Teamwork and Team Talk
Decision-making across the Boundaries in Health and Social Care
Edited by
Srikant Sarangi [+–]
Aalborg University
Srikant Sarangi is Professor in Humanities and Medicine and Director of the Danish Institute of Humanities and Medicine/Health at Aalborg University, Denmark. Between 1993 and 2013, he was Professor in Language and Communication and Director of the Health Communication Research Centre at Cardiff University. Currently he is also Professor in Language and Communication at Norwegian University of Science and Technology (NTNU), Trondheim (Norway); Visiting Research Professor, Centre for the Humanities and Medicine, The University of Hong Kong; and Visiting Professor at University of Malay. In 2012, he was awarded the title of ‘Academician’ by the Academy of Social Sciences, UK.
His research interests include: institutional and professional discourse; quality of life and risk communication in genetic counselling, HIV/AIDS, telemedicine, general practice and palliative care; intercultural pragmatics; language and identity in public life; ethnicity, race and discrimination in multicultural societies.
He is author and editor of twelve books, guest-editor of five journal special issues and has published nearly two hundred book chapters and journal articles in leading journals in discourse and communication. He is the editor of Text & Talk as well as the founding editor of Communication & Medicine and with (C. N. Candlin) of Journal of Applied Linguistics and Professional Practice.
Decision-making in institutional/professional settings has remained an established theme for social science and communication researchers. In contemporary western societies, the conditions of decision making are rapidly changing with the foregrounding of division of professional labour and distributed expertise against the backdrop of a client-centred ideology that legitimises shared decision-making. Increasingly, in health and social care settings, key decisions concerning clients are arrived at in team meetings, which have consequences both for the decisional processes and outcomes. This edited volume for the first time brings together a number of empirically grounded studies focusing on how team talk is functional to decision-making (in terms of problem formulation, generation of options, assessment of solutions etc.), with tensions, at the interactional level, between institutional and professional ways of categorising people, events and evidence.
Series: Studies in Communication in Organisations and Professions
Table of Contents
Introduction
Introduction [+–]
Aalborg University
Srikant Sarangi is Professor in Humanities and Medicine and Director of the Danish Institute of Humanities and Medicine/Health at Aalborg University, Denmark. Between 1993 and 2013, he was Professor in Language and Communication and Director of the Health Communication Research Centre at Cardiff University. Currently he is also Professor in Language and Communication at Norwegian University of Science and Technology (NTNU), Trondheim (Norway); Visiting Research Professor, Centre for the Humanities and Medicine, The University of Hong Kong; and Visiting Professor at University of Malay. In 2012, he was awarded the title of ‘Academician’ by the Academy of Social Sciences, UK.
His research interests include: institutional and professional discourse; quality of life and risk communication in genetic counselling, HIV/AIDS, telemedicine, general practice and palliative care; intercultural pragmatics; language and identity in public life; ethnicity, race and discrimination in multicultural societies.
He is author and editor of twelve books, guest-editor of five journal special issues and has published nearly two hundred book chapters and journal articles in leading journals in discourse and communication. He is the editor of Text & Talk as well as the founding editor of Communication & Medicine and with (C. N. Candlin) of Journal of Applied Linguistics and Professional Practice.
Decision-making in institutional/professional settings has remained an established theme for social science and communication researchers. In contemporary western societies, the conditions of decision making are rapidly changing with the foregrounding of division of professional labour and distributed expertise against the backdrop of a client-centred ideology that legitimises shared decision-making. Increasingly, in health and social care settings, key decisions concerning clients are arrived at in team meetings, which have consequences both for the decisional processes and outcomes. This edited volume for the first time brings together a number of empirically grounded studies focusing on how team talk is functional to decision-making (in terms of problem formulation, generation of options, assessment of solutions etc.), with tensions, at the interactional level, between institutional and professional ways of categorising people, events and evidence.
