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"The Anesthesiologist Won't Return My Pages!": Relational Coordination in a Maternity Services Unit

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"The Anesthesiologist Won't Return My Pages!": Relational Coordination in a Maternity Services Unit

  1. 1. Boston University School of Management “The Anesthesiologist Won’t Return My Pages!” Relational Coordination in a Maternity Services Unit Guy Sack, M.A., Management Fellow Boston University School of Management
  2. 2. Boston University Slideshow Title Goes Here Boston University School of Management Our Collaboration  Bill Kahn – BU SMG  Vicky Parker - BUSPH  Kim Ramsdell – BU SMG  Diagnosis: specialties “bounce off each other”  Delay as a data point ”The Anesthesiologist Won’t Return My Pages!” 2
  3. 3. Boston University Slideshow Title Goes Here Boston University School of Management My Purpose  1) Bring well-thought-out conceptualization to the group  2) Develop frameworks for future independent research ”The Anesthesiologist Won’t Return My Pages!” 3
  4. 4. Boston University Slideshow Title Goes Here Boston University School of Management Communication and Medical Mistakes  Perrow: Normal Accidents (1984)  Regulations aimed at prevention (Kellogg, 2009; QuIC Task Force, 2000)  Evidence-based practice, clinical pathways (Furrow, 2003) ”The Anesthesiologist Won’t Return My Pages!” 4
  5. 5. Boston University Slideshow Title Goes Here Boston University School of Management Communication and Medical Mistakes  Paradigm of “flawless individual performance” and inadequate communication norms lead to failure (Moorman, 2007: 173)  Emotion usually framed as a consequence, not an antecedent (Wu, 2000; Goldberg et al., 2002)  The issue of always being “on stage” ”The Anesthesiologist Won’t Return My Pages!” 5
  6. 6. Boston University Slideshow Title Goes Here Boston University School of Management Specialists Involved  OBGYNs  Pediatricians  Anesthesiologists  Family Medicine  Certified Nurse Midwives (CNMs)  Nurses  Other support staff, such as physician assistants and techs ”The Anesthesiologist Won’t Return My Pages!” 6
  7. 7. Boston University Slideshow Title Goes Here Boston University School of Management How to Improve Communication?  Relational Coordination (Gittell, 2000, 2001, 2002, 2008)  Energy-in-conversation (Quinn & Dutton, 2005)  Role-based coordination (Bechky, 2006)  Threat rigidity (Staw, Sandelands, & Dutton, 1981)  Relational spaces(?) (Kellogg, 2009) ”The Anesthesiologist Won’t Return My Pages!” 7
  8. 8. Boston University Slideshow Title Goes Here Boston University School of Management Targets for Change ”The Anesthesiologist Won’t Return My Pages!” 8
  9. 9. Boston University Slideshow Title Goes Here Boston University School of Management What Are We Looking For?  Nurses  Meetings  Agreement or disagreement (actual, after any discussion)?  Vocal or silent? ”The Anesthesiologist Won’t Return My Pages!” 9
  10. 10. Boston University Slideshow Title Goes Here Boston University School of Management Model ”The Anesthesiologist Won’t Return My Pages!” 10 Agree (shared practices) Disagree Silent (routine) Successful pathway Lack of mutual respect/threat rigidity Vocal Positive communication “Surface agreement” OR power decision/loss of face
  11. 11. Boston University Slideshow Title Goes Here Boston University School of Management Interviews  Interviews are necessary to uncover the inner thoughts (actual agreement/disagreement) of organizational members.  What do you like about working here? What don’t you like?  Think back to a situation when you felt particularly uncertain of what your role should be? Tell me about it. Where were you? Who was with you? Did you discuss this with other people? How did it end up?  Think back to a situation in which you disagreed strongly with a co-worker or co-workers. Tell me about it. Did you speak up? Who? Where?  Have you been in a situation in which there was total agreement about the course of action? Who? Where? Was there a discussion? Was this a surprise? ”The Anesthesiologist Won’t Return My Pages!” 11
  12. 12. Boston University Slideshow Title Goes Here Boston University School of Management Thank You! ”The Anesthesiologist Won’t Return My Pages!” 12

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