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Chemical biology graduate programs that are jointly organized by chemistry and life science departments can offer a stimulating 'bicultural' training environment for students from diverse backgrounds. However, communication, flexibility and responsiveness are crucial for effectively structuring such programs.
The Continuum Center for Health and Healing, affiliated with Beth Israel Hospital, New York, emphasizes education and communication--"the cornerstones of marketing integrative medicine."
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This article presents a series of objections against having philosophers in the health care setting and rebuttals to these objections. These objections occur often enough to deal with them as characteristic criticisms. The rebuttals outline and advocate the positive--yet limited--function of the philosopher's presence in health care.
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The New Zealand Cervical Cancer Inquiry has elicited considerable interest in Australia as well as in New Zealand. However, relatively little attention has been paid to the future practice of medicine with regard to the relevance of the Inquiry's findings for medical education, although it did recommend the incorporation of ethics teaching into all stages of the medical curriculum, and also urged that attention be paid to communication skills within the curriculum. In this article, I argue that medical ethics teaching should be seen as an essential part of the medical curriculum, with the teaching being integrated closely with the other disciplines that comprise the medical course. To illustrate one possible approach, I have outlined elements of current ethics teaching at the University of Otago. I also have raised what I regard as wider issues for the medical curriculum. These include the need for students to develop a critical facility and an ability to handle conflicting data and attitudes (fostered principally by an understanding of research methods), to appreciate the importance of accountability (fostered in part through group learning activities) and to be aware of the impact of community concerns on the practice of medicine. Another issue which I consider is raised indirectly by the Inquiry concerns the procedures that are used for the selection of students into medical courses.
Ethical dilemmas in the high-risk nursery are similar to wilderness experiences. Reinforcers of these experiences for nurses include a lack of knowledge of ethics, communication failures, and the immediacy of the situation. Recommendations are presented to enable nurses to address these ethical dilemmas and to become more actively involved in the decision-making process.
In today's complex and rapidly changing health care environments, patient harm may result if important patient information is not communicated from one health care provider to another during handoffs in care. Issues involving communication, continuity of care, and care planning are cited as a root cause in more than 80% of reported sentinel events. In light of the inherent risks associated with handoffs in care, the use of strategies that reduce the impact of human factors on effective communication and standardize the communication process is essential to ensure appropriate communication patient information and that a plan of care is continued through the process.
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Medical students must be prepared for working in inter-professional and multi-disciplinary clinical teams centred on a patient's care pathway. While there has been a good deal of rhetoric surrounding patient-centred medical education, there has been little attempt to conceptualise such a practice beyond the level of describing education of communication skills and empathy within a broad 'professionalism' framework. Paradoxically, while aiming to strengthen patient-student interactions, this approach tends to refocus on the role modelling of the physician, and opportunities for potentially deep collaborative working relationships between students and patients are missed. A radical overhaul of conventional doctor-led medical education may be necessary, that also challenges the orthodoxies of individualistic student-centred approaches, leading to an authentic patient-centred model that shifts the locus of learning from the relationship between doctor as educator and student to the relationship between patient and student, with expert doctor as resource. Drawing on contemporary poststructuralist theory of text and identity construction, and on innovative models of work-based learning, the potential quality of relationship between student and patient is articulated in terms of collaborative knowledge production, involving close reading with the patient as text, through dialogue. Here, a medical 'education' displaces traditional forms of medical 'training' that typically involve individual information reproduction. Students may, paradoxically, improve clinical acumen through consideration of silences, gaps, and contradictions in patients as texts, rather than treating communication as transparent. Such paradoxical effects have been systematically occluded or denied in traditional medical education.
BACKGROUND: A cluster randomized trial of tailored interventions to support the implementation of guidelines for sore throat and urinary tract infection found little or no change in the main outcomes, which were antibiotic prescriptions, use of laboratory tests and use of telephone consultations. There was great variation between the practices in the change in these outcomes. OBJECTIVES: Our aim was to evaluate how the interventions were received and to understand why practices did or did not change. METHODS: The trial was conducted in general practices in Norway. Data for this process evaluation were collected from the 120 practices that completed the trial. Multiple methods were used: observations, semi-structured telephone interviews, a postal survey and data extracted from electronic medical records. We investigated factors that might explain a lack of change, including: agreement with the guidelines; communication within each practice; degree of participation in the project; taking time to discuss the guidelines and their implementation; use of the components of the interventions; and routines for telephone consultations. Possible explanatory factors were explored in relation to variation in change and the overall extent of change in rates of use of antibiotics, laboratory tests and telephone consultations. RESULTS: Sixty-three per cent of practices agreed with the guidelines. Only 35% reported having regular meetings, and 33% discussed the project before its start, although 75% reported agreement about participating within the practice. Only 33% reported meeting to discuss the guidelines. Use of the components of the interventions ranged from 11% for the increased fee for telephone consultations to 48% for the computerized decision support. Forty-four per cent reported problems with telephone routines. No single factor explained the observed variation in the extent of change across practices. CONCLUSIONS: Inadequate time, resources and support were the most salient factors that might explain a lack of change. Problems with internal communication and telephone routines were important contributing factors in many practices.