Chapter 1
University of Nordland
Previously known as Bodø University College
Previously known as Bodø University College
The topic of this article is collaborative problem solving conducted as talk and social interaction in a particular team in the thoracic ward of a Norwegian hospital. The problems to be solved were complex and required a team consisting of participants from diverse medical specialties that met regularly to discuss examination procedures, formulate diagnoses, and decide forms of treatment. Data for the article come from field notes and audio recordings made while the author observed this meeting regularly over more than one year. The aim of the paper is to investigate how team discourse was regulated in ways that served the reproduction of institutional medical standards for problem solving, and also how the meeting had to deal with deviations from institutional standards and attempted to reproduce a certain form of normative orderliness and interaction order.
Chapter 2
Vestfold University College
NTNU
This article explores collaborative aspects of clinical decision-making, based on a focused ethnography and video recordings of meetings in clinical practices in two wards for gastro-intestinal diseases at the surgical department of a large Norwegian university hospital. By studying clinicians’ communication during patient introduction, handling uncertainties and surprises, collecting information, and negotiating acceptance, we elaborate on how collaborative teamwork in the hospital ward is developed. Further, by drawing on detailed studies of meetings, in which patients are not physically represented, we explore ways in which a ‘collective clinical gaze’ of each patient is constructed on the basis of documents, memory, and a consensus-directed discussion among clinicians who are present. Although electronic patient record systems and the like are expected to produce firm bases for clinical decision-making, our analysis suggests that more emphasis should be put on how clinicians in their daily practice establish collectively based validity of any decision being made.
Chapter 3
The University of Hong Kong
I arrived in Hong Kong in December 2003 after completing my PhD studies in St. Petersburg, Russia, and have researched and taught in this vibrant city ever since. My areas of expertise and research interests broadly include interactional approaches to professional communication, in particular in healthcare and business settings. In the past few years I have been working on a number of research projects studying social interactions in the genetic counselling and prenatal screening contexts in Hong Kong in collaboration with public hospitals and the Clinical Genetic Services of Hong Kong. I have also been studying business interactions in a number of large international corporations and privately-owned businesses.Currently I lead the Health Communication Research Cluster at the Center for the Humanities and Medicine, HKU where I also serve as a Board Member; and I am a member of the Consortium on Clinical Genetics and Genomic Medicine (Hong Kong West Cluster (HKWC)/HKU) that strives to improve genetic and genomic services in Hong Kong. Besides work, I also love spending time with my two sons and enjoy trail running around Asia.
Aalborg University
Srikant Sarangi is Professor in Language and Communication and Director of the Health Communication Research Centre at Cardiff University, Wales, UK (www.cf.ac.uk/encap/research/hcrc). He is also Professor in Language and Communication at Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Honorary Professor at the Faculty of Humanities, Aalborg University, Denmark; and Honorary Professor at the Centre for the Humanities and Medicine, The University of Hong Kong. His research interests are in discourse analysis and applied linguistics; language and identity in public life and institutional/professional communication studies (e.g., healthcare, social welfare, bureaucracy, education etc.). He has held several project grants (Funding bodies include The Wellcome Trust, The Leverhulme Trust, ESRC) to study various aspects of health communication, e.g., genetic counselling, HIV/AIDS and telemedicine. The other areas of healthcare research include communication in primary care, palliative care, with particular reference to assessment of consulting and communication skills. He is author and editor of 12 books, 5 journal special issues and has published nearly 200 journal articles and book chapters. He is the founding editor of Communication & Medicine, editor of TEXT & TALK: An Interdisciplinary Journal of Language, Discourse and Communication Studies (formerly TEXT) as well as co-editor (with C. N. Candlin) of Journal of Applied Linguistics and Professional Practice. He is also general editor (with C. N. Candlin) of three book series[es]: Studies in Applied Linguistics; Studies in Language and Communication; and Studies in Communication in Organisations and Professions. He serves as an editorial board member for other journals and book series[es], and as a consulting advisor at many national and international levels. His involvement in professional societies include membership of the Executive Committee of the British Association of Applied Linguistics (BAAL, 1997-2002) and Member-at-Large of the Executive Board of the International Association of Applied Linguistics (AILA, 1999-2002). He is also the founder of the annual interdisciplinary conference series, Communication, Medicine and Ethics (COMET) and Applied Linguistics and Professional Practice (ALAPP). Over the last ten years, he has held visiting academic attachments in many parts of the world.
