Discourse types and (re)distribution of responsibility in simulated emergency team encounters


  • Gøril Thomassen Norwegian University of Science and Technology
  • Ellen Andenæs Norwegian University of Science and Technology
  • Stine Gundrosen Trondheim University Hospital, St Olavs Hospital
  • Srikant Sarangi Aalborg University




activity type, discourse types, metacommentary, offline commentary, online commentary, simulated emergency medicine, team talk


Successful teamwork, constitutive of team talk, depends largely on shared responsibility in the coordination of tasks in a goal-oriented way. This paper examines how specific modes of talk or ‘discourse types’ are utilised by a healthcare team in simulated emergency care. The data corpus comprises six video-recorded simulation training sessions in an emergency department at a large Norwegian hospital. Our analysis focuses on the critical moment when the original healthcare team is joined by other specialists in an ad hoc manner, which necessitates the (re)distribution of expert responsibility in the management of the patient’s condition. We examine the interactional trajectories and, in particular, the discourse types surrounding the critical moment which marks the incorporation of the new team members. The analysis centres on three discourse types (online commentary, offline commentary and metacommentary) that are utilised in accomplishing the multiple tasks in a collaborative and coordinated fashion. We suggest that team talk overlays and overlaps with distributed medical work in highly charged decision-making contexts such as emergency care. The findings have relevance for how healthcare professionals and students are trained in multidisciplinary team talk and teamwork.

Author Biographies

  • Gøril Thomassen, Norwegian University of Science and Technology
    Gøril Thomassen Hammerstad received her PhD in applied linguistics from the Norwegian University of Science and Technology (NTNu) and is currently Professor at the NTNu’s Department of Language and Literature. Her research interests are within applied linguistics and professional discourse studies, including discourse analysis of various forms of healthcare communication.
  • Ellen Andenæs, Norwegian University of Science and Technology
    Ellen Andenæs is Associate Professor of Applied Linguistics at the Department of Language and Literature at the Norwegian University of Science and Technology, and she is one of the coordinators of the department’s research group on health communication and ethics. Her research interests are professional discourse, multimodal communication and diversity in the healthcare sector.
  • Stine Gundrosen, Trondheim University Hospital, St Olavs Hospital
    Stine Gundrosen is Head of Medical Simulation Centre at St Olavs Hospital Trondheim, University Hospital, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology. Her research interests are in team talk in emergency settings. Her doctoral research is concerned with team communication in simulated and in real clinical emergency encounters.
  • Srikant Sarangi, Aalborg University
    Srikant Sarangi is currently Professor in Humanities and Medicine and Director of the Danish Institute of Humanities and Medicine (DIHM) at Aalborg university, Denmark. He continues as Honorary Professor at Cardiff university. He is author and editor of twelve books, guest-editor of six journal special issues and has published over two hundred journal articles and book chapters. He is editor of Text & Talk, Communication & Medicine and Journal of Applied Linguistics and Professional Practice.


Alvarado, K., Lee, L., Christoffersen, E., Fram, N., Boblin, S., Poole, N., Lucas, J. and Forsyth, S. (2006) Transfer of accountability: Transforming shift handover to enhance patient safety. Healthcare Quarterly 9: 75–79. http://dx.doi.org/10.12927/hcq.2006.18464

Apker, J., Mallak, J. A., Brooks Applegate III, E., Gibson, S. C., Ham, J. J., Johnson, N. A. and Street R. L. Jr. (2010) Exploring emergency physician–hospitalist handoff interactions: Development of the handoff communication assessment. Annals of Emergency Medicine 55 (2): 161–170. http://dx.doi.org/10.1016/j.annemergmed.2009.09.021

Bateson, G. (1972) Steps Towards an Ecology of Mind: Collected Essays in Anthropology, Psychiatry, Evolution and Epistemology. Chicago: University of Chicago Press.

