https://doi.org/10.4081/qrmh.2021.9977
The Difficult Case Consultation: An intervention for interprofessional health communication
Submitted: 15 July 2021
Accepted: 3 January 2022
Published: 31 January 2022
Accepted: 3 January 2022
Abstract Views: 829
PDF: 409
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
An interprofessional group of healthcare practitioners sought a new approach to the early detection, prevention, and resolution of “difficult cases” in the inpatient care context. An action research project addressed this need by developing a narrative re-framing tool that helped reveal entrenched assumptions regarding the root causes of difficult cases in the hospital. The intervention method that emerged from the project — the Difficult Case Consultation (DCC) — is a theoretically-grounded process that helps teams to analyze and address complex communication problems in interprofessional healthcare contexts. Collaborative processes grounded in theory have proven to be the most successful when seeking to optimize healthcare team communication. The article describes the collaborative development of the DCC, presents two cases illustrating the process, and describes systemic factors that exacerbated the emergence of difficult cases in the inpatient context.
Cissna K. Applied communication research in the 21st century. J App Commun Res 2000;28:169-73.
DOI: https://doi.org/10.1080/00909880009365563
De Oliviera GCB, Alves MR, Ramalho De Oliviera D. Action research as a tool for transformation of the pharmacist’s praxis in primary care. Int J Pharm Pharm 2017;9:180-5.
DOI: https://doi.org/10.22159/ijpps.2017v9i3.16486
Eisenberg E, Baglia J, Pynes J. Transforming emergency medicine through narrative: Qualitative action research at a community hospital. Health Commun 2006;19:197-208.
DOI: https://doi.org/10.1207/s15327027hc1903_2
Cheney G. Organizational rhetoric: The practice of criticism. J App Commun Res 1990;18:93-114.
DOI: https://doi.org/10.1080/00909889009360318
Crable RE. Organizational rhetoric as the fourth great system: Theoretical, critical, and pragmatic implications. J App Commun Res 1990;18:115-28.
DOI: https://doi.org/10.1080/00909889009360319
Meisenbach RJ, McMillan JJ. Blurring the boundaries: Historical and future directions in organizational rhetoric. Commun Yearb 2006;30:99-141.
DOI: https://doi.org/10.1080/23808985.2006.11679056
Morgenthaler T, Harper CM. Getting rid of “never events” in hospitals. Harvard Bus Rev 2015. Available from: https://hbr.org/2015/10/getting-rid-of-never-events-in-hospitals
Dieleman JL, Squires E, Bui AL, et al. Factors associated with increases in US health care spending, 1996-2013. J Amer Med Assoc 2017;318:1668-78.
DOI: https://doi.org/10.1001/jama.2017.15927
Hajat C, Stein E. The global burden of multiple chronic conditions: A narrative review. Prevent Med Rep 2018;12:284-93.
DOI: https://doi.org/10.1016/j.pmedr.2018.10.008
Defenbaugh N, Baglia J, Foster E. Billable (h)ours: Autoethnography, ambivalence, and academic labor in a healthcare organization. In Herrmann A, ed. The Routledge international handbook of organizational autoethnography. New York, NY: Routledge; 2020. pp 191-208.
DOI: https://doi.org/10.4324/9780429056987-16
Schot E, Tummers L, Noordegraaf M. Working on working together: A systematic review on how healthcare professionals contribute to interprofessional collaboration. J Interprof Care 2020;34:332-42.
DOI: https://doi.org/10.1080/13561820.2019.1636007
Committee on Diagnostic Error in Health Care; Board on Health Care Services; Institute of Medicine; The National Academies of Sciences, Engineering, and Medicine; et al. Improving diagnosis in health care. Washington, DC: National Academies Press; 2015.
Colvin J. Knotworking in an emergency response team: Understanding team communication and process. Qual Res Med Healthc 2017;1:128-37.
DOI: https://doi.org/10.4081/qrmh.2017.7115
Schmutz J, Meier L, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: A systematic review and meta-analysis. Brit Med J Open 2019;9:1-16.
DOI: https://doi.org/10.1136/bmjopen-2018-028280
Gawande A. Complications: A surgeon’s notes on an imperfect science. New York, NY; 2002.
Makary M, Daniel M. Medical error—the third leading cause of death in the US. Brit Med J 2016;353:i2139.
DOI: https://doi.org/10.1136/bmj.i2139
François P, Lecoanet A, Caporossi A, Dols AM, Seigneurin A, Boussat B. Experience feedback committees: A way of implementing a root cause analysis practice in hospital medical departments. PLoS One 2018;13:e0201067.