University of Warwick
My main research interests are professional and medical communication. I am particularly interested in leadership, and the crucial role that communication plays in leadership performance. I have researched and published widely on various aspects of leadership discourse, gender, the multiple functions and strategic uses of humour, politeness and impoliteness, identity construction, the role of culture, decision making and advice giving, and other aspects of workplace discourse in a range of professional and medical contexts.
In this paper we examine one type of intraprofessional collaborative activity, namely case conferences in a specialist genetics clinic. Our specific focus is on how clinical geneticists manage decision-making through team talk in the event of diagnostic uncertainty which is mainly attributable to limitations in the current state of genomic knowledge, ‘uncertain significances’ associated with genetic test results, and a lack of information/evidence pertaining to cases under discussion. The case conference then becomes a means to minimise the uncertainty and arrive at decisions that optimise the significance of the results in terms of clients’ life trajectories. Adopting theme-oriented activity analysis, we examine video-recorded data from five case conferences in Hong Kong. Beginning with a prototypical structural mapping of the case conference activity type, our analysis focuses on what we call ‘uncertain cases’. Our findings highlight three discourse types constitutive of team talk: pedagogic talk, diagnostic talk and decisional talk. In paying particular attention to how uncertainty is formulated and negotiated, we suggest that access to and assessment of different kinds of evidence as well as the activity-specific expert role-positions of the participants are crucial with regard to establishing a correct diagnosis and/or striving towards a minimisation of current uncertainties.
Chapter 4
Gøril Thomassen Hammerstad,Ellen Andenæs,Stine Gundrosen ,Srikant Sarangi
Norwegian University of Science and Technology
I am a Full professor in Applied Linguistics and Professional Discourse Studies, with a specialization in Health Communication. My main research areas are discourse analysis in institutional and professional domains. Based on my work on Professional Discourse Studies in various healthcare and medical settings I have engaged with how concepts like co-construction, communicative activity type, discursive power, and interactional management can be employed to understand patient participation and have practical implications for user involvement.
Aalborg University
Srikant Sarangi is Professor in Language and Communication and Director of the Health Communication Research Centre at Cardiff University, Wales, UK (www.cf.ac.uk/encap/research/hcrc). He is also Professor in Language and Communication at Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Honorary Professor at the Faculty of Humanities, Aalborg University, Denmark; and Honorary Professor at the Centre for the Humanities and Medicine, The University of Hong Kong. His research interests are in discourse analysis and applied linguistics; language and identity in public life and institutional/professional communication studies (e.g., healthcare, social welfare, bureaucracy, education etc.). He has held several project grants (Funding bodies include The Wellcome Trust, The Leverhulme Trust, ESRC) to study various aspects of health communication, e.g., genetic counselling, HIV/AIDS and telemedicine. The other areas of healthcare research include communication in primary care, palliative care, with particular reference to assessment of consulting and communication skills. He is author and editor of 12 books, 5 journal special issues and has published nearly 200 journal articles and book chapters. He is the founding editor of Communication & Medicine, editor of TEXT & TALK: An Interdisciplinary Journal of Language, Discourse and Communication Studies (formerly TEXT) as well as co-editor (with C. N. Candlin) of Journal of Applied Linguistics and Professional Practice. He is also general editor (with C. N. Candlin) of three book series[es]: Studies in Applied Linguistics; Studies in Language and Communication; and Studies in Communication in Organisations and Professions. He serves as an editorial board member for other journals and book series[es], and as a consulting advisor at many national and international levels. His involvement in professional societies include membership of the Executive Committee of the British Association of Applied Linguistics (BAAL, 1997-2002) and Member-at-Large of the Executive Board of the International Association of Applied Linguistics (AILA, 1999-2002). He is also the founder of the annual interdisciplinary conference series, Communication, Medicine and Ethics (COMET) and Applied Linguistics and Professional Practice (ALAPP). Over the last ten years, he has held visiting academic attachments in many parts of the world.
