Gaps and overlaps in healthcare team communication: analysis of speech

Abstract

Studying groups in their natural contexts can help build understanding of complex organisational behaviours. Guided by the principles of conversation analysis, we discuss some of the dynamics of multidisciplinary teams in cancer care by examining the communication practices used to negotiate levels of participation in their routine work meetings, while considering patient safety implications.Breast, colorectal and gynaecological cancer teams were videoed over 12-weekly meetings encompassing 822 patient-reviews with a cross-section transcribed using Jefferson notation. A low frequency of gaps between speakers (3%) and high frequency of overlaps (24%) and no-gaps-no-overlaps (73%) was found, pointing to fast turn-transitions, secured predominantly with raised pitch and vocalizations. Securing one’s turn to speak in a multi-speaker fast-paced work group setting, such as cancer meetings, can be challenging due to systemic reduction in turn-taking opportunities, hence unequal participation. This may hinder effective communication and open up opportunity for error; an important patient safety implication.

Analysis of communication styles underpinning clinical decision-making in cancer multidisciplinary team meetings

“…Oncologists were also high-frequency contributors in breast MDT meetings, whereas, in colorectal and gynecologic meetings, communication was driven solely by surgeons. This finding is consistent with previous studies showing that surgeons, and to a lesser extent oncologists, are the most frequent contributors to case discussions in the meetings, while CNSs and coordinators do not contribute to the same extent (Lamb et al, 2011(Lamb et al, , 2013Raine et al, 2014;Soukup et al, 2016aSoukup et al, , 2021aSoukup, 2017). However, while coordinators have an administrative role and their input into case discussions is not expected, the input of CNSs is required and is often critical to decisions around care planning.…”

“…The first is the Hawthorne effect. We minimized its effect by (a) using a long-term approach to filming, (b) excluding the first two meetings from the analysis, and (c) filming discreetly (Soukup, 2017;Soukup et al, 2021a). Second, there were instances of inaudible speech in the meetings of all participating teams.…”

“…Second, there were instances of inaudible speech in the meetings of all participating teams. This is a natural limitation of such complex multiparty interactions, where people do not speak in neatly organized rounds (Soukup, 2017;Soukup et al, 2021a).…”

“…For instance, a recent study of MDT meetings (Soukup et al, 2020a) found that higher levels of interactive responsiveness among team members significantly predicted better quality decision-making for patients. Indeed, communication is the channel through which the team progresses through the stages of decision-making: from problem identification, information sharing, and critical evaluation to formulating the decision and implementing it (Orlitzky and Hirokawa, 2001;Hollingshead et al, 2005;Kugler et al, 2012;Soukup, 2017;Soukup et al, 2020bSoukup et al, , 2021a. There is then a need to build an understanding of the communication practices team members employ during their meetings and how this can be improved.…”

A multicentre cross‐sectional observational study of cancer multidisciplinary teams: Analysis of team decision making

“…Disciplinary groups were at consultant level during the study period with on average 9 years of experience (min = 2, max = 22). Detailed breakdown of team composition has been published previously 49 …”