Formal communication
Team meetings were viewed by participants as fundamental to their formal communication process and as an opportunity to engage all members in a consensus-building process.
At team meetings we discuss problems or things that we think need to be addressed. Everyone puts in their two cents regarding the problem. We operate on consensus and solve issues and make sure that everybody is okay with the decision that is made.
Having both regular and scheduled team meetings was also seen as important. Regularly scheduled team meetings provided a venue to discuss issues relevant to the team and to problem solve about clinical and administrative issues.
If there’s something that needs to be instituted or brought in practice-wide, we’ll do it through those meetings and then we’ll send minutes of the meeting so that everyone is aware of what was discussed because not everyone can attend.
Participants also agreed that agendas and minutes of team meetings assisted in organizing and documenting the team’s activities and decisions. One participant commented, “I make an agenda ahead of our discussions of what everyone’s concerns may be and we voice our opinions and try to work things out for ourselves.” Minutes taken at meetings served as documentation and guided the direction of future action. “At the monthly meetings there are minutes taken and [the minutes are] referred to over the course of the following weeks.”
Memorandums served as another means of communication among team members to relay urgent messages (“If there was something urgent I would send a memo”) or to provide updates (“The doctors send a lot of memos. They send them to every team member about something in public health or current issues that are happening”).
Although computer-assisted communication is relatively new to these teams, it was endorsed by most participants. They saw it as a more efficient means of communication that was less vulnerable to human error.
The computers have become a really good communication device because [there is] a messaging system on the [electronic medical record]. So instead of having a whole bunch of little slips of paper with messages on [them], which sometimes get lost, they’re listed in the computers. You don’t have to worry about where you put the piece of paper.
Computer-assisted communication was also viewed as a means of sharing information more quickly: “With our computer system we have a wonderful message system where we can relay the messages and ask questions and then they reply that way.”
However, participants spoke frankly about the strengths and weaknesses of e-mail communication. E-mail communication allowed for transparent documentation, efficiency, and objectivity: “It has to do with documentation and making sure that it is in writing, and in some instances it is more time efficient and it keeps the emotional aspects out of it.” On the other hand several constraints with regard to e-mail use were voiced by front-line staff who felt that they, in comparison to the doctors and nurses on the team, did not have sufficient time available to use e-mail effectively.
We’re front line so computer access for e-mail is quite restricted. You seldom have time to sit and read a full e-mail so, e-mails for me are failing us as secretaries. Doctors and nurses can shut their door in between clients. We don’t have enough time.
As these individuals had limited time to check their e-mail they relied on “grapevine communication” to alert others to essential e-mail messages. “We don’t always have time to check our e-mails … so what happens is one person will see it and then pass it to the rest and then everybody’s checking their e-mails.” Finally, there were team members who were “not computer savvy” or who were perceived as being “afraid of the computer” and “not tenacious enough to figure it out,” as they did not view it as “a priority.”
Another important form of formal communication, which was more profession-specific, was the use of “communication logs” to transmit information about patient care issues. Communication logs were essential where team members held part-time positions or were job-sharing and rarely had face-to-face contact. “The nurses keep a log book so that we can jot things down and communicate important information to the nurses who are not here every day. That way nothing gets missed.”