Successful teamwork, constitutive of team talk, depends largely on shared responsibility in the coordination of tasks in a goal-oriented way. This paper examines how specific modes of talk or ‘discourse types’ are utilised by a healthcare team in simulated emergency care. The data corpus comprises six video-recorded simulation training sessions in an emergency department at a large Norwegian hospital. Our analysis focuses on the critical moment when the original healthcare team is joined by other specialists in an ad hoc manner, which necessitates the (re)distribution of expert responsibility in the management of the patient’s condition. We examine the interactional trajectories and, in particular, the discourse types surrounding the critical moment which marks the incorporation of the new team members. The analysis centres on three discourse types (online commentary, offline commentary and metacommentary) that are utilised in accomplishing the multiple tasks in a collaborative and coordinated fashion. We suggest that team talk overlays and overlaps with distributed medical work in highly charged decision-making contexts such as emergency care. The findings have relevance for how healthcare professionals and students are trained in multidisciplinary team talk and teamwork.
Chapter 5
Contrasting discourse styles and barriers to patient participation in bedside nursing handovers [+–]
University of Technology Sydney
Faculty of Arts and Social Sciences
Australian National University
Diana Slade is Professor of Applied Linguistics, School of Literature, Languages and Linguistics. She is also Director of the ANU Institute of Communication in Health Care. Her major publications include Communicating in Hospital Emergency Departments (co-authored, Springer), Effective Communication in Clinical Handover: from Research to Practice (co-edited with S. Eggins and F. Geddes), and Analysing Casual Conversation (with S. Eggins, Equinox Publishing).
This paper applies qualitative discourse analysis to ‘shift-change handovers’, events in which nurses hand over care for their patients to their colleagues. To improve patient safety, satisfaction and inclusion, hospitals increasingly require nursing staff to hand over at the patient’s bedside, rather than in staff-only areas. However, bedside handover is for many a new and challenging communicative practice. To evaluate how effectively nurses achieve bedside handover, we observed, audio-recorded and transcribed nursing shift-change handovers in a short stay medical ward at an Australian public hospital. Drawing on discourse analysis influenced by systemic functional linguistics we identify four handover styles: exclusive vs inclusive and objectifying vs agentive. The styles capture interactional/interpersonal meaning choices associated with whether and how nurses include patients during handover, and informational/ideational meaning choices associated with whether or not nurses select and organise clinical information in ways that recognise patients’ agency. We argue that the co-occurrence of inclusive with agentive and exclusive with objectifying styles demonstrates that how nurses talk about their patients is powerfully influenced by whether and how they also talk to them. In noting the continued dominance of exclusive objectifying styles in handover interactions, we suggest that institutional change needs to be supported by communication training.
Chapter 6
John Walsh,Nayia Cominos,Jon Jureidini
The aim of this paper is to describe, analyse, and discuss the process of formulation in the specific context of mental health (MH). Formulation is a fundamental element of the work of psychiatrists and other MH clinicians that is expected to be mastered during training. The literature, however, shows that formulation is rarely explicitly addressed in the psychiatric curriculum; rather, it is implicitly developed through modelling, and/or clinical practice. This paper focuses on case formulation in one MH context in Australia. It tracks the iterative formulation of one patient in a hospital emergency department. The analysis uses resources from systemic functional linguistics (SFL) situated within a broader framework of discourse analysis. It highlights patterns of lexical relations and nominalisation as well as the range of conjunctions. These make explicit how the clinicians talk about the patient’s illness and shape their developing understanding into a logical formulation. We see applications of this work for the training of mental health professionals. These data make explicit the ways in which the participating clinicians use language in the process of formulation. By bringing this process to the level of consciousness, it can be discussed and evaluated and become a pedagogic resource.
