Search results

1 – 10 of over 5000
Article
Publication date: 9 May 2016

Victoria Walton, Anne Hogden, Julie Johnson and David Greenfield

The purpose of this paper is to classify and describe the purpose of ward rounds, who attends each round and their role, and participants’ perception of each other’s role during…

2251

Abstract

Purpose

The purpose of this paper is to classify and describe the purpose of ward rounds, who attends each round and their role, and participants’ perception of each other’s role during the respective ward rounds.

Design/methodology/approach

A literature review of face-to-face ward rounds in medical wards was conducted. Peer reviewed journals and government publications published between 2000 and 2014 were searched. Articles were classified according to the type of round described in the study. Purposes were identified using keywords in the description of why the round was carried out. Descriptions of tasks and interactions with team members defined participant roles.

Findings

Eight round classifications were identified. The most common were the generalised ward; multidisciplinary; and consultant rounds. Multidisciplinary rounds were the most collaborative round. Medical officers were the most likely discipline to attend any round. There was limited reference to allied health clinicians and patient involvement on rounds. Perceptions attendees held of each other reiterated the need to continue to investigate teamwork.

Practical implications

A collaborative approach to care planning can occur by ensuring clinicians and patients are aware of different ward round processes and their role in them.

Originality/value

Analysis fulfils a gap in the literature by identifying and analysing the different ward rounds being undertaken in acute medical wards. It identifies the complexities in the long established routine hospital processes of the ward round.

Details

International Journal of Health Care Quality Assurance, vol. 29 no. 4
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 12 October 2015

Kaija Collin, Sanna Herranen, Ulla Maija Valleala and Susanna Paloniemi

The purpose of this paper is to explore interprofessional collaboration during ward rounds on a Finnish emergency and infection ward from the viewpoint of three central…

Abstract

Purpose

The purpose of this paper is to explore interprofessional collaboration during ward rounds on a Finnish emergency and infection ward from the viewpoint of three central professional groups: physicians, nurses and secretaries.

Design/methodology/approach

The authors utilise an ethnographically informed approach, with observations and interviews as the data collection devices. The data comprise ten interviews with staff members and ten hours of observations. The data were analysed using qualitative thematic analysis.

Findings

The ward rounds were found to be rather physician- and medicine-centred, and mostly not interprofessional. Nurses and secretaries in particular expressed dissatisfaction with many of the current ward rounds work practices. Ward rounds are an essential part of collaboration in implementing the emergency-natured operational aim of the ward, yet we found that the ward rounds are complicated by diverging professional views and expectations, variable work practices and interactional inequality.

Originality/value

This study makes a contribution to the research of collaboration in emergency care and ward rounds, both of which are little-studied fields. Further, context-specific studies of collaboration have been called for in order to eventually create a model of shared expertise. The findings of this study can be utilised in studying and developing emergency care contexts.

Details

International Journal of Emergency Services, vol. 4 no. 2
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 11 July 2020

Victoria Walton, Anne Hogden, Janet C. Long, Julie Johnson and David Greenfield

This paper aims to explore if health professionals share understanding of teamwork that supports collaborative ward rounds.

2823

Abstract

Purpose

This paper aims to explore if health professionals share understanding of teamwork that supports collaborative ward rounds.

Design/methodology/approach

A purpose-designed survey was conducted in two acute medical and two rehabilitation wards from a metropolitan teaching hospital. Medical officers, nurses and allied health professionals participated. To understand characteristics that support collaborative ward rounds, questions developed from literature and industry experience asked: what are the enablers and challenges to teamwork; and what are clinicians’ experiences of positive teamwork? Descriptive and thematic analyses were applied to the dimensions of effective teamwork as a framework for deductive coding.

Findings

Seventy-seven clinicians participated (93% response rate). Findings aligned with dimensions of teamwork framework. There was no meaningful difference between clinicians or specialty. Enablers to teamwork were: effective communication, shared understanding of patient goals, and colleague’s roles. Challenges were ineffective communication, individual personalities, lack of understanding about roles and responsibilities, and organisational structure. Additional challenges included: time; uncoordinated treatment planning; and leadership. Positive teamwork was influenced by leadership and team dynamics.

Practical implications

Ward rounds benefit from a foundation of collaborative teamwork. Different dimensions of teamwork present during ward rounds support clinicians’ shared understanding of roles, expectations and communication.

Originality/value

Rounds such as structured rounding, aim to improve teamwork. Inverting this concept to first develop effective collaboration will support team adaptability and resilience. This enables teams to transition between the multiple rounding processes undertaken in a single ward. The emphasis becomes high-quality teamwork rather than a single rounding process.

Details

International Journal of Health Care Quality Assurance, vol. 33 no. 4/5
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 19 September 2016

Birgitte Enslev Jensen, Pauline Anne Found, Sharon J. Williams and Paul Walley

Ward rounds in hospitals are crucial for decision-making in the context of patient treatment processes. However, these tasks are not systematically managed and are often extended…

Abstract

Purpose

Ward rounds in hospitals are crucial for decision-making in the context of patient treatment processes. However, these tasks are not systematically managed and are often extended due to missing information or equipment or staff unavailability. This research aims to assess whether ward rounds can be structured more efficiently and effectively from the perspective of patients and staff.

