Sending and Receiving Safety and Risk Messages in Hospitals: An Exploration into Organizational Communication Channels and Providers' Communication Overload

Communication Overload in Hospitals: Exploring Organizational Safety Communication, Worker Job Attitudes, and Communication Efficacy

Hospitals represent complex organizations where a range of hospital workers, from physicians to administrators, encounter a deluge of information they must quickly process and act upon. New technologies implemented to streamline patient care, like electronic health records and wearable technologies, have both enhanced and complicated communicative exchanges between hospital workers and their organizations. Hospital workers feeling over saturated with workplace communication, and thus unable to effectively manage or interpret workplace messages, experience what has been labeled communication overload, which can negatively impact worker productivity and concentration. This study examines hospital workers (N = 303) in a Midwestern U.S. healthcare network, and uses structural equation modeling to offer a preliminary theoretical model that demonstrates the effects and outcomes of communication overload in high-risk organizations. The model offers theoretical implications through depicting communication overload as indirectly related to burnout, job satisfaction, and organizational identification through participation in decision-making and organizational safety climate. Results suggest that even if communication overload is an expected state in high-risk organizations, managers can prevent its negative effects on workers' job attitudes by providing workers opportunities to get involved in organizational decision-making and constructing a robust organizational safety climate. Finally, we suggest pairings of organizational safety communication channels and sources through which high quantities of safety information can be communicated without communicatively overloading workers.

Centralization and democratization: Managing crisis communication in health care delivery

BACKGROUND

Communication is an essential organizational process for responding to adversity. Managers are often advised to communicate frequently and redundantly during crises. Nonetheless, systematic investigation of how information receivers perceive organizational communication amid crises has remained lacking.

PURPOSE

The aim of this study was to characterize features of effective internal crisis communication by examining how information-sharing processes unfolded during the initial stage of the COVID-19 pandemic.

METHODOLOGY

Between June and August 2020, we conducted 55 semistructured interviews with emergency department workers practicing in a variety of roles. We analyzed interview transcripts following constructivist constant comparative methods.

RESULTS

Our findings revealed that at the onset of COVID-19 pandemic response, emergency department workers struggled with immense fear and anxiety amid high uncertainty and equivocality. Frequent and redundant communication, however, resulted in information delivery and uptake problems, worsening anxiety, and interpersonal tension. These problems were ameliorated by the emergence of contextual experts who centralized and democratized communication. Centralization standardized information received across roles, work schedules, and settings while decoupling internal communication from turbulence in the environment. Democratization made information accessible in a way that all could understand. It also ensured information senders' receptiveness to feedback from information receivers. Centralization and democratization together worked to reduce sensed uncertainty and equivocality, which reduced anxiety and interpersonal tension.

CONCLUSION

Establishing frequent and redundant communication strategies does not necessarily address the anxiety and interpersonal tension produced by uncertainty and equivocality in crises.

PRACTICE IMPLICATIONS

Centralization and democratization of crisis communication can reduce anxiety, improve coordination, and promote a safer workplace and patient care environment.

Increasing Nurse-Physician Family-Centered Rounds Communication: A Quality Improvement Pilot Project

BACKGROUND

High-quality nurse-physician communication during family-centered rounds (FCRs) can increase patient safety.

LOCAL PROBLEM

In our hospital, interdisciplinary team members perceived that nurse-physician communication during FCRs declined during the COVID-19 pandemic.

METHODS

Using quality improvement methodology, we measured nurses' perceived awareness of components of the shared mental model, nurses' attendance during FCRs, compliance with completing FCR summaries, and average time spent per FCR encounter.

INTERVENTIONS

A structured resident huddle took place prior to an FCR. Residents used a tool to send individualized alerts to bedside nurses to prepare them for an FCR. Residents developed comprehensive summaries after each FCR encounter and sent a summary text to nurses who were unable to attend the FCR.

RESULTS

We assessed 40 FCRs over 16 weeks. Nurses' perceived awareness increased from 70% to 87%. Nurse attendance increased from 53% to 75%.