Bezemer, J., Murtagh, G., Cope, A., Kress, G. and Kneebone, R. (2011) ‘Scissors, please’: The practical accomplishment of surgical work in the operating theatre. Symbolic Interaction 34 (3): 398–414. http://dx.doi.org/10.1525/si.2011.34.3.398

Brandon, C., Maughan, L. and Cydulka, R. K. (2011) ED handoffs: Observed practices and communication errors. American Journal of Emergency Medicine 29 (5): 502–511. http://dx.doi.org/10.1016/j.ajem.2009.12.004

Cohen, M. D. and Hilligoss, P. B. (2010) The published literature on handoffs in hospitals: Deficiencies identified in an extensive review. Quality and Safety in Health Care 19 (6): 493–497. http://dx.doi.org/10.1136/qshc.2009.033480

DiPalma, C. (2004) Power at work: Navigating hierarchies, teamwork and webs. Journal of Medical Humanities 25 (4): 291–308. http://dx.doi.org/10.1007/s10912-004-4834-y

Eggins, S. and Slade, D. (2012) Clinical handover as an interactive event: Informational and interactional communication strategies in effective shift-change handovers. Communication & Medicine 9 (3): 215–227. http://dx.doi.org/10.1558/cam.v9i3.215

Eisenberg, E. M., Murphy, A. G., Sutcliffe, K., Wears, R., Schenkel, S., Perry, S. and Vanderhoef, M. (2005) Communication in emergency medicine: Implications for patient safety 1. Communication Monograph 72 (4): 390–413. http://dx.doi.org/10.1080/03637750500322602

Ellingson, L. L. (2002) Communication, collaboration, and teamwork among health care professionals. Communication Research Trends 21 (3): 1–44.

Goodwin, D. (2007) Upsetting the order of teamwork: Is ‘the same way every time’ a good aspiration? Sociology 41 (2): 259–275. http://dx.doi.org/10.1177/0038038507074973

Goffman, E. (1959). The Presentation of Self in Everyday Life. Garden City, NY: Doubleday.

Goffman, E. (1974) Frame Analysis: An Essay on the Organization of Experience. New York: Harper & Row.

Goffman, E. (1981) Forms of Talk. Oxford: Blackwell.

Gumperz, J. (1982) Discourse Strategies. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511611834

Gundrosen, S., Andenæs, E., Aadahl, P. and Thomassen, G. (2016) Team talk and team activity in simulated medical emergencies: A discourse analytical approach. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 24: 135. https://doi.org/10.1186/s13049-016-0325-1

Halvorsen, K. and Sarangi, S. (2015) Team decision-making in workplace meetings: The interplay of activity roles and discourse roles. Journal of Pragmatics 76: 1–14. http://dx.doi.org/10.1016/j.pragma.2014.11.002

Heritage, J. and Stivers, T. (1999) Online commentary in acute medical visits: A method of shaping patient expectations. Social Science & Medicine 49 (11): 1501–1517. http://dx.doi.org/10.1016/S0277-9536(99)00219-1

Hindmarsh, J. and Pilnick, A. (2002) The tacit order of teamwork: Collaboration and embodied conduct in anaesthesia. Sociological Quarterly 43 (2): 139–164. http://dx.doi.org/10.1111/j.1533-8525.2002.tb00044.x

Hindmarsh, J. and Pilnick, A. (2007) Knowing bodies at work: Embodiment and ephemeral teamwork in anaesthesia. Organization Studies 28 (9): 1395–1416. http://dx.doi.org/10.1177/0170840607068258

Iedema, R., Merrick, E. T., Kerridge, R., Herkes, R., Lee, B., Anscombe, M., Rajbhandari, D., Lucey, M. and White, L. (2009) Handover – Enabling learning in communication for safety (HELiCS): A report on achievements at two hospital sites. Medical Journal of Australia 190 (11): S133-S136.

Kolbe, M., Künzle, B., Burtscher, M. J., Wacker, J., Spahn, D. and Grote, G. (2010) The functions of team monitoring and ‘talking to the room’ for performance in anaesthesia teams. Proceedings of the Human Factors and Ergonomics Society 54th Annual Meeting 54 (12): 857–861. http://dx.doi.org/10.1177/154193121005401211

Levinson, S. (1979) Activity types and language. Linguistics 17: 365–399. http://dx.doi.org/10.1515/ling.1979.17.5-6.365

