BackgroundPoor interprofessional communication in hospital is deemed to cause significant patient harm. Although recognition of this issue is growing, protocols are being implemented to solve this problem without empirical research on the interprofessional communication interactions that directly underpin patient care. We report here the first large qualitative study of directly-observed talk amongst professions in general internal medicine wards, describing the content and usual conversation partners, with the aim of understanding the mechanisms by which current patterns of interprofessional communications may impact on patient care.MethodsQualitative study with 155 hours of data-collection, including observation and one-on-one shadowing, ethnographic and semi-structured interviews with physicians, nurses, and allied health professionals in the General Internal Medicine (GIM) wards of two urban teaching hospitals in Canada. Data were coded and analysed thematically with a focus on collaborative interactions between health professionals in both interprofessional and intraprofesional contexts.ResultsPhysicians in GIM wards communicated with other professions mainly in structured rounds. Physicians’ communications were terse, consisting of reports, requests for information, or patient-related orders. Non-physician observations were often overlooked and interprofessional discussion was rare. Intraprofessional interactions among allied health professions, and between nursing, as well as interprofessional interactions between nursing and allied health were frequent and deliberative in character, but very few such discussions involved physicians, whose deliberative interactions were almost entirely with other physicians.ConclusionWithout interprofessional problem identification and discussion, physician decisions take place in isolation. While this might be suited to protocol-driven care for patients whose conditions were simple and courses predictable, it may fail complex patients in GIM who often need tailored, interprofessional decisions on their care.Interpersonal communication training to increase interprofessional deliberation may improve efficiency, patient-centredness and outcomes of care in hospitals. Also, electronic communications tools which reduce cognitive burden and facilitate the sharing of clinical observations and orders could help physicians to engage more in non-medical deliberation. Such interventions should take into account real-world power differentials between physicians and other health professions.

BackgroundEffective nurse-physician communication is critical to delivering high quality patient care. Interprofessional communication between surgical nurses and surgeons, often through the use of pagers, is currently characterized by information gaps and interprofessional tensions, both sources of workflow interruption, potential medical error, impaired educational experience, and job satisfaction.ObjectiveThis study aims to define current patterns of, and understand enablers and barriers to interprofessional communication in general surgery, in order to optimize the use of communication technologies, teamwork, provider satisfaction, and quality and safety of patient care.MethodsWe will use a mixed-methods multiphasic approach. In phase 1, a quantitative and content analysis of alpha-numeric pages (ANP) received by general surgery residents will be conducted to develop a paging taxonomy. Frequency, timing (on-call vs regular duty hours), and interval between pages will be described using a 4-week sample of pages. Results will be compared between pages sent to junior and senior residents. Finally, using an inductive analysis, two independent assessors will classify ANP thematically. In Phase 2, a qualitative constructivist approach will explore stakeholders’ experiences with interprofessional communication, including paging, through interviews and shadowing of 40 residents and 40 nurses at two institutions. Finally, a survey will be developed, tested, and administered to all general surgery nurses and residents at the same two institutions, to evaluate their attitudes about the effectiveness and quality of interprofessional communication, and assess their satisfaction.ResultsDescribing the profile of current pages is the first step towards identifying areas and root causes of IPC inefficiency. This study will identify key contextual barriers to surgical nurse-house staff communication, and existing interprofessional knowledge and practice gaps.ConclusionsOur findings will inform the design of a guideline and tailored intervention to improve IPC in order to ensure high quality patient care, optimal educational experience, and provider satisfaction.

This commentary provides additional background and rationale for the use of ethnographic methods to study and explain constructs related to interprofessional practice. In health services and health professions education research there is now firm recognition for the necessary use of qualitative methodology to develop contextually relevant, yet conceptually generalizable findings [1][2][3][4]. Many qualitative researchers use the terms ethnographic research or ethnography to describe both an overall research approach and the use of a range of qualitative methods, including observation, interviews, and document and archival analysis. Ethnography is traditionally characterized by 1) a sustained period of research in the field during which the researcher is immersed in the setting, to the extent possible, 2) participant or non-participant observation, which involves the ethnographer's attempt to understand the participants' world by actually participating in it, again, to the extent that this is possible, and 3) an operating principle of cultural relativism, that is, an attempt to see the world from the perspective of one's participants without judgment or bias from one's own worldview [5]. The ethnographer's data are collected in the form of field notes, best described as reconstructions and reflections of what s/he saw, did, and heard in the field, written-up in narrative, journal-like fashion [6]. Data analysis involves transforming these descriptions into explanations or interpretive accounts via the development of emergent themes and categories, the identification of negative evidence, also known as deviant cases, and the inductive process of discovering how and why participants make meaning of various social phenomena the way that they do [7].However, the practice of ethnography is not homogeneous. The ethnographic tradition has a few different histories in different social science domains, such as sociology and anthropology, and is neither conceptualized nor carried out the same by everyone who purports to do it [8]. Ethnography in the anthropological tradition, for instance, might be regarded as relatively flexible in terms of its methodology when compared with ethnography typical in health services and health professions education research [9]. Therefore, as application of, and appreciation for, the principles of ethnography and qualitative research in this field continue to develop, it is important to recognize and be clear about the epistemological and methodological traditions that exist and which differentially inform the way ethnographic research is both carried out and translated to the wider audience.The article "Creating Sustainable Change in the Interprofessional Academic Primary Care Setting: An Appreciative Inquiry Approach" draws from the disciplines of anthropology, organizational behaviour research, and communication studies to advance a conceptual model of change in interprofessional primary care