Mapping Collective Sensemaking in Communication: The Interprofessional Patient Case Review in Acute Care Rounds

Observational studies of the actual practices of interprofessional collaborative practice (ICP) are needed to complement research on the determinants and consequences of collaboration. This naturalistic study of team communication maps a key practice: the patient case review in daily rounds. Here, ICP is conceptualized as collective sensemaking, or the joint description of the patient’s situation and associated action planning—a fundamentally communicative practice. METHODS We observed the daily rounds of four acute care teams identified by organizational representatives for their efficient or problematic collaboration. The goal of analysis was to characterize practice differences within and across the teams. Data gathering methods included fieldnotes, structured observations, audio recorded rounds and interviews, and documentary evidence. Informed by conversation analysis, we analyzed transcribed interactions for recurrent and divergent patterns in sensemaking. RESULTS A model of the patient case review offers a framework for exploring variations in sensemaking practice. It emphasizes the importance of framing practices in case overviews and of collective sensitivity to expressions of uncertainty. Case reviews on collaboratively efficient teams were more collectively produced, more comprehensive, richer in detail and complexity, and more routine across rotating leadership. When physicians were present, sensemaking focused more on action planning. DISCUSSION In the time-pressured acute care context, predictable framing practices may lend stability to collective practice by ordering team thinking, while sensitivity to uncertainty and a broad focus may lead to more reliable collective performance. CONCLUSION These findings suggest communication (as social action) as a focus for inquiry into ICP. Received: 04/10/2015 Accepted: 11/13/2015 © 2015 Fox & Gilbert. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Mapping Collective Sensemaking in Communication ORIGINAL RESEARCH 2(4):eP1077 | 2 Introduction Interprofessional collaborative practice (ICP) is collective by nature, emerging at the intersection of different professional knowledges and scopes of practice. Many studies of ICP focus on the determinants or inputs of collaborative practice as well as on the results, outputs, or outcomes (Canadian Interprofessional Health Collaborative (CIHC), 2012; Stutsky & Laschinger, 2014). This is echoed methodologically, as the majority of ICP teamwork studies rely mainly on interview and survey data (Valentine, Nembhard, & Edmondson, 2013). However, many authors point out the need for more studies of the actual practices of collaboration (BuljacSamardzic, Dekker-van Doorn, van Wijngaarden, & van Wijk, 2010; Lemieux-Charles & McGuire, 2006; Lewin & Reeves, 2011; Lingard, Reznick, Espin, Regehr, & DeVito, 2002). Some argue that close observations are the methods best suited methods for investigating the collective behavioural processes of interprofessional collaboration (Careau, Vincent, & Swaine, 2014; Ilgen, Hollenbeck, Johnson, & Jundt, 2005). Studies using naturalistic observation of ICP can thus enrich what is already known about practitioners’ attitudes and perceptions of working together. This article is based on research relying primarily on observations of ICP in interprofessional team rounds in acute care. It takes seriously the term practice in ICP by adopting a practice lens from social theory (Nicolini, 2013; Schatzki, Knorr Cetina, & von Sevigny, 2001) that views language and communication as social action (e.g., Austin, 1962; Searle, 1969). Stemming from a naturalistic study of four teams in an acute care Canadian teaching hospital, this interpretive research explores and describes the collective nature and key processes of a common interprofessional practice in acute care: the interprofessional patient case review in daily team rounds. It suggests that this practice consists of collective sensemaking, specifically how different professionals on a team collaborate to determine a shared understanding of the patient’s situation and of what matters most at that point in time on the patient’s care trajectory. Central to our argument is that this practice occurs in and through communicative action. Taking inspiration from scholarship in the field of organizational communication, our overall goal is to provide IP researchers, practitioners, and educators with a fresh perspective on communication as practice, specifically collective sensemaking practice, as it pertains to collaboration in health care and particularly in acute care. We begin by examining three concepts in the IP literature that proved key to our understanding of what teams do together in daily rounds: practice, communication, and sensemaking. This conceptual portrait is intended to guide the reader through what might be unfamiliar terrain, and it lays the groundwork for presenting this article’s main contribution to IP scholarship, namely a detailed description of sensemaking processes in the Implications for Interprofessional Practice • The way the patient’s situation is framed during case overviews organizes and orients team sensemaking and discussion. • “Framing training” for team facilitators should include a focus on parsing their profession-specific notes and interpreting them for other professionals involved. This is where knowledge with, from, and about other professions is brought to life. • The rounds facilitator plays a key role in realizing IP collaborative potential by nurturing an interactional environment that welcomes questions and expressions of uncertainty because they can lead to more comprehensive and nuanced understanding of the patient’s situation. • The model of the acute care patient case review could serve as a pedagogical aid. H IP & ISSN 2159-1253 Health & Interprofessional Practice | commons.pacificu.edu/hip 2(4):eP1077 | 3 interprofessional patient case review. We propose a model of the typical patient case review, based on our observations of acute care teams, both high and low performing, and explore variations in their collective communicative practices.