CONCLUSIONS

We successfully piloted multiple interventions to improve nurse perceived awareness after an FCR.

Communication in Sudden-Onset Major Incidents: Patterns and Challenges-Scoping Review

OBJECTIVE

To identify and describe patterns and challenges in communication in sudden-onset major incidents.

METHODS

Systematic scoping review according to Joanna Briggs Institute and PRISMA-ScR guidelines. Data sources included Cochrane Library, EMBASE, PubMed/MEDLINE, Scopus, SweMed+, Web of Science, and Google Scholar. Non-indexed literature was searched as well. The included literature went through data extraction and quality appraisal as per pre-registered protocol.

RESULTS

The scoping review comprised 32 papers from different sources. Communication breakdown was reported in 25 (78.1%) of the included papers. Inter-authority communication challenges were reported in 18 (56.3%) of the papers. System overload and incompatibility was described in 9 papers (28.1%). Study design was clearly described in 30 papers (93.8%).

CONCLUSIONS

The pattern in major incident communication is reflected by frequent breakdowns with potential and actual consequences for patient survival and outcome. The challenges in communication are predominantly inter-authority communication, system overload and incompatibility, and insufficient pre-incident planning and guidelines.

Matching Digital Intervention Affordances with Tasks: The Case of a Zoom and WhatsApp Mental Health Intervention for Seniors during the COVID-19 Pandemic

During the first COVID-19 wave, we conducted a Zoom and WhatsApp digital group intervention that promoted community-dwelling seniors' mental health. A total of 82 community-dwelling adults participated in this intervention. Based on the media richness theory (MRT) and the affordances approach, we used netnography to explore how group moderators and technical support team members (n = 9), but not the seniors themselves, perceived the ways Zoom and WhatsApp technological affordances/constraints matched intervention tasks and increased intervention performance. We identified four Zoom and WhatsApp affordances: temporality, interactivity, multimediality, and portability. Empirically, our findings represent a first step in creating a conceptual framework for analyzing digital intervention performances that addresses users' perceptions of technologies and intervention goals. Theoretically, our synergic analysis of MRT and the affordances approach offers a cohesive framework that shifts from a focus on users' interactions with one type of media to their interactions with all media that are used in attaining intervention goals.

Motivators and inhibitors of nurses' speaking up behaviours: A descriptive qualitative study

AIMS

To identify factors that motivate or inhibit nurses' speaking up for patient safety.

DESIGN

A descriptive qualitative study.

METHODS

We conducted semi-structured interviews with 15 nurses from four Korean hospitals between December 2020 and January 2021. Data were analysed using inductive content analysis.

RESULTS

We identified safety culture, supportive unit managers and role models, positive reactions from or familiarity with others, high-risk situations and personal characteristics and beliefs as motivators of nurses' speaking up. Hierarchies and power differentials, seniority and unit tenure, concerns about relationships, and heavy workloads inhibited nurses' speaking up.

CONCLUSION

Individual, organizational and cultural characteristics influence nurses' decisions on whether or not to voice their concerns, suggestions or ideas. Certain characteristics of Korean culture, such as strong hierarchies and the valuing of good relationships, play an important role in nurses' speaking up behaviours. Our findings can be used to inform educational interventions and management expectations about interpersonal behaviours, especially in a culture where age- and seniority-based hierarchies and collectivism are prevalent.

IMPACT

Nurses perceived speaking up as a challenging behaviour, and they sometimes withhold their voices even when speaking up is needed for patient safety. We found that individual, organizational, and contextual factors affect the speaking up behaviours of nurses. Nurse managers can create environments that are more supportive of nurses' speaking up behaviours by using inclusive leadership to create psychological safety, by inviting and showing appreciation for staff input, and by helping physicians and senior nurses understand the importance of all nurses' voices.

NO PATIENT OR PUBLIC CONTRIBUTION

Patient or public contribution does not apply to this study as its purpose was to explore the speaking up experiences of nurses themselves.

