Understanding decision-making in interprofessional team meetings through interpretative repertoires and discursive devices

ABSTRACT

Health practitioners of the geriatrics ward in a teaching hospital participate in interprofessional team meetings to agree on treatment and discharge care plans for their patients suffering from chronic illnesses and co-morbidities and in need of coordinated assessments and care. We turn to the ideas in critical discursive psychology to grow a much-needed research area of examining the language-in-use and its effects in team decision-making. Specifically we explore how healthcare team members use language to perform collaboration or disengagement, creating different subject positionings for themselves and others out of a backcloth of discursive resources and practices. We observed and transcribed 108 case discussions and analyzed them for interpretative repertoires and discursive devices. During the first half of the team discussions, the members of various health professions employed the empiricist and lifeworld interpretative repertoires and the discursive strategy of perspective-taking, articulating these through formulations and questions. We use the notion of argumentative texture to better understand why an administrative structural support like protected turn-taking in team meetings is not enough to promote interprofessional collaboration. We conclude that health practitioners can improve their contributions and subject positionings at team meetings and consequently patient-care, by identifying habitually deployed linguistic resources depicting professional knowledge, and augmenting these with Other-oriented perspectives in their repertoires. By expanding their range of discursive repertoires and recognizing that discursive practices are embedded in the bigger context or argumentative texture of institutional and societal discourses, norms, values, beliefs and practices, interprofessional teams can work to improve communication and knowledge-sharing.

KEYWORDS:

• Interprofessional team meetings
• decision-making
• interpretative repertoires
• formulations
• questions

Notation

Spoken simultaneously

Acknowledgements

We are grateful to our participants for their contributions; and to Dr Lim Wee Shiong and Dr Mark Chan for their support of the study. We are greatly indebted to Ms Tan Keng Teng for her initiation and facilitation of this research. We appreciate Dr Bernadette Bartlam for her time and input in the review of the paper.

Declaration of interest

The authors report no conflict of interest. We obtained institutionalethics approval for observing, recording and interviewing our participants.

Additional information

Funding

This research was funded 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 a research analyst at HOMER (Health Outcomes & Medical Education Research), National Healthcare Group, Singapore.

Maria Athina Martimianakis

Maria Athina Martimianakis (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 Strategic Lead International, Wilson Centre for Research in Education, University Health Network, University of Toronto.