Packaging Patients and Handing Them Over: Communication Context and Persuasion in the Emergency Department - 19/04/17
, Sally McCarthy, MD, MBA b, Anna Holdgate, MD c, Jeffrey Braithwaite, PhD, MBA d, Anne Schoenmakers, MD e, Cordula Wagner, PhD fAbstract |
Study objective |
Communication is commonly understood by health professional researchers to consist of relatively isolated exchanges of information. The social and organizational context is given limited credit. This article examines the significance of the environmental complexity of the emergency department (ED) in influencing communication strategies and makes the case for adopting a richer understanding of organizational communication.
Methods |
This study draws on approximately 12 months (1,600 hours) of ethnographic observations, yielding approximately 4,500 interactions across 260 clinicians and staff in the EDs of 2 metropolitan public teaching hospitals in Sydney, Australia.
Results |
The study identifies 5 communication competencies of increasing complexity that emergency clinicians need to accomplish. Furthermore, it identifies several factors—hierarchy, formally imposed organizational boundaries and roles, power, and education—that contribute to the collective function of ensuring smooth patient transfer through and out of the ED. These factors are expressed by and shape external communication with clinicians from other hospital departments.
Conclusion |
This study shows that handoff of patients from the ED to other hospital departments is a complex communication process that involves more than a series of “checklistable” information exchanges. Clinicians must learn to use both negotiation and persuasion to achieve objectives.
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| Please see page 211 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD |
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| Author contributions: PN conducted the fieldwork, conducted primary analysis of the data, and prepared the first draft of the article. SM and AH recruited participants and contributed to second-phase interpretation of the data. SM, AH, and JB planned the data collection strategies. SM, AH, JB, AS, and CW contributed to the writing of the article. JB obtained the funding and supervised data analysis. AS and CW contributed to secondary analysis of the data and informed the conceptualization of the project in international context. All authors contributed substantially to the final version of the article. PN takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. This research was funded by the Institute for Clinical Excellent, New South Wales Department of Health. |
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| The funder had no influence on or benefit to gain from the particular direction of the findings of this descriptive study. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 69 - N° 2
P. 210 - février 2017 Retour au numéro
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