Ideological dilemmas of healthcare professionals who do not speak up at interprofessional team meetings

ABSTRACT

In healthcare settings, speaking up is considered essential for patient safety. Indeed, voice opportunities are widely available mandatory mechanisms for speaking up at the routine interprofessional team meetings of our study site. Yet, healthcare professionals in team meetings often do not go beyond straightforward reporting of test results and biomedical-functional parameters, suggesting that members with psycho-social information related to the patient are not participating fully in team meetings. Post-meeting interviews with some of the team members revealed the moments of silence and the ideological contradictions underlying team discussions. We explored silences and contradictions as argumentative meanings inherent in naturally occurring speech. The identification of opposing meanings tells of ideological dilemmas that may explain why healthcare practitioners do not speak up vigorously. We identified three such dilemmas: the ideology of working in teams versus the ideology of working solo; the ideology of autonomy versus the ideology of paternalism; and the ideology of collectivism versus the ideology of individuality. The dilemmas made visible the dimensions of silence as well as silencing as an imposition of silence from above. We suggest focussing on mapping disciplinary and interpretive differences and their effects amongst team members may motivate voice. Further studies should explore the affective dimensions of silence in interprofessional team meetings.

KEYWORDS:

• Speaking up
• ideological dilemmas
• acquiescent silence
• silencing
• difference thinking

Acknowledgments

We are grateful to our participants for their contributions and to Dr Lim Wee Shiong and Dr Mark Chan for their support of this study. We are indebted to Ms Tan Keng Teng for her initiation, facilitation, and support of this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website

Additional information

Funding

This work was supported by HOMER Grant (FY16/B04).

Notes on contributors

Mary Lee

Mary Lee is Principal Research Analyst at HOMER (Health Outcomes & Medical Education Research), National Healthcare Group, Singapore.

Yu Han Ong

Yu Han Ong is Research Analyst at HOMER (Health Outcomes & Medical Education Research), National Healthcare Group, Singapore.

Maria Athina Martimianakis

Maria Athina (Tina) Martimianakis is Associate Professor and Director of Medical Education Scholarship, Department of Paediatrics, Faculty of Medicine, University of Toronto. She is also Scientist and Associate Director, Collaborations and Partnerships at the Wilson Centre, University Health Network, University of Toronto.