Chapter 7
Sara Keel,Veronika Schoeb
HESAV, University of applied health sciences, Lausanne, Switzerland
Research department
post-doc researcher
post-doc researcher
To enhance the patient’s involvement, clinical guidelines on rehabilitation require the patient’s participation in the entire rehabilitation process, including discharge planning (DP). However, very little is known about how this institutional demand is actually dealt with in everyday clinical practice. Adopting a conversation analytic (CA) approach, our paper tackles the matter by looking at interdisciplinary entry meetings (IEMs) at a rehabilitation clinic in German-speaking Switzerland. Our study is based on audio-visual recordings of 11 IEMs, whose central aim is to formulate patients’ rehabilitation goals and to plan their discharge. The paper offers a detailed analysis of the embodied practices through which healthcare professionals seek to involve patients in the IEMs, and also investigates patients’ responses. Our analysis shows that, although carefully elaborated, the professionals’ practices do not elicit more than reactive patient participation. The paper argues that this is due to (1) the practices’ temporal positioning within the overall activity structure of the meeting – they are deployed when no important decision is at stake, projecting minimal patient participation on the phases in which decisions are taken – and (2) the actions the practices project on the next turn: confirmation, acknowledgement or ratification of what has previously been proposed by professionals.
Chapter 8
Swiss Federal Institute for Vocational Education and Training
Chiara Piccini received her PhD in Communication Sciences from Università della Svizzera italiana and is currently lecturer at the Swiss Federal Institute for Vocational Education and Training. Her research interests concern discursive practices in professional contexts, with reference to social services, health care, and vocational education.
Università della Svizzera italiana
Antonella Carassa received her PhD in Psychology of Cognitive Processes at the Universities of Milan and Pavia. Prior to her retirement, she was Professor of Theory and Systems of Artificial Intelligence at the University of Padua and Full Professor at Università della Svizzera italiana in the area of communication psychology. Her research interests concern interpersonal communication as cooperative activity, with regard to cognitive and relational aspects.
This article presents a study on team talk in psycho-social rehabilitation, with reference to collective decision making and in particular to problem formulation processes occurring during the weekly team meetings in a Swiss organization providing psycho-social rehabilitation to chronic mental patients. The corpus of team meetings (34 hours of recorded talk) was analyzed along 3 narrative dimensions: participation framework, timeline organization and forms of evaluation. The analysis was supported by ethnographic information (field notes collected during participant observation over 10 months), in order to access the local conception and organization of rehabilitation work, which is repeatedly referred to and reshaped through discourse. On the one hand, the discursive practices identified show that team members learn to formulate problems in a way that allows them to identify and plan interventions in line with the rehabilitation model and the actual opportunities they have. On the other hand, role-related forms of participation highlight how different professionals contribute to the problem formulation in specific ways. In sum, the interaction turns out to be strongly centralized around the role of a meeting coordinator, who is able to enhance the participation of the other team members and to build institutional narratives on the basis of individual contributions, carrying out discursive work that can be metaphorically described as the weaving and knotting threads resulting in a tapestry.
Chapter 9
Tensions between institutional and professional frames in team talk in gerontological social work [+–]
Linköping University
Elisabet Cedersund received her Ph.D. in Communication Studies from Linköping University and is currently Professor in Ageing and Later life at Linköping University, Sweden. She has conducted research on the client/social worker encounters, and on interactions between older people and professionals in health and social care. Many of her studies deal with human interaction in various types of casework where oral communication is used as the basis for decision-making.
Linköping University
Anna Olaison received her Ph.D. in Age and Ageing from Linköping University and is currently a Senior Associate Professor of Social Work at Linköping University, Sweden. Her program of research aims to investigate how neoliberalism, changing social policies and standardization of social services influence needs assessment practices for older people. She has published on questions related to decision making and delivery of care and services for older people as well as social workers’ abilities to use discretion in assessment meetings and documentation practices.
