BMJ 1998;316:673-676 ( 28 February )

Information in practice

Communication behaviours in a hospital setting: an observational study

Editorial by Gosbee

Enrico Coiera, senior project manager,  Vanessa Tombs, senior member of technical staff. 

Hewlett-Packard Laboratories, Bristol BS12 6QZ

Correspondence to: Dr Coiera, School of Computer Science and Engineering, University of New South Wales, Sydney 2052, Australia ewc{at}pobox.com

Objective: An exploratory study to identify patterns of communication behaviour among hospital based healthcare workers.
Design: Non-participatory, qualitative observational study.
Setting: British district general hospital.
Subjects: Eight doctors and two nurses.
Results: Communication behaviours resulted in an interruptive workplace, which seemed to contribute to inefficiency in work practice. Medical staff generated twice as many interruptions via telephone and paging systems as they received. Hypothesised causes for this level of interruption include a bias by staff to interruptive communication methods, a tendency to seek information from colleagues in preference to printed materials, and poor provision of information in support of contacting individuals in specific roles. Staff were observed to infer the intention of messages based on insufficient information, and clinical teams demonstrated complex communication patterns, which could lead to inefficiency.
Conclusion: The results suggest a number of improvements to processes or technologies. Staff may need instruction in appropriate use of communication facilities. Further, excessive emphasis on information technology may be misguided since much may be gained by supporting information exchange through communication technology. Voicemail and email with acknowledgment, mobile communication, improved support for role based contact, and message screening may be beneficial in the hospital environment.

Key messages

  • We observed communication behaviour among 10 hospital based healthcare workers

  • Communication behaviours resulted in an interruptive work place, which seemed to contribute to inefficiency in work practice

  • Medical staff generated twice as many interruptions via telephone and paging systems as they received, and possible causes for this included a bias by staff to interruptive communication methods, a tendency to seek information from colleagues in preference to printed materials, and poor provision of information in support of contacting individuals in specific roles

  • Staff were observed to infer the intention of messages based on insufficient information, and clinical teams showed complex communication patterns, which could lead to inefficiency

  • We conclude that hospital staff may need instruction in appropriate use of communication facilities and that some communication technology---voicemail and email with acknowledgment, cellular telephones for mobile communication, improved support for role based contact, and message screening---may be beneficial



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