Towards safer interprofessional communication: constructing a model of "utility" from preoperative team briefings.
Towards safer interprofessional communication: constructing a model of "utility" from preoperative team briefings.
复制标题
DOI：
10.1080/13561820600921865
复制
发表时间：
2006-10-01
影响因子：
2.7
通讯作者：
Doran, Diane
中科院分区：
文献类型：
--
作者：
Lingard, Lorelei;Whyte, Sarah;Doran, Diane
“改进团队沟通”在安全讨论中得到广泛提倡，但很少得到对具体沟通实践与协作工作流程具体改进之间关系的精确理解的支持。我们试图通过分析外科医生、护士和麻醉师在普通外科手术前进行的结构化术前团队简报所产生的话语来提高这种理解。通过对302份简报中观察员的现场记录进行分析，得出了一个由两部分组成的沟通“效用”模型，定义为沟通对团队意识和行为的可见影响。当团队意识或知识通过提供新的信息、明确的确认、提醒或教育而得到提高时，就会出现“信息效用”。“职能效用”代表直接的沟通-工作联系：许多情况介绍会查明了问题，促进了决策和后续行动。该模型的关键是一个具体的沟通实践（团队简报），中间过程，如增强知识和有目的的行动，以及协作护理过程的质量和安全之间的因果关系的路径的阐述。对这条途径进行建模是促进变革的关键一步，因为它可以让当前团队沟通系统中存在的潜在危险以及改变的沟通模式可能影响团队意识和行为的具体方式变得可见。
"Improved team communication" is broadly advocated in the discourse on safety but rarely supported by a precise understanding of the relationship between specific communication practices and concrete improvements in collaborative work processes. We sought to improve such understanding by analyzing the discourse arising from structured preoperative team briefings among surgeons, nurses, and anesthesiologists prior to general surgery procedures. Analysis of observers' fieldnotes from 302 briefings yielded a two-part model of communicative "utility", defined as the visible impact of communication on team awareness and behavior. "Informational utility" occurred when team awareness or knowledge was improved by provision of new information, explicit confirmation, reminders, or education. "Functional utility" represented direct communication - work connections: many briefings identified problems, prompting decision-making and follow-up actions. The crux of the model is an elaboration of the causal pathway between a specific communication practice (the team briefing), intermediary processes such as enhanced knowledge and purposeful action, and the quality and safety of collaborative care processes. Modeling this pathway is a critical step in promoting change, as it renders visible both the latent dangers present in current team communication systems and the specific ways in which altered communication patterns can impact team awareness and behaviors.