Benefits and drawbacks of communication visibility: from vicarious learning and supplemental work to knowledge reuse and overload

Purpose

This study aims to examine some of the benefits and drawbacks of communication visibility. Specifically, building on communication visibility theory, the authors study how and why message transparency and network translucence may increase knowledge reuse and perceived overload through behavioral responses of vicarious learning and technology-assisted supplemental work.

Design/methodology/approach

Drawing on survey data obtained from 1,127 employees of a global company operating in the industrial machinery sector, the authors used structural equation modeling to test the hypothesized model.

Findings

The results demonstrate that the two aspects of communication visibility yield somewhat differential benefits and drawbacks in terms of knowledge reuse and communication overload, through vicarious learning and supplemental work practices.

Research limitations/implications

The results demonstrate the relationship between different aspects of communication visibility and knowledge reuse, specifically through vicarious learning. Furthermore, the findings highlight a potential drawback of visibility – communication overload – specifically through technology-assisted supplemental work. Overall, network translucence seems more beneficial compared to message transparency in terms of knowledge reuse and communication overload.

Originality/value

The study connects with recent work on communication visibility by distinguishing differential direct and indirect effects of message transparency and network translucence. It also extends this work by testing relationships between communication visibility and a potential drawback of visibility – communication overload – specifically through technology-assisted supplemental work.

Improving Knowledge of Active Safety and QI Projects Amongst Practitioners in a Pediatric ICU

Introduction

The success of quality improvement (QI) projects depends on many factors, with communication and knowledge of project-specific practice change being fundamental. This project aimed to improve the knowledge of active safety and QI projects.

Methods

Two interventions were trialed to improve knowledge: paired email and meeting announcements followed by a daily huddle to review ongoing projects. Knowledge, measured as the ability to recall a project and its practice change, was the primary outcome. The frequency and duration of the Huddle were process and balancing measures, respectively.

Results

Seven days after a meeting/email announcement, 3 of 13 (23%) faculty and fellows recalled the announced practice change. Investigators then tested the effects of the Huddle by assessing practitioners' knowledge of safety and QI project-related practice changes on the first and last day of a service week. The average percentage of items recalled increased from the beginning to end of a service week by 33% [46% to 79%, 95% confidence interval (CI) 12-53] for faculty and 27% (51% to 77%, 95% CI 13-40) for fellows. The Huddle occurred in four of seven (interquartile range 2-5) days/wk with a mean duration of 4.5 (SD 2) minutes. Follow-up assessment 2 years after Huddle implementation demonstrate sustained increase in item recall [faculty +36% (95% CI +13% to 40%); fellows +35% (95% CI +23% to 47%)].

Conclusions

A daily huddle to discuss safety and QI project-related practice change is an effective and time-efficient communication method to increase knowledge of active projects.

Management practices for leaders to promote infection prevention: Lessons from a qualitative study

BACKGROUND

Prevention of healthcare-associated infections (HAIs) is critical to reduce preventable deaths and healthcare costs. Variable success with HAI prevention efforts has suggested that management practices are critical to support clinical infection prevention practices. This study examined hospital leaders' management practices around the prevention of catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs) to identify actions that leaders can take to promote HAI prevention efforts.

METHODS

We conducted interviews with 420 key informants, including managers and frontline staff, in 18 hospitals across the United States. Interviewees were asked about management practices supporting HAI prevention. We analyzed interview transcripts using rigorous qualitative methods to understand how management practices were operationalized in infection prevention efforts.

RESULTS

Across hospitals and interviewees, three management practices were characterized as important facilitators of HAI prevention: (1) engagement of executive leadership; (2) information sharing; and (3) manager coaching. We found that visible executive leadership, efficient communication, and frequent opportunities to provide and promote learning from feedback were perceived to promote and sustain HAI prevention efforts.

CONCLUSIONS

Our findings provide insight into management practices for leaders that support successful HAI prevention. In practice, these tactics may need to be adjusted to accommodate the current restrictions caused by the COVID-19 pandemic, in order to maintain HAI prevention efforts as a priority.