Examining emergency department communication through a staff-based participatory research method: identifying barriers and solutions to meaningful change.
OBJECTIVE
We test an initiative with the staff-based participatory research (SBPR) method to elicit communication barriers and engage staff in identifying strategies to improve communication within our emergency department (ED).


METHODS
ED staff at an urban hospital with 85,000 ED visits per year participated in a 3.5-hour multidisciplinary workshop. The workshop was offered 6 times and involved: (1) large group discussion to review the importance of communication within the ED and discuss findings from a recent survey of patient perceptions of ED-team communication; (2) small group discussions eliciting staff perceptions of communication barriers and best practices/strategies to address these challenges; and (3) large group discussions sharing and refining emergent themes and suggested strategies. Three coders analyzed summaries from group discussions by using latent content and constant comparative analysis to identify focal themes.


RESULTS
A total of 127 staff members, including attending physicians, residents, nurses, ED assistants, and secretaries, participated in the workshop (overall participation rate 59.6%; range 46.7% to 73.3% by staff type). Coders identified a framework of 4 themes describing barriers and proposed interventions: (1) greeting and initial interaction, (2) setting realistic expectations, (3) team communication and respect, and (4) information provision and delivery. The majority of participants (81.4%) reported that their participation would cause them to make changes in their clinical practice.


CONCLUSIONS
Involving staff in discussing barriers and facilitators to communication within the ED can result in a meaningful process of empowerment, as well as the identification of feasible strategies and solutions at both the individual and system levels.
Cameron
Kenzie A
KA
Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. k-cameron@northwestern.edu
Engel
Kirsten G
KG
McCarthy
Danielle M
DM
Buckley
Barbara A
BA
Mercer Kollar
Laura Min
LM
Donlan
Sarah M
SM
Pang
Peter S
PS
Makoul
Gregory
G
Tanabe
Paula
P
Gisondi
Michael A
MA
Adams
James G
JG
D000328:Adult; D003142:Communication; D003144:Communication Barriers; D016529:Emergency Nursing; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006302:Health Services Research / Q000379:methods; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008502:Medical Secretaries; D008505:Medical Staff, Hospital; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D010817:Physician-Patient Relations; D000078329:Workforce; D055815:Young Adult