PURPOSE: Absorptive capacity has been defined as an organization's ability to recognize the value of new information, assimilate it, and apply it to productive ends. This study aims to examine the type of organization culture that influences the capacity of hospital organizations to innovate by absorbing new technology and the importance of this absorptive capacity in information technology (IT) implementation success. DESIGN/METHODOLOGY/APPROACH: Based on previous research, this study proposes a measure of absorptive capacity that includes managerial IT knowledge and communication channels and tests its relationship to the level of success implementing new systems. A sample of 192 hospital administrators shared their opinions about their organizations culture, ability to absorb new technology, and the extent to which their latest IT implementation operational for at least one year has been a success. FINDINGS: The results show the importance of organization culture as an important factor in developing absorptive capacity, and the latter's influence in the implementation of new technologies. ORIGINALITY/VALUE: The study provides insights into the types of activities that management should undertake in order to enhance absorptive hospital capacity.
BACKGROUND: Breakdown in communication among members of the healthcare team threatens the effective delivery of health services, and raises the risk of errors and adverse events. AIM: To describe the process of developing an authentic, theory-based evaluation instrument that measures communication among members of the operating room team by documenting communication failures. METHODS: 25 procedures were viewed by 3 observers observing in pairs, and records of events on each communication failure observed were independently completed by each observer. Each record included the type and outcome of the failure (both selected from a checklist of options), as well as the time of occurrence and a description of the event. For each observer, records of events were compiled to create a profile for the procedure. RESULTS: At the level of identifying events in the procedure, mean inter-rater agreement was low (mean agreement across pairs 47.3%). However, inter-rater reliability regarding the total number of communication failures per procedure was reasonable (mean ICC across pairs 0.72). When observers recorded the same event, a strong concordance about the type of communication failure represented by the event was found. DISCUSSION: Reasonable inter-rater reliability was shown by the instrument in assessing the relative rate of communication failures displayed per procedure. The difficulties in identifying and interpreting individual communication events reflect the delicate balance between increased subtlety and increased error. Complex team communication does not readily reduce to mere observation of events; some level of interpretation is required to meaningfully account for communicative exchanges. Although such observer interpretation improves the subtlety and validity of the instrument, it necessarily introduces error, reducing reliability. Although we continue to work towards increasing the instrument's sensitivity at the level of individual categories, this study suggests that the instrument could be used to measure the effect of team communication intervention on overall failure rates at the level of procedure.
The authors conclude this special issue by responding to the commentaries of their colleagues and reviewing relevant scholarship that appeared in the bibliometric literature since their literature reviews for the initial three articles in this issue were completed. They conclude, in part, that examination of bibliometric data regarding the entry of an article into the profession's knowledge base, and its ongoing life therein, may provide insights about the scientific communication process that lead to improvements of that process.
BACKGROUND: Improving communication and collaboration among doctors and nurses can improve satisfaction among participants and improve patients' satisfaction and quality of care. OBJECTIVE: To determine the impact of a multidisciplinary intervention on communication and collaboration among doctors and nurses on an acute inpatient medical unit. METHODS: During a 2-year period, an intervention unit was created that differed from the control unit by the addition of a nurse practitioner to each inpatient medical team, the appointment of a hospitalist medical director, and the institution of daily multidisciplinary rounds. Surveys about communication and collaboration were administered to personnel in both units. Physicians were surveyed at the completion of each rotation on the unit; nurses, biannually. RESULTS: Response rates for house staff (n = 111), attending physicians (n = 45), and nurses (n = 123) were 58%, 69%, and 91%, respectively. Physicians in the intervention group reported greater collaboration with nurses than did physicians in the control group (P < .001); the largest effect was among the residents. Physicians in the intervention group reported better collaboration with the nurse practitioners than with the staff nurses (P < .001). Physicians in the intervention group also reported better communication with fellow physicians than did physicians in the control group (P = .006). Nurses in both groups reported similar levels of communication (P = .59) and collaboration (P = .47) with physicians. Nurses in the intervention group reported better communication with nurse practitioners than with physicians (P < .001). CONCLUSIONS: The multidisciplinary intervention resulted in better communication and collaboration among the participants.