Digital Transformation in Healthcare: The Critical Role of Clinical Staff Interactions

Digital Transformation in Healthcare: The Critical Role of Clinical Staff Interactions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Digital Transformation in Healthcare: The Critical Role of Clinical Staff Interactions Susan Stead, Nicole Hartwich, David Antons, Torsten-Oliver Salge This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9365928/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The healthcare sector plays a critical role in society, with hospitals often facing resource shortages. As costs rise and pressure to improve service quality increases, the need for digital transformation in healthcare has become more pronounced. This study examines the impact of digital team capabilities and organizational digital readiness on team efficacy and ultimately hospital performance, to understand how these factors interact to enhance patient safety. A comprehensive analysis was conducted using data from 96 hospital trusts within the English National Health Service (NHS), involving over 50,000 clinical staff members. Quantitative analyses were performed to investigate the relationships among the key variables. The findings reveal a significant positive effect of digital team capabilities on team efficacy (b = .012, p < .05). Additionally, organizational digital readiness moderates the relationship between digital team capabilities and team efficacy (b = − .011, p < .05). Higher team efficacy is associated with lower hospital mortality rates (b = − .01, p < .05). Overall, the results indicate that digital team capabilities are crucial for enhancing team efficacy, which in turn contributes to improved hospital performance, while support from organizational digital readiness amplifies this effect. Consequently, hospital managers should invest in digital infrastructure and develop strategies to foster digital capabilities, particularly in facilities with low levels of digital readiness, as this may support clinical staff in adopting new technologies and ultimately enhance patient safety. Digital Transformation Team Efficacy Organizational Readiness Hospital Performance Healthcare Innovation Figures Figure 1 Figure 2 Introduction The healthcare sector plays a critical role in society and the economy, often facing significant challenges related to resource allocation and management. Hospitals frequently operate at full capacity, encountering shortages in medical supplies, facilities, and human resources. As costs in the healthcare sector continue to rise, medical staff are often pushed to their physical limits [ 1 ], working overtime and adapting to capability constraints [ 2 ]. With increasing pressure on healthcare organizations to improve the quality and efficacy of services, the call for digitalization has grown louder, and investments in information technology (IT) are set to increase in the healthcare sector [ 3 ]. While technological advancements take place at an accelerating pace, we are still in early stages of digital maturity – referred to as the level of IT used in hospitals to support high quality and efficacy in care processes [ 4 ]. A recent review shows contradictions in the effect of digital maturity on outcomes such as team or organizational benefits and performance [ 5 ]. Given the urge to improve healthcare quality and efficacy, and the amount of investment spent on digital transformation, it is not surprising that most studies take an organizational perspective on the effectiveness of digitalization [ 6 ]. However, especially the healthcare sector provides an ideal example, where service quality and efficacy are largely determined by the functioning of teams and the daily work of employees. Hence, solely focusing on organizational performance provides an incomplete picture, lacking insights on the actual drivers of performance [ 7 ]. Furthermore, most existing research focuses on the assessment of digital maturity, considering a specific technology or tool. Martin et al. [ 4 ] point out that we lack an understanding of how resources, capabilities, and infrastructure change across multiple, interwoven service processes, reflecting employees’ complex activities involved [ 8 ]. For example, staff handovers across the patient journey along the treatment process deserve dedicated scholarly attention [ 9 ]. A review on digital transformation in healthcare by Ritu et al. [ 10 ] shows that the main barriers of digital service transformation are linked to four factors: functionality, users, finance, and the environment. The first two factors are determined by the evaluation of employees directly, whereas the latter two pertain more to the organizational level, such as financial restrictions or governmental regulations. To better understand the influence of digital service innovation on performance, it is therefore important to consider the influence on both, employees (i.e., clinical staff) and the organizational (i.e., hospital) performance at large. Building on this, digital transformation in healthcare has recently received substantial research attention [ 3 ]. While most of the research focuses on specific technological innovations, the present study seeks to understand how digital team capabilities and organizational digital readiness jointly influence team efficacy and ultimately hospital performance. While the process of digital transformation has received substantial attention in IS literature [ 11 ], it is still relatively unexplored from a service perspective [ 12 ]. In IS literature, the development of multistage digital maturity models has become a hot topic in recent years [ 6 ]. These models serve to assess the development and influence of organizational capabilities on meaningful outcomes at an organizational and health systems level [ 4 ], enabling a stepwise integration of IS and IT capabilities [ 5 ]. While these models are the fundamental base for digital transformation in the healthcare sector, there are yet limited studies that assess the impact of digital capabilities on healthcare processes drawing on appropriately large and representative samples. Martin et al. [ 4 ] point out that much of the existing research takes a rather narrow perspective on specific and isolated processes within one institution, which impedes a holistic understanding of the role of digital capabilities for interrelated and complex processes that clinical staff engage in during daily team activities. In the context of digital transformation, organizational learning plays a fundamental role that leads to organizational change [ 13 ]. Organizational learning theory has evolved as a meta-theory dealing with the socio-organizational context of learning and processing of newly derived knowledge into subsequent processes [ 14 ]. Under the phenomenological perspective, organizational learning is generated by the interaction and construction of meaning between actors and manifests resulting learnings in organizational communication, culture, and behavioral norms [ 15 ]. Extant literature in management science establishes the link between organizational learning theory and team capabilities, suggesting that leveraging effective team capabilities can boost organizational performance [ 16 ]. Following this line of reasoning, the present study investigates three important team capabilities that occur at the intersection and are relevant for the service transition of key patient care and treatment processes: transfer of care, records of care assessment, and decision support. First, transfer of care refers to the use of digital technology to facilitate a smooth and effective transfer of patients across treatment processes. This capability includes leveraging digital tools that support the process and reduce the risk of hospital discharge and avoidable retrospective follow-up treatments [ 17 ]. The exchange of information prevails as a difficult task for clinical staff during the transition phase. Szary et al. [ 18 ] found that shift changes between clinical staff teams is a denominator of delays in the delivery of (laboratory) test results. The complexity arising from multi-tasking activities, which require shifting in attention towards other tasks and actors (i.e., clinical staff or patients), can cause information loss [ 18 ]. Second, related to the transition processes patients and caregivers go through, recently records of care assessment based on IS to support clinical notetaking, vital parameter monitoring, and care scheduling, are disposed to facilitate storing, managing, and displaying of all essential information, independent of location. Especially, the role of the electronic health record (EHR) has caused controversial discussions regarding the benefits for clinical staff [ 19 ]. A study by Boonstra et al. [ 20 ] found that diverse healthcare stakeholders hold mixed attitudes. While most stakeholders perceived the EHR as beneficial for the patient, some stakeholders also resisted the implementation, fearing a conflict in their interests. Third, the urgency to decide and act quickly led to the development of digital tools for decision support, which should guide more effective and efficient decision-making of clinical staff. These tools are, e.g., automated prompts that highlight the caregivers’ actions, or alerts and notifications informing on patients’ changing vital parameters necessitating further actions. The digital decision support is used at the intersection, matching information from the EHR with clinical knowledge. The use of these computerized clinical support systems has also caused legal and ethical concerns regarding the accountability for wrong decisions and their consequences [ 21 ]. As these digital capabilities are all designed to improve and simplify team collaboration and coordination, we expect that the digital capabilities will enhance team efficacy (Hypothesis 1). Facilitated by increasingly developed IT infrastructures, the amount of data that is captured and retained in hospitals