Methods Inf Med 2008; 47(04): 336-345
DOI: 10.3414/ME0502
Original Article
Schattauer GmbH

Intra-organizational Communication in Healthcare

Considerations for Standardization and ICT Application
H. Pirnejad
1   Healthcare Governance, Institute of Health Policy and Management, Erasmus MC, Rotterdam, The Netherlands
,
Z. Niazkhani
1   Healthcare Governance, Institute of Health Policy and Management, Erasmus MC, Rotterdam, The Netherlands
,
M. Berg
1   Healthcare Governance, Institute of Health Policy and Management, Erasmus MC, Rotterdam, The Netherlands
,
R. Bal
1   Healthcare Governance, Institute of Health Policy and Management, Erasmus MC, Rotterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Received: 25 July 2007

accepted: 27 February 2008

Publication Date:
18 January 2018 (online)

Summary

Objectives: Intra-organizational communication is mostly interpersonal. Synchronous interruptive communication is recognized as aprimary source of inefficiency anderror in healthcare, and there is much potential for information and communication technology (ICT) to improve such communication. As recently suggested, however, due to communication failures ICT can also compound medical errors. In this paper we analyze factors that restrict the role of ICT in improving interpersonal healthcare communication and suggest solutions. Methods: We critically analyzed the literature from a selection of diverse scientific disciplines. These were related to interpersonal communication, tothe role and place of standardization and computerization in its improvement, and to reducing medical errors.

Results: Four possible scenarios were defined on how ICT can serve healthcare communication. Two differing conceptual frameworks about communication in health-care were discussed. Considering “information space” as apart of “communication space ” allows the recognition and control of the source of the semantic gaps in conventional standardization and an enhancement of the role of ICT in improving intra-organizational communication. Moreover, cognitive, social, and organizational dimensions of complexity in interpersonal communication can be managed. Three approaches to control the variability in those dimensions and to promote therole of ICT in intra-organizational communication were discussed.

Conclusion: A multi-dimensional approach is required to promote the role of ICT in intra-organizational communication in healthcare. Parallel to conventional standardization, atleast three dimensions need to be addressed: controlling the effect of the social context, developing standard information processing skills, and most importantly, controlling variations in care practices’ performance.

