork innovations for primary health care practices and practitioners: Evidence from a comparison of reform in three countries. Journal of Multidisciplinary Healthcare, 9, 35–46. https://doi.org/10.2147/JMDH.S97371
22.
HeanS.ClarkJ. M.AdamsK.HumphrisD. (2006). Will opposites attract? Similarities and differences in students’ perceptions of the stereotype profiles of other health and social care professional groups. Journal of Interprofessional Care, 20(2), 162–181. https://doi.org/10.1080/13561820600646546
23.
HeardC. P.ScottJ.McGinnT.Van Der KampE.YahiaA. (2018). Informal leadership in the clinical setting: Occupational therapist perspectives. The Open Journal of Occupational Therapy, 6(2), 1–13. https://doi.org/10.15453/2168-6408.1427
24.
HomanA. C.GündemirS.BuengelerC.van KleefG. A. (2020). Leading diversity: Towards a theory of functional leadership in diverse teams. Journal of Applied Psychology, 105(10), 1101–1128. https://doi.org/10.1037/apl0000482
25.
HowellJ. M.HigginsC. A. (1990). Champions of technological innovation. Administrative Science Quarterly, 35(2), 317–341. https://doi.org/102307/2393393
26.
HowellJ. M.SheaC. M.HigginsC. A. (2005). Champions of product innovations: Defining, developing, and validating a measure of champion behavior. Journal of Business Venturing, 20(5), 641–661. https://doi.org/10.1016/j.jbusvent.2004.06.001
27.
HsuA. T.BertaW.CoyteP. C.LaporteA. (2016). Staffing in Ontario’s long-term care homes: Differences by profit status and chain ownership. Canadian Journal on Aging, 35(2), 175–189. https://doi.org/10.1017/S0714980816000192
28.
JacobsS. R.WeinerB. J.ReeveB. B.HofmannD. A.ChristianM.WeinbergerM. (2015). Determining the predictors of innovation implementation in healthcare: A quantitative analysis of implementation effectiveness. BMC Health Services Research, 15(1), 142–164. https://doi.org/10.1186/s12913-014-0657-3
JohnsonA.HongH.GrothM.ParkerS. K. (2011). Learning and development: Promoting nurses’ performance and work attitudes. Journal of Advanced Nursing, 67(3), 609–620. https://doi.org/10.1111/j.1365-2648.2010.05487.x
31.
JonesT.Drach-ZahavyA.SermeusW.WillisE.ZelenikovaR. (2021). Understanding missed care: Definitions, measures, conceptualizations, evidence, prevalence, and challenges. In PapastavrouE.SuhonenR. (Eds.), Impacts of rationing and missed nursing care: Challenges and solutions (pp. 9–47). Springer International Publishing.
32.
KahveciC.GündüzŞ.YozgatU. (2011). What is knowledge stickeness? Wisdom metaphor in knowledge transfer and the movie “Les Schtroumpfs.”The Knowledge Economy.
33.
KleinK. J.KnightA. P. (2005). Innovation implementation: Overcoming the challenge. Current Directions in Psychological Science, 14(5), 243–246. https://doi.org/10.1111/j.0963-7214.2005.00373.x
34.
KossioniA. E.Hajto-BrykJ.MaggiS.McKennaG.PetrovicM.Roller-WirnsbergerR. E.SchimmelM.TamulaitienèM.VanobbergenJ.MüllerF. (2018). An expert opinion from the European college of gerodontology and the European geriatric medicine society: European policy recommendations on oral health in older adults. Journal of the American Geriatrics Society, 66(3), 609–613. https://doi.org/10.1111/jgs.15191
35.
LamM.RobertsonD. (2012). Organizational culture, tenure, and willingness to participate in continuous improvement projects in healthcare. Journal of Quality Management, 19(3), 7–15. https://doi.org/10.1080/10686967.2012.11918070
36.
LawsonT. D. (2016). Informal leadership: A study of the impact of leadership on patient satisfaction in hospitals (10154845) [Doctoral dissertation, Dallas Baptist University]. ProQuest LLC.
37.
LingardL.ReznickR.DeVitoI.EspinS. (2002). Forming professional identities on the health care team: Discursive constructions of the ‘other’ in the operating room. Medical Education, 36(8), 728–734. https://doi.org/10.1046/j.1365-2923.2002.01271.x
38.
