Knotworking in an emergency response team: understanding team communication and process

Janet W. Colvin

doi:10.4081/qrmh.2017.7115

Authors

Janet W. Colvin
colvinja@uvu.edu
Communication Department, Utah Valley University, Orem, UT, United States. http://orcid.org/0000-0001-5649-3578

Over the last 30 years, many studies have focused on responses to crisis in organizations. Crises can occur at any time of the day or night on a regular but unforeseen basis and are characterized by high consequences and short decision time. In healthcare, multidisciplinary crisis management or rapid response teams (RRT) have become more common. RRTs allow for a cross-sectional focus on patients’ needs and, thereby, prevent avoidable deaths or significant harm. This study uses Activity Theory and knotworking theory to examine how communication, multiple roles and power structures are negotiated in RRT’s in a large intermountain teaching hospital. Results from focus groups indicate a single-minded focus on training for system errors may miss important aspects. Knotworking theory is promising because it helps providers move beyond an understanding of teamwork to an understanding of how objectives can be shared and merged.

Yu T, Sengul M, Lester RH. Misery love company: The spread of negative impacts resulting from an organizational crisis. Academy of Management Review. 2008;33:452-72. DOI: https://doi.org/10.5465/amr.2008.31193499

Stachowski AA, Kaplan SA. The benefits of flexible team interaction during crises. Journal of Applied Psychology. 2009;94(6):1536-43. DOI: https://doi.org/10.1037/a0016903

Leach LS, Mayo AM. Rapid response teams: Qualitative analysis of their effectiveness. American Journal of Critical Care. 2013;22(3):198-210. DOI: https://doi.org/10.4037/ajcc2013990

Laxmisan A, Hakimzada F, Sayan OR, Green RA, Zhang J, Patel VL. The multitasking clinician: decision-making and cognitive demand during and after team handoffs in emergency care. International Journal Of Medical Informatics. 2007;76(11-12):801-11. DOI: https://doi.org/10.1016/j.ijmedinf.2006.09.019

Lingard L, Espin S, Evans C, Hawryluck L. The rules of the game: interprofessional collaboration on the intensive care unit team. Critical Care (London, England). 2004;8(6):R403-R8. DOI: https://doi.org/10.1186/cc2958

Shearer B, Marshall S, Buist MD, Finnigan M, Kitto S, Hore T, et al. What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service. BMJ Quality and Safety. 2012;21(7):569-75. DOI: https://doi.org/10.1136/bmjqs-2011-000692

Rapid response teams: A systematic review and meta-analysis [Internet]. Retrieved October 10, 2014, from http://archinte.jamanetwork.com/. 2010.

Janss R, Rispens S, Segers M, Jehn KA. What is happening under the surface? Power, conflict and the performance of medical teams. Medical Education. 2012;46(9):838-49. DOI: https://doi.org/10.1111/j.1365-2923.2012.04322.x

Varpio L, Hall P, Lingard L, Schryer CF. Interprofessional communication and medical error: A reframing of research questions and approaches. Academic Medicine. 2008;83(10):576-81. DOI: https://doi.org/10.1097/ACM.0b013e318183e67b

Engestrom Y. Activity theory as a framework for analyzing and redesigning work. Ergonomics. 2000;43(7):960-75. DOI: https://doi.org/10.1080/001401300409143

Lundby K. Interdisciplinarity and Infrastructure: Mediation and Knotworking in Communication Research. NORDICOM Review. 2007;28:195-209.

Kuutti K. Activity theory as a potential framework for human computer interaction research. In: Nardi BA, editor. Context and consciousness: Activity theory and human-computer interaction. Cambridge, MA: MIT Press; 1996. p. 17-24.

Engestrom Y. Learning by expanding: An activity-theoretical approach to developmental research. Helsinki: Orienta-Konsultit; 1987.

Engestrom Y. Communication, Discourse and Activity. Communication Review. 1999;3(1/2):165. DOI: https://doi.org/10.1080/10714429909368577

Engestrom R. Voice as communicative action. Mind, Culture, and Activity. 1996;2(3):192-215. DOI: https://doi.org/10.1080/10749039509524699

Engestrom Y, Engestrom R, Vahaaho T. When the center does not hold: The importance of knotworking. In: Chaiklin S, Hedegaard M, Jensen UI, editors. Activity theory and social practice: Cultural-historical approaches. Aarhus: Aarhus University Press; 1999. p. 345-74.

Engestrom Y. New Forms of Learning in Co-Configuration Work. Journal of Workplace Learning. 2004;16(1-2):11-21. DOI: https://doi.org/10.1108/13665620410521477

Engestrom Y. From design experiments to formative interventions. Theory and Psychology. 2011;21(5):598-628. DOI: https://doi.org/10.1177/0959354311419252

Blackler F, McDonald S. Power, mastery and organizational learning.(Organizational Learning: Past, Present and Future). Journal of Management Studies. 2000(6):832. DOI: https://doi.org/10.1111/1467-6486.00206

Engeström Y, Kaatrakoski H, Kaiponen P, Lahikainen J, Laitinen A, Myllys H, et al. Knotworking in Academic Libraries: Two Case Studies from the University of Helsinki. Liber Quarterly: The Journal of European Research Libraries, Vol 21, Iss 3-4, Pp 387-405 (2012). 2012(3-4):387.

Eppich WJ, Brannen M, Hunt EA. Team training: Implications for emergency and critical care pediatrics. Emergency and Critical Care Medicine. 2008;20:255-60. DOI: https://doi.org/10.1097/MOP.0b013e3282ffb3f3

Andreatta P, Frankel J, Smith SB, Bullough A, Marzano D. Interdisciplinary team training identifies discrepancies in institutional policies and practices. 2011:298. DOI: https://doi.org/10.1016/j.ajog.2011.02.022

Sofaer S. Qualitative Methods: What Are They and Why Use Them? Health Services Research. 1999;34(5):1101-18.

Rundall TG, Devers KJ, Sofaer S. Qualitative Methods in Health Services Research: Introduction. Health Services Research. 1999;34(5):1091-9.

Lindlof TR, Taylor BC. Qualitative communication research methods. 2nd ed. Thousand Oaks, CA: Sage Publications, Inc.; 2002.

Tracy S. Qualitative research methods. Malden, MA: Wiley-Blackwell; 2013.

Lapan SD, Quartaroli MT, Riemer FJ, editors. Qualitative research: An introduction to methods and designs. San Francisco: Wiley/Jossey-Bass; in press.

Hsieh H-F, Shannon SE. Three Approaches to Qualitative Content Analysis. Qualitative Health Research. 2005;15(9):1277-88. DOI: https://doi.org/10.1177/1049732305276687

Tesch R. Qualitative research: Analysis types and software tools. Bristol, PA: Falmer; 1990.

Thornberg R, Charmaz K. Grounded Theory. In: Lapan SD, Quartaroli MT, Riemer FJ, editors. Qualitative research: An introduction to methods and designs. San Francisco, CA: Jossey-Bass; 2012. p. 42-67.

Colvin, Janet W. 2017. “Knotworking in an Emergency Response Team: Understanding Team Communication and Process”. Qualitative Research in Medicine and Healthcare 1 (3). https://doi.org/10.4081/qrmh.2017.7115.