Analysing teamwork in health care: What matters when clinicians negotiate the continuity of clinical tasks and care responsibilities?
Keywords:clinical handover, continuity of care, discourse analysis, teamwork, video-reflexive ethnography
AbstractThis paper considers the ways in which clinicians enact ‘being a team’, by analysing how they inform one another about critical patient information. The process where this information exchange happens is known as ‘clinical handover’. The study that informs this paper spanned ten months of data collection in four hospitals, involving 150 clinicians and five patients. The analysis presented here draws on data collected at one of the hospital sites: an emergency department at a regional tertiary teaching hospital. Our analysis reveals how central clinical handover is to ‘being a team’ in health care, and how deficiencies in handover weaken clinical teams’ ability to provide continuous and safe care for their patients. We further discuss how clinical practitioners’ own responses to the footage foregrounded different issues compared to those revealed by formal analysis; namely, issues centring on relationships, and on practical steps to ensure these relationships could be improved. We reflect on the differences between our own formal analysis of the footage, and practitioners’ ‘lived response’ to the footage, and the implications of these differences for how we as analysts conceptualise ‘teamness’ in organisations.
Australian Commission on Safety and Quality in Health Care (2008b) Clinical Handover: A Literature Review. Sydney: Australian Commission on Safety and Quality in Health Care.
Australian Commission on Safety and Quality in Health Care (2009) The OSSIE Guide to Clinical Handover Improvement. Sydney: Australian Commission on Safety and Quality in Health Care.
Australian Medical Association (2006) Safe Handover: Safe Patients. Guidance on Clinical Handover for Clinicians and Managers. Kingston, ACT: Australian Medical Association.
Bate, P. and Robert, G. (2003) Knowledge management and communities of practice in the private sector: Lessons for leading the quality revolution in health care. In S. Dopson and A. L. Mark (eds) Leading Health Care Organizations, 81–99. Basingstoke, UK: Palgrave Macmillan.
Boreham, N. (2004) A theory of collective competence: Challenging the neo-liberal individualisation of performance at work. British Journal of Educational Studies 52 (2): 5–17. http://dx.doi.org/10.1111/j.1467-8527.2004.00251.x
Cohen, M. and Hilligoss, B. (2009) Handoffs in hospitals: A review of the literature on information exchange while transferring patient responsibility or control. Ann Arbor: University of Michigan.
Degeling, P., Sorensen, R., Maxwell, S., Aisbett, C., Zhang, K. and Coyle, B. (2000) The Organization of Hospital Care and its Effects. Sydney: Centre for Clinical Governance Research, University of New South Wales.
Dessein, W. and Santos, T. (2006) Adaptive organisations. Journal of Political Economy 114 (5): 956–997. http://dx.doi.org/10.1086/508031
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. Communication Monographs 72 (4): 390–413. http://dx.doi.org/10.1080/03637750500322602
Engeström, Y. (2008) From Teams to Knots: Activity-Theoretical Studies of Collaboration and Learning at Work. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511619847
Engeström, Y. and Middleton, D. (1998) Cognition and Communication at Work. Cambridge: Cambridge University Press.
Erickson, F. (1999) Appropriation of voice and presentation of self as a fellow physician: Aspects of a discourse of apprenticeship in medicine. In S. Sarangi and C. Roberts (eds) Talk, Work and the Institutional Order: Discourse in Medical, Mediation and Management Settings, 109–144. Berlin: Mouton de Gruyter.
Firth-Cozens, J. (1998) Celebrating teamwork. Quality in Health Care 7 (Suppl): S3–S7.
Haig, K. M., Sutton, S. and Whittington, J. (2006) Sbar: A shared mental model for improving communication between clinicians. Journal on Quality and Patient Safety 32 (3): 167–175.
Hutchins, E. (1995) Cognition in the Wild. Cambridge, MA: MIT Press.
Hutchins, E. and Klausen, T. (1998) Distributed cognition in an airline cockpit. In Y. Engeström and D. Middleton (eds) Cognition and Communication at Work, 15–34. Cambridge: Cambridge University Press.