DOI: https://doi.org/10.1371/journal.pone.0201067
Weick K, Sutcliffe K. Managing the unexpected: Resilient performance in an age of uncertainty. San Francisco, CA:Jossey-Bass;2007.
Worman D, Rock M. Teaching nursing students root-cause readmission analysis. Nurse Educ 2021;46:15-6.
DOI: https://doi.org/10.1097/NNE.0000000000000851
Martin-Delgado J, Martínez-García A, Aranaz JM, Valencia-Martín JL, Mira JJ. How much of root cause analysis translates into improved patient safety: A systematic review. Med Princ Pract. Published online May 15, 2020.
DOI: https://doi.org/10.1159/000508677
Hong H, Oh HJ. The effects of patient-centered communication: Exploring the mediating role of trust in healthcare providers. Health Comm 2020;35:502-11.
DOI: https://doi.org/10.1080/10410236.2019.1570427
The Joint Commission. Sentinel Event. 2021. Available from: https://www.jointcommission.org/resources/patient-safety-topics/sentinel-event/
The Schwartz Center (n.d.). Official Website. https://www.theschwartzcenter.org/programs/schwartz-rounds
Charon R. Narrative medicine: Honoring the stories of illness. Oxford, UK: Oxford University Press; 2006.
Silverman RE, Baglia J. Communicating pregnancy loss: Narrative as a method for change. New York, NY: Peter Lang Academic Publishing; 2014.
DOI: https://doi.org/10.3726/978-1-4539-1384-0
Foster E. Physicians’ stories: Autoethnography, presence, and rhizomatic inquiry. Int Rev Qual Res 2014;7:290-301.
DOI: https://doi.org/10.1525/irqr.2014.7.3.290
Taylor B. Narrative analysis. In Taylor B, Francis K, eds. Qualitative research in the health sciences. London: Routledge; 2013. pp. 243-265.
DOI: https://doi.org/10.4324/9780203777176
Burke K. A grammar of motives. Berkeley, CA: University of California Press; 1969.
DOI: https://doi.org/10.1525/9780520341715
Bareiss W. Space, boundaries, and identification: A dramatistic approach to HIV counter-narratives. Int J Comm Health 2016;9:62-72.
Chou C, Hirschmann K, Fortin A, Lichstein P. The impact of a faculty learning community on professional and personal development. Acad Med 2014;89:1051-6.
DOI: https://doi.org/10.1097/ACM.0000000000000268
McDougall A, Goldszmidt M, Kinsella EA, et al. Collaboration and entanglement: An actor-network theory analysis of team-based intraprofessional care for patients with heart failure. Soc Sci Med 2016;164:108-17.
DOI: https://doi.org/10.1016/j.socscimed.2016.07.010
Goffman E. Frame analysis: An essay on the organization of experience. Cambridge, MA: Harvard University Press; 1974.
Lindlof T, Taylor B. Qualitative communication research methods. 2nd ed. Walnut Creek, CA: Sage Publications; 2002.
Willis R. The use of composite narratives to present interview findings. Qual Res 2018;19:471-80.
DOI: https://doi.org/10.1177/1468794118787711
Barker R, Cornwell J, Gishen F. Introducing compassion into the education of health care professionals: can Schwartz Rounds help? J Comp Care 2016;3:3.
DOI: https://doi.org/10.1186/s40639-016-0020-0
Isfahani HM, Tourani S, Seyedin H. Lean management approach in hospitals: a systematic review. Int J Lean Six Sigma 2019;10:161-88.
DOI: https://doi.org/10.1108/IJLSS-05-2017-0051
Burke K. Language as symbolic action: Essays on life, literature, and method. Berkeley, CA: University of California Press; 1966.
DOI: https://doi.org/10.1525/9780520340664
Miller EM, Hill PD. Intuition in clinical decision making: Differences among practicing nurses. J Holist Nurs 2018;36:318-29.
DOI: https://doi.org/10.1177/0898010117725428
Mehase E. Covid-19: What do we know about “long covid”? BMJ 2020;370:m2815.
DOI: https://doi.org/10.1136/bmj.m2815
How to Cite
Foster, Elissa, and Jay Baglia. 2022. “The Difficult Case Consultation: An Intervention for Interprofessional Health Communication”. Qualitative Research in Medicine and Healthcare 5 (3). https://doi.org/10.4081/qrmh.2021.9977.
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