Dataset Information

Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?

ABSTRACT:

Objectives

This interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving 'traces' in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt. This paper brings awareness to its existence in the context of healthcare teamwork.

Design

Interview-based study using Constructivist Grounded Theory methodology.

Setting

This study was conducted in multiple team contexts at one of Canada's largest acute-care teaching hospitals.

Participants

25 clinicians from across professions and disciplines. Specialties included surgery, anesthesiology, psychiatry, internal medicine, geriatrics, neonatology, paramedics, nursing, intensive care, neurology and emergency medicine.

Intervention

Not relevant due to the qualitative nature of the study.

Primary and secondary outcome

Not relevant due to the qualitative nature of the study.

Results

The dataset was analysed using the sensitising concept of 'traces' from Swarm Intelligence. This study brought to light novel and unique elements of trace-based communication in the context of healthcare teamwork including focused intentionality, successful versus failed traces and the contextually bounded nature of the responses to traces. While participants initially felt ambivalent about the idea of using traces in their daily teamwork, they provided a variety of examples. Through these examples, participants revealed the multifaceted nature of the purposes of trace-based communication, including promoting efficiency, preventing mistakes and saving face.

Conclusions

This study demonstrated that clinicians pervasively use trace-based communication despite differences in opinion as to its implications for teamwork and safety. Other disciplines have taken up traces to promote collective adaptation. This should serve as inspiration to at least start exploring this phenomenon in healthcare.

SUBMITTER: Cristancho S

PROVIDER: S-EPMC7643497 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?

Cristancho Sayra S Field Emily E

BMJ open 20201104 11

<h4>Objectives</h4>This interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving 'traces' in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been desc ...[more]

PMID: 33148735

Similar Datasets

Project description:BackgroundReturn on Investment (ROI), whereby the ratio of costs to benefits is assessed, is encouraged in-order to justify the value of Quality Improvement (QI) programmes. We previously performed a literature review to develop a ROI conceptual framework for QI programmes. We concluded that, QI-ROI is conceptualised as any monetary and non-monetary benefit. In the current study, we explored if this finding is shared by mental healthcare leaders. We also investigated the stability of this conceptualisation against influencing factors and potential for disinvestment.MethodsWe performed qualitative interviews with leaders in an NHS mental health organisation. There were 16 participants: nine board members and seven senior leaders. The interviews were held online via Microsoft Teams and lasted an hour on average. We performed deductive-inductive analysis to seek data from our initial ROI framework and any new data.ResultsWe found that in mental healthcare, QI-ROI is also conceptualised as any valued monetary and non-monetary benefits. There was a strong emphasis on benefits to external partners and a de-emphasis of benefit monetisation. This conceptualisation was influenced by the 1) perceived mandates to improve quality and manage scarce resources, 2) expectations from QI, 3) health and social care values, 4) ambiguity over expectations, and 5) uncertainty over outcomes. Uncertainty, ambiguity, and potential for disinvestment posed a threat to the stability of this conceptualisation but did not ultimately change it. Health and social care values supported maintaining the QI-ROI as any benefit, with a focus on patients and staff outcomes. Socio-political desires to improve quality were strong drivers for QI investment.ConclusionMental healthcare leaders primarily conceptualise QI-ROI as any valued benefit. The inclusion of externalised outcomes which are hard to attribute may be challenging. However, mental healthcare services do collaborate with external partners. The de-emphases of benefit monetisation may also be controversial due to the need for financial accountability. Mental healthcare leaders recognise the importance of efficiency savings. However, they raised concerns over the legitimacy and utility of traditional ROI as a tool for assessing QI value. Further research is needed to bring more clarity on these aspects of the QI-ROI concept.

Project description:BackgroundSeverely and multiply disadvantaged members of the homeless population are disproportionately vulnerable to exceptionally high levels of multi-morbidity and premature death. Given widespread calls for the development of interventions that might improve the uptake and effectiveness of healthcare for this population, this study investigated patient and other stakeholder perspectives regarding an outreach service, delivered by prescribing pharmacists in collaboration with a local voluntary sector provider, within homelessness services and on the street in Glasgow (UK).MethodsThe qualitative study involved semi-structured face-to-face interviews with 40 purposively sampled individuals with current or recent experience of homelessness (32 of whom had direct experience of the service and 8 of whom did not), all (n = 4) staff involved in frontline delivery of the service, and 10 representatives of stakeholder agencies working in partnership with the service and/or with the same client group. Pseudonymised verbatim interview transcriptions were analysed systematically via thematic and framework analysis.ResultsThe service was effective at case finding and engaging with patients who were reluctant to utilise or physically unable to access existing (mainstream or specialist 'homeless') healthcare provision. It helped patients overcome many of the barriers that homeless people commonly face when attempting to access healthcare, enabled immediate diagnosis and prescription of medication, and catalysed and capitalised on windows of opportunity when patients were motivated to address healthcare needs. A number of improvements in health outcomes, including but not limited to medication adherence, were also reported.ConclusionsA proactive, informal, flexible, holistic and person-centred outreach service delivered within homelessness service settings and on the street can act as a valuable bridge to both primary and secondary healthcare for people experiencing homelessness who would otherwise 'fall through the gaps' of provision. Prescribing pharmacist input coupled with third sector involvement into healthcare for this vulnerable population allows for the prompt treatment of and/or prescription for a range of conditions, and offers substantial potential for improving health-related outcomes.