LövestamE.BoströmA. M.OrrevallY. (2017). Nutrition care process implementation: Experiences in various dietetics environments in Sweden. Journal of the Academy of Nutrition and Dietetics, 117(11), 1738–1748. https://doi.org/10.1016/j.jand.2017.02.001
39.
LuzS.ShadmiE.AdmiH.PeterfreundI.Drach-ZahavyA. (2019). Characteristics and behaviours of formal versus informal nurse champions and their relationship to innovation success. Journal of Advanced Nursing, 75(1), 85–95. https://doi.org/10.1111/jan.13838
40.
MakK. H. M.KippistL.SloanT.EljizK. (2019). What is the professional identity of allied health managers?Asia Pacific Journal of Health Management, 14(1), 58–67. https://doi.org/10.24083/apjhm.v14i1.219
41.
McGowanE.StokesE. (2017). Leadership and leadership development within the profession of physiotherapy in Ireland. Physiotherapy Theory and Practice, 33(1), 62–71. https://doi.org/10.1080/09593985.2016.1230659
42.
McNeilK. A.MitchellR. J.ParkerV. (2013). Interprofessional practice and professional identity threat. Health Sociology Review, 22(3), 291–307. https://doi.org/10.5172/hesr.2013.22.3.291
43.
MitchellR.BoyleB.ParkerV.GilesM.ChiangV.JoyceP. (2015). Managing inclusiveness and diversity in teams: How leader inclusiveness affects performance through status and team identity. Human Resource Management, 54(2), 217–239. https://doi.org/10.1002/hrm.21658
44.
MitchellR. J.ParkerV.GilesM. (2011). When do interprofessional teams succeed? Investigating the moderating roles of team and professional identity in interprofessional effectiveness. Human Relations, 64(10), 1321–1343. https://doi.org/10.1177/0018726711416872
45.
MordarskiB. A.HandR. K. (2019). Patterns in adult malnutrition assessment and diagnosis by registered dietitian nutritionists: 2014–2017. Journal of the Academy of Nutrition and Dietetics, 119(2), 310–322. https://doi.org/10.1016/j.jand.2018.07.010
46.
NembhardI. M.AlexanderJ. A.HoffT. J.RamanujamR. (2009). Why does the quality of health care continue to lag? Insights from management research. The Academy of Management Perspectives, 23(1), 24–42. http://www.jstor.org/stable/27747492
47.
NembhardI. M.EdmondsonA. C. (2006). Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. Journal of Organizational Behavior, 27(7), 941–966. https://doi.org/10.1002/job.413
48.
NeubertM. J.TaggarS. (2004). Pathways to informal leadership: The moderating role of gender on the relationship of individual differences and team member network centrality to informal leadership emergence. The Leadership Quarterly, 15(2), 175–194. https://doi.org/10.1016/j.leaqua.2004.02.006
49.
PattenE. V.SauerK. (2019). A leadership taxonomy for clinical dietetics practice. Journal of the Academy of Nutrition and Dietetics, 119(3), 369–374. https://doi.org/10.1016/j.jand.2018.01.011
PodsakoffP. M.MacKenzieS. B.LeeJ. Y.PodsakoffN. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903. https://doi.org/10.1037/0021-9010.88.5.879
52.
PolitD. F.BeckC. T.OwenS. V. (2007). Focus on research methods: Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health, 30(4), 459–467. https://doi.org/10.1002/nur.20199
53.
PorterJ.WiltonA. (2020). Professional identity of allied health staff associated with a major health network organizational restructuring. Nursing and Health Sciences, 22(4), 1103–1110. https://doi.org/10.1111/nhs.12777
54.
RamanujamR.RousseauD. M. (2006). The challenges are organizational not just clinical. Journal of Organizational Behavior, 27(7), 811–827. https://doi.org/10.1002/job.411
55.
Reiter-PalmonR.KennelV.AllenJ.JonesK. J. (2018). Good catch! Using interdisciplinary teams and team reflexivity to improve patient safety. Group & Organization Management, 43(3), 414–439. https://doi.org/10.1177/1059601118768163
56.
RogersE. M. (2003). Diffusion of innovations (5th ed.). Free Press.
57.
