Factors affecting communication in emergency departments: doctors and nurses’ perceptions of communication in a trilingual ED in Hong Kong

© 2015, Pun et al. Background: This study investigates clinicians’ views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong. Methods: Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs. Results: The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians’ engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills. Conclusions: These communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the primary causes of communication problems in EDs, (2) accepting the tenets and practices of patient-centred care, (3) establishing clear and consistent knowledge transfer procedures and (4) lowering the patient-to-clinician ratio in order to create the conditions that foster successful communication. The research provides a model for future research on the relationship between communication and the quality and safety of the patient safety

Communication in Hong Kong accident and emergency departments: The clinicians’ perspectives

© The Author(s) 2015. In this article, we report findings from the first qualitatively driven study of patient–clinician communication in Hong Kong Accident and Emergency Departments (AEDs). In light of the Hong Kong Hospital Authority’s policy emphasis on patientcentered care and communication in the public hospitals it oversees, we analyze clinicians’ perceptions of the role and relevance of patient-centered communication strategies in emergency care. Although aware of the importance of effective communication in emergency care, participants discussed how this was frequently jeopardized by chronic understaffing, patient loads, and time pressures. This was raised in relation to the absence of spoken interdisciplinary handovers, the tendency to downgrade interpersonal communication with patients, and the decline in staff attendance at communication training courses. Participants’ frequent descriptions of patient-centered communication as dispensable from, and timeburdensome in, AEDs highlight a discrepancy between the stated Hong Kong Hospital Authority policy of patient-centered care and the reality of contemporary Hong Kong emergency practice

On Being Negative

This paper investigates the pragmatic expressions of negative evaluation (negativity) in two corpora: (i) comments posted online in response to newspaper opinion articles; and (ii) online reviews of movies, books and consumer products. We propose a taxonomy of linguistic resources that are deployed in the expression of negativity, with two broad groups at the top level of the taxonomy: resources from the lexicogrammar or from discourse semantics. We propose that rhetorical figures can be considered part of the discourse semantic resources used in the expression of negativity. Using our taxonomy as starting point, we carry out a corpus analysis, and focus on three phenomena: adverb + adjective combinations; rhetorical questions; and rhetorical figures. Although the analysis in this paper is corpus-assisted rather than corpus-driven, the final goal of our research is to make it quantitative, in extracting patterns and resources that can be detected automatically

Towards an understanding of contextual features that influence the linguistic formality of British Sign Language users

This paper seeks to understand linguistic formality through the identification and measurement of contextual features. Using an adapted sociometric methodology to combine systemic functional linguistics and sign linguistics, a survey identifies the elements of context that have an effect upon the level of linguistic formality employed by British Sign Language users. The responses of 51 participants are analysed in order to ascertain (i) the level of linguistic formality that would be employed in certain communicative scenarios, and (ii) the contextual features of these scenarios that have an influence on linguistic formality. The results obtained from this study posit that there is an overall agreement shared between British Sign Language users when choosing levels of linguistic formality based on broad contextual description alone. The people involved in the communication and their interpersonal relationships tend to be the biggest influence on the level of formality employed, whereas the topic of the interaction appears to show no significant influence upon linguistic formality on its own. This work contributes further evidence to the importance of studying language within communicative contexts and the importance of formality as an influential factor in linguistic production. It is hoped that this will encourage future studies to derive linguistic data of British Sign Language users, or indee

Patterns of interaction in doctor-patient communication and their impact on health outcomes

© 2016 by Georgetown University Press. All rights reserved. Studies across the world have demonstrated that effective communication is fundamental to the delivery of safe and high-quality health care. However, identifying the direct relationship between effective communication and patient health outcomes that can affect patient safety has proved more problematic. This chapter reports on research into authentic communication between doctors and patients during consultations in an Accident and Emergency Department (AED) at a Hong Kong hospital. It is part of a wider study of communication within the AED that combined ethnographic observations, interviews with clinicians and patients, and audio recordings of ten patient journeys from triage to disposition. The primary focus here is on how information is exchanged and relationships are developed in the doctor-patient consultations of two patients in the AED. One consultation we characterize as effective, with the patient reporting a high level of satisfaction and understanding of the diagnosis and treatment plan; the other we characterize as less effective, with the patient expressing a high degree of dissatisfaction with the doctor and indicating that she would not comply with the recommended treatment. Recognizing that communication has both interpersonal and experiential dimensions, we analyze the discourse of the two consultations in terms of both move and speech function-which realize interpersonal meanings-and in terms of lexis, which realize experiential meanings. By demonstrating the interdependency of these two dimensions of meanings, our analyses show clear differences between the two consultations. In the less effective consultation, the patient is largely relegated to the passive speech role of answering the doctor’s mainly closed questions, and it is the doctor who mostly controls movement through the field of medically related information. In the more effective consultation, speech roles are more equally distributed, and the patient has much more control over movement through the field. We argue that the doctor-centered discourse of the less effective consultation makes it much more difficult for the patient to introduce additional information that may be relevant to the diagnosis, and to have her concerns and anxieties adequately addressed. This leads directly to the unsatisfactory outcomes of the consultation, with potential negative consequences for patient safety. Conversely, in the more patient-centered discourse of the effective consultation, the patient is able to communicate to the doctor additional information relevant to his diagnosis, and to have his concerns and issues fully discussed. This leads directly to the satisfactory outcome of the consultation and ultimately to adherence with the recommended treatment

Clause complexing in systemic functional lingustics – towards an alternative description

Abstract This article examines Halliday & Matthiessen’s systemic functional description of expanding clause complexing. As a perspective, their description is compared to the Cardiff Grammar’s treatment of clause combining. In particular, the article discusses the Hallidayan approach to the subordinate clause in a hypotactic clause complex: functionally speaking – and contrary to Halliday and Matthiessen’s claims – it is far from convincing that a subordinate clause upholds its functional meanings, i.e. its functions as a ‘move’ (interpersonal meaning), a ‘figure’ (experiential meaning) and a ‘message’ (textual meaning); and systemically speaking, it is problematic to see why all hypotactic clause complexes are agnates with paratactic clause complexes, and why no subordinate clauses in hypotactic clause complexes could be said to be agnate with a prepositional phrase. In the final part of the article, we shall provide principles for a solution to the problematic issues at stake in the Hallidayan approach

Complexities of emergency communication: clinicians’ perceptions of communication challenges in a trilingual emergency department

© 2016 John Wiley & Sons Ltd Aims and objectives: To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department. Background: Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication. Design: A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview. Methods: Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis. Results: Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting medical information. Around 50% believed that long work hours reduced their ability to communicate effectively with patients. In addition, 34% admitted that they rarely or never listen to patients during a consultation. Conclusion: The findings reveal that the quality of communication in this Hong Kong emergency department is compromised by specific factors inherent in the linguistic complexity of Hong Kong emergency departments. These factors include the constant translation of medical information, inadequate documentation of medical information and significant professional and cultural pressures. Each of these issues increases the likelihood that healthcare communication will be difficult, incomplete or incorrect. This research provides empirical evidence for, and justifies the development of, an effective framework to enable clinicians to overcome communication challenges. Relevance to clinical practice: The findings of this study may shed light on the unique conditions faced by clinicians, particularly in relation to communication, in the complex trilingual healthcare context of an emergency department similar to those in Hong Kong, and provide potential policy solutions for barriers to improve communication in such settings