Using a Sociogram to Characterize Communication During an Interprofessional Team Huddle

Figures & data

Figure 1 The sociogram used to document the flow and frequency of team-members information exchange, questions, and requests. The sociogram depicts the inpatient nursing station where the huddle took place. Circles represent participant positions within the huddle. The diagonal line represents the window at the nursing station.

Table 1 Sample Sociomatrix with Data from Three Sociograms. We Included Up to Six Interactions per Patient Volley in Each Sociomatrix

Date	Initial Start–Interaction 1			Interaction 2			Interaction 3			Interaction 4			Interaction 5			Interaction 6			Volley Has > 6 Interactions
	Resident Info to Nurse	Resident Question to Nurse	Resident Request to Nurse	Nurse Info to Resident	Nurse Question to Resident	Nurse Request to Resident	Resident Info to Nurse	Resident Question to Nurse	Resident Request to Nurse	Nurse Info to Resident	Nurse Question to Resident	Nurse Request to Resident	Resident Info to Nurse	Resident Question to Nurse	Resident Request to Nurse	Nurse Info to Resident	Nurse Question to Resident	Nurse Request to Resident
Team 1
Volley 1	1			1
Volley 2	1			1			1			1
Volley 3	1	1		1
Volley 4	1				1		1					1
Volley 5	1				1		1
Volley 6	1				1		1
Volley 7	1			1			1			1			1				1		1
Volley 8	1
Volley 9	1
Team 2
Volley 1	1			1			1				1		1					1
Volley 2	1			1				1			1		1					1	1
Volley 3	1
Volley 4	1
Volley 5		1		1				1		1
Volley 6		1		1					1	1				1		1			1
Volley 7	1			1				1			1		1
Team 3
Volley 1	1				1		1
Volley 2	1			1							1
Volley 3	1				1		1				1		1
Volley 4	1
Totals:	18	3	0	10	5	0	8	3	1	4	5	1	5	1	0	1	1	2	3

Figure 2 Sample of one completed sociogram. Using a multi-colored pen, we captured the first interaction by drawing a line from the “resident” circle to the “nurse” circle. We captured the direction of communication with an arrow and annotated the type of communication as a question (?), a request (R), or information (I). If the nurse responded to the resident, a new line was drawn using the same pen color from the nurse circle back to the resident circle. We used the same process to capture direction of communication and type of communication. We documented each interaction between participants and truncated the lines by using a slash instead of the full line arrow. If a resident or nurse provided multiple forms of communication during the same interaction, symbols were written together without a slash.

Table 2 Themes from Analysis of Resident and Nurse Focus Groups Aligned with Representative Quotes

Themes	Representative Quotes
The huddle promoted a better-informed team.	Nurse: Things would happen overnight … pain prescriptions, one-time dose of something … some of these things and precautions were not put in actual orders, so the huddle gave us the opportunity to communicate these things to the residents. The huddle allowed for more big-picture planning … residents would use information and provide us with the plan for the day. Resident: There is no other point in the day you would have that interaction with the nursing staff about what happened overnight … nurses had just received direct checkout from night staff, so timing allowed less possibility for the nurses to forget what happened.
The huddle promoted relationship building.	Nurse: It provided a way for the nurse to be a part of the communication process, face-to-face with the residents … We got to know the residents and built rapport … and made them easier to approach. Resident: It was no longer Nurse X; you knew their name. It became my friend Rebecca instead of Nurse X. You see the nurse's face and their thought processes instead of a random voice on the phone.
The huddle promoted communication process efficiencies.	Nurse: Communication first thing in the morning reduced the number of calls to the resident throughout the day. Resident: The unit clerk and nurse may know who the attending physician is but they may not know which resident was responsible for which patient on a certain day. The huddle provided an opportunity to clarify which resident physician to call for which team … identifying the right patient care provider reduced calls throughout the day.
The huddle created logistical challenges.	Nurse: There were times the nurse could not be at the huddle because of patient-care issues. Resident: It was difficult to align everything at one single time. All three senior residents showed up for the huddle at 8:00 a.m. … without having scheduled times for each team, we would wait until the other residents gave report … so time was wasted.