increases sharply. Data is viewed as a strategic resource that can be transformed into information, which in turn supports informed decision making [ 22 ]. This process is in the literature referred to as information governance, which requires organizational capabilities to collect, assess, validate, store, and retrieve information over a period of time [ 23 ]. The theory of IT and information governance proposes that the adoption of an information governance capability can leverage value creation processes and improve firm performance [ 22 ]. An important determinant of information governance constitutes the strategic orientation of the organization [ 24 ]. Strategic alignment, referred to as the extent to which the hospital incorporates digital transformation as a strategic priority [ 25 ], and digital leadership, which refers to the organizational ambition to drive digitalization forward [ 26 ], are additional indications of the organization’s digital readiness. As such, the hospitals’ ability to develop goals and strategies for digital service transformation, to collect, store, and manage digital information, and to monitor and support this digital agenda in daily routines, constitutes a predictor of the organizational digital readiness, measured by the three capabilities: digital governance, strategic alignment, and digital leadership. As numerous studies highlight the resistance of clinical staff to adopt IT and IS tools in their daily operations [ 27 , 28 ], we expect a strong need for a supporting organizational environment that guides the digital transformation and facilitates the adoption of digital tools by clinical staff. We therefore expect the effect of digital team capabilities on team efficacy to be stronger when organizational digital readiness is high (Hypothesis 2). Information exchange is the basis for adequate patient treatment. The outcome of patient care is largely determined by the effectiveness of capturing, managing, and processing patient information [ 29 ]. In the fertile working environment that requires high quality, fast and efficient handling and communication, and safe and secure care, team efficacy and communication between clinical staff members are expected to have a profound impact on hospital performance. Literature has established the link between effective teamwork and team communication on patient safety [ 30 ], showing that effective communication is a prerequisite of team effectiveness [ 31 ]. Especially in more critical, life-threatening situations where patients deteriorate rapidly, communication between clinical staff is essential and necessitates a safe and secure work environment that empowers all clinical staff in open communication [ 32 ]. Teunissen et al. [ 33 ] demonstrate that confusion in tasks and responsibilities, misconceptions and misunderstanding among the team and existing hierarchies rank among the most important obstacles that prevent teams from interacting effectively. A recent review by Buljac-Samardzic [ 34 ] on interventions to improve team effectiveness in healthcare finds that organizational training, tools to structure processes, and strategic organizational redesigns constitute the main capabilities that contribute to enhanced efficacy. On the collective and organizational level, better collaboration and cooperation among staff should enhance hospital performance (Hypothesis 3). By employing a large-scale study that investigates 96 hospital trusts operating in the English National Healthcare System (NHS), drawing on multiple data sources collected over a one-year period (2017–2018), the current paper seeks to contribute to this knowledge gap in three meaningful ways. First, contributing to recent advancement of the organizational learning theory, the study shows how leveraging relevant digital team capabilities can reduce commonly identified communication and interaction barriers and facilitate performance increases. Second, employing a nationwide study on the effects of different levels of digital capabilities and organizational digital readiness, the study provides a robust statistical analysis that quantifies effects on team efficacy and hospital risk-adjusted mortality rates. Third, this study makes a first step towards more comprehensive analyses of the digital service transformation process and its effects on team functioning in a healthcare context. Methods We conducted our study in the setting of the NHS in England. The NHS is the largest publicly funded health service in the world and is accountable for around 90% of national health expenditures [ 35 ]. To analyze the relationships among our key concepts, we integrated data from different sources. We extracted, merged, and aggregated the data. First, data were derived from a national survey collected by the NHS to measure digital maturity through a self-assessment tool completed by a large number of clinical staff. The survey assesses the use of technology in hospitals and helps to evaluate its digital maturity level. Second, we draw on the annual NHS staff survey. This survey is conducted by the Department of Health and is administered among all employees of each hospital trust. Third, we extracted archival performance data for each trust and drew on several hospital estates and facility statistics, as well as hospital episode statistics, to get a more profound understanding of the hospital working environment. We combined and integrated the data from these different sources for the financial year 2017–2018. The final data set includes 96 hospital trusts. Each acute trust manages a mean of around 2.35 hospitals. Measures Digital team capabilities : Digital capabilities were captured from the NHS digital maturity self-assessment. Digital team capabilities include six items regarding transfer of care (e.g., “Discharge summaries are created in a consistent format across the organization”), 12 items regarding records of care assessment (e.g., ”when using digital records, health and care professionals can find what they need quickly and easily”), and four items regarding decision support (e.g., “Digital systems provide automatic prompts for the next action required by multi-step care plans, pathways protocols”). We then assessed scale reliability for digital team capabilities, consisting of 22 items, and reported a Cronbach’s alpha of .89, which can be considered high. Organizational digital readiness : Organizational digital readiness was also captured from the digital maturity assessment and includes six items on digital governance (i.e., “Digital projects are underpinned by valid business cases and fully-engaged business owners.”), five items on strategic alignment (i.e., “Digital technology is used to support improved collaboration and coordination across different parts of your organization”), as well as seven items on digital leadership (i.e., “You have recognized and engaged digital leadership throughout all levels of the organization”). The scale reliability for organizational digital readiness, including a total of 18 items, can be considered high with Cronbach’s alpha = .92. Team efficacy : We measured team efficacy with five items from the annual staff survey of the national health system. Sample items are “The team I work in often meets to discuss the team's effectiveness” and “I am able to make suggestions to improve the work of my team/department”. Assessment of the scale reliability reports a Cronbach’s alpha = .90 and can be considered high. Performance : To measure hospital performance, we used the standardized hospital mortality index (SHMI). This score draws on risk models and reports a ratio between the number of expected deaths per trust, compared with the number of actual deaths at the trust. This calculated risk level depicts how each trust performs compared to the NHS average. Control variables : We included a substantial set of control variables that might confound our analyses in all our analyses. We controlled for hospital size, occupancy, trust type, patient bed days, hospital total episodes, patients’ mean age, and patients’ mean length of stay that might affect the standardized mortality rate of a hospital. In addition, we included the availability of adequate work materials and the perception of being adequately staffed to do the daily work in our analyses, as these factors could influence employees' perceived team efficacy. The causal relationships investigated in this empirical research are illustrated in Fig. 1 , which presents our conceptual model. Results We employed hierarchical regression analyses to test our hypothesized model. All continuous variables were standardized before the analyses. We extracted our independent, mediating, and dependent variables from three separate data sources to avoid common method bias. Table 1 shows the descriptive statistics and correlations of our variables. Results reveal a significant negative correlation between team efficacy and the SHMI score and a significant positive correlation between team efficacy and digital readiness. Table 1 Descriptive statistics and study variable correlations 1. SHMI Mean SD 1 2 3 4 5 6 7 8 9 10 11 1 .10 2. Team Efficacy 3.72 .08 -0.28 * 3. Digital Team Capabilities 61.08 21.3 -0.02 0.19 + 4. Organizational Digital Readiness 83.34 13.82 -0.06 0.24 * 0.66 *** 5. Adequate Materials 3.99 0.08 0.16 0.61 *** 0.25 * 0.19 + 6. Enough Staff 3.81 0.08 -0.07 0.79 *** 0.22 * 0.19 + 0.91 *** 7. Hospital Size 711.25 368.23 -0.02 -0.07 0.15 0.15 -0.20 + -0.12 8. Hospital Occupancy 0.87 0.07 0.18 -0.17 -0.07 -0.07 -0.11 -0.14 0.07 9. Patient Bed Days 245269.93 138431.42 -0.08 -0.08 0.18 0.17 -0.21 + -0.11 0.98 *** 0.15 10. Total Episodes 122934.30 67583.85 -0.11 -0.08 0.20 + 0.20 + -0.21 + -0.12 0.94 *** 0.05 0.94 *** 11. Patient Mean Age 52.85 9.23 0.35 ** -0.13 -0.11 -0.11 0.23 * -0.00 -0.26 * 0.05 -0.29 * -0.22 * 12. Patient Mean Lenth of Stay 4.20 1.06 0.05 -0.16 -0.06 -0.07 -0.06 -0.13 0.30 ** 0.26 * 0.34 * 0.14 0.24 * + < 0.01; * < 0.05; ** < 0.01; *** < 0.001 Results of our analyses are