Design/methodology/approach

This mixed-method approach examines the ward rounds conducted in three units within a haematology department of a major Danish hospital. Baseline measures were collected to capture the value of the ward round described by patients and staff. The information on patient and equipment flows associated with a typical ward round was mapped with recommendations for improvement.

Findings

Staff aspired to deliver a good-quality ward round, but what this meant was never articulated and there were no established standards. The duration of the ward round was unpredictable and could take 6 hours to complete. Improvements identified by the team allow the ward rounds to be completed by mid-day with much more certainty.

Research limitations/implications

This research provides an insight as to how ward rounds are conducted within a Danish haematology department.

Practical implications

The research has implications for those involved in ward rounds to reduce the time taken whilst maintaining quality and safety of patient care.

Social implications

This research has implications for patients and their families who wish to spend time with consultants.

Originality/value

Previous research has focused on the interactions between doctors and nurses. This research focuses on the operational process of the ward round and presents a structured approach to support multi-disciplinary teams with a focus on value from the patient’s perspective.

Details

International Journal of Quality and Service Sciences, vol. 8 no. 3
Type: Research Article
ISSN: 1756-669X

Keywords

Article
Publication date: 1 January 2016

Fredrik Bååthe, Gunnar Ahlborg Jr, Lars Edgren, Annica Lagström and Kerstin Nilsson

The purpose of this paper is to uncover paradoxes emerging from physicians’ experiences of a patient-centered and team-based ward round, in an internal medicine department.

Abstract

Purpose

The purpose of this paper is to uncover paradoxes emerging from physicians’ experiences of a patient-centered and team-based ward round, in an internal medicine department.

Design/methodology/approach

Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings.

Findings

This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician’s professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician’s professional identity was centered. Physicians with more of an I-perspective experienced challenges with the new round, while physicians with more of a We-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered.

Practical implications

For change processes affecting physicians’ professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure.

Originality/value

This paper provides increased understanding about how physicians’ professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.

Details

Leadership in Health Services, vol. 29 no. 2
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 23 March 2010

Ulrike Burkhardt, Astrid Erbsen and Marjam Rüdiger‐Stürchler

The hospitalist concept aims for integration and continuity of care in inpatient treatment. The purpose of this paper is to understand how the hospitalist function emerges and…

Abstract

Purpose

The hospitalist concept aims for integration and continuity of care in inpatient treatment. The purpose of this paper is to understand how the hospitalist function emerges and unfolds on wards. Therefore, the paper aims to focus on interaction patterns and the role of the hospitalist.

Design/methodology/approach

Building on methodological approaches in health care team research, this process‐oriented case study used participatory observations and semi‐structured interviews. Over a year, 14 observational days were conducted, simultaneously accompanying hospitalists, nurses and surgeons. Observational data illustrate the findings.

Findings

The hospitalist function was perceived to have a positive impact. He/she serves as an informal leader by taking up five interrelated, mostly coordinative roles, which help to cope with different organisational gaps. The interaction patterns are bilateral, ad hoc, reactive, repetitive and dependent on chance and people. Roles, tasks and responsibilities are continuously negotiated.

Research limitations/implications

Hospitalist research should make use of the debate in health care team research about overlapping roles, tasks and responsibilities. Additionally, one could look at the origins behind the evolvement of interaction patterns and the hospitalist's roles.

Practical implications

The sole creation of the hospitalist function is not sufficient to tap its full potential. Organisational issues concerning the interaction processes need to be addressed. In so doing, the professions' orientations must be taken into account.

Originality/value

This paper addresses theoretical and methodological gaps in hospitalist research. Using a process‐oriented qualitative design, the findings question the prominent stimulus‐response assumption. The focus on the interplay of functions and the hospitalists' roles lead to a more comprehensive picture of the patient‐related interaction processes.

Details

Journal of Health Organization and Management, vol. 24 no. 1
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 8 July 2014

Wei Liu, Elizabeth Manias and Marie Gerdtz

The purpose of this paper is to examine power relations embedded in verbal and non-verbal medication communication processes that involve nurses, doctors, pharmacists and patients…

Abstract

Purpose

The purpose of this paper is to examine power relations embedded in verbal and non-verbal medication communication processes that involve nurses, doctors, pharmacists and patients in two general medical wards of an acute care hospital.

Design/methodology/approach

This paper reports on the findings of an ethnographic study investigating medication communication processes in hospital spatial environments. It was theoretically informed by the work of Norman Fairclough. Data collection methods comprising video-recordings and video reflexive focus groups were employed. Fairclough's critical discourse analytic framework guided data analysis.

