WHY ?

A Case Overview
There was this case in the hospital's Intensive Care ward where patients always
died in the same bed, on Sunday morning at 11 a.m., regardless of their medical
condition.

This puzzled the doctors and some even thought that it had something to do with
the supernatural. Why the death? So the doctors decide to go down to the ward to
investigate the cause of the incidents. So on the next Sunday morning few minutes
before 11 a.m., all doctors and nurses nervously wait outside the ward to see for
themselves what the terrible phenomenon was all about. Some were holding
wooden crosses, prayer books and other holy objects to ward off the evil........ Just
when the clock struck 11....
Scroll down for what happened...

Santa Singh, the part-time Sunday sweeper, entered the ward and unplugged the
life support system so that he could use the vacuum cleaner.
 Business Communication Term
I
Project Presentation

Section E
Group-10
Saurav Sen Sharma (2009309)
Shalin Lohia (2009311)
Tejeshwar M. Lawania (2009296)
Trisha Kulshreshtha (2009297)
Tulip Sen (2009298)
BACKGROUND
 Hospital culture segmented inter and intra professionally.

 United front needed at executive level on common issues

to avoid interdepartmental wars.

 Hand-over communication: patient’s current condition,

recent changes in condition, ongoing treatment and
possible changes or complications that might occur.-
occurs in many settings across the continuum of care.
 BACKGROUND( Cont…)
 Hospital communication can be thought of as:
◦ Rapid Fire Communication : Change in an instant from
fairly stable to totally chaotic situations.
◦ Team Approach : Any time there is a crisis or emergency
situation, a team of health care professionals converges on
the scene.
◦ No Time for Misunderstandings : team need to be alert
and focused on the tasks at hand. No time for a lot of
questions or delays due to the inability to communicate
effectively.
◦ Has to be Written Down: For present and future
references, proficiency in reading and writing required.
 METHOD(s) USED
 Setting:
◦ Orange City Hospital (Nagpur)
◦ Workers had telephones and mobile.
 Subjects:
◦ Four physicians from the general medicine department,
ranging in grade from junior medical consultant to senior
consultant
◦ 4 nurses from the medical wards while they carried out their
routine duties
 Data Collection:
◦ Subjects were asked for 2­3 hours during the morning or
afternoon of a normal weekday for inter-department
communication.
 METHOD
 Our study is based on the degree of inter-department
communication and flow of information, in an
organization. The Hospital (Orange City) is been
broadly classified into five departments:
§ Doctors ( or consultants)
§ Nurses
§ Investigatory Facilities
§ Administration and secretarial staff
§ Switchboards
RESULTS
 Cultural or Environment :

§ Subjects can be characterised as habitual

(selfish), they value completion of their own tasks
over their colleagues' tasks.

§ Calls to the switchboard are seeking contact

information for specific roles i.e. subjects are unsure
about which role could assist them in a task .
Cont…
 Inefficiencies with team communication i.e. Hand-
over communication loss.

 Some of the doctors indicated that, they assessed the

urgency of a page (or a call) by the number of times
they were called and the origin of the call.

 Ineffective cooperative task when team members

were geographically separated (cultural and
language barriers).
Interdepartmental calls (or pages) :
20
Investigatory
facilities (radiology,
3
endoscopy, etc. ) 1

10 4 2
Doctors Nurses
12

3 Switchboards 3

2
3 10
6
Administrative and 3
Secretarial staff

Flow of information

X X number of calls or pages

( within one shift)
Functional\Operational Barriers:

 Lack of knowledge about how to improve systems.

 Staffs were observed to infer the intention of messages

based on insufficient information.

 Lack of information technology infrastructure and

interoperability.

 Time pressures from patient care needs and other

responsibilities.
CONCLUSIONS
 High interruptive approach:
ØSubjects favoured interruptive communication mechanisms
(face to face discussion, or telephone)—over less interruptive
methods.

Associated
costs

Psychological costs:
Leading to diversion of attention, forgetfulness, and
errors
Other costs:
Staff time & efficiency
 Inclination towards Synchronous
Communication:

Synchronous communication, occurs when

two individuals participate in a conversation at interruptio
creates n
the same time, such as using the telephone or
face to face

Asynchronous communication, occurs when Less

the exchange does not require both to be active interruptio
participants at the same time, such as causes
n
exchanging letters.
Contd….

Bias to asynchronous communication

beca
use

üHospital low in providing synchronous channels like

voicemail or email
üSubjects needed immediate acknowledgement
üNegligence on the part of subjects
 Role based contact:

üA quarter of call events were associated with

identifying the name of an individual occupying a
specific role.

üThe long sequences of information seeking calls

results into poor support for their realization.
 Communication policies often unsound:

üInferences about the intention of caller or

receiver were unsound on a number of
grounds for e.g., assessment of urgency by
doctors and nurses is likely to be different.

üSituations judged to be non urgent by nurses

have been shown to require medical
assessment as much as ones deemed urgent
which can lead to great chaotic situations.
RECOMMENDATION
PROPOSED STANDARDS

ØClear: Information that is being communicated must be CLEAR AND

EASY TO UNDERSTAND.

ØCompleteness: Information must be shared with LESS UNNECESSARY

DETAILS

ØTimeliness: Information must reach the intended person ON TIME

ØAcknowledgement: for effective exchange of information

ACKNOWLEDGEMENT AND VERIFICATION by the receiver is important.
RECOMMENDATION(
cont…)
INFORMATION TRANSFER
TECHNIQUES

ØCheck-back: Medical orders written for a patient must be reviewed for

completeness and clarity.

ØCall-out: The critical information is said aloud during an emergency

ØHand-off : Verbally transferring information, responsibility, and

accountability of a patient to another staff, receiving staff has to accepts
the responsibilities.
SUGGESTED FOLLOW-UP
SUGGESTED FOLLOW-UP
(cont…)