Communication and Culture in the Surgical Intensive Care Unit: Boundary Production and the Improvement of Patient Care.
This ethnography explores communication around critically ill surgical patients in three surgical intensive care units (ICUs) in Canada. A boundary framework is used to articulate how surgeons', intensivists', and nurses' communication practices shape and are shaped by their respective disciplinary perspectives and experiences. Through 50 hours of observations and 43 interviews, these health care providers are found to engage in seven communication behaviors that either mitigate or magnify three contested symbolic boundaries: expertise, patient ownership, and decisional authority. Where these boundaries are successfully mitigated, experiences of collaborative, high-quality patient care are produced; by contrast, boundary magnification produces conflict and perceptions of unsafe patient care. Findings reveal that high quality and safe patient care are produced through complex social and cultural interactions among surgeons, intensivists, and nurses that are also expressions of knowledge and power. This enhances our understanding of why current quality improvement efforts targeting communication may be ineffective.
Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada Lesley.gotlibconn@sunnybrook.ca.
Lesley Gotlib
LG
Conn
Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada.
Barbara
B
Haas
Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada.
Brian H
BH
Cuthbertson
Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada.
Andre C
AC
Amaral
Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada Department of Surgery, Division of General Surgery, University of Toronto, Canada.
Natalie
N
Coburn
Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada Department of Surgery, Division of General Surgery, University of Toronto, Canada.
Avery B
AB
Nathens
D000884:Anthropology, Cultural; D003142:Communication; D003422:Critical Care / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007400:Interprofessional Relations; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration
Canada; boundaries; communication; ethnography; intensive care; qualitative; quality improvement; surgery