Findings

Four different forms of power relations between clinician-patient, nurse-doctor, clinician-organisation and multidisciplinary interactions were uncovered. Nurses asserted their professional autonomy when communicating with doctors about medications by offering specific advice on medical prescribing and challenging medication decisions. Video reflexivity enabled nurses to critically examine their contribution to medication decision-making processes. Clinicians of different disciplines openly contested the organisational structure of patient allocation during medical discussions about management options. Clinicians of different disciplines also engaged in medication communication interchangeably to accomplish patient discharge.

Originality/value

An investigation of existing power relations embedded in medication communication processes within specific clinical contexts can lead to a better understanding of medication safety practices. Video reflexive focus groups are helpful in encouraging clinicians to reflect on their practice and consider ways in which it could be improved in how power relations are played out.

Details

Qualitative Research Journal, vol. 14 no. 2
Type: Research Article
ISSN: 1443-9883

Keywords

Article
Publication date: 18 April 2019

Ursula Reichenpfader, Anette Wickström, Madeleine Abrandt Dahlgren and Siw Carlfjord

The purpose of this paper is to explore the embedding of hospital-based medication review attending to the conflictual and developmental nature of practice. Specifically, this…

Abstract

Purpose

The purpose of this paper is to explore the embedding of hospital-based medication review attending to the conflictual and developmental nature of practice. Specifically, this paper examines manifestations of contradictions and how they play out in professional practices and local embedding processes.

Design/methodology/approach

Using ethnographic methods, this paper employs the activity-theoretic notion of contradictions for analyzing the embedding of medication review. Data from participant observation (in total 290 h over 48 different workdays) and 31 semi-structured interviews with different healthcare professionals in two Swedish hospital-based settings (emergency department, department of surgery) are utilized.

Findings

The conflictual and developmental potential related to three interrelated characteristics (contested, fragmented and distributed) of the activity object is shown. The contested nature is illustrated showing different conceptualizations, interests and positions both within and across different professional groups. The fragmented character of medication review is shown by tensions related to the appraisal of the utility of the newly introduced practice. Finally, the distributed character is exemplified through tensions between individual and collective responsibility when engaging in multi-site work. Overall, the need for ongoing “repair” work is demonstrated.

Originality/value

By using a practice-theoretical approach and ethnographic methods, this paper presents a novel perspective for studying local embedding processes. Following the day-to-day work of frontline clinicians captures the ongoing processes of embedding medication review and highlights the opportunities to learn from contradictions inherent in routine work practices.

Details

Journal of Health Organization and Management, vol. 33 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 14 June 2019

Paraskevi Angelopoulou and Efharis Panagopoulou

The purpose of this paper is to systematically describe the types of non-clinical rounds implemented in hospital settings.

Abstract

Purpose

The purpose of this paper is to systematically describe the types of non-clinical rounds implemented in hospital settings.

Design/methodology/approach

This scoping review was conducted and reported in accordance with the PRISMA. The review followed the four stages of conducting scoping review as defined by Arskey and O’Malley (2005).

Findings

Initially, 978 articles were identified through database search from which only 24 studies were considered relevant and included in the final review. Overall, eight types of non-clinical rounds were identified (death rounds, grand rounds, morbidity and mortality conferences, multidisciplinary rounds, patient safety rounds, patient safety huddles, walkarounds and Schwartz rounds) that independently of their format, goal, participants and type of outcomes aimed to enhance patient safety and improve quality of healthcare delivery in hospital settings, either by focusing on physician, patient or organizational system.

Originality/value

To the authors’ knowledge this is the first review that aims to provide a comprehensive summary to the types of non-clinical rounds that has been applied in clinical settings.

Details

Journal of Health Organization and Management, vol. 33 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 20 June 2008

Janet M. Scott and Peri Hawkins

This paper aims to explore the unintentional formation of internal functional barriers, (organisational silos) during moves towards departmental efficiency, within an acute trust…

1423

Abstract

Purpose

This paper aims to explore the unintentional formation of internal functional barriers, (organisational silos) during moves towards departmental efficiency, within an acute trust, and the subsequent effects on the discharge process in elderly patients.

Design/methodology/approach

This paper presents some of the findings from a qualitative study examining the role of the nurse in the discharge process. Semi‐structured interviews were conducted with a purposively selected cohesive sample of 28 registered nurses, from the medical and elderly care wards in an NHS Acute Trust. The interviews were taped, transcribed and their content analysed.

Findings

The problems associated with patient discharge were frequently operational. Each part of the process was hindered, often inadvertently, by attempts on the part of individuals, departments and services to make themselves efficient, without regard for the resulting organisational consequences. This left the ward nurses attempting to overcome the obstacles in an attempt to effectively discharge patients, within a required period of time.

Research limitations/implications

It is recognised that, the perceptions of those not participating in the study may have been different to those who did participate. As a small study in one trust the results may not be generalisable.

Practical implications

It is imperative that evaluation of operational changes is undertaken, with particular regard to the consequences of change, for other services, patients and clients.

Originality/value

This type of study can provide a method of diagnosing organisational problems, especially in areas that are reliant on inter‐professional and departmental collaboration

Details

Journal of Health Organization and Management, vol. 22 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

1 – 10 of over 5000