The work performed through interprofessional meeting discourse: an observational study

Figures & data

Figure 1. Visual depiction of an activity system adapted from Engeström (Engeström, 2018).

Table 1. Overview of genre analysis.

Preliminary genre analysis	Secondary genre analysis
Mapping stages of each meeting as macro-genre	Identifying variation in each micro-genre existing within macro-genre
Complete data set (4 meetings = 439 mins)Video, audio recordings and field notes	Data subset (253 mins): Video, audio recordings and field notes relating to patient care planning micro-genre
Datapoints: Setting Up N = 4 Patient care planning N = 69 Closing N = 4	Data points: Patient care planning N = 35 (61% of this stage)

Table 2. Meeting details.

Participants	Meeting One	Meeting Two	Meeting Three	Meeting Four
Nursing	NUM1*	NUM1	NUM1	NUM1
Medical	M1 M2	M1 M3* M4	M1 M3 M5	M3 M5
Allied health	OT1	OT2	OT2	OT1 OT2*
	PT1	PT2	PT2*	PT2
	SW1	SW1	SW1	SW1
	SP1* SP2	SP1	SP1	SP1 SP2
ESD Team	ESD1 (SP)	ESD2 (PT)	ESD2 (PT)	ESD3 (OT)
Students	MEDS1 (with M2) MEDS2 (with M2) AHS1 (with ESD1)	MEDS1 (with M3) MEDS2 (with M3) AHS2 (with SP1) AHS3 (with SP1)	MEDS1 (with M3) MEDS2 (with M3) AHS2 (with SP1) AHS3 (with SP1)	MEDS1 (with M3) MEDS2 (with M3) AHS2 (with SP1) AHS3 (with SP1)
Meeting duration	94 mins	126 mins	96 mins	132 mins
Patients discussed	N = 17	N = 18	N = 17	N = 17
Time spent discussing patients	92 mins N = 1–9: 62 mins N = 10–17: 30 mins	123 mins N = 1–9: 76 mins N = 10–18: 47 mins	93 mins N = 1–9: 60 mins N = 10–17: 33 mins	128 mins N = 1–9: 72 mins N = 10–17: 56 mins

Attendees: ESD team members were from different professional backgrounds (in parentheses). Each undergraduate student attended meetings with one team member (in parentheses). *indicates which participants were interviewed after each meeting. Abbreviated codes are explained in Appendix One.

Table 3. Excerpt of scripted discourse.

Turn no.	Speaker	Transcription
5	M1	Ok, bed six. ~John. Let’s go through the goals.
6	M3*	Yep. I’ve got his.
14	M3*	Functional … upper limb use?
15	OT2	Yeah, progressing.
16	M3*	Thank you. Independent standing to left hand side?
17	OT2	Progressing.
18	M1	I’d say that’s achieved.
19	OT2	Yeah, achieved.
25	M3*	Ok, that’s all the goals. Snapshot?

Figure 2. Representation of scripted and unscripted activity systems. Pivotal factors highlighted in bold italics, strong alignment between factors represented by bold lines. Tensions represented by lightning shaped arrows. Tensions were between the subjects and the objective, and the division of labor and the objective of scripted discourse. A tension also existed between the two activity systems (i.e., between scripted discourse and unscripted discourse).

Figure 3. Visual representation of a scripted discursive interaction.

Figure 4. Visual representation of an unscripted discursive interaction.

Table 4. Excerpt of unscripted discourse.

Turn no.	Speaker	Transcription
10	SP1	I talked to the daughter who raised concerns that there were some cognitive changes … I flagged with OT, and we’ll do some joint things about the appropriateness of home. He also has quite significant receptive dysphasia receptive aphasia. He can’t follow more than single stage verbal instructions and he can’t read them either. That’s going to be a big barrier for him to go home. I’ll talk to the daughter about her capacity to provide any sort of care or any other additional options.
11	SW1	So, is the wife going to remain in care?
12	SP1	I think so.
13	M1	Yes, she is in permanent care. He told us today. He was really good with me today. He was struggling with word finding difficulties – but like, with prompting, um–

Table 5. Excerpt of unscripted (bold) and unscripted discourse.

Turn no.	Speaker	Transcription
31	M1	So, she has some clinical findings … not related to the seizure and it’s not explained by seizure. We need a speech assessment and to hear from ~SP1 whether this is a functional or whether this is secondary to the stroke … She’s having still ongoing symptoms for dizziness and vomiting. It looks like vertigo, but the history she was talking about ~PT2, so she maybe needs vestibular assessment.
32	PT2*:	Yeah, I’ve had a chat to her. I need to follow up with her husband too–
33	M1:	That will be great. But definitely – there is a functional element. I’m not sure if she had a diagnosis of FND ((functional neurological disorder)) before, like a confirmed–
34	PT2*:	I reckon she has because I think I’ve seen her ((before at another service)) and that was –
177	M1:	I think we need to get back – I think we need to clarify the diagnosis. Is that a pseudo seizure? Is that a true seizure or is that a clinical diagnosis of a stroke – I’m just – all of her symptoms and signs are mixed up –
178	M3:	And I don’t know, it sounds like some of [the symptoms] … are chronic and she does have a history of stroke.
179	M1:	Exactly, so there is lots of things – she’s under ~Dr. Johnson who’s a neurologist, so we may need to get in touch with ~Johnson because she knows her baseline … she will know, “That has been ongoing for a long time, this is a pseudo seizure.”
180	PT2*:	[Are there] any other goals?
181	M1:	No. But action plan; We really need social work – We’ll just get in touch with the neurologist to clarify the diagnosis and the plan ongoing.
182	SP1:	Do you think she’d need a TPM ((team planning meeting)) for the–
183	M1:	I think so … So, we need to get some information, go through her notes, and sit down together maybe end of the week?
209	PT2*:	So, I’ve written, ‘liaise with neurology, we’ll liaise with family, a TPM, vestibular assessment and speech assessment, and a social work referral’.

Engeström, Y. (2018). Expertise in transition: Expansive learning in medical work. Cambridge University Press.

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