depicted in Table 2 . Model 1 shows that our control variables: adequate materials for the daily work, perception of being adequately staffed, and hospital size all have a significant effect on team efficacy. Table 2 Results of hierarchical regression analysis Model 1 Model 2 Model 3 Model 4 Team Efficacy Team Efficacy Team Efficacy SHMI Score Controls Constant -0.343 1.440 *** 1.549 *** 0.437 (0.514) (0.311) (0.300) (0.612) adequate Materials 1.293 *** -0.829 *** -0.795 *** 0.906 * (0.349) (0.183) (0.175) (0.404) enough Staff -1.138 *** 1.438 *** 1.378 *** -0.475 (0.314) (0.159) (0.154) (0.434) Hospital Size 0.000 ** 0.000 * 0.000 + 0.000 ** (0.000) (0.000) (0.000) (0.000) Hospital Occupancy 0.449 * 0.038 0.001 0.431 * (0.190) (0.091) (0.088) (0.189) Trust Type 0.000 0.002 0.004 0.000 (.) (0.024) (0.023) (.) Patient Bed Days -0.000 -0.000 * -0.000 + -0.000 (0.000) (0.000) (0.000) (0.000) Total Episodes -0.000 + 0.000 0.000 -0.000 + (0.000) (0.000) (0.000) (0.000) Mean Patient Age 0.004 0.000 0.001 0.005 (0.003) (0.001) (0.001) (0.003) Mean Length of Stay -0.038 0.017 ** 0.016 ** -0.037 (0.024) (0.005) (0.005) (0.024) Main Effects Digital Team 0.012 * 0.006 0.005 Capabilities (0.005) (0.006) (0.011) Organizational Digital 0.006 -0.004 Readiness (0.006) (0.012) Digital Team Capabilities X Organizational Digital -0.011 * -0.010 Readiness (0.004) (0.009) Team Efficacy -0.474 * (0.197) R-Squared 0.435 0.727 0.728 0.476 Number of Hospital Trusts 96 96 96 96 Notes . OLS model, standard errors are reported in parantheses. + < 0.01; * < 0.05; ** < 0.01; ***< 0 .001 The results of our hypothesis 1 are shown in Model 2. In support of H1, the results reveal a significantly positive effect of digital team capabilities on team efficacy, b =.012, p<.05. To investigate hypothesis 2, we included organizational digital readiness in the analysis and investigated the interaction effect of digital team capabilities and organizational digital readiness. Model 3 reports the results, which show a significant negative interaction effect, b =-.011, p<.05. To assess the moderation in more detail, Fig. 2 plots the simple slopes from which we can derive that team efficacy is higher when organizational digital readiness is high as opposed to low. Moreover, if organizational digital readiness is low, digital team capabilities have a stronger effect on team efficacy, implying that team digital capabilities are especially important when organizational digital readiness, captured by digital leadership, digital governance, and strategic alignment, is low. These results do not support H2 that digital team capabilities have a more positive influence on team efficacy when the digital organizational digital readiness is high. In hypothesis 3, we predicted a positive effect of team efficacy on hospital performance. The results of H3 are shown in Table 2 , Model 4. We find support for H3 with a significantly negative effect of team efficacy on the hospital SHMI score, b =-.01, p<.05. This implies that compared to the baseline, when mortality is decreasing, hospital performance is increasing. Discussion The goal of the study was to identify how digital team capabilities and organizational digital readiness can influence services to achieve higher team efficacy and hospital performance. For this purpose, the responses of over 50.000 clinical staff members from 96 healthcare trusts of the English NHS have been aggregated to investigate how digital service transformation affects daily clinical activities, interactions, and ultimately performance. The findings of the study show that there is a strong relationship between digital team capabilities, organizational digital readiness, and team efficacy, which jointly drive hospital performance. More specifically, the results highlight that digital team capabilities have a positive influence on team efficacy. This means that increasing the use of digital systems in services such as records of care, transfer of care, and decision support can help teams become more effective, with positive implications for patient care and mortality. Using digitized services involves activities such as digital note-taking, monitoring, and automated reporting of vital parameters, which can ease the transfer of care process and avoid misconceptions or misunderstandings in shifts of caregivers [ 18 ]. Especially, the latter two are repeatedly shown to have a profound impact on error rates and patient care [ 33 ]. Furthermore, digital systems that support clinical management and diagnostics can save a significant amount of time, so that caregivers and physicians can spend more time on cognitively complex tasks, which require their full attention [ 21 ]. Second, the results illustrate that digital team capabilities and organizational digital readiness jointly affect team efficacy. When organizational digital readiness is low, digital team capabilities have a stronger effect on team efficacy, suggesting that team capabilities that support routine services are even more important when organizational digital readiness towards strategic alignment, digital leadership, and digital governance is limited. Although the direction of this interplay is different from what was expected, we find strong support for a joint effect, showing that supporting digital organizational environments guides digital service transformation and facilitates an informed adoption for clinical staff. These team capabilities can ease the daily interaction and enhance team efficacy. Third, and most important from an organizational point of view, the higher the team efficacy, the higher the organizational performance. This means that patient mortality reduces with greater team efficacy. This not only shows that investment in digital team capabilities is worthwhile but also highlights the importance to evaluate team performance and developing a work environment and culture that supports learning from errors, open communication, and feedback loops (e.g., [ 33 ]). Digital maturity in healthcare has attracted substantial attention in research and practice in recent years. Yet, we are still in an infancy state, where most studies aim to develop assessment criteria, enabling hospitals to stepwise engage in digital service transformation [ 37 ]. While the benefits for organizations are highlighted in several studies, there is still a controversy regarding the effectiveness of digital capabilities for clinical staff members [ 28 ], especially on how digital team capabilities influence team efficacy and how this ultimately drives hospital performance. The present study contributes to this knowledge gap in several ways. First, we show how digital team capabilities and organizational digital readiness jointly influence the team efficacy and hospital performance. This finding contributes to recent developments of organizational learning theory, suggesting that leveraging relevant digital team capabilities reduces communication and interaction barriers and enhances performance. Second, the study provides a robust statistical analysis, in aggregating the responses of more than 50,000 clinical staff members, enabling a comparison between 96 hospital trusts. Overall, the study provides evidence that team digital capabilities and team efficacy can both help contain patient mortality in hospitals. Third, this study contributes to the call for research that takes a more comprehensive perspective on the effectiveness of multifunctional technological developments, spanning across diverse service processes in the hospital. Practical implications From a managerial point of view, several important implications are noteworthy. First, this study sheds light on the controversy of whether digital service transformation can benefit clinical staff in their daily care delivery. In particular, the prominent critical moments, where information exchange, informed decision-making, and handover are repeatedly reported as sources for errors sources for errors [ 18 , 33 ] and staff frustration [ 36 ], can be supported by digitized service processes. The findings show that the more digital team capabilities are in place, the higher the team efficacy and the better the hospital performance. Second, hospitals’ digital readiness in the form of strategic alignment, leadership, and information governance influences to what extent digital team capabilities are critical for team efficacy. This means that for hospitals that score relatively low on digital readiness, digital transfer of care, records of care, and decision support play an even more important role for team efficacy. Third, the findings of this study can help hospital managers to communicate the importance and effectiveness of increasingly digitalized infrastructures to more resistant and sceptical clinical staff members. Finally, the results provide scientific support on the benefits of the process of digital service transformation, achieving higher team efficacy and better performance, for hospitals that developed more digital team capabilities than other hospitals. Conclusion This study reveals the influence of digital service transformation, in the form of digital team capabilities and hospitals’ digital readiness, on the perception of clinical staff, focusing on communication, shared objectives, and perceived interaction as well as hospital performance in general. Data from 96 hospital trusts and over 50,000 clinical staff members have been aggregated to shed light on the effectiveness of digital capability development for hospitals’ daily activities. Acknowledging the limitations of this research endeavour, several areas for future research can be derived. While the study provides a robust and large sample to show the effect of digital service transformation on hospital performance, the availability of data has limited the analysis to responses collected within one year. Future studies can build on the insights of this research and extend the approach to a longitudinal study. This approach would allow to estimate within-hospital changes, investigate