Communication and interprofessional collaborative practice: collective sensemaking work

Communication is often listed as a key ingredient for effective interprofessional collaborative practice (ICP) in health care, and is frequently conceptualized as information transmission. Without denying this important function, I propose to problematize communication as constitutive, social action. This allows us to understand ICP as a process of collective sensemaking that emerges in and through communicative action. Taking seriously the term practice in ICP, this ethnography adopts a practice theory lens, informed by ethnomethodology and interaction analysis, to examine and characterize a specific practice: the interprofessional patient case review in daily team rounds. This practice is seen to be collectively enacted in routines and socio-materially embedded in other practices. The study draws on observations and audio recordings of 4,000 patient case reviews from 120 daily rounds of 3 interprofessional acute care teams in a university hospital in Western Canada. Variations in practice within and across the teams prompted three interrelated and emergent analyses. First, I show the importance of introductions to case reviews as salience-framing resources that emplot the patient’s situation on the care trajectory for listening team members, thereby underscoring the essential gatekeeping role played by charge nurses. I argue an interprofessional performance has to do with heedful interrelating, discernable in interaction as displayed mindfulness of difference and an attentiveness to expressions of uncertainty. Second, I recast the question of medical dominance in terms of authorship, and consider its interactional enactment. Here, the presence of a medical representative changes the focus of sensemaking work as well as the audience for whom talk is designed. Third, I examine potential stabilizers of sensemaking practice in the context of shifting team composition. Practice is stabilized and continuity of the patient’s story maintained through the participation of multiple authors or “story porters,” both human and non-human, shedding new light on IP and multivocality. These findings inform a model of IP sensemaking in the patient case review, especially highlighting the key role of the hybrid nurse-and-notes actor and the importance of sensitivity to expressions of uncertainty. The model could be useful in teaching interprofessional practice to students and practitioners.