Let's talk about it: Reframing communication in medical teams (original) (raw)
Related papers
Academic Medicine, 2002
Purpose. Although the communication that occurs within health care teams is important to both team function and the socialization of novices, the nature of team communication and its educational influence are not well documented. This study explored the nature of communications among operating room (OR) team members from surgery, nursing, and anesthesia to identify common communicative patterns, sites of tension, and their impact on novices. Method. Paired researchers observed 128 hours of OR interactions during 35 procedures from four surgical divisions at one teaching hospital. Brief, unstructured interviews were conducted following each observation. Field notes were independently read by each researcher and coded for emergent themes in the grounded theory tradition. Coding consensus was achieved via regular discussion. Findings were returned to insider ''experts'' for their assessment of authenticity and adequacy.
Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2012
Introduction: Organizational behavior and management fields have long realized the importance of teamwork and team-building skills, but only recently has health care training focused on these critical elements. Communication styles and strategies are a common focus of team training but have not yet been consistently applied to medicine. We sought to determine whether such communication strategies, specifically ''advocacy'' and ''inquiry,'' were used de novo by medical professionals in a simulation-based teamwork and crisis resource management course. Explicit expression of a jointly managed clinical plan between providers, a strategy shown to improve patient safety, was also evaluated. Methods: Forty-four of 54 videotaped performances of an ongoing team-building skills course were viewed and analyzed for presence of advocacy and/or inquiry that related to information or a plan; inclusion criteria were participation of a nonconfederate obstetrician and an anesthesiologist. Verbal statement of a jointly managed clinical plan was also recorded. Results: Anesthesiologists advocated information in 100% of cases and advocated their plans in 93% of cases but inquired information in 30% of cases and inquired about the obstetricians' plans in 11% of cases. Obstetricians advocated information in 73% of cases, advocated their plans in 73% of cases, inquired information in 75% of cases, and inquired about the anesthesiologists' plans in 59% of cases. An explicitly stated joint team plan was formed in 45% of cases. Conclusions: Anesthesiologists advocated more frequently than obstetricians, while obstetricians inquired and advocated in more balanced proportions. However, fewer than half of the teams explicitly agreed on a joint plan. Increasing awareness of communication styles, and possibly incorporating these skills into medical training, may help teams arrive more efficiently at jointly managed clinical plans in crisis situations.
Gaps and overlaps in healthcare team communication: analysis of speech
2019
Studying groups in their natural contexts can help build understanding of complex organisational behaviours. Guided by the principles of conversation analysis, we discuss some of the dynamics of multidisciplinary teams in cancer care by examining the communication practices used to negotiate levels of participation in their routine work meetings, while considering patient safety implications.Breast, colorectal and gynaecological cancer teams were videoed over 12-weekly meetings encompassing 822 patient-reviews with a cross-section transcribed using Jefferson notation. A low frequency of gaps between speakers (3%) and high frequency of overlaps (24%) and no-gaps-no-overlaps (73%) was found, pointing to fast turn-transitions, secured predominantly with raised pitch and vocalizations. Securing one’s turn to speak in a multi-speaker fast-paced work group setting, such as cancer meetings, can be challenging due to systemic reduction in turn-taking opportunities, hence unequal participati...
Team talk and team activity in simulated medical emergencies: a discourse analytical approach
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2016
Background: Communication errors can reduce patient safety, especially in emergency situations that require rapid responses by experts in a number of medical specialties. Talking to each other is crucial for utilizing the collective expertise of the team. Here we explored the functions of "team talk" (talking between team members) with an emphasis on the talk-work relationship in interdisciplinary emergency teams. Methods: Five interdisciplinary medical emergency teams were observed and videotaped during in situ simulations at an emergency department at a university hospital in Norway. Team talk and simultaneous actions were transcribed and analysed. We used qualitative discourse analysis to perform structural mapping of the team talk and to analyse the function of online commentaries (real-time observations and assessments of observations based on relevant cues in the clinical situation). Results: Structural mapping revealed recurring and diverse patterns. Team expansion stood out as a critical phase in the teamwork. Online commentaries that occurred during the critical phase served several functions and demonstrated the inextricable interconnections between team talk and actions. Discussion: Discourse analysis allowed us to capture the dynamics and complexity of team talk during a simulated emergency situation. Even though the team talk did not follow a predefined structure, the team members managed to manoeuvre safely within the complex situation. Our results support that online commentaries contributes to shared team situation awareness. Conclusions: Discourse analysis reveals naturally occurring communication strategies that trigger actions relevant for safe practice and thus provides supplemental insights into what comprises "good" team communication in medical emergencies.
BMJ Open
ObjectivesExplore the function of three specific modes of talk (discourse types) in decision-making processes.DesignTen real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied.SettingInterdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED).ParticipantsAll emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team.ResultsThe three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions o...
Team Communication With Patient Actors
Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2011
Introduction: Patient satisfaction is an important healthcare outcome and communication with clinical staff is an important determinant. Simulation could identify problems and inform corrective action to improve patient experience. Methods: One hundred eight randomly selected maternity professionals in 18 teams were videoed managing a patient-actor with a simulated emergency. The trained patient-actor assessed the quality of staff-patient interaction. Clinicians scored teams for their teamwork skills and behaviors. Results: There was significant variation in staff-patient interaction, with some teams not having exchanged a single word and others striving to interact with the patientactor in the heat of the emergency. There was significant correlation between patientactor perceptions of communication, respect, and safety and individual and team behaviors: number, duration, and content of communication episodes, as well as generic teamwork skills and teamwork behaviors. The patient-actor perception of safety was better when the content of the communication episodes with them included certain items of information, but most teams failed to communicate these to the patient-actor. Conclusion: Some aspects of staff-patient interaction and teamwork during management of a simulated emergency varied significantly and were often inadequate in this study, indicating a need for better training of individuals and teams.
