General internal medicine (GIM) is a communicatively complex specialty because of its diverse patient population and the number and diversity of health care providers working on a medicine ward. Effective interprofessional communication in such information-intensive environments is critical to achieving optimal patient care. Few empirical studies have explored the ways in which health professionals exchange patient information and the implications of their chosen communication forms. In this article, we report on an ethnographic study of health professionals' communication in two GIM wards through the lens of communication genre theory. We categorize and explore communication in GIM into two genre sets—synchronous and asynchronous—and analyze the relationship between them. Our findings reveal an essential relationship between synchronous and asynchronous modes of communication that has implications for the effectiveness of interprofessional collaboration in this and similar health care settings, and is intended to inform efforts to overcome existing interprofessional communication barriers.
Arora, V., Johnson, J., Lovinger, D., Humphrey, H.J., & Meltzer, D.O. (2005). Communication failures in patient sign-out and suggestions for improvement: A critical incident analysis. Quality and Safety in Health Care, 14, 401-407.
2.
Artemeva, N. (1998). The writing consultant as cultural interpreter: Bridging cultural perspectives on the genre of the periodic engineering report . Technical Communication Quarterly, 7(3), 285-299.
3.
Atwal, A., & Caldwell, K. (2002). Do multidisciplinary integrated care pathways improve interprofessional collaboration? Scandinavian Journal of Caring Sciences, 16, 360-367.
4.
Carroll, K., Iedema, R., & Kerridge, R. (2008). Reshaping ICU ward round practices using video-reflexive ethnography. Qualitative Health Research, 18, 380-390.
5.
Coiera, E., & Tombs, V. (1998). Communication behavior in a hospital setting: An observational study. British Medical Journal, 316, 673-676.
6.
Coombs, M., & Ersser, S.J. (2004). Medical hegemony in decisionmaking-a barrier to interdisciplinary working in intensive care. Journal of Advanced Nursing, 46(3), 245-252.
7.
Detweiler, J., & Peyton, C. (1999). Defining occupations: A chronotopic study of narrative genres in a health discipline's emergence. Written Communication , 16(4), 412-468.
8.
Dunmire, P.L. (2000). Genre as temporally situated social action-a study of temporality and genre activity. Written Communication, 17(1), 93-138.
9.
Geertz, C. (1988). Works and lives: The anthropologist as author . Stanford, CA: Stanford University Press.
10.
Haber, R., & Lingard, L. (2001). Learning oral presentation skills: A rhetorical analysis with pedagogical and professional implications. Journal of General Internal Medicine, 16(5), 308-314.
11.
Hall, P. (2005). Interprofessional teamwork: Professional cultures as barriers. Journal of Interprofessional Care, Supplement1, 188-196.
12.
Halm, M.A., Gagner, S., Goering, M., Sabo, J., Smith, M., & Zaccagnini, M. (2003). Interdisciplinary rounds: Impact on patients, families, and staff. Clinical Nurse Specialist , 17(3), 133-142.
13.
Hammersley, M., & Atkinson, P. (1995). Ethnography: Principles in practice (2nd ed.). London: Routledge .
14.
Hugman, R. (1991). Power in caring professions. Basingstoke, UK: Macmillan.
15.
Jones, A. (2006). Multidisciplinary team working: Collaboration and conflict. International Journal of Mental Health Nursing , 15, 19-28.
16.
Lingard, L., Garwood, K., Schryer, C.F., & Spafford, M.M. (2003). A certain art of uncertainty: Case presentation and the development of professional identity. Social Science and Medicine, 56, 603-616.
17.
Lingard, L., Gotlib Conn, L., Russell, A., Reeves, S., Miller, K-L., Kenaszchuk, C., et al. (2007). Interprofessional information work: Innovations in the use of the chart on internal medicine teams. Journal of Interprofessional Care, 21(6), 657-667.
18.
Lingard, L., & Haber, R.J. (1999). Teaching and learning communication in medicine: A rhetorical approach. Academic Medicine, 74, 507-510.
19.
Lingard, L., Resnick, R., Espin, S., Regehr, G., & DeVito, I. (2002). Team communications in the operating room: Talk patterns, sites of tension, and implications for novices. Academic Medicine, 77(3), 232-237.
20.
Lingard, L., Schryer, C., Garwood, K., & Spafford, M.M. (2003). Talking the talk: School and workplace genre tension in clerkship case presentations. Medical Education, 37, 612-620.
21.
Miller, C.R. (1984). Genre as social action. Quarterly Journal of Speech, 70, 151-157.
22.
Miller, K.-L., Reeves, S., Zwarenstein, M., Beales, J.D., Kenaszchuk, C., & Gotlib Conn, L. (2008). Nursing emotion work and interprofessional collaboration in general internal medicine wards: A qualitative study. Journal of Advanced Nursing, 64(4), 332-343.