lagged relationships between digital maturity increases and effects on employees. Moreover, the interplay of digital team capabilities and organizational digital readiness could be examined in more detail. Especially, their effect on team performance, potentially including concepts such as learning or organizational culture, would provide fruitful avenues for service research on digital maturity and transformation. Declarations Ethics Ethics declaration: not applicable. Funding The authors did not receive funding or support from any organization for the submitted work. Competing interests All authors certify that they have no competing interests, meaning no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Data Availability The data that support the findings of this study were obtained from NHS England/NHS Digital (https://digital.nhs.uk/data) and consist of trust-level responses to the NHS digital maturity self-assessment, the annual NHS Staff Survey, and hospital performance and estates statistics, including the Standardized Hospital Mortality Index (SHMI), as described in the Methods section. Aggregated NHS Staff Survey and SHMI data are publicly accessible via NHS England/NHS Digital online resources. The combined analytical dataset constructed for this study cannot be shared publicly because of data-sharing agreements with the data providers, but it can be reconstructed by researchers who obtain access to the same source data through the standard NHS data access procedures . Author Contribution Susan Stead conceived and designed the study, developed the theoretical framework, coordinated the work, and led the writing of the manuscript. Nicole Hartwich designed and implemented the empirical methodology, conducted the statistical analyses, and contributed to writing and revising the manuscript. David Antons contributed to the study design and interpretation of the findings, and critically revised the manuscript for important intellectual content. Torsten-Oliver Salge provided overall guidance on the research design, contributed to the interpretation of the results, and critically reviewed and revised the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work. References Gavin, B., Hayden, J., Adamis, D., McNicholas, F.: Caring for the psychological well-being of healthcare professionals in the COVID-19 pandemic crisis. Ir. Med. J. 113 , 51 (2020) Zhou, X., Snoswell, C.L., Harding, L.E., Bambling, M., Edirippulige, S., Bai, X., Smith, A.C.: The role of telehealth in reducing the mental health burden from COVID-19. 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Health Inf. J. 17 , 63–71 (2011). https://doi.org/10.1177/1460458211399403 Boonstra, A., Boddy, D., Bell, S.: Stakeholder management in IOS projects: analysis of an attempt to implement an electronic patient file. Eur. J. Inform. Syst. 17 , 100–111 (2008). https://doi.org/10.1057/ejis.2008.2 Sutton, R.T., Pincock, D., Baumgart, D.C., Sadowski, D.C., Fedorak, R.N., Kroeker, K.I.: An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digit. Med. 3 , 1–10 (2020). https://doi.org/10.1038/s41746-020-0221-y Tallon, P.P., Ramirez, R.V., Short, J.E.: The information artifact in IT governance: toward a theory of information governance. J. Manage. Inform. Syst. 30 , 141–178 (2013). https://doi.org/10.2753/MIS0742-1222300306 Khatri, V., Brown, C.V.: Designing data governance. Commun. ACM. 53 , 148–152 (2010). https://doi.org/10.1145/1629175.1629210 Raghupathi, W.R.: Corporate governance of IT: a framework for development. Commun. ACM. 50 , 94–99 (2007). https://doi.org/10.1145/1278201.1278212 Street, C., Gallupe, B., Baker, J.: The influence of entrepreneurial action on strategic alignment in new ventures: searching for the genesis of alignment. J. Strategic Inform. Syst. 27 , 59–81 (2018). https://doi.org/10.1016/j.jsis.2017.06.002 Ziadlou, D.: Digital Transformation Leadership for Smart Healthcare Organizations: House of Success Model. Opportunities and Challenges. Digit. Healthc. Innov. 72–96 (2020). https://doi.org/10.4018/978-1-7998-3274-4 Granja, C., Janssen, W., Johansen, M.A.: Factors determining the success and failure of eHealth interventions: systematic review of the literature. J. Med. Internet. Res. 20 , e10235 (2018). https://doi.org/10.2196/10235 Henoch, I., Strang, S., Larnebratt, C., Hermansson, J.: Digital health support – a good thing, but not for me. Experiences of family caregivers and healthcare staff. Br. J. Guidance Couns. (2020). https://doi.org/10.1080/03069885.2020.1826030 Mamlin, B.W., Tierney, W.M.: The promise of information and communication technology in healthcare: extracting value from the chaos. Am. J. Med. Sci. 351 , 59–68 (2016). https://doi.org/10.1016/j.amjms.2015.10.015 Gillespie, B.M., Chaboyer, W., Longbottom, P., Wallis, M.: The impact of organisational and individual factors on team communication in surgery: a qualitative study. Int. J. Nurs. Stud. 47 , 732–741 (2010). https://doi.org/10.1016/j.ijnurstu.2009.11.001 Bleakley, A., Boyden, J., Hobbs, A., Walsh, L., Allard, J.: Improving teamwork climate in operating theatres: the shift from multiprofessionalism to interprofessionalism. J. Interprof. Care. 20 , 461–470 (2006). https://doi.org/10.1080/13561820600921915 Ridley, C.H., et al.: Building a collaborative culture: focus on psychological safety and error reporting. Ann. Thorac. Surg. 111 , 683–689 (2021). https://doi.org/10.1016/j.athoracsur.2020.05.152 Teunissen, C., Burrell, B., Maskill, V.: Effective surgical teams: an integrative literature review. West. J. Nurs. Res. 42 , 61–75 (2020). https://doi.org/10.1177/0193945919834896 Buljac-Samardzic, M., Doekhie, K.D., van Wijngaarden, J.D.: Interventions to improve team effectiveness within health care: a systematic review of the past decade. Hum. Resour. Health. 18 , 1–42 (2020). https://doi.org/10.1186/s12960-019-0411-3 Piening, E.P., Baluch, A.M., Salge, T.O.: The relationship between employees’ perceptions of human resource systems and organizational performance. J. Appl. Psychol. 98 , 926–941 (2013). https://psycnet.apa.org /doi/10.1037/a0033925 Gardner, R.L., et al.: Physician stress and burnout: the impact of health information technology. J. Am. Med. Inform. Assoc. 26 , 106–114 (2019). https://doi.org/10.1093/jamia/ocy145 Johnston, D.S.: Digital maturity: are we ready to use technology in the NHS? Future Healthc. J. 4 , 189–192 (2017). https://doi.org/10.7861/futurehospital4 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9365928","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":629043168,"identity":"6cf3a8aa-4335-40f4-977a-0aa999d0941a","order_by":0,"name":"Susan Stead","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYLACngoGHijzAIhgAxGMDbiUg6R5zhhAtSQQq4W3zYCBeC3y85sPfng774+MbnsD22feH3cY+NsPP3vwcQeDbD8OLQbH2JIl524z4DE7c4B5Nk/CMwaJM2nmhjPPMBjPxGGNARuPgTQvSMuNBGbmnITD9Q0HctikedsYEjccwOGwNv7Pv3nnALXcfwDWwiB//g2b9F+glv04tDAc4wGa2QCyhQGixeAG0BZGkC04/ZJmZjnnmDHQL4nNzH/SDjMY3nhmJtnbJmE8A5fDmg8/vvGmRs7e7Pjhw4wzbA4zyJ1Pfibxs81Gth+H95EAakRIEFQ/CkbBKBgFowA3AAAbSlmyc+vQRwAAAABJRU5ErkJggg==","orcid":"","institution":"RWTH Aachen University","correspondingAuthor":true,"prefix":"","firstName":"Susan","middleName":"","lastName":"Stead","suffix":""},{"id":629043170,"identity":"4a74f127-4827-48a2-b287-6b625577919e","order_by":1,"name":"Nicole Hartwich","email":"","orcid":"","institution":"RWTH Aachen University","correspondingAuthor":false,"prefix":"","firstName":"Nicole","middleName":"","lastName":"Hartwich","suffix":""},{"id":629043172,"identity":"1c27efef-3316-425a-83e7-ff721791a864","order_by":2,"name":"David Antons","email":"","orcid":"","institution":"University of Bonn","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Antons","suffix":""},{"id":629043175,"identity":"47358b52-9f56-4237-923e-817bc76af49e","order_by":3,"name":"Torsten-Oliver Salge","email":"","orcid":"","institution":"RWTH Aachen University","correspondingAuthor":false,"prefix":"","firstName":"Torsten-Oliver","middleName":"","lastName":"Salge","suffix":""}],"badges":[],"createdAt":"2026-04-09 09:08:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9365928/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9365928/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108734219,"identity":"ae3bb50c-f193-4dde-8a7e-352f7bc20414","added_by":"auto","created_at":"2026-05-07 19:50:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19177,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual model\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9365928/v1/f9a17fcea7eea64963424dd0.png"},{"id":108734217,"identity":"71322cee-3786-4233-a91a-06be6ffa8daf","added_by":"auto","created_at":"2026-05-07 19:50:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":21471,"visible":true,"origin":"","legend":"\u003cp\u003ePredictive margins\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9365928/v1/6af40760c325636e902e84a8.png"},{"id":108806946,"identity":"6fcd1081-3a31-4aa8-ac8d-c2a8b27d23ea","added_by":"auto","created_at":"2026-05-08 15:29:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":498476,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9365928/v1/9072886f-22ea-4282-b0df-fd86100099f2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDigital Transformation in Healthcare: The Critical Role of Clinical Staff Interactions\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe healthcare sector plays a critical role in society and the economy, often facing significant challenges related to resource allocation and management. Hospitals frequently operate at full capacity, encountering shortages in medical supplies, facilities, and human resources. As costs in the healthcare sector continue to rise, medical staff are often pushed to their physical limits [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], working overtime and adapting to capability constraints [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. With increasing pressure on healthcare organizations to improve the quality and efficacy of services, the call for digitalization has