Background Effective communication between operating room staff is widely acknowledged as an essential element that contributes to patient safety. Various structured communicative practices have been proposed to optimise patient safety in operating rooms. Methods We introduced a structured communication tool to a clinical simulation training programme that Weller and colleagues (2014) proposed for optimising patient safety during an anaesthetic crisis. The tool comprises six elements: stop, notify, assess, plan, prioritise, and invite ideas (SNAPPI). We wanted to know whether people would use the tool and the qualitative effect this tool would have on their practices. We studied 120 operating theatre staff participating in the MORSim study (a multidisciplinary operating room simulation team training study) who were shown the SNAPPI tool and then encouraged to use it during a simulated surgical crisis. The simulation was observed by members of the research team and filmed. The film was later analysed using ethnographic methods of observation to create structured field notes, which formed the data. SNAPPI scores were assigned to each surgical team based on clear SNAPPI use. We applied an ethnographic approach to the data analysis for understanding how communication manifests in the operating room. In this paper we look at the bearing that structured communication had on team engagement. Results Communication is central to social interaction. In the context of an anaesthetic crisis the effectiveness of communication can be critical to informing patient safety and wellbeing. Participants in the MORSim training utilised the SNAPPI tool as a strategy to optimise communication during the simulated anaesthetic crisis. Conclusions and implications Operating room staff can utilise
Promoters and barriers in hospital team communication. A focus group study
Journal of Communication in Healthcare, 2012
Purpose: Poor teamwork and communication in healthcare teams have been correlated to adverse events and higher patient morbidity and mortality. However, detailed insight into the link between team communication and medical error is still lacking. The objective of this study is to identify the common characteristics of team communication among multiprofessional teams at four Danish acute care university hospitals. Method: Four focus group interviews with multiprofessional hospital teams (N = 24). Results: Communication is particularly vulnerable during handover of patient information between shifts or units, when a team has to establish skills and roles during teamwork and when staff has to await and combine information from different chart systems. Established frameworks for communication, mutual knowledge, ease of speaking up, experience in getting the message through, and focus on teamwork and communication promote safe information exchange. Lack of standard assignments and procedures, a flat hierarchy that leaves responsibility unclear, different agendas for the treatment of the patient, interruptions, and multitasking, inhibit safe information exchange. Conclusion: Power distance, team structure, and hospital organization influence team communication and vary between settings and national cultures. These factors must be accounted for before developing or adapting team communication interventions to improve patient safety.
Nursing team communication in a medical ward
Revista brasileira de enfermagem, 2018
To describe the essential elements that make the nursing team communication process effective, and to analyze such elements in the light of two main theorists, Berlo and King. This is a qualitative study of assistant convergent research approach. The data production technique was the semi-structured interview, with 25 nursing professionals from a public hospital. Data were analyzed with thematic content techniques. The main element of consolidation of the communication process and interpersonal relationship, with consequent interaction, is the dialogue, which is guided by emotions, feelings, and team integration. The communication process and the interpersonal relationship reach their objectives and the reciprocal understanding expected when there is effective dialogue, validated by the source and receiver of the processes, with consequent interaction.
Navigating Communication Challenges in Clinical Practice: A New Approach to Team Education
Critical Care Nurse, 2018
BACKGROUND Cultivating a healthy work environment and upholding patient safety are important priorities in health care. Challenges in workplace communication are common and affect staff well-being and patient outcomes. Previous interventions have focused on organizational issues and work-life balance. OBJECTIVE To assess the feasibility of monthly interdisciplinary educational rounds that support clinicians' ability to navigate workplace clinical and communication challenges while promoting interprofessional teamwork and self-care. METHODS The Program to Enhance Relational and Communication Skills rounds are an educational initiative within a large pediatric tertiary care hospital. Participation is voluntary and offered to interprofessional clinicians from 4 critical care units, cardiac catheterization unit, and intermediate care unit. Topics of monthly hour-long sessions are developed collaboratively. Feasibility is assessed by ongoing documentation of attendance. Postintervention questionnaires are used to evaluate the program's value. RESULTS Between April 2010 and December 2016, a total of 1156 clinicians participated (median, 18 per seminar): 653 nurses (56%), 103 social workers (9%), 102 child life specialists (9%), 32 psychologists (3%), 40 chaplains (3%), 18 physicians (2%), 18 ethicists (2%), and 190 others (16%), including medical interpreters, nursing students, and administrative staff. Ninety-two percent of participants rated their participation as "quite valuable" or "very valuable." Programs of highest interest included child assent, bereavement, social media, and workplace bullying. Evolution into actual clinical practice change remains a challenge for the future. CONCLUSION Our approach to communication and workplace challenges is relevant, user-friendly, and feasible. Diffi cult topics are addressed in real time, with clinicians learning interprofessionally. (Critical Care Nurse. 2018;38[6]:15-22) This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1. Describe the key philosophy of the Program to Enhance Relational and Communication Skills (PERCS) rounds and Workshops 2. Identify the importance of PERCS champions to the promotion and development of PERCS rounds 3. Identify 3 important characteristics of the PERCS rounds that may aide in developing a similar educational initiative To complete evaluation for CE contact hour(s) for activity C1861, visit www.ccnonline.org and click the "CE Articles" button. No CE fee for AACN members. This activity expires on December 1, 2021. The American Association of Critical-Care Nurses is an accredited provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AACN has been approved as a provider of continuing education in nursing by the State Boards of Registered Nursing of California (#01036) and Louisiana (#LSBN12).