Date of Degree


Document Type


Degree Name

Doctor of Philosophy (PhD)




Dorothy Ettling / Osman Özturgut


Maureen Rauschhuber


Absael Antelo


Neeta Singh


Increasing patient demands and decreasing reimbursement require better efficiency and effectiveness in health care systems and, subsequently, in health care teams. These environmental and societal factors are further complicated by the complex initiatives set forth by the Affordable Care Act (2010). In this study, the researcher sought to examine and identify the strongest variables of health care teaming and to explore resulting themes through the perception of groups of health care associates. This mixed sequential explanatory design first examined the relationships between coworker relations, employee involvement, and leadership with associate commitment and with each other. An existing database of associate satisfaction survey data from a 4-year period for a health care organization of seven different operating companies was utilized in the study. Pearson product correlation, multiple regression, and one-way ANOVA were included in the quantitative design. In the second phase of the study, the relationships between contributing variables were further explored through qualitative semistructured interviews with nine groups of 75 associates from across the organization representing three commitment-level tiers. Very strong to strong relationships existed between coworker relations, employee involvement, leadership, and associate commitment for all 4 years (r values of r = 0.80 to r = 0.53) at a 99% certainty level. Leadership had the strongest relationship with and was the biggest driver (β = 0.48–0.52) of associate commitment for all 4 years. Leadership also exhibited a very strong relationship with coworker relations (r = 0.75) in the first year and strong relationships with both coworker relations and employee involvement in subsequent years. Coworker relations, employee involvement, and leadership accounted for 69.5% of the variance with associate commitment. Having friends on the team, trust in team members, making a difference, liking their patients and their jobs, flexibility with work schedules, feeling valued, and earning better pay and benefits emerged as qualitative themes relative to associate commitment. In addition, helping each other, spending time with each other, having mutual commitments, trust, and being dedicated to patients emerged as themes of effective teaming. Supplementary files provide coding detail for sixteen focus group questions and responses. Groups of associates spoke, first and foremost, about the “work family” and acknowledged the leader as the person who sets the environment and expectations and models the work family. This study suggests that leadership is a potential skill in every associate and that the leader serves to set the environment to support everyday leadership from the team collectively and from the team’s individual members. The researcher hopes this study’s findings may be a topic in future leadership and associate development, ultimately creating a more effective health care delivery team and system.