Open Access Research article

Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department: a comparative case study

Mandus Frykman1*, Henna Hasson12, Åsa Muntlin Athlin3456 and Ulrica von Thiele Schwarz1

Author Affiliations

1 Department of Learning, Informatics, Management and Ethics, Medical Management Centre (MMC), Karolinska Institutet, 171 77 Stockholm, Sweden

2 Centre for Epidemiology and Community Medicine (CES), Stockholm County Council, P.O. Box 1497, 171 29 Stockholm, Sweden

3 School of Nursing, University of Adelaide, SA 5005 Adelaide, Australia

4 Department of Medical Sciences, Uppsala University, Uppsala University Hospital, 751 85 Uppsala, Sweden

5 Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden

6 Department of Emergency Care, Uppsala University Hospital, 751 85 Uppsala, Sweden

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BMC Health Services Research 2014, 14:218  doi:10.1186/1472-6963-14-218

Published: 15 May 2014



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.


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.


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.


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.

Implementation; Adherence; Fidelity; Operant psychology; DCOM®; Organizational behavior management; Applied behavior analysis; Motivation