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Communication, Collaboration, and Teamwork among …

Centre for the Study of communication and CultureVolume 21 (2002) No. 3 communication , collaboration , andTeamwork among health CareProfessionalsLaura L. Ellingson, Clara UniversityA QUARTERLYREVIEW OFCOMMUNICATIONRESEARCHISSN: 0144-4646IN THISISSUET able of ContentsCommunication, collaboration , and Teamworkamong health Care Professionals .. 3I. Introduction to the Fieldof health communication .. 3II. Theoretical Approaches .. 4 III. collaboration in Heath Care .. 5A. Nurse-Physician collaboration .. 5B. Nurse Practitioner-Physician collaboration .. 6C. social Worker-Physician collaboration .. 6D. Pharmacist-Physician collaboration .. 7E. Physician-Physician collaboration .. 7IV. health Care Teams .. 7A. Defining Hospital Teamwork .. 8B. Effectiveness of health Care Teams ..10C. communication and Conflict in Teams ..10D. Role Overlap on Teams ..11V. Perspective and Suggestions for Further Research.

ies of health care systems. Health communication research has been, and continues to be, interdiscipli-nary, with researchers located in the fields of medicine, sociology, psychology, communication, anthropology, public health, social work, and nursing (du Pre, 1999). In the remainder of this essay, I explore one par-ticular aspect of health ...

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1 Centre for the Study of communication and CultureVolume 21 (2002) No. 3 communication , collaboration , andTeamwork among health CareProfessionalsLaura L. Ellingson, Clara UniversityA QUARTERLYREVIEW OFCOMMUNICATIONRESEARCHISSN: 0144-4646IN THISISSUET able of ContentsCommunication, collaboration , and Teamworkamong health Care Professionals .. 3I. Introduction to the Fieldof health communication .. 3II. Theoretical Approaches .. 4 III. collaboration in Heath Care .. 5A. Nurse-Physician collaboration .. 5B. Nurse Practitioner-Physician collaboration .. 6C. social Worker-Physician collaboration .. 6D. Pharmacist-Physician collaboration .. 7E. Physician-Physician collaboration .. 7IV. health Care Teams .. 7A. Defining Hospital Teamwork .. 8B. Effectiveness of health Care Teams ..10C. communication and Conflict in Teams ..10D. Role Overlap on Teams ..11V. Perspective and Suggestions for Further Research.

2 12A. Teams in Action ..12B. Informal Backstage communication ..13C. Power and the Culture of Medicine ..14 Afterword ..16 References ..17 Additional Bibliography ..21 Book Reviews ..22 Journals Received ..35 Newsletters Received ..39 Obituary: Rev. Jean Desautels, ..42 Notices ..432-VOLUME21 (2002) NO. 1 COMMUNICATIONRESEARCHTRENDSC ommunication Research TrendsVolume 21 (2002) Number 3 four times a year by the Centre for the Study ofCommunication and Culture (CSCC), sponsored by theCalifornia Province of the Society of Jesus. Copyright 2002. ISSN 0144-4646 Editor: William E. Biernatzki, Editor: Paul A. Soukup, :Annual subscription (Vol. 21) US$45 Payment by check, MasterCard, Visa or US$ payments by MasterCard or Visa, send full accountnumber, expiration date, name on account, and and/or International Money Orders (drawn onUSA banks; for non-USA banks, add $10 for handling)should be made payable to communication ResearchTrends and sent to the managing editorPaul A.

3 Soukup, SJCommunication DepartmentSanta Clara University500 El Camino RealSanta Clara, CA 95053 USAT ransfer by wire to: Bank of America, 485 El CaminoReal, Santa Clara, California. 95050, Account 00425-14510, Routing #121000358. Add $10 for all correspondence to the managing editor at theaddress shown : +1-408-554-5498 Fax: +1-408-554-4913email: Centre for the Study of communication and Culture(CSCC) is an international service of the Society of Jesusestablished in 1977 and currently managed by theCalifornia Province of the Society of Jesus, Box 519,Los Gatos, CA communication is a vital topic for researchbecause everyone either interacts with health profes-sionals, encounters health -related messages in themedia, has suffered from a serious illness, or has expe-rienced a loved one with a life-threatening or terminalillness (Sharf, 1993).

4 Our experiences with health andillness are significant to our sense of self. Two journalsin the field of communication , health Communicationand the Journal of health Communicationpublishresearch exclusively on communication topics withinhealth care, public health campaigns, and relatedissues. Additionally, mainstream communication jour-nals such as Journal of Applied CommunicationResearchand communication Monographs, also pub-lish articles on health communication . Journals in arange of other disciplines cover health communicationtopics, such as health Psychology, Sociology of Healthand Illness, and Qualitative health Research. Bothgraduate and undergraduate communication curriculain universities across the commonly includehealth communication courses, and there is a growingmarket for textbooks in the field. Three excellent intro-ductory textbooks written by communication scholarsinclude Beck s (2001) Communicating for betterhealth: A guide through the medical mazes, du Pre s(1999) Communicating about health : Current issuesand perspectivesand the forthcoming (October 2002)Communicating health : Personal, cultural, and politi-cal complexitiesby Geist-Martin, Ray, and Sharf.

