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SUMMARIZING THE THEORETICAL FOUNDATION FOR HOSPITAL COMMUNICATION RESEARCH

Arun Keepanasseril

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Trivial mistakes may trigger large accidents

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Thomas Farrinor-the Careless Baker

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Accidents are multifactorial in origin

Common factor - Failure to communicate

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Dangerous hospitals

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Medical Error Data

•Harvard Medical Practice Studies - I and II -“there is a substantial amount of injury to patients from medical management”

•Utah & Colorado studies -1992Brennan TA, Leape LL, Laird N et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. Qual Saf Health Care.

2004;13(2):145-151.

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IOM Report

•“Healthcare in United States is not as safe as it should be and can be”

•‘44000-98000’ deaths- often repeated data.

Institute Of Medicine. To Err Is Human: Building a Safer Health System. National Academies Press. 1999;1-312.

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Canadian Data

•AE in 7.5% of all hospital admissions.

•36% preventable.

Baker GR, Norton PG, Flintoft V et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ . 2004;170(11):1678-1686.

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Canadian Data

•‘9250-23750’ preventable deaths

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Medication Management Ford CD, Killebrew J, Fugitt P, Jacobsen J, Prystas EM. Study of medication errors on a community hospital oncology ward. J Oncol Pract.

2006;2(4):149-154.

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Handover / HandoffKripalani S. What have we learned about safe hand overs? Web M&M. 2011.

Joint Commission. Sentinel Event Data-Root Causes by Event Type 2004-Fourth Quarter 2010. 2011.

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The Response

•Training - Six Sigma, CRM,SBAR.

•Technology - Cell phones, pagers, smart phones, tablet computers,EMR.

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Statistical Summary of Commercial Jet Airplane Accidents 1959-2011.Available at http://www.boeing.com/news/techissues/pdf/statsum.pdf

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Aim• Collect communication theories, models, frameworks that

have been used in basic science and applied science domains such as cognitive psychology, human factors engineering, organizational behavior, sociology, and communication sciences as well as other HROs like aviation, nuclear power generation and defense that may be applied to healthcare.

• Summarize the knowledge determined in the first 2 objectives and make suggestions for future research in inter professional hospital communication using ICTs.

• To conduct a case study of a reported instance of faulty communication in a hospital in the light of the theories and models contained in this review.1

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Methods

•Scoping review.

•Most effective when a highly specific body of literature does not exist.

Danielle L, Heather Colquhoun Kelly K O'Brien. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69.

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Search Diagram

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List of Databases Systematically Searched

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•Ovid MEDLINE (1948-2011 Oct)

•EMBASE

•Psycarticles (1806- Oct 2011)

•OVID Health and Psychosocial Instruments

•IEEE

•Engineering Village

•CINAHL

•Business Source Complete

•Military and Intelligence database20

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List of Databases and Sources Hand Searched

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•Scholar's Portal

•Business Source Complete

•The International Journal of Aviation Psychology

•Google Scholar

•Proquest

•International Journal of Human-Computer Interaction

•Tayler and Francis

•Science Direct

•OVID Health and Psychosocial Instruments

•Cognitive Systems Research

•Leadership in Health Services

•ACM Special interest group - HCI

•Computer Supported Cooperative Work

•Cognition, Technology & Work

•Journal of Loss Prevention

•Computers in Human Behavior

•Social Science & Medicine

•Human Resource Management Review

•International Emergency Nursing

•Nursing Times Research

•Journal of Communication Management

•International Journal of Nursing Studies

•Campus-Wide Information Systems

•Journal of Managerial Psychology

•Wilson Web

•Corporate Communications: An International Journal

•Journal of Clinical Psychology in Medical Settings.

•Multicultural Education & Technology Journal

•International Journal of Operations & Production Management  

•Business Process Management Journal

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List of Theories Identified in the Review

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•Information theory

•Systems theory

•Socio-technical theory

•Taylor’s theory of organizational communication

•Humanistic communication theory

•Communication accommodation theory

•Convergence theory

•Network theory

•Likert’s four system’s theory

•Uncertainty reduction theory

•Wicked problems theory

•Task artifact cycle

•Chaos theory

•Risk communication theory

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List of Models Identified in the Review

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•Limited capacity model

•Wicken’s staged model

•Socio-technical theory

•Shannon – Weaver’s model

•Linear model

•Mechanical model

•Psychological model

•Interactional and Transactional model

•Systemic interaction model

•Uncertainty reduction theory

•Schein’s cultural model

•Andersch, Staats and Bostom model26

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List of Methods for Communication Analysis Identified in the Review

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•Cognitive work analysis

•Computer-based linguistic method of text analysis

•Sentence completeness analysis method

•Social network analysis

•Communication And Teamwork Skills Assessment

•C3TRACE (Command, Control, and Communication Techniques for Reliable Assessment

•Case based reasoning (CBR)

•Cognitive archeology

•CREAM-based communication error analysis method (CEAM) communication

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Case study

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•A 20-month-old boy in ICU following a Fontan surgical procedure.

•Respiratory distress in the first post op evening

•On call ICU attending .

•Surgeon orders ECG

•ECG result communicated to surgeon(admitting doc).

•RP communicates with ICU-A for rest of night.

•Child suffers cardiac arrest in the morning, dies.

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•Solo vs Teamwork

•Team composition.

•Goal-Exemplary care delivery [within the confines].

•Caring for patients with multiple conditions is a complex process

•Diverse and large quantity of data

Initial considerations

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System Theory Considerations

•Hospital - System

•Diff units - Sub systems.

•Objects and attributes.

•Interrelationships.

•Need to clearly identify the anchoring unit.

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System theory considerationscontd

•Loss of clarity of anchor role in the case.

•lack of awareness of how to ensure effective team communication when multiple attending physicians were involved in caring for the child.

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Information theory

•Information about the child’s condition was present in the system but was not transmitted to all concerned.

•High entropy.

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Network Theory

•Absolute Vs Distributed information.

•Failure of distribution policy.

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Convergence Theory, Cultural Model

•Collision b/w artifacts, behaviors, and espoused values of each each group of professionals.

•High level of convergence

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•H-H-S Framework.

Proposed Analysis

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H-H-S Framework

•Extends the conventional framework for human–human communication analysis to include the information processed by the technical system.

•Analyze team communication in depth, including the ‘shifting’ phenomenon that results from system information processing.

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Information flow pattern A

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Information pattern B

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Steps in analysis

•Creating chronology of events

•Creating transcript of conversation b/w team members.

•Creating info flow diagram

•HHS tool

Resident 1Resident 1

Cardiology Cardiology FellowFellow Nurse 1Nurse 1

Nurse 1INurse 1I

SurgeonSurgeon

ICU ICU attendingattending

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Cardiology Cardiology FellowFellow Nurse 1Nurse 1

Nurse 1INurse 1I

SurgeonSurgeon

ICU ICU attendingattendingResident 1Resident 1

EMEMRR

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Conclusion•Adopt theories and models to hospital

communication research, modifying existing theories and models to suit the unique requirements of hospitals or by developing a strategy to design them de-novo.

•Identified 14 theories, 12 models and 12 communication analysis methods.

•Needs to ascertain their application in healthcare