I have attended one morning patient information session and conducted two interviews. I am waiting on two more hospitalists to determine an interview time.
As I mentioned in an earlier post, my intention was to divide my research into two parts: interview session and observation session (this one video taped using a think out loud protocol). The observation session isn't going to happen on this project because the coordinator is very hesitant about my videotaping anything. So, making the most of the situation, I'm conducting interviews but also decided to explore the breakdowns in communication. I would gather this data from observing their group sessions as the hospitalists discuss each hospitalized patient and what has happened in their care in the last 24 hours.
My second interview (on Friday) was with the medical director of the Hospitalist Program and this interview was incredibly rich in information, largely because he was very open, honest in the interview. (I would add VERY soft spoken and so transcribing the interview is not going to be enjoyable.) In my encounters with physicians, their number one concern is how much time will I need - how much time will they have to set aside. One of the goals of the interview time with the director was to ask if I could sit in on multiple group sessions in order to research breakdowns. His question back to me: "Will this involved additional time on the part of the hospitalists?" When he found out that I would be able to observe them and not take up any additional time, he said he would definitely consider the request. I'll be following up with him next week.
For my project, I may only be able to focus on information gained from personal interviews. I hope to begin observing the group sessions but will continue those for several months. The hospitalists who are present are the ones on call, so I want to observe multiple times with multiple hospitalists (not the same hospitalists each time I observe). Each session discusses 85-100 patients, which is the number I was given as the lowest and highest number typically hospitalized in any given day.
After Spinuzzi (sounds like life before and after reading his book :), I realized that I will need to document the history and context of each breakdown. As a researcher entering the medical world, I'm also keeping in mind that asking about history, context are sometimes very sensitive issues because they bring to the forefront egos, lack of patient concern, etc. that the profession typically doesn't like to talk about.
The two phrases that both hospitalists shared - a hospital needs physicians who are willing to "play well together" - the good 'ole sandbox analogy!
Debra
Subscribe to:
Post Comments (Atom)
5 comments:
Hey--academics need people who can "work and play well" together!
I love the idea of BS and AS (Before Spinuzzi/After Spinuzzi).
I know this is sounding more and more like a long-term project. You know I'll be flexible w/ the final project: If you can only use the interviews with an eye towards where you're going, that would be ok; maybe you could also include some really quick passes through the observations; but I see this as an entry into some real, long term dissertation type research, which I think is exciting.
I love reading about your research. I currently am still not doing any work on my project, for various reasons. So,I feel like I'm learning by reading you go through the process. You go girl!
Deb-
You suggest documenting the history and context of each breakdown. This sounds time consuming, but it will help you identify common threads and negative trends.
Your last sentence, about doctors playing in the sandbox together, can be summed up in two words: team players. Do you get the sense that the group functions as a team? Or, is it a dysfunctional team?
Rob
Rob,
It's the team approach that is the most important goal of the medical director. In his interview, he gave me several examples of trying to get doc to play well. The greatest challenge is with hospitalists and specialists. There is a hierarchy within the professional that creates some specialists to feel superior to the hospitalists. So, if the hospitalist perceives that the cardiologist(for example) doesn't have time to talk to the hospitalist, the hospitalist gets mad and says that "he'll just have to come to me." The medical director keeps pushing "what is best for the patient?" - "are we doing what is best for the patient" - "it's about the patient."
So, I get the sense that they know it's important, but in individual hostile situations they can't get beyond "this was said to me - how dare that person talk to me that way."
Becky,
Yes we do, don't we. I appreciate your comments. Now that I have two interviews and three group sessions to analyze, I'm going to begin writing.
I've asked to observe the group sessions 12 times, which will last through June. So, my paper is definitely...more to come....
Thank you for you insight.
Debra
Post a Comment