Data on communication and team dynamics extracted from 38 patient discussions
Background: Antimicrobial resistance (AMR) is of critical concern requiring multimodal mitigation strategies, including effective communication in antimicrobial stewardship (AMS) and infection prevention and control (IPC). Despite multidisciplinary healthcare worker (HCW) collaboration being essential to IPC and AMS, professional hierarchies, silos, and health system barriers impact infection care outcomes.
Aims: This thesis investigates optimisation of infection related clinical practices using team dynamics and communication. Four connected studies addressed the following research questions related to IPC and AMS care: 1) What existing evidence supports hospital HCW team communication to improve practices? 2) Can reflexive workshops with sociograms enhance multidisciplinary team dynamics and communication in a South African tertiary hospital Intensive Care Unit (ICU)? 3) Can a visual ICU nursing handover tool support structured and consistent practice for every patient review? 4) How can the learning on adopting sociograms to describe team dynamics and communication for IPC and AMS be generalisable to other settings?
Study Design: The mixed methods design included 1) scoping review of literature on effective HCWs’ team communication in hospitals to enhance IPC and AMS bedside team communication 2) ethnographic study using sociograms to analysing ICU team interactions 3) participatory action research study with ICU nurses to design and adopt a nursing handover tool for structured IPC and AMS 4) collaborative knowledge transfer of sociogram approach through a pilot study with surgical teams in India.
Results: Limited evidence suggests effective multidisciplinary communication enhances teamwork and patient outcomes. Communication practices vary across disciplines, highlighting the need for self-assessment and tailored interventions. Structured communication strategies reduced opportunities for missed clinical information and enhanced clarity and target of clinical tasks. Sociograms and team reflexivity revealed dominant communication roles in ICU teams highlighting areas for improvement. A visual handover tool improved consistent AMS and IPC information transfer. Sociograms in the operating theatre provided insights into team dynamics and communication patterns in India.
Conclusion: Enhancing communication and teamwork among HCWs is vital for infection management. Targeted, structured communication on IPC and AMS can improve patient care. Using sociograms and reflexive feedback fosters team participation and problem- solving, engaging busy clinicians in co-design of interventions.
