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The Sound of Silence


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Via Lorelei Lingard: In an effort to convey research results a little differently, I created the following 'short story', to be performed in silence, at the HRS Graduate Research Day at UWO on February 9th. I thought it would be neat, and symbolic, to delivery a silent talk on the topic of "Silence" in team communication research. I learned two things: 1) It's hard to create slides that say it all, without verbal transition material spoken within and between them, and 2) It's a bit nerve-wracking to present a talk and stay perfectly silent while it unfolds.

Published in: Health & Medicine
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The Sound of Silence

  1. 2. Silence A short story about turning an unexpected corner in communication research
  2. 3. Silence is more eloquent than words. ~ Thomas Carlyle
  3. 4. Silence is a text easy to misread.  ~A.A. Attanasio
  4. 5. Better silent than stupid. ~ German proverb
  5. 6. Silence is one of the hardest arguments to refute.  ~ Josh Billings
  6. 7. Silence at the proper season is wisdom, and better than any speech. ~Plutarch
  7. 8. Silence is the most perfect expression of scorn. ~ George Bernard Shaw
  8. 9. Silence is the ultimate weapon of power. ~ Charles De Gaulle
  9. 10. In field research, there are moments when you can literally hear a pin drop. In fact, an observation session may contain as much silence as sound. Are you listening for that? What meaning do you make of it?
  10. 11. I study how healthcare teams communicate. My work has tended to focus on communication that is visible & audible. Recently, however, my data have revealed something I hadn’t paid any attention to before:
  11. 12. Team communication exists in a spectrum of speech and silence.
  12. 13. Sounds obvious, doesn’t it? In fact, you might wonder why I hadn’t noticed it before. Now that it’s smacked me in the head, the role of silence seems absolutely critical to my work. Let me show you what I mean, and why I think it matters.
  13. 14. <ul><li>The circulating nurse, who is new to the operating room, relieving someone on break, says to the scrub nurse: “How many sets of sponges did you have?” (The circulating nurse speaks loudly; the scrub nurse is soft spoken.) The staff surgeon picks up on this exchange and asks: &quot;What are you missing?” Neither nurse responds to his question. The circulating nurse leaves the rooom and checks something with the earlier circulating nurse, then returns to the room. The staff surgeon says, &quot;you're not answering the question. Are you missing something?” The circulating nurse says there is no issue. </li></ul>(Operating room fieldnote 672)
  14. 15. <ul><li>The staff surgeon noted loudly, without looking at anyone in particular: &quot;So we'll maybe give this guy a couple of doses of postoperative antibiotics&quot;. There is no immediate response from anyone present, although the staff anaesthetist looks up, seems to register what the staff surgeon has said, pauses in her work, but does not respond. A couple minutes later, the junior surgical resident asks, &quot;What did you say about postoperative antibiotics?&quot; There is no response from the staff surgeon. The question remains unresolved . </li></ul>(Operating room fieldnote 1103)
  15. 16. Methods point <ul><li>Silence is not the absence of communication. </li></ul>
  16. 17. Methods point <ul><li>Silences communicate : </li></ul><ul><li>agreement, passivity, resistance, distractedness, disregard, biding time… </li></ul>
  17. 18. Silence can influence the quality of the care that teams provide in both positive and negative ways.
  18. 19. <ul><li>The circulating nurse and scrub nurse are doing their count near the end of the case. Surgical resident requests “4-0 Vicryl please” [a type of suture] from the scrub nurse. The scrub nurse’s back is to him; she doesn’t immediately respond. Resident requests again with a slightly louder voice: “Can I get a 4-0 Vicryl please?” Nurse still doesn’t respond. The surgical resident raises his eyebrow at the junior resident across the table. A few moments later, the count is done. The nurse repeats “4-0 Vicryl”, handing the suture. The resident takes it, appears irritated, sighing loudly and shaking his head. </li></ul>(Operating room fieldnote 1171)
  19. 20. What does this silence mean?
  20. 21. Nurse didn’t hear the request; silence is not a communicative act.
  21. 22. Nurse did hear the request, but she’s busy. Silence is a communicative act that delays response.
  22. 23. Nurse did hear the request. She seeks to delay wound closure until the counting protocol is complete. Silence acts as a conflict-avoidance mechanism in a situation of potential conflict.
  23. 24. <ul><li>Silence is not the absence of meaning: it can be purposeful and meaningful, functional or dysfunctional. </li></ul><ul><li>(Glenn 2004) </li></ul>
  24. 25. <ul><li>Silence may reveal power relations and communicative constraints. </li></ul><ul><li>(Manias & Street 2001; Riley & Manias 2005; Gillespie et al 2007; Bradbury-Jones et al 2007) </li></ul>
  25. 26. For team communication research, silence is a key piece of the puzzle. But most empirical work in this domain focuses on communicative presence – what can be seen and heard.
  26. 27. Furthermore, observational and assessment tools in this domain emphasize concrete, audible bits of data: “information gathered and exchanged” Silences, neither gathered nor exchanged, are elided by these tools.
  27. 28. We’ve only begun to grapple with the problem of silence . One interesting place to start…
  28. 29. Her hearing was keener than his, and she heard silences he was unaware of. ~D.M. Thomas
  29. 30. How do we educate novices to hear – and correctly interpret – silences in healthcare team practices?
  30. 31. <ul><li>Staff surgeon says loudly without taking his eyes from the surgical field: &quot;Almost certainly we’re going to need a flexible sigmoidoscope and Dr. Black [urologist].&quot; The circulating nurse responds, using the surgeon’s first name, “When, Larry?” There is no response from the surgeon, who continues working. The nurse goes to call central processing to get the equipment sent up, after which she pages the urologist. </li></ul>(Operating room fieldnote 893)
  31. 32. What does this nurse hear in the silence that prompts her to act rather than wait?
  32. 33. <ul><li>Situation too emergent for surgeon to respond? </li></ul><ul><li>Surgeon doesn’t have ‘when’ answer yet and will respond when s/he does? </li></ul><ul><li>Question not worthy of response? </li></ul><ul><li>“ I asked for it now, so I need it now” </li></ul>
  33. 34. The use and the interpretation of silence are sophisticated communication skills on a healthcare team. We don’t know much about these skills; there’s a lot of research to be done here.
  34. 35. Ideas to pursue Silence and power Silence and decision-making Silence and persuasion Silence and socialization
  35. 36. [email_address]