Article Text

Download PDFPDF
Visual mapping of team dynamics and communication patterns on surgical ward rounds: an ethnographic study
  1. Candice Bonaconsa1,
  2. Oluchi Mbamalu1,
  3. Marc Mendelson1,
  4. Adam Boutall2,
  5. Claire Warden2,
  6. Shreya Rayamajhi2,
  7. Tim Pennel3,
  8. Mark Hampton4,
  9. Ivan Joubert5,
  10. Carolyn Tarrant6,
  11. Alison Holmes7,
  12. Esmita Charani7
  13. Groote Schuur Hospital Antimicrobial Stewardship and Surgical Study Group
    1. 1 Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
    2. 2 Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
    3. 3 Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
    4. 4 Dr. Matley & Partners Surgical Practice, Cape Town, South Africa
    5. 5 Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
    6. 6 Department of Health Sciences, University of Leicester, Leicester, UK
    7. 7 NIHR Health Protection Research Unit in Healthcare Associated infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, London, UK
    1. Correspondence to Candice Bonaconsa, Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch 7700, South Africa; candice.bonaconsa{at}uct.ac.za

    Abstract

    Background The effect of team dynamics on infection management and antimicrobial stewardship (AMS) behaviours is not well understood. Using innovative visual mapping, alongside traditional qualitative methods, we studied how surgical team dynamics and communication patterns influence infection-related decision making.

    Materials/methods Between May and November 2019, data were gathered through direct observations of ward rounds and face-to-face interviews with ward round participants in three high infection risk surgical specialties at a tertiary hospital in South Africa. Sociograms, a visual mapping method, mapped content and flow of communication and the social links between participants. Data were analysed using a grounded theory approach.

    Results Data were gathered from 70 hours of ward round observations, including 1024 individual patient discussions, 60 sociograms and face-to-face interviews with 61 healthcare professionals. AMS and infection-related discussions on ward rounds vary across specialties and are affected by the content and structure of the clinical update provided, consultant leadership styles and competing priorities at the bedside. Registrars and consultants dominate the discussions, limiting the input of other team members with recognised roles in AMS and infection management. Team hierarchies also manifest where staff position themselves, and this influences their contribution to active participation in patient care. Leadership styles affect ward-round dynamics, determining whether nurses and patients are actively engaged in discussions on infection management and antibiotic therapy and whether actions are assigned to identified persons.

    Conclusions The surgical bedside ward round remains a medium of communication between registrars and consultants, with little interaction with the patient or other healthcare professionals. A team-focused and inclusive approach could result in more effective decision making about infection management and AMS.

    • antibiotic management
    • communication
    • surgery
    • social sciences
    • teamwork

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    Statistics from Altmetric.com

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    View Full Text

    Footnotes

    • Twitter @e_charani

    • Collaborators Groote Schuur Hospital Antimicrobial Stewardship and Surgical Study Group: Ms J Abrahams, Professor B Biccard, Professor A Brink, Ms Brits, Dr C Centner, Professor S Dlamini, Dr B Eick, Mr E Nywagi, Ms G Joosten, Dr JP Kloppers, Dr A Kruger, Dr M Miller, Mr A Mohamed, Ms V Morris, Ms V Naicker, Dr B Nkgudi, Professor E Panieri, Dr J Piercy, Dr E Prentice, Dr R Manganyi, Dr N Samodien, Dr E Scout, Professor J Sherman, Dr D Thomson, Professor S Wasserman and Professor P Zilla.

    • Contributors MM, AH, EC and CT contributed to protocol development and design of the study. EC led the study and EC, CB and OM collected data. MM, AB, MH, SR and TP enabled access to the teams and the study site. EC, CB, OM, MM and CT contributed to data analysis and write up of this manuscript. All authors critically revised the content of the manuscript. All authors and collaborators read and approved the final version.

    • Funding This study was supported by National Institute for Health Research, UK Department of Health in partnership with Public Health England, Economic and Social Research Council.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.