Lingard, L. Espin, S., Whyte, S., Regehr, G., Baker, G. R., Reznick, R., Bohnen, J., Orser, B., Doran, D. and Grober, E. (2004) Communication failures in the operating room: An observational classification of recurrent types and effects. Quality and Safety in Health Care 13 (5): 330–334. http://dx.doi.org/10.1136/qshc.2003.008425

Manser, T. (2009) Teamwork and patient safety in dynamic domains of healthcare: A review of the literature. Acta Aneasthesiol Scandinavia 53 (2): 143–151. http://dx.doi.org/10.1111/j.1399-6576.2008.01717.x

Mondada, L. (2011) The organisation of concurrent courses in surgical demonstrations. In J. Streeck, C. Goodwin and C. Le Baron (eds) Embodied Interaction: Language and Body in the Material World, 207–226. Cambridge: Cambridge University Press.

Mondada, L. (2014) Instructions in the operating room: How the surgeon directs their assistant’s hands. Discourse Studies 16 (2): 131–161. http://dx.doi.org/10.1177/1461445613515325

Moreira, T. (2004). Coordination and embodiment in the operating room. Body & Society 10 (1): 109–129. http://dx.doi.org/10.1177/1357034X04042169

Sarangi, S. (2000) Activity types, discourse types and interactional hybridity: The case of genetic counselling. In S. Sarangi and M. Coulthard (eds) Discourse and Social Life, 1–27. London: Pearson.

Sarangi, S. (2010) Practising discourse analysis in healthcare settings. In I. Bourgeault, R. DeVries and R. Dingwall (eds) The SAGE Handbook of Qualitative Methods in Health Research, 397–416. London: Sage. http://dx.doi.org/10.4135/9781446268247.n21

Sarangi, S. and Gilstad, H. (2014) Communicative expertise in obstetric ultrasound encounters. In H. E. Hamilton and S. C. Wen-ying (eds) Handbook of Language and Health Communication, 539–556. London: Routledge.

Sundstrom, E., De Meuse, K. P. and Futrell, D. (1990) Work teams: Applications and effectiveness. American Psychologist 45 (2): 120–133. http://dx.doi.org/10.1037/0003-066X.45.2.120

Svensson, M. S., Heath, C. and Luff, P. (2007) Instrumental action: The timely exchange of implements during surgical operations. In L. Bannon, I. Wagner, C. Gutwin, R. Harper and K. Scmhidt (eds) ECSCW’07: Proceedings of the Tenth European Conference on Computer Supported Cooperative Work. London: Springer. http://dx.doi.org/10.1007/978-1-84800-031-5_3

Tschan, F., Semmer, N. K., Gurtner, A., Bizzari, L., Spychiger, M., Breuer, M. and Marsch, S. U. (2009) Explicit reasoning, confirmation bias, and illusory transactive memory: A simulation study of group medical decision making. Small Group Research 40 (3): 271–300. http://dx.doi.org/10.1177/1046496409332928

Vincent, C. and Wears, R. L. (2002) Communication in the emergency department: Separating the signal from the noise. Medical Journal of Australia 176 (9): 409–410.

Wears, R. L. and Perry, S. J. (2010) Discourse and process analyses of shift change handoffs in emergency departments. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 54 (12): 953–956. http://dx.doi.org/10.1177/154193121005401232

Xiao, Y. Hunter, W. A., Mackenzie, C. F., Jefferies, N. J., Horst, R. L. and Lotas Group (1996) Special Section: Task Complexity in Emergency Medical Care and Its Implications for Team Coordination. Human Factors: The Journal of the Human Factors and Ergonomics Society 38 (4): 636–645. http://dx.doi.org/10.1518/001872096778827206

Ye, K., Taylor, D. M., Knott, J. C., Dent, A. and MacBean, C. E. (2007) Handover in the emergency department: De?ciencies and adverse effects. Emergency Medicine Australasia 19 (5): 433–441. http://dx.doi.org/10.1111/j.1742-6723.2007.00984.x



How to Cite

Thomassen, G., Andenæs, E., Gundrosen, S., & Sarangi, S. (2017). Discourse types and (re)distribution of responsibility in simulated emergency team encounters. Communication and Medicine, 13(1), 51–70. https://doi.org/10.1558/cam.32148