Talking at work--professional advice-seeking at primary health care centres

Discursive patterns in multiprofessional healthcare teams

AIM

The aim of this paper is to report a study exploring how members of multiprofessional healthcare teams talk about their team. Specifically, the team members' talk was analysed to explore the discursive patterns that emerged and their functions.

BACKGROUND

Over recent decades there has been an increasing demand in Western countries to change care organizations and to coordinate resources and professional competencies to meet the needs of patients/service users better. Because society promotes this kind of work, it may be valuable to explore the self-presentations of a multiprofessional healthcare team.

METHODS

A discourse analysis was carried out on existing empirical data from focus group interviews with a member-identified category sample comprising 32 healthcare professionals in six authentic multiprofessional teams in south-east Sweden. The analysis focused on the participants' discursive constructions of multiprofessional teamwork, on the way they talked about their group, and, in particular, on their use of the pronouns we, they and I.

FINDINGS

The constructions of 'we' by multiprofessional healthcare teams showed discursive patterns that are here referred to as knowledge synergy and trusting support, which included factors such as cross-learning and personal chemistry. The pronoun we was also used as a flexible resource to manage expertise, power and leadership within the teams, and it might also function to ease the pressure for consensus.

CONCLUSION

These discursive patterns provided powerful rhetorical resources for team members, both to affirm their choice of membership and to claim superiority in relations with the surrounding community (the others) by linking to a societal discourse that promotes collaboration.

Development of systems for support of collaboration in health care: the design arenas

To explore the design of computer-supported collaborative work in health care, a case study is described addressing the social contexts and conditions influencing the development process. The data set covers 13 consecutive meetings held in a systems design group over a 2-year period, in total approximately 24 h of video recordings. Subjectivist methods are used for the data analyses. The results suggest that the development of computer-supported collaborative work in health care is situated at three social arenas: the societal arena, the organizational arena and the workplace arena. These are visited by the design group in patterns which correspond to the micro-, meso- and macro-level social structures involved in the design. The study displays that longitudinal analyses of design meeting dialogues provide the opportunity of improving the understanding of external influences on design processes in health care.

A list system can help to reduce the proportion of out of hours referrals for male patients

OBJECTIVE

To examine differences in referral patterns by general practitioners (GPs) with and GPs without a list of patients.

DESIGN

Survey of all referrals from primary to secondary care during one week.

SETTING

Central and northern Finland, in a region comprising 72% of the area of the country and one-third of the population.

PARTICIPANTS

851 GPs, of whom 199 (23%) had a list system.

OUTCOME MEASURES

Referrals in terms of practice characteristics.

RESULTS

There were 58760 consultations during the study period, and 2921 patients were referred to secondary care. GPs with a list referred 64% of all referred male patients and 63% of all referred female patients during normal working hours. The corresponding referral figures for GPs without a list were 43% and 58%.

CONCLUSION

GPs with a list of patients had a more appropriate distribution of referrals between normal and out of hours work than GPs without a list. Our results may help in developing solutions to problems of providing good primary health care.