While there is growing recognition of leadership as a collective phenomenon, the question of how ... more While there is growing recognition of leadership as a collective phenomenon, the question of how leadership is shared in the context of hierarchical asymmetry has been neglected in the collective leadership literature. Our article addresses this gap by examining how sharing leadership is negotiated in team interactions that are steeped in asymmetry deriving from the professional hierarchy. Adopting a leadership-in-interaction approach, we draw on fine-grained analysis of observed interactions on interprofessional teams from two health care organizations to compare the discursive strategies used by professionals in a superior hierarchical position to the ones used by those in inferior positions to share leadership. These strategies are organized into a matrix of interactional moves that resist or enact the professional hierarchy. Empirical vignettes are provided to demonstrate how sharing leadership and hierarchical leadership can be co-present and even intertwined in an interaction....
This article shows how the structuration of space and time occurs through the articulation of dif... more This article shows how the structuration of space and time occurs through the articulation of different agents’ doings, whether these agents are human, technological or textual. Spacing and timing should therefore be considered hybrid achivements. This reflection then leads us to a reconceptualization of societies’ and organizations’ modes of being. Far from reifying these forms of life, that is to say, to transform them into things, this approach leads us - analytically speaking - to plurify them, to show that they are literally made of things, texts and humans: that they are plural and incarnated.
An interpretive qualitative approach insists on the plural and negotiated nature of the meanings ... more An interpretive qualitative approach insists on the plural and negotiated nature of the meanings that humans attach to their social realities. Thus, the qualitative researcher must navigate multiple and sometimes conflicting commitments to method, data, oneself, participants, and one's reader. This can lead us to obscure the messiness of data analysis in final research reports and to downplay how methodological choices can make our participants 'say things.' In this article, we compare two interpretive methods, thematic and narrative analysis, including their shared epistemological and ontological premises, and offer a pedagogical demonstration of their application to the same data excerpt. However, our broader goal is to use the divergent results to critically examine how our choice of analytic method in interpretive research influences how we (researcher + method) 'author' data stories. Ultimately, researcher reflexivity must go beyond acknowledging how one's position may influence the data analysis or the participant.
To improve patient-centered care, many health care systems are mandating interprofessional collab... more To improve patient-centered care, many health care systems are mandating interprofessional collaboration (IPC). However, in many primary care contexts, IPC is still nascent and fraught with tension. Communication is thought to be a key determinant of IPC, but few studies empirically examine IP communication practices. Therefore, we report here on the qualitative portion of a mixed methods pilot study investigating observed IPC and communication in primary care clinics in Quebec, Canada. Studying actual communication practices to understand collaborative activities, we seek to investigate how the ideals of patient centeredness and clinical democracy put forward in the IP literature stack up against actual IPC practice in primary care. Qualitative data was gathered by shadowing health professionals in two primary care clinics, and analyzed through thematic coding. A typology of observed IP practices was created and compared to the continuum of interprofessional collaborative practice. Further analysis focused on how participants made sense of their collaboration, especially why, how and with whom they collaborated. Findings were grouped into three categories of communicative actions: coordinating sequential efforts; assisting others' sensemaking; and working to understand together. Implications for practice and future research are discussed.
How can interprofessional health care teams be more patientcentered in their team talk in the cli... more How can interprofessional health care teams be more patientcentered in their team talk in the clinical backstage? This article addresses this question in the practice of an acute care team to achieve a twofold purpose. First, we develop the notion of joint emplotment to conceptualize our observations of how acute care teams work out understandings of the patient's situation through narrative practice, in particular in rapid-paced daily interprofessional team meetings. Second, we draw on illustrative data from a longitudinal naturalistic study of communication in interprofessional team meetings in acute care to demonstrate the usefulness of this conceptual lens for investigating a core element of patient-centered care, namely how different perspectives of the patient's situation are made relevant and meaningful in team talk. Thus, this article makes important contributions to the literature on the role of communication in interprofessional collaboration and provides useful recommendations for practice.
To improve patient-centered care, many health care systems are mandating interprofessional collab... more To improve patient-centered care, many health care systems are mandating interprofessional collaboration (IPC). However, in many primary care contexts, IPC is still nascent and fraught with tension. Communication is thought to be a key determinant of IPC, but few studies empirically examine IP communication practices. Therefore, we report here on the qualitative portion of a mixed methods pilot study investigating observed IPC and communication in primary care clinics in Quebec, Canada. Studying actual communication practices to understand collaborative activities, we seek to investigate how the ideals of patient centeredness and clinical democracy put forward in the IP literature stack up against actual IPC practice in primary care. Qualitative data was gathered by shadowing health professionals in two primary care clinics, and analyzed through thematic coding. A typology of observed IP practices was created and compared to the continuum of interprofessional collaborative practice. Further analysis focused on how participants made sense of their collaboration, especially why, how and with whom they collaborated. Findings were grouped into three categories of communicative actions: coordinating sequential efforts; assisting others’ sensemaking; and working to understand together. Implications for practice and future research are discussed.
