Objective: To determine which aspects of open disclosure “work” for patients and health care staff, based on an evaluation of the National Open Disclosure Pilot.
Design, setting and participants: Qualitative analysis of semi‐structured and open‐ended interviews conducted between March and October 2007 with 131 clinical staff and 23 patients and family members who had participated in one or more open disclosure meetings. 21 of 40 pilot hospital sites, in New South Wales, South Australia, Victoria and Queensland, were included in the evaluation. Participating health care staff comprised 49 doctors, 20 nurses, and 62 managerial and support staff. In‐depth qualitative data analysis involved mapping of discursive themes and subthemes across the interview transcripts.
Results: Interviewees broadly supported open disclosure; they expressed uncertainty about its deployment and consequences, and made detailed suggestions of ways to optimise the experience, including careful pre‐planning, participation by senior medical staff, and attentiveness to consumers’ experience of the adverse event.
Conclusion: Despite some uncertainties, the national evaluation indicates strong support for open disclosure from both health care staff and consumers, as well as a need to resource this new practice.
Central to the critical study of contemporary management practice has been an understanding of the possibilities for worker subjugation framed in terms of the disciplinary practices of surveillance and responses to it in terms of compliance and resistance. In this paper, we explore how the volatility of everyday interaction also leads to a different response — one we call ‘observance’. We introduce this term to refer to the process of identity diversification at work, and to create an analytical-conceptual space that is not fully circumscribed by compliance and resistance. To give the concept of observance empirical flesh, we present an account of team meetings held as part of a quality improvement programme in a manufacturing workplace in Sydney, Australia. We use this account to show how the interpersonal dynamics among team workers led to ‘emergent’ subject positions and conducts. Capturing the effects of the volatility of everyday workplace interaction, the concept of observance is shown to account for such emergent positioning and reflexivity. Observance enables us to highlight this and also how people exceed the parameters of surveillance, compliance and resistance, especially in relation to participativecommunicative or ‘immaterial’ forms of work.
Effective communication and interpersonal skills have long been recognized as fundamental to the delivery of quality health care. However, there is mounting evidence that the pressures of communication in high stress work areas such as hospital emergency departments (EDs) present particular challenges to the delivery of quality care. A recent report on incident management in the Australian health care system (NSW Health, 2005a) cites the main cause of critical incidents (that is, adverse events such as an incorrect procedure leading to patient harm), as being poor and inadequate communication between clinicians and patients. This article presents research that describes and analyses spoken interactions between health care practitioners and patients in one ED of a large, public teaching hospital in Sydney, Australia. The research aimed to address the challenges and critical incidents caused by breakdowns in communication that occur between health practitioners and patients and by refining and extending knowledge of discourse structures, to identify ways in which health care practitioners can enhance their communicative practices thereby improving the quality of the patient journey through the ED. The research used a qualitative ethnographic approach combined with discourse analysis of audio-recorded interactions. Some key findings from the analysis of data are outlined including how the absence of information about processes, the pressure of time within the ED, divergent goals of clinicians and patients, the delivery of diagnoses and professional roles impact on patient experiences. Finally, the article presents an in-depth linguistic analysis on interpersonal and experiential patterns in the discursive practices of patients, nurses and doctors.
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