Iedema, R., Jorm, C. M., Braithwaite, J., Travaglia, J. and Lum, M. (2006) A root cause analysis of clinical error: Confronting the disjunction between formal rules and situated clinical activity. Social Science & Medicine 63 (5): 1201–1212. http://dx.doi.org/10.1016/j.socscimed.2006.03.035
Iedema, R., Long, D., Forsyth, R. and Lee, B. (2006) Visibilizing clinical work: Video ethnography in the contemporary hospital. Health Sociology Review 15 (2): 156–168. http://dx.doi.org/10.5172/hesr.2006.15.2.156
Iedema, R. and Merrick, E. (2008) HELiCS: Handover – Enabling Learning in Communication for Safety: A Handover Improvement Kit. Sydney: Australian Commission on Safety and Quality in Health Care.
Iedema, R., Merrick, E., Kerridge, R., Herkes, R., Lee, B., Anscombe, 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.
Iedema, R., Mesman, J. and Carroll, K. (2013) Visualising Health Care Improvement: Innovation from Within. Oxford: Radcliffe.
Kennedy, T., Regehr, G., Baker, R. and Lingard, L. (2009) Preserving professional credibility: Grounded theory study of medical trainees’ requests for clinical support. British Medical Journal 338 (2009): 1–7. http://dx.doi.org/10.1136/bmj.b128
Klein, G. (1999) Sources of Power: How People Make Decisions. Cambridge, MA.: MIT Press.
Leonard, M., Graham, S. and Bonacum, D. (2004) The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care 13 (5): i85–i90. http://dx.doi.org/10.1136/qshc.2004.010033
Long, D., Forsyth, R., Carroll, K. and Iedema, R. (2006) The (im)possibility of clinical democracy. Health Sociology Review 15 (5): 506–519. http://dx.doi.org/10.5172/hesr.2006.15.5.506
Manidis, M., Sheeres, H. and Iedema, R. (2013) Information transfer in emergency rooms. Focus on Patient Safety 15 (2): 3–7.
Mickan, S. and Rodger, S. (2000) Characteristics of effective teams: A literature review. Australian Health Review 23 (3): 201–208. http://dx.doi.org/10.1071/AH000201
NSW Health (2009) The NSW Health Clinical Handover Toolkit. Sydney: NSW Department of Health.
Pike, K. (1967) Language in Relation to a Unified Theory of the Structure of Human Behaviour. The Hague: Mouton & Co. http://dx.doi.org/10.1037/14786-000
Plsek, P. and Greenhalgh, T. (2001) Complexity science: The challenge of complexity in health care. British Medical Journal 323 (7313): 625–628. http://dx.doi.org/10.1136/bmj.323.7313.625
Raeithel, A. (1998). On the ethnography of cooperative work. In Y. Engestrom and D. Middleton (eds) Cognition and Communication at Work, 319–339. Cambridge: Cambridge University Press.
Sacks, H. (1992) Lectures on Conversation. 2 Volumes. Oxford: Blackwell.
Timmermans, S. and Berg, M. (2003) The Gold Standard: The Challenge of Evidence-Based Medicine and Standardization in Health Care. Philadelphia: Temple University Press.
Trist, E. (1981a) The Evolution of Socio-Technical Systems: A Conceptual Framework and an Action Research Program. Occasional Paper 2. Ontario: Ontario Quality of Working Life Centre.
Trist, E. (1981b) The sociotechnical perspective. In A. Van De Ven and W. Joyce (eds) Perspectives on Organizational Design and Behavior, 19–75. New York: Wiley.
Wenger, E. (1998) Communities of Practice. Cambridge: Cambridge University Press.
Wilson, K. A., Burke, C. S., Priest, H. A. and Salas, E. (2005) Promoting health care safety through training high reliability teams. Quality and Safety in Health Care 14: 303–309. http://dx.doi.org/10.1136/qshc.2004.010090
Wong, M. C, Yee, K. C. and Turner, P. (2008) A Structured Evidence-Based Literature Review Regarding the Effectiveness of Improvement Interventions in Clinical Handover. Hobart: eHealth Services Research Group, University of Tasmania / Sydney: Australian Commission on Safety and Quality in Health Care.
Woods, D. D., Patterson, E. S. and Cook, R. I. (2007) Behind human error: Taming complexity to improve patient safety. In P. Carayon (ed.) Handbook of Human Factors and Ergonomics in Health Care and Patient Safety, 459–476. Mahwah, NJ: Lawrence Erlbaum Associates.
World Health Organization (2016) Action on patient safety: High 5s. Retreived from http://www.who.int/patientsafety/implementation/solutions/high5s/en/
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