grown louder, and investments in information technology (IT) are set to increase in the healthcare sector [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While technological advancements take place at an accelerating pace, we are still in early stages of digital maturity \u0026ndash; referred to as the level of IT used in hospitals to support high quality and efficacy in care processes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A recent review shows contradictions in the effect of digital maturity on outcomes such as team or organizational benefits and performance [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Given the urge to improve healthcare quality and efficacy, and the amount of investment spent on digital transformation, it is not surprising that most studies take an organizational perspective on the effectiveness of digitalization [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, especially the healthcare sector provides an ideal example, where service quality and efficacy are largely determined by the functioning of teams and the daily work of employees. Hence, solely focusing on organizational performance provides an incomplete picture, lacking insights on the actual drivers of performance [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, most existing research focuses on the assessment of digital maturity, considering a specific technology or tool. Martin et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] point out that we lack an understanding of how resources, capabilities, and infrastructure change across multiple, interwoven service processes, reflecting employees\u0026rsquo; complex activities involved [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. For example, staff handovers across the patient journey along the treatment process deserve dedicated scholarly attention [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A review on digital transformation in healthcare by Ritu et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] shows that the main barriers of digital service transformation are linked to four factors: functionality, users, finance, and the environment. The first two factors are determined by the evaluation of employees directly, whereas the latter two pertain more to the organizational level, such as financial restrictions or governmental regulations. To better understand the influence of digital service innovation on performance, it is therefore important to consider the influence on both, employees (i.e., clinical staff) and the organizational (i.e., hospital) performance at large.\u003c/p\u003e \u003cp\u003eBuilding on this, digital transformation in healthcare has recently received substantial research attention [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While most of the research focuses on specific technological innovations, the present study seeks to understand how digital team capabilities and organizational digital readiness jointly influence team efficacy and ultimately hospital performance.\u003c/p\u003e \u003cp\u003eWhile the process of digital transformation has received substantial attention in IS literature [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], it is still relatively unexplored from a service perspective [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In IS literature, the development of multistage digital maturity models has become a hot topic in recent years [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These models serve to assess the development and influence of organizational capabilities on meaningful outcomes at an organizational and health systems level [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], enabling a stepwise integration of IS and IT capabilities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While these models are the fundamental base for digital transformation in the healthcare sector, there are yet limited studies that assess the impact of digital capabilities on healthcare processes drawing on appropriately large and representative samples. Martin et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] point out that much of the existing research takes a rather narrow perspective on specific and isolated processes within one institution, which impedes a holistic understanding of the role of digital capabilities for interrelated and complex processes that clinical staff engage in during daily team activities.\u003c/p\u003e \u003cp\u003eIn the context of digital transformation, organizational learning plays a fundamental role that leads to organizational change [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Organizational learning theory has evolved as a meta-theory dealing with the socio-organizational context of learning and processing of newly derived knowledge into subsequent processes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Under the phenomenological perspective, organizational learning is generated by the interaction and construction of meaning between actors and manifests resulting learnings in organizational communication, culture, and behavioral norms [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Extant literature in management science establishes the link between organizational learning theory and team capabilities, suggesting that leveraging effective team capabilities can boost organizational performance [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Following this line of reasoning, the present study investigates three important team capabilities that occur at the intersection and are relevant for the service transition of key patient care and treatment processes: transfer of care, records of care assessment, and decision support.\u003c/p\u003e \u003cp\u003eFirst, transfer of care refers to the use of digital technology to facilitate a smooth and effective transfer of patients across treatment processes. This capability includes leveraging digital tools that support the process and reduce the risk of hospital discharge and avoidable retrospective follow-up treatments [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The exchange of information prevails as a difficult task for clinical staff during the transition phase. Szary et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] found that shift changes between clinical staff teams is a denominator of delays in the delivery of (laboratory) test results. The complexity arising from multi-tasking activities, which require shifting in attention towards other tasks and actors (i.e., clinical staff or patients), can cause information loss [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Second, related to the transition processes patients and caregivers go through, recently records of care assessment based on IS to support clinical notetaking, vital parameter monitoring, and care scheduling, are disposed to facilitate storing, managing, and displaying of all essential information, independent of location. Especially, the role of the electronic health record (EHR) has caused controversial discussions regarding the benefits for clinical staff [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A study by Boonstra et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] found that diverse healthcare stakeholders hold mixed attitudes. While most stakeholders perceived the EHR as beneficial for the patient, some stakeholders also resisted the implementation, fearing a conflict in their interests. Third, the urgency to decide and act quickly led to the development of digital tools for decision support, which should guide more effective and efficient decision-making of clinical staff. These tools are, e.g., automated prompts that highlight the caregivers\u0026rsquo; actions, or alerts and notifications informing on patients\u0026rsquo; changing vital parameters necessitating further actions. The digital decision support is used at the intersection, matching information from the EHR with clinical knowledge. The use of these computerized clinical support systems has also caused legal and ethical concerns regarding the accountability for wrong decisions and their consequences [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. As these digital capabilities are all designed to improve and simplify team collaboration and coordination, we expect that the digital capabilities will enhance team efficacy (Hypothesis 1).\u003c/p\u003e \u003cp\u003eFacilitated by increasingly developed IT infrastructures, the amount of data that is captured and retained in hospitals increases sharply. Data is viewed as a strategic resource that can be transformed into information, which in turn supports informed decision making [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This process is in the literature referred to as information governance, which requires organizational capabilities to collect, assess, validate, store, and retrieve information over a period of time [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The theory of IT and information governance proposes that the adoption of an information governance capability can leverage value creation processes and improve firm performance [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. An important determinant of information governance constitutes the strategic orientation of the organization [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Strategic alignment, referred to as the extent to which the hospital incorporates digital transformation as a strategic priority [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], and digital leadership, which refers to the organizational ambition to drive digitalization forward [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], are additional indications of the organization\u0026rsquo;s digital readiness. As such, the hospitals\u0026rsquo; ability to develop goals and strategies for digital service transformation, to collect, store, and manage digital information, and to monitor and support this digital agenda in daily routines, constitutes a predictor of the organizational digital readiness, measured by the three capabilities: digital governance, strategic alignment, and digital leadership. As numerous studies highlight the resistance of clinical staff to adopt IT and IS tools in their daily operations [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], we expect a strong need for a supporting organizational environment that guides the digital transformation and facilitates the adoption of digital tools by clinical staff. We therefore expect the effect of digital team capabilities on team efficacy to be stronger when organizational digital readiness is high (Hypothesis 2).