Visual mapping of team dynamics and communication patterns on surgical ward rounds: an ethnographic study

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Title: Visual mapping of team dynamics and communication patterns on surgical ward rounds: an ethnographic study
Authors: Bonaconsa, C
Mbamalu, O
Mendelson, M
Boutall, A
Warden, C
Rayamajhi, S
Pennel, T
Hampton, M
Joubert, I
Tarrant, C
Holmes, A
Charani, E
Item Type: Journal Article
Abstract: Background: Team dynamics influence infection prevention and management practices and implementation of antibiotic stewardship (AS). Using an innovative visual mapping approach, alongside traditional qualitative methods, we aimed to study team dynamics and flow of communication (who gets to speak, and whose voice is heard) during surgical ward rounds, and how team dynamics and communication patterns may shape decision-making in relation to infection management and AS. Materials/methods: Between May and November 2019, data were gathered through direct observations of ward rounds and face-to-face interviews with ward round participants in selected surgical specialties at a tertiary hospital in South Africa. Using a visual mapping method – sociograms – content and flow of communication and the social links between individual participants were plotted. Field notes from observations and interview transcripts were analysed using a grounded theory approach. Results: Data were gathered from 60 hours of ward round observations, including 1024 individual patient discussions; 60 sociograms, interviews with healthcare professionals (60) and patients (7). The nature of discussions about AS and IPC on ward rounds vary across specialties and are affected by the content and structure of the clinical update provided, the consultant’s leadership and interaction style, and competing priorities at the bedside. Registrars act as gatekeepers, initiating antibiotic discussions; consultants are key decision-makers. Other team members have limited input in ward round conversations, despite having recognised roles in AS and IPC. Hierarchies in teams manifest themselves on ward rounds in where staff position themselves, influencing their contribution to care. Varied leadership styles affect ward-round dynamics, in particular, whether nurses and patients are actively engaged in key decisions on infection management and antibiotic therapy, and whether actions are assigned to identified persons. Conclusions: The surgical bedside ward round, though attended by many specialties, remains a medium of communication between registrars and consultants, with little interaction with the patient or other healthcare professionals. A more team-focused and inclusive approach could result in more effective decision making about infection management and AS.
Issue Date: 17-Sep-2021
Date of Acceptance: 19-Jan-2021
DOI: 10.1136/bmjqs-2020-012372
ISSN: 2044-5415
Publisher: BMJ Publishing Group
Start Page: 812
End Page: 824
Journal / Book Title: BMJ Quality & Safety
Volume: 30
Issue: 10
Copyright Statement: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. This article has been accepted for publication in BMJ Quality & Safety following peer review. The definitive copyedited, typeset version Bonaconsa C, Mbamalu O, Mendelson M Groote Schuur Hospital Antimicrobial Stewardship and Surgical Study Group, et alVisual mapping of team dynamics and communication patterns on surgical ward rounds: an ethnographic studyBMJ Quality & Safety 2021;30:812-824 is available online at:
Sponsor/Funder: Economic & Social Research Council (ESRC)
Economic & Social Research Council (ESRC)
National Institute for Health Research
Funder's Grant Number: ES/M500562/1
Keywords: antibiotic management
social sciences
Groote Schuur Hospital Antimicrobial Stewardship and Surgical Study Group
Health Policy & Services
1103 Clinical Sciences
1117 Public Health and Health Services
1302 Curriculum and Pedagogy
Publication Status: Published
Online Publication Date: 2021-02-09
Appears in Collections:Department of Infectious Diseases
Faculty of Medicine