 
  • References

  • 1 Coiera E. When conversation is better than computation. J Am Med Inform Assoc 2000; 7 (Suppl. 03) 277-286.
  • 2 Stetson PD, McKnight LK, Bakken S, Curran C, Kubose TT, Cimino JJ. Development of an ontology to model medical errors, information needs, and the clinical communication space. Proc AMIA Symp 2001; pp 672-676.
  • 3 Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T. et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA 1995; 274 (Suppl. 01) 35-43.
  • 4 Bates DW, Evans RS, Murff H, Stetson PD, Pizziferri L, Hripcsak G. Detecting adverse events using information technology. J Am Med Inform Assoc 2003; 10 (Suppl. 02) 115-128.
  • 5 Wilson R, Runciman W, Gibberd R. The Quality in Australia Health Care Study. Med J Aust 1995; 163: 458-471.
  • 6 Coiera E. Designing Interactions. In: Berg M, ed. Handbook of Health Information Management: Integrating Information and Communication Technology in Health Care Work. London: Routledge; 2004. pp 101-123.
  • 7 Coiera E, Tombs V. Communication behaviours in a hospital setting: an observational study. Bmj 1998; 316 7132 673-676.
  • 8 Donchin Y, Gopher D, Olin M, Badihi Y, Biesky M, Sprung CL. et al. A look into the nature and causes of human errors in the intensive care unit. Crit Care Med 1995; 23 (Suppl. 02) 294-300.
  • 9 Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc 2004; 11 (Suppl. 02) 104-112.
  • 10 Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson RS, Nguyen TC. et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116 (Suppl. 06) 1506-1512.
  • 11 Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE. et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293 (10) 1197-1203.
  • 12 van Bemmel JH, Musen M. Handbook of Medical Informatics. 1st ed. Houten: Bohen Stafeu Van Loghum; 1997 chapter 2.
  • 13 Gurses AP, Xiao Y. A systematic review of the literature on multidisciplinary rounds to design information technology. J Am Med Inform Assoc 2006; 13 (Suppl. 03) 267-276.
  • 14 Suchman L. Plans and situated actions: the problem of human-machine communication. Cambridge: Cambridge University Press; 1987
  • 15 Spencer R, Logan P. Role-based Communication Patterns Within an Emergency Department Setting. In: Ribbones R, Dall V, Webb R editors. Tenth National Health Informatics Conference 2002. Melbourne – Australia: Health Information Society of Australia; 2002. pp 166-169.
  • 16 Reitman JS. Without surreptitious rehearsal, information in short-term memory decays. Verbal learning and verbal behavior 1974; 13: 367-377.
  • 17 Coiera E. Clinical communication: a new informatics paradigm. Proc AMIA Annu Fall Symp 1996; pp 17-21.
  • 18 Coiera EW, Jayasuriya RA, Hardy J, Bannan A, Thorpe ME. Communication loads on clinical staff in the emergency department. Med J Aust 2002; 176 (Suppl. 09) 415-418.
  • 19 Safran C, Sands DZ, Rind DM. Online medical records: a decade of experience. Methods Inf Med 1999; 38 4-5 308-312.
  • 20 Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met?. Ann Intern Med 1985; 103 (Suppl. 04) 596-599.
  • 21 Parker J, Coiera E. Improving clinical communication: a view from psychology. J Am Med Inform Assoc 2000; 7 (Suppl. 05) 453-461.
  • 22 Marchetti D, Lanzola G, Stefanelli M. An AIBased Approach to Support Communication in Health Care Organizations. In: Qualini S, Barach P, Andreassen S. editors. The 8th Conference on AI in Medicine in Europe. 2001. Cascaia; Portugal: 2001. pp 384-394.
  • 23 Krauss R. The Psychology of Verbal Communication. Accessible from http://www.columbia.edu/~rmk7/PDF/IESBSpdf.2002 2005
  • 24 Kraut RE, Fish R, Root R, Chalfonte B. Informal Communication in Organizations: form, function, and technology. Claremont Symposium on Applied Social Psychology 1990 pp 145-199.
  • 25 Lavie N, Hirst A, de Fockert JW, Viding E. Load theory of selective attention and cognitive control. J Exp Psychol Gen 2004; 133 (Suppl. 03) 339-354.
  • 26 Rossnagel C. Cognitive load and listener orientation in monologue instruction. Z Exp Psychol 1995; 42 (Suppl. 01) 94-110.
  • 27 Dean B, Schachter M, Vincent C, Barber N. Causes of prescribing errors in hospital inpatients: a prospective study. Lancet 2002; 20 359 9315 1373-1378.
  • 28 Bardram J, Bonssen C. Mobility Work: The spatial Dimension of Collaboration at a Hospital. Computer Supported Cooperative Work (CSCW) 2005; 14: 131-160.
  • 29 Cooper R, Viller S, Burmeister J. Observations in a maternity ward: Usability considerations for EHRs in an interrupt driven environment. 2003 (cited 2005). Available from: http://www.infenv. itee.uq.edu.au/esl2004/publications/034_cooper.pdf
  • 30 Strauss AL, Fagerhaugh S, Suczek B, Wiener C. Social Organization of Medical Work. New Brunswick: Transaction Publishers; 1997
  • 31 Veltman K. Syntactic and Semantic Interoperability: New Approaches to Knowledge and the Semantic Web. The New Review of Information Networking 2001; 7: 159-184.
  • 32 Safran C, Jones PC, Rind D, Bush B, Cytryn KN, Patel VL. Electronic communication and collaboration in a health care practice. Artif Intell Med 1998; 12 (Suppl. 02) 137-151.
  • 33 Mead CN. Data interchange standards in healthcare IT – computable semantic interoperability: now possible but still difficult, do we really need a better mousetrap?. J Healthc Inf Manag 2006; 20 (Suppl. 01) 71-78.
  • 34 Weigand H, Dignum F. Formalization and rationalization of communication. In: Veldhoven, editor. The Second International Workshop on Communication Modeling, the Language/Action Perspective (LAP’97) 1997 June 9-10 The Netherlands 1997
  • 35 Schmidt K, Bannon L. Taking CSCW Seriously: Supporting Articulation Work. Computer Supported Cooperative Work (CSCW). 1992; 1 (Suppl. 01) 7-40.