5 At the same time that professional interest andresearch is expanding, public awareness of health risksand disease prevention is at an all time high (Sharf,1993; du Pre, 1999). With the proliferation of managedcare in the , patients are becoming more active intheir own care. The popular press is rife with articles ona wide range of health care issues ( , Strauman,2001). These popular press topics ( , managed care,physician-patient communication ) mirror health com-munication research areas. health communication research began inresponse to physicians frustration with patients whodid not comply with physicians orders or recommen-dations. Physicians wanted to know why this was so,and enlisted the assistance of medical sociologists tostudy what strategies would be most effective in per-suading patients to obey physicians (du Pre, 1999).

6 communication between physicians and patients con-tinues to be one of the most researched topics withinhealth communication . Traditionally, health communi-cation research has focused on three main areas ofresearch: physician-patient communication , healthinformation dissemination ( , media campaigns topromote smoking cessation, encourage early cancerscreening), and social support (Sharf, 1993). Overtime, the field developed a broader focus. The focus ofthe health communication field is now large and varied,and, in addition to traditional topics, includes researchon health care teams, collaboration within health care,the organization of health care institutions, the commu-nication effects of managed care, communicationbetween health care institutions and members of disen-franchised groups, and transnational comparative stud-ies of health care systems.

7 health communicationresearch has been, and continues to be, interdiscipli-nary, with researchers located in the fields of medicine,sociology, psychology, communication , anthropology,public health , social work, and nursing (du Pre, 1999).In the remainder of this essay, I explore one par-ticular aspect of health communication research: com-munication among health care professionals from dif-ferent disciplines in pairs, small groups, and and interdisciplinary health careCOMMUNICATIONRESEARCHTRENDSVOLUME21 (2002) NO. 1-3 communication , collaboration , and Teamworkamong health Care ProfessionalsLaura L. Ellingson, of CommunicationSanta Clara UniversityEmail: Introduction to the Field of health Communicationteams have become standard practice in many aspectsof health care provision, particularly geriatrics. Themajority of the research reviewed here comes researchers; however, I incorporate research onteams from New Zealand, the United Kingdom,Sweden, and Australia.

8 I begin with an overview oftheoretical approaches to studying health care collabo-ration and Teamwork . I then review literature on inter-professional collaboration between physicians andother types of health care and social services , I explore the nature of Teamwork in health care,particularly as it relates to cross-disciplinary communi-cation and boundary negotiation. Finally, I provide aperspective on the state of research in health care col-laboration and Teamwork and offer suggestions for fur-ther (2002) NO. 3 COMMUNICATIONRESEARCHTRENDSII. Theoretical ApproachesTraditionally, health communication research hasbeen largely quantitative and positivist in its orienta-tion ( , du Pre, 1999; Vanderford, Jenks, & Sharf,1997). health communication research historically hasreflected a biomedical perspective that privileges thephysicians perspectives and puts physicians (notpatients ) concerns at the center of the research (Sharf,1993; Thompson, 1994).

9 Although much work remainsquantitative with its emphasis on controlling and pre-dicting behavior, researchers of health care teams haveintegrated a range of theoretical and methodologicalapproaches into their work. According to Sands (1993), four main approach-es to studying health care teams include group dynam-ics, systems, collaborative or consensus, and construc-tivism (Sands, 1993). The group dynamics model posi-tions a team as a small group in which norms, roles,and communication patterns are studied ( , Hannay,1980). communication scholars using this approachtend to focus on decision making in groups ( ,Sabourin & Geist, 1990). Systems theorists see theteam as a system with subsystems (disciplines) that isembedded within a suprasystem (hospital or otherhealth care organization), with roles and responsibili-ties shifting over time to achieve homeostasis of thesystem ( , Estes, 1981; O Connor, 1980).

10 Collaborative/consensus approaches to understandinghealth care teams emphasize shared responsibility andconsensus building among team members (Mailick &Ashley, 1981). This approach seeks to foster decisionmaking as an egalitarian process with all membershaving input towards reaching a common broad and commonly used theory is social con-structivism. Constructivist theorists propose thatmeaning is constructed through language in interaction(Berger & Luckmann, 1966; Gergen, 1994; Hacking,1999). This approach to research is valuable for look-ing at teams because it draws attention to the complexways in which health care teams construct the meaningof their work, of the team itself, and of their patientsthrough communication about cases, research, andclinic practice (Sands, 1993). Indeed, Communicationis not just a tool that groups use; groups are bestregarded as a phenomenon that emerges from commu-nication (Frey, 1994, p.)


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