Why ? A Case Overview

WHY ? A Case Overview There was this case in the hospital's Intensive Care ward where patients always died in the same bed, on Sunday morning at 11 a.m., regardless of their medical condition. This puzzled the doctors and some even thought that it had something to do with the supernatural. Why the death? So the doctors decide to go down to the ward to investigate the cause of the incidents. So on the next Sunday morning few minutes before 11 a.m., all doctors and nurses nervously wait outside the ward to see for themselves what the terrible phenomenon was all about. Some were holding wooden crosses, prayer books and other holy objects to ward off the evil........ Just when the clock struck 11.... Scroll down for what happened... Santa Singh, the part-time Sunday sweeper, entered the ward and unplugged the life support system so that he could use the vacuum cleaner.

Business Communication Term I Project Presentation

Section E Group-10 Saurav Sen Sharma (2009309) Shalin Lohia (2009311) Tejeshwar M. Lawania (2009296) Trisha Kulshreshtha (2009297) Tulip Sen (2009298)

BACKGROUND 

Hospital culture segmented inter and intra professionally.



United front needed at executive level on common issues to avoid interdepartmental wars.



Hand-over communication: patient’s current condition, recent changes in condition, ongoing treatment and possible changes or complications that might occur.occurs in many settings across the continuum of care.

BACKGROUND( Cont…) 

Hospital communication can be thought of as: ◦ Rapid Fire Communication : Change in an instant from fairly stable to totally chaotic situations. ◦ Team Approach : Any time there is a crisis or emergency situation, a team of health care professionals converges on the scene. ◦ No Time for Misunderstandings : team need to be alert and focused on the tasks at hand. No time for a lot of questions or delays due to the inability to communicate effectively. ◦ Has to be Written Down: For present and future references, proficiency in reading and writing required.

METHOD(s) USED 





Setting: ◦ Orange City Hospital (Nagpur) ◦ Workers had telephones and mobile. Subjects: ◦ Four physicians from the general medicine department, ranging in grade from junior medical consultant to senior consultant ◦ 4 nurses from the medical wards while they carried out their routine duties Data Collection: ◦ Subjects were asked for 2­3 hours during the morning or afternoon of a normal weekday for inter-department communication.

METHOD 

Our study is based on the degree of inter-department communication and flow of information, in an organization. The Hospital (Orange City) is been broadly classified into five departments: § § § § §

Doctors ( or consultants) Nurses Investigatory Facilities Administration and secretarial staff Switchboards

RESULTS 

Cultural or Environment : § Subjects

can

be

characterised

as

habitual

(selfish), they value completion of their own tasks over their colleagues' tasks.

§ Calls

to

the

switchboard

are

seeking

contact

information for specific roles i.e. subjects are unsure about which role could assist them in a task .

Cont… 

Inefficiencies with team communication i.e. Handover communication loss.



Some of the doctors indicated that, they assessed the urgency of a page (or a call) by the number of times they were called and the origin of the call.



Ineffective cooperative task when team members were geographically separated (cultural and language barriers).

Interdepartmental calls (or pages) : 20

Investigatory facilities (radiology, endoscopy, etc. )

3

10

1

4

2

Doctors

Nurses 12 3

3

10

3

Switchboards 2

6

Administrative and Secretarial staff

3

Flow of information

X

X number of calls or pages ( within one shift)

Functional\Operational Barriers: 

Lack of knowledge about how to improve systems.



Staffs were observed to infer the intention of messages based on insufficient information.



Lack of information technology infrastructure and interoperability.



Time pressures from patient care needs and other responsibilities.

CONCLUSIONS 

High interruptive approach: ØSubjects favoured interruptive communication mechanisms (face to face discussion, or telephone)—over less interruptive methods.

Associated costs

Psychological costs: Leading to diversion of attention, forgetfulness, and errors Other costs: Staff time & efficiency



Inclination towards Synchronous Communication: Synchronous communication, occurs when two individuals participate in a conversation at the same time, such as using the telephone or face to face

Asynchronous communication, occurs when the exchange does not require both to be active participants at the same time, such as exchanging letters.

creates

interruptio n

causes

Less interruptio n

Contd…. Bias to asynchronous communication

beca use

üHospital low in providing synchronous channels like voicemail or email üSubjects needed immediate acknowledgement üNegligence on the part of subjects



Role based contact:

üA quarter of call events were associated with identifying the name of an individual occupying a specific role.

üThe long sequences of information seeking calls results into poor support for their realization.



Communication policies often unsound:

üInferences about the intention of caller or receiver were unsound on a number of grounds for e.g., assessment of urgency by doctors and nurses is likely to be different. üSituations judged to be non urgent by nurses have been shown to require medical assessment as much as ones deemed urgent which can lead to great chaotic situations.

RECOMMENDATION PROPOSED STANDARDS

ØClear: Information that is being communicated must be CLEAR AND EASY TO UNDERSTAND. ØCompleteness: Information must be shared with LESS UNNECESSARY DETAILS ØTimeliness: Information must reach the intended person ON TIME ØAcknowledgement: for effective exchange of information ACKNOWLEDGEMENT AND VERIFICATION by the receiver is important.

RECOMMENDATION( cont…) INFORMATION TRANSFER TECHNIQUES

ØCheck-back: Medical orders written for a patient must be reviewed for completeness and clarity. ØCall-out: The critical information is said aloud during an emergency ØHand-off : Verbally transferring information, responsibility, and accountability of a patient to another staff, receiving staff has to accepts the responsibilities.

SUGGESTED FOLLOW-UP

SUGGESTED FOLLOW-UP (cont…)