Registered nurse with over 20 years experience and a background in Critical Care. Currently Deputy Chief Nurse for Organ and Tissue Donation and Transplantation. Have a keen interest in using a systems and human factors approach to improve patient safety.
What are the barriers and facilitators to the effective communication of clinical information between non-clinical administrative staff and clinical teams?
Links between ‘poor’ healthcare professionals’ communication and negative patient outcomes are widely accepted. Despite attempts to mitigate risks, poor communication that negatively impacts patient safety still occurs within healthcare, and the organ donation and transplantation pathway is no different.
Hub Operations is a team within this pathway who coordinate deceased organ donor offering across the UK, 24 hours-a-day, 7 days-a-week, 365 days-a-year. Whilst Hub Operations receive training in the tasks they complete, they are administrative staff with no requirement for clinical qualifications or background. They are often a conduit of complex clinical information from one clinical group to another, and as is often the case with administrative staff, provide a crucial role in ensuring patient safety. However, most previous studies exploring the communication pathways only include healthcare professionals, such as doctors and nurses, and administration staff are often not considered.
This study identified the barriers and facilitators to effective communication of clinical information between non-clinical administrative staff, specifically Hub Operations, and clinical staff, specifically Recipient Coordinators and Specialist Nurses – Organ Donation.
Two pilot interviews were completed to support the development of interview guides. Using these guides, 13 participants, four Specialist Nurses – Organ Donation, five Recipient Coordinators and four Hub Operation team members, were interviewed using semi-structured interviews. Indirect observations in the form of voice recordings were also used to complement the interviews. Interviews were transcribed and both content and thematic analysis were performed using NVivo 14 ®. This led to the development of sub-themes and descriptive themes, the relevance of which were discussed.
18 sub-themes were generated that enabled development of four descriptive themes consisting of peer support, appreciation of roles, civility and communication and risk. Clear interconnections and interdependencies were identified between all four descriptive themes. For example, an appreciation of someone’s role impacted positively on civility, and the presence of peer support benefitted communication.
It was identified that themes could behave as both facilitators and/or barriers depending on whether they were present, absent, positive or negative. This resulted in the development of two overarching themes: facilitators to communication and barriers to communication.
The Systems Engineering Initiative Patient Safety (SEIPS) 2.0 framework was used to explore the findings within the wider work system. This was chosen as it is a healthcare specific system approach that has been shown to identify potential barriers and facilitators of healthcare work systems. This highlighted that the sub-themes identified were system wide, and that many sat within the organisation component. However, whilst each sub-theme may be within a single component, they are not isolated from each other and interconnections and interdependencies are present between them.
This study highlighted that factors affecting communication within the organ donation and transplantation pathway are both multi-factorial and system wide. It also showed they can be both facilitators and/or barriers depending on their presence or absence which is consistent with previous literature. Further research to validate and evaluate the findings would be useful.
Several potential recommendations for practice were suggested based on the findings. Some of these may have a positive impact on more than one sub-theme, such as exploring the use of inter-professional education, and strategies to reduce incivility.
Examples of course work that have contributed to a wider understanding of Ergonomics and Human Factors.
Human Factors and Systems
The findings of the Bristol Royal Infirmary Inquiry were explored using systems models, including SEIPS and AcciMap. These highlighted that a systems approach supports the review of wider factors that either promote conditions that allow something to occur, or which failed to prevent it.
Inclusive Design
A persona of a lady with mild dementia was created to enable the development of a user-centred journey map. The use of the persona helped highlight the interactions the lady had through ‘her eyes’ whilst making the journey to visit her husband in Critical Care Unit. This allowed identification of several potential recommendations to develop an inclusive service for individuals with dementia.
Physical Ergonomics
The task of lifting boxes was analysed, considering postural, anatomical, physiological, biomedical and anthropometric factors. The participant was observed completing the task in several positions, and a variety of methods were used to analyse, including the Rapid Entire Body Assessment (REBA). Subsequently, several recommendations were made to mitigate risks.