How can interprofessional health care teams be more patient- centered in their team talk in the c... more How can interprofessional health care teams be more patient- centered in their team talk in the clinical backstage? This article addresses this question in the practice of an acute care team to achieve a twofold purpose. First, we develop the notion of joint emplotment to conceptualize our observations of how acute care teams work out understandings of the patient’ssituation through narrative practice, in particular in rapid-paced daily interprofessional team meetings. Second, we draw on illustrative data from a longitudinal naturalistic study of communication in interprofessional team meetings in acute care to demonstrate the usefulness of this conceptual lens for investigating a core element of patient-centered care, namely how different perspectives of the patient’s situation are made relevant and meaningful in team talk. Thus, this article makes important contributions to the literature on the role of communication in interprofessional collaboration and provides useful recommendations for practice
While there is growing recognition of leadership as a collective phenomenon, the question of how ... more While there is growing recognition of leadership as a collective phenomenon, the question of how leadership is shared in the context of hierarchical asymmetry has been neglected in the collective leadership literature. Our article addresses this gap by examining how sharing leadership is negotiated in team interactions that are steeped in asymmetry deriving from the professional hierarchy. Adopting a leadership-in-interaction approach, we draw on fine-grained analysis of observed interactions on interprofessional teams from two health care organizations to compare the discursive strategies used by professionals in a superior hierarchical position to the ones used by those in inferior positions to share leadership. These strategies are organized into a matrix of interactional moves that resist or enact the professional hierarchy. Empirical vignettes are provided to demonstrate how sharing leadership and hierarchical leadership can be co-present and even intertwined in an interaction. We show that leadership is shared (or not) as a result of how the professional hierarchy gets negotiated in interactions. More specifically, we conclude that the sharing of leadership in this context tends to occur prior to decision making, especially around problem formulation, if the interactional climate allows. Furthermore, it requires concrete effort: Those in superior positions of influence mindfully relax the hierarchy whereas those in inferior positions create moments of sharing leadership through resistance and struggle.
An interpretive qualitative approach insists on the plural and negotiated nature of the meanings ... more An interpretive qualitative approach insists on the plural and negotiated nature of the meanings that humans attach to their social realities. Thus the qualitative researcher must navigate multiple and sometimes conflicting commitments to method, data, oneself, participants, and one’s reader. This can lead us to obscure the messiness of data analysis in final research reports and to downplay how methodological choices can make our participants “say things.” In this article, we compare two interpretive methods, thematic and narrative analysis, including their shared epistemological and ontological premises, and offer a pedagogical demonstration of their application to the same data excerpt. However, our broader goal is to use the divergent results to critically examine how our choice of analytic method in interpretive research influences how we (researcher + method) “author” data stories. Ultimately, researcher reflexivity must go beyond acknowledging how one’s position may influence the data analysis or the participant.
INTRODUCTION
Observational studies of the actual practices of interprofessional collaborative pr... more INTRODUCTION Observational studies of the actual practices of interprofessional collaborative practice (ICP) are needed to complement research on the determinants and consequences of collaboration. This naturalistic study of team communication maps a key practice: the patient case review in daily rounds. Here, ICP is conceptualized as collective sensemaking, or the joint description of the patient’s situation and associated action planning—a fundamentally communicative practice.
METHODS We observed the daily rounds of four acute care teams identified by organizational representatives for their efficient or problematic collaboration. The goal of analysis was to characterize practice differences within and across the teams. Data gathering methods included field notes, structured observations, audio recorded rounds and interviews, and documentary evidence. Informed by conversation analysis, we analyzed transcribed interactions for recurrent and divergent patterns in sensemaking. RESULTS A model of the patient case review offers a framework for exploring variations in sensemaking practice. It emphasizes the importance of framing practices in case overviews and of collective sensitivity to expressions of uncertainty. Case reviews on collaboratively efficient teams were more collectively produced, more comprehensive, richer in detail and complexity, and more routine across rotating leadership. When physicians were present, sensemaking focused more on action planning.