Region Stockholm/ Linköping University
Susanne Kvarnström received her Ph.D. in Social Work from Jönköping University and is currently Senior Educational Officer at Region Stockholm, Sweden and is affiliated to Department of Health, Medicine and Caring Sciences, Linköping University, Sweden. Her research interests include interprofessional teamwork in health and social care, person centered care and interprofessional learning.
Team meetings are central to social workers’ decision-making practices. These meetings often function as a forum for collegial consultations when applications are processed and recommendations on decisions are discussed. In this paper, we present findings from a case study on team talk and decision-making practices in gerontological social work. The data comes from a body of material gathered within the framework of a larger project covering the process of assessing elder care for older persons in three Swedish municipalities. The case concerns an application, due to homelessness, from a couple for an apartment in special housing. The team meeting was analysed using a data-driven perspective within a micro-analytical approach to talk. The analysis focused in detail on how conflicting perspectives in the assessment of the couple’s needs are dealt with, and how tensions between divergent views and opinions are handled in relation to institutional and professional conversational frames. The findings show how the care managers (in Sweden the professional title for social workers working in elder care) negotiated the boundaries of responsibility and power within both the institutional and professional frames, revealing that the institutional frame dominated when it came to making decisions. The findings have implications for practice as they give insight into the interactional dynamics involved in social workers’ assessments when navigating different conversational frames within their decision-making practices.
Chapter 10
University of Newcastle
K. Neil Jenkings received his PhD for an ethnomethodological study of text and talk in legal tribunals from Nottingham University and is currently a research fellow at Newcastle University, UK. His research interests include healthcare decision support technologies and practices, the sociology of military in society and the representation of war cultures, and the ethnomethodology of sport. He is co-editor of the Routledge book series Directions in Ethnomethodology and Conversation Analysis.
This article looks at team talk in a validation committee meeting assessment of a guidance document text item. The item assessment is not evidence-based in terms of Evidence Based Medicine (EBM) criteria; instead it is assessed via the professional knowledge and experience of the committee members present, i.e., using their practice-based practitioner members’ knowledge. ‘Mere opinion’ is revealed as systematic evaluation of professional knowledge and personal experiences, in ways ‘compatible’ with thought experiments. Thought experiments are argued to be a members’ resource as well as an analyst’s one, although its detailed occasionedness is not reducible to a constructivist formalisation. The approach is informed by ethnomethodology and Conversation Analysis, and while the use of thought experiments as a heuristic device in the analysis is controversial, a warrant for this is attempted. The research was undertaken to locate ways of understanding and supporting the team members’ work of robust and useful guidance content production. What ‘validating’ guidance is, is shown in-and-as the emergent collaborative work of the committee members themselves.
Chapter 11
Amy Gillis,Marie Morris,Nikita Bhatt ,Paul F. Ridgway
Background: Despite widespread use of multidisciplinary team meetings (MDTs) to facilitate patient care, little evidence exists that MDTs improve patient survival or impact care. Research into MDT function and outcome is limited. This pilot study looks to validate a novel tool developed to assess MDT functioning. Methods: A tool was developed with predefined Likert behaviour stems in the areas of structure, communication and collaboration. The tool was evaluated in nine MDTs by three independent observers and included participant evaluation. Inter-rater reliability was calculated with intra class-correlation coefficients (ICC); Student’s t-test was used to calculate significance in participant evaluation and matched observations. Results: The tool was used to evaluate 9 MDTs, discussing 133 cases. The overall ICC for the three coders was 0.935; for each MDT: 0.776–0.917. The inter-rater reliability for each MDT observation ranged from 0.245–0.923; the majority with an ICC >0.8. No significant difference was noted between participant evaluation and observer response. Discussion: MDTs provide a means of coordinating complex care for patients. This tool provides a means of evaluating group interaction within MDTs and is designed for use by different medical personnel. The pilot study has shown promising ICC; further evaluation is needed using a broader group of MDTs and including case complexity and outcome.
ISBN-13 (Hardback)
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9781845539054
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ISBN (eBook)
9781800505797
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Publication
01/06/2025
Pages
256
Size
234 x 156mm
Readership
researchers and professionals
