Understanding communication networks in the emergency department

<p>Abstract</p> <p>Background</p> <p>Emergency departments (EDs) are high pressure health care settings involving complex interactions between staff members in providing and organising patient care. Without good communication and cooperation amongst members of the ED team, quality of care is at risk. This study examined the problem-solving, medication advice-seeking and socialising networks of staff working in an Australian hospital ED.</p> <p>Methods</p> <p>A social network survey (Response Rate = 94%) was administered to all ED staff (n = 109) including doctors, nurses, allied health professionals, administrative staff and ward assistants. Analysis of the network characteristics was carried out by applying measures of density (the extent participants are concentrated), connectedness (how related they are), isolates (how segregated), degree centrality (who has most connections measured in two ways, in-degree, the number of ties directed to an individual and out-degree, the number of ties directed from an individual), betweenness centrality (who is important or powerful), degree of separation (how many ties lie between people) and reciprocity (how bi-directional are interactions).</p> <p>Results</p> <p>In all three networks, individuals were more closely connected to colleagues from within their respective professional groups. The problem-solving network was the most densely connected network, followed by the medication advice network, and the loosely connected socialising network. ED staff relied on each other for help to solve work-related problems, but some senior doctors, some junior doctors and a senior nurse were important sources of medication advice for their ED colleagues.</p> <p>Conclusions</p> <p>Network analyses provide useful ways to assess social structures in clinical settings by allowing us to understand how ED staff relate within their social and professional structures. This can provide insights of potential benefit to ED staff, their leaders, policymakers and researchers.</p

Non-technical Skills in Healthcare

AbstractNon-technical Skills (NTS) are a set of generic cognitive and social skills, exhibited by individuals and teams, that support technical skills when performing complex tasks. Typical NTS training topics include performance shaping factors, planning and preparation for complex tasks, situation awareness, perception of risk, decision-making, communication, teamwork and leadership. This chapter provides a framework for understanding these skills in theory and practice, how they interact, and how they have been applied in healthcare, as well as avenues for future research

Towards Understanding Workplace Learning Through Theorising Practice: At Work in Hospital Emergency Departments

© 2012, Springer Science+Business Media Dordrecht. Focusing on the experiences of one 95-year-old patient, Jane Edna, this chapter uses a practice theory approach to investigate in situ ‘knowing-in-practice’ (Gherardi, Situated knowledge and situated action: what do practice-based studies promise? In Barry D, Hansen H (eds) The Sage handbook of new approaches in management and organization. Sage, Los Angeles, pp 516–525, 370, 2009b) in emergency health care. In particular, we discuss relationships between work, knowledge/knowing and learning through an examination of professional and interprofessional ‘doings and sayings’ (Schatzki, Organ Stud 27(12):1863–1873, 2006) by clinicians around the bedside of Jane Edna, who spends over 11 h in a busy Australian hospital emergency department (ED). We present and explore some of the ethnographic and spoken interactional data recorded between Jane Edna and her team of clinicians. We are primarily concerned with the practices and the potential for learning practices that the ED affords the junior doctor who directs Jane Edna’s care. The junior doctor’s ‘doings’, ‘sayings’ and ‘beings’ concentrate on applying biomedical scientific knowledge – practising medicine learned in vacuo – privileged within the institutional order (Sarangi and Roberts (eds), Talk, work and institutional order: discourse in medical, mediation and management settings. Mouton de Gruyter, Berlin/New York, 1999) of the ED. We consider the interplay and consequences of differentially valued epistemologies (Cook and Brown, Organ Sci 10(4):381–400, 1999), in particular, the dominance of ‘organisational knowledge’ (knowledge possessed by individuals – here, high-status doctors). We discuss how ‘organisational knowing’ (the collective working/knowing of all the participants who care for Jane Edna including Jane Edna herself) and ‘knowing-in-practice’ (Gherardi, Learn Organ 16(5):352–359, 2009a) could be more explicitly foregrounded to help create the team-based models of care that are enshrined in twenty-first-century hospital policies. The chapter concludes with some implications for understanding practice and learning practice in organisations as doing knowledge together where knowledge is emergent and co-constructed in situ through language, actions, relationships and material arrangements