Workplace Communication
Effective communication in the workplace is often a topic of discourse during interviews but seems to fall to the wayside once employment begins. Too often, employees are given the vague task of improving teamwork communication with nary a hint of how to do so. This 2008 review paper makes an attempt to identify specific aspects of healthcare related interprofessional communication that can reduce instances of medical error. Varpio et al. also shift their analysis on causes of error from individuals to system failures.
In this article, two types of failures are defined. Active failures are identified as mistakes made by individuals who are actively performing a task and whose effects are typically felt immediately. Latent failures are described as system-based failures that lie dormant until a local trigger activates the latent condition, exposing the failure. Varpio et al. implements the use of two social science theories to frame interprofessional communications in a manner such that specific components to improve upon can be identified. The Activity Theory (AT) considers six elements that influence an individual’s decision making: objectives, tools, communities, rules, division of labor, and individuals. The knotworking theory poses a metaphor wherein each person on the healthcare team (patient, patient’s family member, resident, nurse, pharmacist, etc) contributes one thread to patient care. Via collaborative effort, these threads come together to form a knot. The knot has no stationary center that fixes the collaborative efforts of the team members to any one aspect of care. It is constantly being undone and reknotted as team members rotate in and out, focuses change, and members constantly complete work tasks.
It is recommended that professionals consider the complexity of the patient care network, beyond those persons and tools they interact directly with, and the intricacies each team member faces in their decision making. Patient information shared across multiple communication tools, such as paper, electronic, and oral record keeping, can easily generate latent failures. Each individual working in the healthcare setting acts as a layer of defense against medical errors. Any gaps in their activity system, the six elements identified previously that impact individual decision making, leaves an opening for medical errors to occur.
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Medical errors in the healthcare field can lead to compromised patient safety, unintentional HIPAA violations, and delays in administering care. This leaves no doubt as to whether or not cohesive teamwork is paramount to delivering excellent patient care. I am not sure if the theories used in this review paper are the best choices for explaining healthcare related interprofessional communication, though I appreciate the attempt to identify particular facets that we can improve upon. This is a topic I intend to investigate further so that I may enter my calling with a strong understanding of communication difficulties that may arise during my career.