RossL. J.MudgeA. M.YoungA. M.BanksM. (2011). Everyone’s problem but nobody’s job: Staff perceptions and explanations for poor nutritional intake in older medical patients. Nutrition & Dietetics, 68(1), 41–46. https://doi.org/10.1111/j.1747-0080.2010.01495.x
58.
SheaC. M.TurnerK.AlbrittonJ.ReiterK. L. (2018). Contextual factors that influence quality improvement implementation in primary care: The role of organizations, teams, and individuals. Health Care Management Review, 43(3), 261–269. https://doi.org/10.1097/HMR.0000000000000194
59.
Sheffer-HilelG.Drach-ZahavyA.GoldblattH.EndeveltR. (2021). Dietitians’ change in practice: A challenge or a threat?Topics in Clinical Nutrition, 36(3), 189–201. https://doi.org/10.1097/tin.0000000000000247
60.
ShifazaF.EvansD.BradleyH.UllrichS. (2013). Developing evidence-based practice champions in the Maldives. International Journal of Nursing Practice, 19(6), 596–602. https://doi.org/10.1111/ijn.12106
61.
SmallfieldS.FlaniganL.ShermanA. (2019). Comparing outcomes of entry-level degrees from one occupational therapy program. Journal of Occupational Therapy Education (JOTE), 3(1), 1–28. https://doi.org/10.26681/jote.2019.030107
62.
SmithK. M.ThomasK. S.JohnsonS.MengH.HyerK. (2019). Dietary service staffing impact nutritional quality in nursing homes. Journal of Applied Gerontology, 38(5), 639–655. https://doi.org/10.1177/0733464816688309
63.
StanleyW.BorthwickA. M. (2013). Extended roles and the dietitian: Community adult enteral tube care. Journal of Human Nutrition and Dietetics, 26(3), 298–305. https://doi.org/10.1111/jhn.12016
64.
SuterE.GoldmanJ.MartimianakisT.ChatalalsinghC.DeMatteoD. J.ReevesS. (2013). The use of systems and organizational theories in the interprofessional field: Findings from a scoping review. Journal of Interprofessional Care, 27(1), 57–64. https://doi.org/10.3109/13561820.2012.739670
65.
SwanW. I.VivantiA.Hakel-SmithN. A.HotsonB.OrrevallY.TrostlerN.Beck HowarterK.PapoutsakisC. (2017). Nutrition care process and model update: Toward realizing people-centered care and outcomes management. Journal of the Academy of Nutrition and Dietetics, 117(12), 2003–2014. https://doi.org/10.1016/j.jand.2017.07.015
66.
SzetoM. O.MailletJ. O.BrodyR. A.ParrottJ. S. (2014). Registered dietitians’ roles in decision-making processes: For PEG placement in the elderly. Canadian Journal of Dietetic Practice and Research, 75(2), 78–83. https://doi.org/10.3148/75.2.2014.78
67.
SzulanskiG.RingovD.JensenR. J. (2016). Overcoming stickiness: How the timing of knowledge transfer methods affects transfer difficulty. Organization Science, 27(2), 304–322. https://doi.org/10.1287/orsc.2016.1049
68.
ThyleforsI. (2012). All professionals are equal but some professionals are more equal than others? Dominance, status and efficiency in Swedish interprofessional teams. Scandinavian Journal of Caring Sciences, 26(3), 505–512. https://doi.org/10.1111/j.1471-6712.2011.00955.x
69.
van KnippenbergD.MellJ. N. (2016). Past, present, and potential future of team diversity research: From compositional diversity to emergent diversity. Organizational Behavior and Human Decision Processes, 136, 135–145. https://doi.org/10.1016/j.obhdp.2016.05.007
70.
VoyerB. (2013). Changes in the relations and roles of doctors and nurses. British Journal of Healthcare Management, 19(1), 16–21. https://doi.org/10.12968/bjhc.2013.19.1.16
71.
WellerJ.BoydM.CuminD. (2014). Teams, tribes and patient safety: Overcoming barriers to effective teamwork in healthcare. Postgraduate Medical Journal, 90(1061), 149–154. https://doi.org/10.1136/postgradmedj-2012-131168
72.
WykesK.TaylorK.WilkinsonS. A. (2013). An investigation into the perioperative nutritional management of open colorectal surgery patients in major Australian hospitals: A comparison with the ERAS guidelines. Nutrition & Dietetics, 70(3), 175–180. https://doi.org/10.1111/1747-0080.12021