\u003c/p\u003e \u003cp\u003eInformation exchange is the basis for adequate patient treatment. The outcome of patient care is largely determined by the effectiveness of capturing, managing, and processing patient information [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In the fertile working environment that requires high quality, fast and efficient handling and communication, and safe and secure care, team efficacy and communication between clinical staff members are expected to have a profound impact on hospital performance. Literature has established the link between effective teamwork and team communication on patient safety [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], showing that effective communication is a prerequisite of team effectiveness [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Especially in more critical, life-threatening situations where patients deteriorate rapidly, communication between clinical staff is essential and necessitates a safe and secure work environment that empowers all clinical staff in open communication [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Teunissen et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] demonstrate that confusion in tasks and responsibilities, misconceptions and misunderstanding among the team and existing hierarchies rank among the most important obstacles that prevent teams from interacting effectively. A recent review by Buljac-Samardzic [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] on interventions to improve team effectiveness in healthcare finds that organizational training, tools to structure processes, and strategic organizational redesigns constitute the main capabilities that contribute to enhanced efficacy. On the collective and organizational level, better collaboration and cooperation among staff should enhance hospital performance (Hypothesis 3).\u003c/p\u003e \u003cp\u003eBy employing a large-scale study that investigates 96 hospital trusts operating in the English National Healthcare System (NHS), drawing on multiple data sources collected over a one-year period (2017\u0026ndash;2018), the current paper seeks to contribute to this knowledge gap in three meaningful ways. First, contributing to recent advancement of the organizational learning theory, the study shows how leveraging relevant digital team capabilities can reduce commonly identified communication and interaction barriers and facilitate performance increases.\u003c/p\u003e \u003cp\u003eSecond, employing a nationwide study on the effects of different levels of digital capabilities and organizational digital readiness, the study provides a robust statistical analysis that quantifies effects on team efficacy and hospital risk-adjusted mortality rates. Third, this study makes a first step towards more comprehensive analyses of the digital service transformation process and its effects on team functioning in a healthcare context.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe conducted our study in the setting of the NHS in England. The NHS is the largest publicly funded health service in the world and is accountable for around 90% of national health expenditures [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. To analyze the relationships among our key concepts, we integrated data from different sources. We extracted, merged, and aggregated the data. First, data were derived from a national survey collected by the NHS to measure digital maturity through a self-assessment tool completed by a large number of clinical staff. The survey assesses the use of technology in hospitals and helps to evaluate its digital maturity level. Second, we draw on the annual NHS staff survey. This survey is conducted by the Department of Health and is administered among all employees of each hospital trust. Third, we extracted archival performance data for each trust and drew on several hospital estates and facility statistics, as well as hospital episode statistics, to get a more profound understanding of the hospital working environment. We combined and integrated the data from these different sources for the financial year 2017\u0026ndash;2018. The final data set includes 96 hospital trusts. Each acute trust manages a mean of around 2.35 hospitals.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003e \u003cem\u003eDigital team capabilities\u003c/em\u003e: Digital capabilities were captured from the NHS digital maturity self-assessment. Digital team capabilities include six items regarding transfer of care (e.g., \u0026ldquo;Discharge summaries are created in a consistent format across the organization\u0026rdquo;), 12 items regarding records of care assessment (e.g., \u0026rdquo;when using digital records, health and care professionals can find what they need quickly and easily\u0026rdquo;), and four items regarding decision support (e.g., \u0026ldquo;Digital systems provide automatic prompts for the next action required by multi-step care plans, pathways protocols\u0026rdquo;). We then assessed scale reliability for digital team capabilities, consisting of 22 items, and reported a Cronbach\u0026rsquo;s alpha of .89, which can be considered high. \u003cem\u003eOrganizational digital readiness\u003c/em\u003e: Organizational digital readiness was also captured from the digital maturity assessment and includes six items on digital governance (i.e., \u0026ldquo;Digital projects are underpinned by valid business cases and fully-engaged business owners.\u0026rdquo;), five items on strategic alignment (i.e., \u0026ldquo;Digital technology is used to support improved collaboration and coordination across different parts of your organization\u0026rdquo;), as well as seven items on digital leadership (i.e., \u0026ldquo;You have recognized and engaged digital leadership throughout all levels of the organization\u0026rdquo;). The scale reliability for organizational digital readiness, including a total of 18 items, can be considered high with Cronbach\u0026rsquo;s alpha = .92. \u003cem\u003eTeam efficacy\u003c/em\u003e: We measured team efficacy with five items from the annual staff survey of the national health system. Sample items are \u0026ldquo;The team I work in often meets to discuss the team's effectiveness\u0026rdquo; and \u0026ldquo;I am able to make suggestions to improve the work of my team/department\u0026rdquo;. Assessment of the scale reliability reports a Cronbach\u0026rsquo;s alpha = .90 and can be considered high. \u003cem\u003ePerformance\u003c/em\u003e: To measure hospital performance, we used the standardized hospital mortality index (SHMI). This score draws on risk models and reports a ratio between the number of expected deaths per trust, compared with the number of actual deaths at the trust. This calculated risk level depicts how each trust performs compared to the NHS average. \u003cem\u003eControl variables\u003c/em\u003e: We included a substantial set of control variables that might confound our analyses in all our analyses. We controlled for hospital size, occupancy, trust type, patient bed days, hospital total episodes, patients\u0026rsquo; mean age, and patients\u0026rsquo; mean length of stay that might affect the standardized mortality rate of a hospital. In addition, we included the availability of adequate work materials and the perception of being adequately staffed to do the daily work in our analyses, as these factors could influence employees' perceived team efficacy. The causal relationships investigated in this empirical research are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which presents our conceptual model.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eWe employed hierarchical regression analyses to test our hypothesized model. All continuous variables were standardized before the analyses. We extracted our independent, mediating, and dependent variables from three separate data sources to avoid common method bias. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the descriptive statistics and correlations of our variables. Results reveal a significant negative correlation between team efficacy and the SHMI score and a significant positive correlation between team efficacy and digital readiness.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics and study variable correlations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1. SHMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.10\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Team Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.28 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Digital Team Capabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.19 +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Organizational Digital Readiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.24 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.66 ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Adequate Materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61 ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.25 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.19 +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Enough Staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79 ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.22 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.19 +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.91 ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Hospital Size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e711.