23.
Molyneux, J. (2001). Interprofessional team working: What makes teams work well? Journal of Interprofessional Care, 15(1), 29-35.
24.
Orlikowski, W.J., & Yates, J. (1994). Genre repertoire: The structuring of communicative practices in organizations. Administrative Science Quarterly , 39(4), 541-574.
25.
Osterlund, C. (2007). Genre combinations: A window into dynamic communication practices. Journal of Management Information Systems, 23(4), 81-108.
26.
Paré, A., & Smart, G. (1994). Observing genres in action: Towards a research methodology. In A. Freedman & P. Medway (Eds.), Genre and the new rhetoric (pp. 146-154). London: Taylor & Francis.
27.
Pethybridge, J. (2004). How team working influences discharge planning from hospital: A study of four multi-disciplinary teams in an acute hospital in England. Journal of Interprofessional Care, 18(1), 29-41.
28.
Pope, C., Ziebland, S., & Mays, M. (2000). Qualitative research in health care: Analysing qualitative data. British Medical Journal, 320, 114-116.
29.
*Reader, T.W., Flin, R., & Cuthbertson, B.H. (2007). Communication skills and error in the intensive care unit. Current Opinion in Critical Care, 13, 732-736.
30.
Reeves, S., Kuper, A., & Hodges, B. (2008). Qualitative research methodologies: Ethnography . British Medical Journal, 337, 512-514.
31.
Reeves, S., & Lewin, S. (2004). Interprofessional collaboration in the hospital: Strategies and meanings. Journal of Health Services Research & Policy, 9(4), 218-225.
32.
Reeves, S., Nelson, S., & Zwarenstein, M. (2008). The doctor-nurse game in the age of interprofessional care: A view from Canada. Nursing Inquiry15(1), 1-2.
33.
Reeves, S., Russell, A., Zwarenstein, M., Kenaszchuk, C., Gotlib Conn, L., Doran, D., et al. (2007). Structuring communication relationships for interprofessional teamwork (SCRIPT): A Canadian initiative aimed at improving patient-centred care. Journal of Interprofessional Care, 21(1), 111-114.
34.
Sanjek, R. (1990). A vocabulary for fieldnotes. In R. Sanjek (Ed.), Fieldnotes: The makings of anthropology (pp. 92-121). Ithaca, NY: Cornell University Press.
35.
Schryer, C. (1993). Records as genre. Written Communication , 10, 200-234.
36.
Schryer, C.F., Lingard, L., & Spafford, M.M. (2005). Techne or artful science and the genre of case presentations in health care settings. Communication Monographs, 72(2), 234-260.
37.
Spafford, M.M., Lingard, L., Schryer, C.F., & Hrynchak, P.K. (2004). Tensions in the field: Teaching standards of practice in optometry case presentations. Optometry and Vision Science, 81(10), 800-806.
38.
Spafford, M.M., Lingard, L., Schryer, C.F., & Hrynchak, P.K. (2005). Teaching the balancing act: Integrating patient and professional agendas in optometry. Optometric Education, 31(1), 21-27.
39.
Spafford, M.M., Schryer, C.F., Mian, M., & Lingard, L. (2006). Look who's talking: Teaching and learning using the genre of medical care presentation. Journal of Business and Technical Communication, 20(2), 121-158.
40.
Spinuzzi, C. (2003). Compound mediation in software development: Using genre ecologies to study textual artifacts. In C. Bazerman & D. R. Russell (Eds.), Writing selves/writing societies: Research from activity perspectives (pp. 97-124). Fort Collins, CO: WAC Clearinghouse and Mind, Culture, and Activity.
41.
Vazirani, S., Hays, R.D., Shapiro, M.F., & Cowan, M. (2005). Effect of a multidisciplinary intervention on communication and collaboration. American Journal of Critical Care, 14(1), 71-76.
42.
Winsor, D. (2000). Ordering work: Blue-collar literacy and the political nature of genre. Written Communication, 17(2), 155-184.
43.
Xiao, Y., Schenkel, S., Faraj, S., Mackenzie, C., & Moss, J. (2007). What whiteboards in a trauma center operating suite can teach us about emergency department communication. Annals of Emergency Medicine, 50(4), 387-395.
44.
Yates, J., & Orlikowski, W.J. (1992). Genres of organizations communication: A structurational approach to studying communication and media . Academy of Management Review, 17(2), 299-326.
45.
Yates, J., & Orlikowski, W.J. (2002). Genre systems: Structuring interaction through communicative norms. Journal of Business Communication, 39(1), 13-35.
46.
Zwarenstein, M., & Reeves, S. (2002). Working together but apart: Barriers and routes to nurse-physician collaboration. The Joint Commission Journal on Quality Improvement, 28(5), 242-247.