DISCUSSION In the time-pressured acute care context, predictable framing practices may lend stability to collective practice by ordering team thinking, while sensitivity to uncertainty and a broad focus may lead to more reliable collective performance.
CONCLUSION These findings suggest communication (as social action) as a focus for inquiry into ICP.
This article shows how the structuration of space and time occurs through the articulation of dif... more This article shows how the structuration of space and time occurs through the articulation of different agents' doings, whether these agents are human, technological or textual. Spacing and timing should therefore be considered hybrid achivements. This reflection then leads us to a reconceptualization of societies' and organizations' modes of being. Far from reifying these forms of life, that is to say, to transform them into things, this approach leads usanalytically speaking -to plurify them, to show that they are literally made of things, texts and humans: that they are plural and incarnated. KEY WORDS • hybridicity • interaction • ontology • organization • timing We can define organization as a social collective, produced, reproduced and transformed through the ongoing, interdependent, and goal-oriented communica-Time
While there is growing recognition of leadership as a collective phenomenon, the question of how ... more While there is growing recognition of leadership as a collective phenomenon, the question of how leadership is shared in the context of hierarchical asymmetry has been neglected in the collective leadership literature. Our article addresses this gap by examining how sharing leadership is negotiated in team interactions that are steeped in asymmetry deriving from the professional hierarchy. Adopting a leadership-in-interaction approach, we draw on fine-grained analysis of observed interactions on interprofessional teams from two health care organizations to compare the discursive strategies used by professionals in a superior hierarchical position to the ones used by those in inferior positions to share leadership. These strategies are organized into a matrix of interactional moves that resist or enact the professional hierarchy. Empirical vignettes are provided to demonstrate how sharing leadership and hierarchical leadership can be co-present and even intertwined in an interaction....
This article shows how the structuration of space and time occurs through the articulation of dif... more This article shows how the structuration of space and time occurs through the articulation of different agents’ doings, whether these agents are human, technological or textual. Spacing and timing should therefore be considered hybrid achivements. This reflection then leads us to a reconceptualization of societies’ and organizations’ modes of being. Far from reifying these forms of life, that is to say, to transform them into things, this approach leads us - analytically speaking - to plurify them, to show that they are literally made of things, texts and humans: that they are plural and incarnated.
An interpretive qualitative approach insists on the plural and negotiated nature of the meanings ... more An interpretive qualitative approach insists on the plural and negotiated nature of the meanings that humans attach to their social realities. Thus, the qualitative researcher must navigate multiple and sometimes conflicting commitments to method, data, oneself, participants, and one's reader. This can lead us to obscure the messiness of data analysis in final research reports and to downplay how methodological choices can make our participants 'say things.' In this article, we compare two interpretive methods, thematic and narrative analysis, including their shared epistemological and ontological premises, and offer a pedagogical demonstration of their application to the same data excerpt. However, our broader goal is to use the divergent results to critically examine how our choice of analytic method in interpretive research influences how we (researcher + method) 'author' data stories. Ultimately, researcher reflexivity must go beyond acknowledging how one's position may influence the data analysis or the participant.
To improve patient-centered care, many health care systems are mandating interprofessional collab... more To improve patient-centered care, many health care systems are mandating interprofessional collaboration (IPC). However, in many primary care contexts, IPC is still nascent and fraught with tension. Communication is thought to be a key determinant of IPC, but few studies empirically examine IP communication practices. Therefore, we report here on the qualitative portion of a mixed methods pilot study investigating observed IPC and communication in primary care clinics in Quebec, Canada. Studying actual communication practices to understand collaborative activities, we seek to investigate how the ideals of patient centeredness and clinical democracy put forward in the IP literature stack up against actual IPC practice in primary care. Qualitative data was gathered by shadowing health professionals in two primary care clinics, and analyzed through thematic coding. A typology of observed IP practices was created and compared to the continuum of interprofessional collaborative practice. Further analysis focused on how participants made sense of their collaboration, especially why, how and with whom they collaborated. Findings were grouped into three categories of communicative actions: coordinating sequential efforts; assisting others' sensemaking; and working to understand together. Implications for practice and future research are discussed.
How can interprofessional health care teams be more patientcentered in their team talk in the cli... more How can interprofessional health care teams be more patientcentered in their team talk in the clinical backstage? This article addresses this question in the practice of an acute care team to achieve a twofold purpose. First, we develop the notion of joint emplotment to conceptualize our observations of how acute care teams work out understandings of the patient's situation through narrative practice, in particular in rapid-paced daily interprofessional team meetings. Second, we draw on illustrative data from a longitudinal naturalistic study of communication in interprofessional team meetings in acute care to demonstrate the usefulness of this conceptual lens for investigating a core element of patient-centered care, namely how different perspectives of the patient's situation are made relevant and meaningful in team talk. Thus, this article makes important contributions to the literature on the role of communication in interprofessional collaboration and provides useful recommendations for practice.