  • 36 Reddy MC, Dourish P, Pratt W. Coordinating Heterogenous Work: Information and Representation in Medical Care. European Conference on Computer Supported Cooperative Work (ECSCW) 2001. Bonn; Kluwer: 2001. pp 235-258.
  • 37 Shannon C, Weaver W. The mathematical theory of communication. University of Illinois Press; 1949
  • 38 Lomier R. Mass Communication: Some Redefinitional Notes. Canadian Journal of Communication 2002; 27 (Suppl. 01) 63-72.
  • 39 Coiera E. Interaction design theory. Int J Med Inf 2003; 69 2-3 205-222.
  • 40 Hayes P, Reddy D. Steps toward graceful interaction in spoken and written man-machine communication. International Journal of Man-Machine Studies 1983; 19: 231-284.
  • 41 Hartly P. Interpersonal Communication. 2nd ed. Routledge 1993
  • 42 Nardi BA, Whittaker S. The place of face-to-face communication in distributed work. (Cited 2002.) Available from: http://dagda.shef.ac.uk/is/people/ stafpage/whittake/FTF.pdf
  • 43 Bazerman MH, Curhan JR, Moore DA, Valley KL. Negotiation. Annu Rev Psychol 2000; 51: 279-314.
  • 44 Dorlet A, Morris M. Rapport in Conflict Resolution: Accounting for How Face-to-Face Contact Fosters Mutual Cooperation in Mixed-Motive Conflicts. Journal of Experimental Social Psychology 2000; 36: 26-50.
  • 45 Gunawardena C. Social Presence Theory and Implications for Interaction and Collaborative Learning in Computer Conferences. International Journal of Educational Telecommunications 1995; 1 2/3 147-166.
  • 46 Bardram J. Temporal coordination: On Time and Coordination of Collaborative Activities at a Surgical Department. Computer Supported Cooperative Work (CSCW) 2000; 9 (Suppl. 02) 157-187.
  • 47 Sallnas E. Presence in Multimodal Interfaces. (Cited 2006.) Available from: http://www.nada. kth.se/~evalotta/Presence/IWVP.html
  • 48 Cimino JJ. Review paper: Coding Systems in Health Care. Methods Inf Med 1996; 35 4-5 273-284.
  • 49 Lenz R, Beyer M, Kuhn KA. Semantic integration in healthcare networks. Int J Med Inform 2007; 76 2-3 201-207.
  • 50 Garde S, Knaup P, Hovenga EJS, Heard S. Towards Semantic Interoperability for Electronic Health Records. Methods Inf Med 2007; 46: 332-343.
  • 51 Pirnejad H, Stoop AP, Berg M. Bridging information gaps between primary and secondary healthcare. Stud Health Technol Inform 2006; 124: 1003-1008.
  • 52 Rector AL. Terminology and concept representation languages: where are we?. Artif Intell Med 1999; 15 (Suppl. 01) 1-4.
  • 53 Sproull L, Kiesler S. Reducing Social Context Cues: Electronic Mail in Organizational Communication. Management Science 1986; 32: 1492-1512.
  • 54 Morgan PA, McCourt CA, Youll P. Social richness, socio-technical tension and the virtual commissioning of NHS research. Health Res Policy Syst 2007; 5: 8.
  • 55 Walther J. Computer Mediated Communication: Impersonal, Interpersonal and Hyperpersonal Interaction. Communication Research 1996; 23 (Suppl. 01) 3-43.
  • 56 McCourt CA, Morgan PA, Youll P. Evaluation of a ‘virtual’ approach to commissioning health research. Health Res Policy Syst 2006; 4: 9.
  • 57 Short J, Williams E, Christie B. The social psychology of telecommunications. London: John Wiley & Sons; 1976
  • 58 Maldonado JA, Moner D, Tomas D, Angulo C, Robles M, Fernandez JT. Framework for clinical data standardization based on archetypes. Medinfo 2007; 12 Pt 1 454-458.
  • 59 Winthereik BR. “We fill in our working understanding”: On Codes, Classifications and the Production of Accurate Data. Methods Inf Med 2003; 42 (Suppl. 04) 489-496.
  • 60 Reader TW, Flin R, Cuthbertson BH. Communication skills and error in the intensive care unit. Curr Opin Crit Care 2007; 13 (Suppl. 06) 732-736.
  • 61 Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004 13 (Suppl. 01) i85-90.
  • 62 Davies K. The information-seeking behaviour of doctors: a review of the evidence. Health Info Libr J 2007; 24 (Suppl. 02) 78-94.
  • 63 Berg M. Health Information Management: Integrating Information Technology in Health Care Work. London: Routledge; 2004
  • 64 Secco ML, Woodgate RL, Hodgson A, Kowalski S, Plouffe J, Rothney PR. et al. A survey study of pediatric nurses’ use of information sources. Comput Inform Nurs 2006; 24 (Suppl. 02) 105-112.
  • 65 As-Sanie S, Zolnoun D, Wechter ME, Lamvu G, Tu F, Steege J. Teaching residents coding and documentation: effectiveness of a problemoriented approach. Am J Obstet Gynecol 2005; 193 (Suppl. 05) 1790-1793.
  • 66 Lemen PM. Development and assessment of a Web-based evaluation and management coding curriculum for residents. Am J Obstet Gynecol 2005; 193 (Suppl. 05) 1785-1789.
  • 67 Timmermans S, Berg M. Standards at Work, A Dynamic Transformation of Medicine. The Gold Standard, The Challenges of Evidence-Based Medicine and Standardization in Health Care. Philadelphia; Tempel University Press: 2003. pp 55-81.
  • 68 Berg M, Bergen C, Schellekens W. Bridging the Quality Chasm: Integrating Professional and Organizational Quality. Int J for Quality in Health Care 2004; 17 (Suppl. 01) 75-82.
  • 69 Blaser R, Schnabel M, Biber C, Baumlein M, Heger O, Beyer M. et al. Improving pathway compliance and clinician performance by using information technology. Int J Med Inform 2007; 76 2-3 151-156.
  • 70 Dahl Y. ‘You have a message here’: Enhancing Interpersonal Communication in a Hospital Ward with Location-based Virtual Notes. Methods Inf Med 2006; 45 (Suppl. 06) 602-609.
  • 71 Jian G, Jeffres L. Understanding Employees’ Willingness to Contribute to Shared Electronic Databases A Three-Dimensional Framework. Communication Research 2006; 33 (Suppl. 04) 242-261.
  • 72 Dykstra R. Computerized physician order entry and communication: reciprocal impacts. Proc AMIA Symp 2002; pp 230-234.