title: The Influence of Organizational Systems on Information Exchange in Long-Term Care Facilities: An Institutional Ethnography.
abstract: Person-centered care is heavily dependent on effective information exchange among health care team members. We explored the organizational systems that influence resident care attendants' (RCAs) access to care information in long-term care (LTC) settings. We conducted an institutional ethnography in three LTC facilities. Investigative methods included naturalistic observations, in-depth interviews, and textual analysis. Practical access to texts containing individualized care-related information (e.g., care plans) was dependent on job classification. Regulated health care professionals accessed these texts daily. RCAs lacked practical access to these texts and primarily received and shared information orally. Microsystems of care, based on information exchange formats, emerged. Organizational systems mandated written exchange of information and did not formally support an oral exchange. Thus, oral information exchanges were largely dependent on the quality of workplace relationships. Formal systems are needed to support structured oral information exchange within and between the microsystems of care found in LTC.
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada University of Victoria, Victoria, British Columbia, Canada Sienna.caspar@uleth.ca.
authors.forename: Sienna
authors.initials: S
authors.lastname: Caspar
authors.affiliation: University of British Columbia, Vancouver, Canada.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Ratner
authors.affiliation: University of British Columbia, Vancouver, Canada.
authors.forename: Alison
authors.initials: A
authors.lastname: Phinney
authors.affiliation: University of Victoria, Victoria, British Columbia, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: MacKinnon
mesh_terms: D000884:Anthropology, Cultural; D003142:Communication; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008134:Long-Term Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D017132:Workplace / Q000458:organization & administration / Q000523:psychology
keywords: Canada; communication; institutional ethnography; long-term care; qualitative; quality of care