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e368.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.20 +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Hospital Occupancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Patient Bed Days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e245269.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138431.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.21 +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.98 ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Total Episodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122934.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67583.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.20 +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.20 +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.21 +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.94 ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.94 ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Patient Mean Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.35 **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.23 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.26 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-0.29 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.22 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. Patient Mean Lenth of Stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.30 **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.26 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.34 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.24 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003e+ \u0026lt; 0.01; * \u0026lt; 0.05; ** \u0026lt; 0.01; *** \u0026lt; 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eResults of our analyses are depicted in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Model 1 shows that our control variables: adequate materials for the daily work, perception of being adequately staffed, and hospital size all have a significant effect on team efficacy.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of hierarchical regression analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eModel 4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTeam Efficacy\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eTeam Efficacy\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eTeam Efficacy\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eSHMI Score\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eControls\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.440\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.514)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.311)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.300)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.612)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eadequate Materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.795\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.349)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.183)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.175)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.404)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eenough Staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.314)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.159)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.154)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.434)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital Size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital Occupancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.190)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.091)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.088)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.189)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Bed Days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Episodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Patient Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Length of Stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMain Effects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDigital Team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCapabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.006)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational\u003c/p\u003e \u003cp\u003eDigital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.006)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDigital Team Capabilities X \u003c/p\u003e \u003cp\u003eOrganizational Digital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeam Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(0.197)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Hospital Trusts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003cem\u003eNotes\u003c/em\u003e. OLS model, standard errors are reported in parantheses. + \u0026lt; 0.01; * \u0026lt; 0.05; ** \u0026lt; 0.01; ***\u0026lt; 0 .001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of our hypothesis 1 are shown in Model 2. In support of H1, the results reveal a significantly positive effect of digital team capabilities on team efficacy, \u003cem\u003eb\u003c/em\u003e=.012, p\u0026lt;.05. To investigate hypothesis 2, we included organizational digital readiness in the analysis and investigated the interaction effect of digital team capabilities and organizational digital readiness. Model 3 reports the results, which show a significant negative interaction effect, \u003cem\u003eb\u003c/em\u003e=-.011, p\u0026lt;.05. To assess the moderation in more detail, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e plots the simple slopes from which we can derive that team efficacy is higher when organizational digital readiness is high as opposed to low. Moreover, if organizational digital readiness is low, digital team capabilities have a stronger effect on team efficacy, implying that team digital capabilities are especially important when organizational digital readiness, captured by digital leadership, digital governance, and strategic alignment, is low.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThese results do not support H2 that digital team capabilities have a more positive influence on team efficacy when the digital organizational digital readiness is high. In hypothesis 3, we predicted a positive effect of team efficacy on hospital performance. The results of H3 are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Model 4. We find support for H3 with a significantly negative effect of team efficacy on the hospital SHMI score, \u003cem\u003eb\u003c/em\u003e=-.01, p\u0026lt;.05. This implies that compared to the baseline, when mortality is decreasing, hospital performance is increasing.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe goal of the study was to identify how digital team capabilities and organizational digital readiness can influence services to achieve higher team efficacy and hospital performance. For this purpose, the responses of over 50.000 clinical staff members from 96 healthcare trusts of the English NHS have been aggregated to investigate how digital service transformation affects daily clinical activities, interactions, and ultimately performance. The findings of the study show that there is a strong relationship between digital team capabilities, organizational digital readiness, and team efficacy, which jointly drive hospital performance. More specifically, the results highlight that digital team capabilities have a positive influence on team efficacy. This means that increasing the use of digital systems in services such as records of care, transfer of care, and decision support can help teams become more effective, with positive implications for patient care and mortality. Using digitized services involves activities such as digital note-taking, monitoring, and automated reporting of vital parameters, which can ease the transfer of care process and avoid misconceptions or misunderstandings in shifts of caregivers [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Especially, the latter two are repeatedly shown to have a profound impact on error rates and patient care [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Furthermore, digital systems that support clinical management and diagnostics can save a significant amount of time, so that caregivers and physicians can spend more time on cognitively complex tasks, which require their full attention [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSecond, the results illustrate that digital team capabilities and organizational digital readiness jointly affect team efficacy. When organizational digital readiness is low, digital team capabilities have a stronger effect on team efficacy, suggesting that team capabilities that support routine services are even more important when organizational digital readiness towards strategic alignment, digital leadership, and digital governance is limited. Although the direction of this interplay is different from what was expected, we find strong support for a joint effect, showing that supporting digital organizational environments guides digital service transformation and facilitates an informed adoption for clinical staff. These team capabilities can ease the daily interaction and enhance team efficacy.\u003c/p\u003e \u003cp\u003eThird, and most important from an organizational point of view, the higher the team efficacy, the higher the organizational performance. This means that patient mortality reduces with greater team efficacy. This not only shows that investment in digital team capabilities is worthwhile but also highlights the importance to evaluate team performance and developing a work environment and culture that supports learning from errors, open communication, and feedback loops (e.g., [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]).