To improve patient-centered care, many health care systems are mandating interprofessional collab... more To improve patient-centered care, many health care systems are mandating interprofessional collaboration (IPC). However, in many primary care contexts, IPC is still nascent and fraught with tension. Communication is thought to be a key determinant of IPC, but few studies empirically examine IP communication practices. Therefore, we report here on the qualitative portion of a mixed methods pilot study investigating observed IPC and communication in primary care clinics in Quebec, Canada. Studying actual communication practices to understand collaborative activities, we seek to investigate how the ideals of patient centeredness and clinical democracy put forward in the IP literature stack up against actual IPC practice in primary care. Qualitative data was gathered by shadowing health professionals in two primary care clinics, and analyzed through thematic coding. A typology of observed IP practices was created and compared to the continuum of interprofessional collaborative practice. Further analysis focused on how participants made sense of their collaboration, especially why, how and with whom they collaborated. Findings were grouped into three categories of communicative actions: coordinating sequential efforts; assisting others’ sensemaking; and working to understand together. Implications for practice and future research are discussed.
How can interprofessional health care teams be more patient- centered in their team talk in the c... more How can interprofessional health care teams be more patient- centered in their team talk in the clinical backstage? This article addresses this question in the practice of an acute care team to achieve a twofold purpose. First, we develop the notion of joint emplotment to conceptualize our observations of how acute care teams work out understandings of the patient’ssituation through narrative practice, in particular in rapid-paced daily interprofessional team meetings. Second, we draw on illustrative data from a longitudinal naturalistic study of communication in interprofessional team meetings in acute care to demonstrate the usefulness of this conceptual lens for investigating a core element of patient-centered care, namely how different perspectives of the patient’s situation are made relevant and meaningful in team talk. Thus, this article makes important contributions to the literature on the role of communication in interprofessional collaboration and provides useful recommendations for practice
While there is growing recognition of leadership as a collective phenomenon, the question of how ... more While there is growing recognition of leadership as a collective phenomenon, the question of how leadership is shared in the context of hierarchical asymmetry has been neglected in the collective leadership literature. Our article addresses this gap by examining how sharing leadership is negotiated in team interactions that are steeped in asymmetry deriving from the professional hierarchy. Adopting a leadership-in-interaction approach, we draw on fine-grained analysis of observed interactions on interprofessional teams from two health care organizations to compare the discursive strategies used by professionals in a superior hierarchical position to the ones used by those in inferior positions to share leadership. These strategies are organized into a matrix of interactional moves that resist or enact the professional hierarchy. Empirical vignettes are provided to demonstrate how sharing leadership and hierarchical leadership can be co-present and even intertwined in an interaction. We show that leadership is shared (or not) as a result of how the professional hierarchy gets negotiated in interactions. More specifically, we conclude that the sharing of leadership in this context tends to occur prior to decision making, especially around problem formulation, if the interactional climate allows. Furthermore, it requires concrete effort: Those in superior positions of influence mindfully relax the hierarchy whereas those in inferior positions create moments of sharing leadership through resistance and struggle.
An interpretive qualitative approach insists on the plural and negotiated nature of the meanings ... more An interpretive qualitative approach insists on the plural and negotiated nature of the meanings that humans attach to their social realities. Thus the qualitative researcher must navigate multiple and sometimes conflicting commitments to method, data, oneself, participants, and one’s reader. This can lead us to obscure the messiness of data analysis in final research reports and to downplay how methodological choices can make our participants “say things.” In this article, we compare two interpretive methods, thematic and narrative analysis, including their shared epistemological and ontological premises, and offer a pedagogical demonstration of their application to the same data excerpt. However, our broader goal is to use the divergent results to critically examine how our choice of analytic method in interpretive research influences how we (researcher + method) “author” data stories. Ultimately, researcher reflexivity must go beyond acknowledging how one’s position may influence the data analysis or the participant.
INTRODUCTION
Observational studies of the actual practices of interprofessional collaborative pr... more INTRODUCTION Observational studies of the actual practices of interprofessional collaborative practice (ICP) are needed to complement research on the determinants and consequences of collaboration. This naturalistic study of team communication maps a key practice: the patient case review in daily rounds. Here, ICP is conceptualized as collective sensemaking, or the joint description of the patient’s situation and associated action planning—a fundamentally communicative practice.
