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INTRODUCTION Observational studies of the actual practices of interprofessional collaborative practice (ICP) are needed to complement research on the determinants and consequences of collaboration. This naturalistic study of team communication maps a key practice: the patient case review in daily rounds. Here, ICP is conceptualized as collective sensemaking, or the joint description of the patient’s situation and associated action planning—a fundamentally communicative practice.
METHODS We observed the daily rounds of four acute care teams identified by organizational representatives for their efficient or problematic collaboration. The goal of analysis was to characterize practice differences within and across the teams. Data gathering methods included fieldnotes, structured observations, audio recorded rounds and interviews, and documentary evidence. Informed by conversation analysis, we analyzed transcribed interactions for recurrent and divergent patterns in sensemaking.
RESULTS A model of the patient case review offers a framework for exploring variations in sensemaking practice. It emphasizes the importance of framing practices in case overviews and of collective sensitivity to expressions of uncertainty. Case reviews on collaboratively efficient teams were more collectively produced, more comprehensive, richer in detail and complexity, and more routine across rotating leadership. When physicians were present, sensemaking focused more on action planning.
DISCUSSION In the time-pressured acute care context, predictable framing practices may lend stability to collective practice by ordering team thinking, while sensitivity to uncertainty and a broad focus may lead to more reliable collective performance.
CONCLUSION These findings suggest communication (as social action) as a focus for inquiry into ICP.
The authors declare that they have no competing interests.
Mapping Collective Sensemaking in Communication: The Interprofessional Patient Case Review in Acute Care Rounds.
Health and Interprofessional Practice
Available at: http://dx.doi.org/10.7710/2159-1253.1077
© 2015 Fox & Gilbert.