\u003c/p\u003e \u003cp\u003eDigital maturity in healthcare has attracted substantial attention in research and practice in recent years. Yet, we are still in an infancy state, where most studies aim to develop assessment criteria, enabling hospitals to stepwise engage in digital service transformation [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. While the benefits for organizations are highlighted in several studies, there is still a controversy regarding the effectiveness of digital capabilities for clinical staff members [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], especially on how digital team capabilities influence team efficacy and how this ultimately drives hospital performance.\u003c/p\u003e \u003cp\u003eThe present study contributes to this knowledge gap in several ways. First, we show how digital team capabilities and organizational digital readiness jointly influence the team efficacy and hospital performance. This finding contributes to recent developments of organizational learning theory, suggesting that leveraging relevant digital team capabilities reduces communication and interaction barriers and enhances performance. Second, the study provides a robust statistical analysis, in aggregating the responses of more than 50,000 clinical staff members, enabling a comparison between 96 hospital trusts. Overall, the study provides evidence that team digital capabilities and team efficacy can both help contain patient mortality in hospitals. Third, this study contributes to the call for research that takes a more comprehensive perspective on the effectiveness of multifunctional technological developments, spanning across diverse service processes in the hospital.\u003c/p\u003e\n\u003ch3\u003ePractical implications\u003c/h3\u003e\n\u003cp\u003eFrom a managerial point of view, several important implications are noteworthy. First, this study sheds light on the controversy of whether digital service transformation can benefit clinical staff in their daily care delivery. In particular, the prominent critical moments, where information exchange, informed decision-making, and handover are repeatedly reported as sources for errors sources for errors [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and staff frustration [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], can be supported by digitized service processes. The findings show that the more digital team capabilities are in place, the higher the team efficacy and the better the hospital performance. Second, hospitals\u0026rsquo; digital readiness in the form of strategic alignment, leadership, and information governance influences to what extent digital team capabilities are critical for team efficacy. This means that for hospitals that score relatively low on digital readiness, digital transfer of care, records of care, and decision support play an even more important role for team efficacy. Third, the findings of this study can help hospital managers to communicate the importance and effectiveness of increasingly digitalized infrastructures to more resistant and sceptical clinical staff members. Finally, the results provide scientific support on the benefits of the process of digital service transformation, achieving higher team efficacy and better performance, for hospitals that developed more digital team capabilities than other hospitals.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reveals the influence of digital service transformation, in the form of digital team capabilities and hospitals\u0026rsquo; digital readiness, on the perception of clinical staff, focusing on communication, shared objectives, and perceived interaction as well as hospital performance in general. Data from 96 hospital trusts and over 50,000 clinical staff members have been aggregated to shed light on the effectiveness of digital capability development for hospitals\u0026rsquo; daily activities. Acknowledging the limitations of this research endeavour, several areas for future research can be derived. While the study provides a robust and large sample to show the effect of digital service transformation on hospital performance, the availability of data has limited the analysis to responses collected within one year. Future studies can build on the insights of this research and extend the approach to a longitudinal study. This approach would allow to estimate within-hospital changes, investigate lagged relationships between digital maturity increases and effects on employees. Moreover, the interplay of digital team capabilities and organizational digital readiness could be examined in more detail. Especially, their effect on team performance, potentially including concepts such as learning or organizational culture, would provide fruitful avenues for service research on digital maturity and transformation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics declaration: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive funding or support from any organization for the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors certify that they have no competing interests, meaning no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study were obtained from NHS England/NHS Digital (https://digital.nhs.uk/data) and consist of trust-level responses to the NHS digital maturity self-assessment, the annual NHS Staff Survey, and hospital performance and estates statistics, including the Standardized Hospital Mortality Index (SHMI), as described in the Methods section. Aggregated NHS Staff Survey and SHMI data are publicly accessible via NHS England/NHS Digital online resources. The combined analytical dataset constructed for this study cannot be shared publicly because of data-sharing agreements with the data providers, but it can be reconstructed by researchers who obtain access to the same source data through the standard NHS data access procedures\u003cem\u003e.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSusan Stead conceived and designed the study, developed the theoretical framework, coordinated the work, and led the writing of the manuscript. Nicole Hartwich designed and implemented the empirical methodology, conducted the statistical analyses, and contributed to writing and revising the manuscript. David Antons contributed to the study design and interpretation of the findings, and critically revised the manuscript for important intellectual content. Torsten-Oliver Salge provided overall guidance on the research design, contributed to the interpretation of the results, and critically reviewed and revised the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGavin, B., Hayden, J., Adamis, D., McNicholas, F.: Caring for the psychological well-being of healthcare professionals in the COVID-19 pandemic crisis. Ir. Med. J. \u003cb\u003e113\u003c/b\u003e, 51 (2020)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou, X., Snoswell, C.L., Harding, L.E., Bambling, M., Edirippulige, S., Bai, X., Smith, A.C.: The role of telehealth in reducing the mental health burden from COVID-19. 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J. \u003cb\u003e4\u003c/b\u003e, 189\u0026ndash;192 (2017). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7861/futurehospital4\u003c/span\u003e\u003cspan address=\"10.7861/futurehospital4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Digital Transformation, Team Efficacy, Organizational Readiness, Hospital Performance, Healthcare Innovation","lastPublishedDoi":"10.21203/rs.3.rs-9365928/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9365928/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe healthcare sector plays a critical role in society, with hospitals often facing resource shortages. As costs rise and pressure to improve service quality increases, the need for digital transformation in healthcare has become more pronounced. This study examines the impact of digital team capabilities and organizational digital readiness on team efficacy and ultimately hospital performance, to understand how these factors interact to enhance patient safety. A comprehensive analysis was conducted using data from 96 hospital trusts within the English National Health Service (NHS), involving over 50,000 clinical staff members. Quantitative analyses were performed to investigate the relationships among the key variables. The findings reveal a significant positive effect of digital team capabilities on team efficacy (b = .012, p \u0026lt; .05). Additionally, organizational digital readiness moderates the relationship between digital team capabilities and team efficacy (b\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.011, p \u0026lt; .05). Higher team efficacy is associated with lower hospital mortality rates (b\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.01, p \u0026lt; .05). Overall, the results indicate that digital team capabilities are crucial for enhancing team efficacy, which in turn contributes to improved hospital performance, while support from organizational digital readiness amplifies this effect. Consequently, hospital managers should invest in digital infrastructure and develop strategies to foster digital capabilities, particularly in facilities with low levels of digital readiness, as this may support clinical staff in adopting new technologies and ultimately enhance patient safety.\u003c/p\u003e","manuscriptTitle":"Digital Transformation in Healthcare: The Critical Role of Clinical Staff Interactions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 19:50:16","doi":"10.21203/rs.3.rs-9365928/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52dc6899-0856-4c25-b0be-73485cf91910","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T19:50:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 19:50:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9365928","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9365928","identity":"rs-9365928","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}