Project description:BackgroundReadmission of a patient to a hospital is typically associated with significant clinical changes in the patient's condition, but it is unknown how healthcare workers modify their provision of care when considering these changes. The purpose of the present study was to determine how healthcare workers shift their care strategies when treating readmitted patients.MethodsA typical case sampling study of healthcare workers was conducted using the grounded theory approach. The study setting comprised several patient care units at an academic center and tertiary-care hospital. We purposively sampled 34 healthcare workers (19 women, 15 men) to participate in individual interviews, either face-to-face or by telephone. We asked the participants semi structured questions regarding their thoughts on readmissions and how they altered their process and behavior for readmitted patients. Interviews were audio-recorded and transcribed. We used a qualitative data analyses based on an inductive approach to generate themes about how healthcare workers shift their strategies for readmitted patients.ResultsHealthcare workers' shifts in strategy for readmissions were reflected in three major themes: clinical assessment, use and management of information, and communication patterns. Participants reported that they became more conservative in their assessment of the clinical condition of a readmitted patient. The participants also indicated that readmitted patients would be treated in a similar way to normal admission based on care requirements; however, somewhat paradoxically, they also expressed that having access to prior patient information changed the way they treated a readmitted patient.ConclusionsAlthough healthcare workers may exhibit a tendency to become more conservative with readmissions, readily available patient information from the previous admission played a large part in guiding their thinking. A more conservative approach with a readmitted patient, on its own, does not necessarily lead to improved documentation or better patient care.

Project description:AimTo explore the range and use of communication strategies by Parkinson's nurse specialists, and describe key communication strategies, to support health professionals in their healthcare interactions with people with Parkinson's.DesignA qualitative descriptive study.MethodsDue to the COVID-19 pandemic, the study took place in an online setting. Online semi-structured interviews were conducted with eight Australian Parkinson's nurse specialists and one UK Parkinson's nurse between August and October of 2020. Interviews explored healthcare communication, specifically (1) ways Parkinson's nurse specialists support communication during healthcare interactions, (2) factors influencing the use of communication strategies, and (3) how the nurses learned to communicate effectively with people with Parkinson's disease. Reflexive thematic analysis was used to analyse the data.ResultsParkinson's nurse specialists described the importance of establishing strong therapeutic relationships, the key role of the communication partner, adapting communication to reduce cognitive load, ensuring two-way understanding, and enabling expressive communication for people with Parkinson's. Knowing the person and family, knowing the disease and understanding the symptoms appeared to influence the choice of communication strategies in healthcare interactions. Learning through others, learning through experience and learning through education and research were considered important parts of becoming a skilled healthcare communicator when working with people with Parkinson's.ConclusionKnowledge and use of effective communication strategies to support people with Parkinson's is crucial for all health professionals working with this population, in order to reduce the occurrence of poor healthcare outcomes. A deep understanding of how Parkinson's disease affects communication and experience in implementing communication strategies were reported as contributing to the success of Parkinson's nurses in communicating with their patients.ImpactThis study provides a description of the key, translational communication strategies that can be used by all health professionals to support healthcare interactions with people with Parkinson's.

Project description:BackgroundClinical leadership competencies for effective teamwork differ between Western cultures, where an independent self-construal prevails, and Japanese society, where the self-construal is rooted in interdependence. Although 27 out of 82 Japanese medical schools have 'leadership' as an educational outcome, specific competencies are poorly described, hindering the development of contextually-relevant leadership education. This study aimed to identify clinical leadership competencies and articulate the attributes and skills fundamental to leadership as perceived by Japanese physicians.MethodsThe 80 items of the UK clinical leadership competency framework (CLCF) formed the stimulus in a modified Delphi. Participants, comprising 26 Japanese physicians, rated the importance of each item using a 5-point Likert scale with free-text comments regarding the modification of competencies and suggestions for new items. Items were eliminated if the Likert mean was less than 4.0 and if fewer than 70% of participants considered them to be important. Newly described or modified items derived from free-text comments were rated for importance in a second round with reflective thematic analysis of the free-text descriptions.ResultsA CLCF of 84 items, reflective of Japanese clinical leadership, was created by eliminating three items describing tasks rarely involving Japanese physician leaders, revising seven items to emphasize understanding of members, and adding seven items to maximize feelings of team comfort. Seven skills and attributes emerged to construct Japanese clinical leadership from thematic analysis. "Humility" was viewed as a fundamental to leadership. Humility-driven "self-discipline" and "attentive listening", "supporting members" and "guiding members" with humility-based compassion, were essential elements to create "psychological safety" for freedom of expression. Achieving "unity" through emotional integration was identified as the overall goal of leadership.ConclusionsThe reorganized CLCF has embedded more member-centered behaviors that build rapport and comfort for the members than the original CLCF. Modeling the Confucian virtue of humility and building unity by acting with compassion toward members are characteristics of Japanese clinical leadership that reflect an interdependent social context. These findings are a step toward the development of leadership education aligned with a Japanese context.

Dataset Information

Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?

Objectives

Design

Setting

Participants

Intervention

Primary and secondary outcome

Results

Conclusions

Publications

Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets