Using participatory research to identify actionable facilitators and barriers to effective inpatient interdisciplinary communication

Abstract

Background Communication failures occur often in the inpatient setting. Efforts to understand and improve communication often exclude patients or are siloed by discipline. Objective We aimed to identify barriers and facilitators to effective communication within interdisciplinary inpatient internal medicine (IM) teams using a participatory research approach. Design We conducted a single‐center participatory mixed methods study using group‐level assessment (GLA) and concept mapping to iteratively engage stakeholders. Stakeholder groups included patients/families, IM faculty, IM residents, nurses and ancillary staff, and care managers. Stakeholder‐specific GLA sessions were conducted. Participants responded to prompts addressing interdisciplinary communication then worked in small groups to synthesize the qualitative data into unique ideas. A subset of each stakeholder group then sorted ideas through a concept mapping exercise. Multidimensional scaling and hierarchical cluster analysis were used to generate a concept map of the data. Results Participants generated 97 unique ideas that were then sorted. The research team chose an eight‐cluster concept map representing patient inclusion and engagement, processes and resources, team morale and inclusive dynamics, attitudes and behaviors, effective communication, barriers to communication, the culture of healthcare, and clear expectations. Three larger domains of patient inclusion and engagement, organizational conditions and role clarity, and team dynamics and behaviors were noted. Conclusion Use of a participatory research approach made it feasible to engage diverse stakeholders including patients. Our results highlight the need to identify context‐specific facilitators and barriers of interdisciplinary communication. The importance of clear expectations was identified as a prioritized area to target communication improvement efforts.

Ensuring effective interdisciplinary communication

“…In this issue of Journal of Hospital Medicine , Jenkins et al 4 combined two different participatory research methodologies, group‐level assessment, and concept mapping, to identify actionable factors for medical teams to consider when caring for hospitalized patients. Participants included representatives from a patient and family advisory council, staff and leadership from patient and family experience, and care managers.…”