METHODS We observed the daily rounds of four acute care teams identified by organizational representatives for their efficient or problematic collaboration. The goal of analysis was to characterize practice differences within and across the teams. Data gathering methods included field notes, structured observations, audio recorded rounds and interviews, and documentary evidence. Informed by conversation analysis, we analyzed transcribed interactions for recurrent and divergent patterns in sensemaking. RESULTS A model of the patient case review offers a framework for exploring variations in sensemaking practice. It emphasizes the importance of framing practices in case overviews and of collective sensitivity to expressions of uncertainty. Case reviews on collaboratively efficient teams were more collectively produced, more comprehensive, richer in detail and complexity, and more routine across rotating leadership. When physicians were present, sensemaking focused more on action planning.
DISCUSSION In the time-pressured acute care context, predictable framing practices may lend stability to collective practice by ordering team thinking, while sensitivity to uncertainty and a broad focus may lead to more reliable collective performance.
CONCLUSION These findings suggest communication (as social action) as a focus for inquiry into ICP.
This article shows how the structuration of space and time occurs through the articulation of dif... more This article shows how the structuration of space and time occurs through the articulation of different agents' doings, whether these agents are human, technological or textual. Spacing and timing should therefore be considered hybrid achivements. This reflection then leads us to a reconceptualization of societies' and organizations' modes of being. Far from reifying these forms of life, that is to say, to transform them into things, this approach leads usanalytically speaking -to plurify them, to show that they are literally made of things, texts and humans: that they are plural and incarnated. KEY WORDS • hybridicity • interaction • ontology • organization • timing We can define organization as a social collective, produced, reproduced and transformed through the ongoing, interdependent, and goal-oriented communica-Time
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Observational studies of the actual practices of interprofessional collaborative practice (ICP) are needed to complement research on the determinants and consequences of collaboration. This naturalistic study of team communication maps a key practice: the patient case review in daily rounds. Here, ICP is conceptualized as collective sensemaking, or the joint description of the patient’s situation and associated action planning—a fundamentally communicative practice.
METHODS
We observed the daily rounds of four acute care teams identified by organizational representatives for their efficient or problematic collaboration. The goal of analysis was to characterize practice differences within and across the teams. Data gathering methods included field notes, structured observations, audio recorded rounds and interviews, and documentary evidence. Informed by conversation analysis, we analyzed transcribed interactions for recurrent and divergent patterns in sensemaking.
RESULTS A model of the patient case review offers a framework for exploring variations in sensemaking practice. It emphasizes the importance of framing practices in case overviews and of collective sensitivity to expressions of uncertainty. Case reviews on collaboratively efficient teams were more collectively produced, more comprehensive, richer in detail and complexity, and more routine across rotating leadership. When physicians were present, sensemaking focused more on action planning.
DISCUSSION
In the time-pressured acute care context, predictable framing practices may lend stability to collective practice by ordering team thinking, while sensitivity to uncertainty and a broad focus may lead to more reliable collective performance.
CONCLUSION
These findings suggest communication (as social action) as a focus for inquiry into ICP.
Observational studies of the actual practices of interprofessional collaborative practice (ICP) are needed to complement research on the determinants and consequences of collaboration. This naturalistic study of team communication maps a key practice: the patient case review in daily rounds. Here, ICP is conceptualized as collective sensemaking, or the joint description of the patient’s situation and associated action planning—a fundamentally communicative practice.
METHODS
We observed the daily rounds of four acute care teams identified by organizational representatives for their efficient or problematic collaboration. The goal of analysis was to characterize practice differences within and across the teams. Data gathering methods included field notes, structured observations, audio recorded rounds and interviews, and documentary evidence. Informed by conversation analysis, we analyzed transcribed interactions for recurrent and divergent patterns in sensemaking.
RESULTS A model of the patient case review offers a framework for exploring variations in sensemaking practice. It emphasizes the importance of framing practices in case overviews and of collective sensitivity to expressions of uncertainty. Case reviews on collaboratively efficient teams were more collectively produced, more comprehensive, richer in detail and complexity, and more routine across rotating leadership. When physicians were present, sensemaking focused more on action planning.
DISCUSSION
In the time-pressured acute care context, predictable framing practices may lend stability to collective practice by ordering team thinking, while sensitivity to uncertainty and a broad focus may lead to more reliable collective performance.
CONCLUSION
These findings suggest communication (as social action) as a focus for inquiry into ICP.