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Communicating in the Clinic: Negotiating Frontstage and Backstage Teamwork

Communicating in the Clinic presents the results of an innovative ethnography of communication on an interdisciplinary geriatric oncology team. This book goes beyond existing research on the correlations between team interventions and desired patient outcomes and on communication in formal team meetings by exploring the “backstage” regions of the clinic where team members communicate without patients present. Fluid communication patterns in the backstage of the clinic embody the dynamic enactment of teamwork in daily medical practice. Teams pervade contemporary healthcare organizations of all kinds, making attention to the effectiveness of their communication critical to successful patient care and smooth organizational functioning. Despite established correlations between use of teams and favorable outcomes, the effectiveness of the actual communication among team members is often in doubt. Much of the research on teams is “anecdotal, exhortatory and prescriptive. . . there is an absence of research describing and analyzing teams in action” (Opie, 1997, p. 260).
Communicating in the Clinic analyzes a real team in action. To thoroughly explore communication patterns on a “bona fide” (authentic, pre-existing) interdisciplinary health care team, I conducted an ethnography of geriatric team at a regional cancer center. I drew upon fieldnotes, transcripts of patient-team member interactions, clinic notes and dictations, and team member interviews to demonstrate the integral nature of the clinic backstage to cross-disciplinary collaboration and teamwork, and to document the direct and indirect effects of the backstage on communication with patients.
Throughout the book, I develop a model of embedded teamwork grounded in an inductively derived typology of backstage communication processes. This holistic model reflects the complexity, dynamism, and multiple sites of cross-disciplinary communication in the everyday enactment of teamwork. Embedded teamwork acknowledges the discourse between dyads and triads of team members in which disciplinary (or professional) lines are blurred and redrawn; hierarchies are subverted and reinscribed; significant variation in teamwork practices occurs; team members’ beliefs, values, and attitudes are expressed and change over time; and contextual constraints are reproduced, resisted, and negotiated through communication among team members. Moreover, the study addresses the opportunities and limitations of the current organization and ideology of the medical establishment as a context for cross-disciplinary teamwork.