Clinical Communication

Researchers at CHI are internationally recognised for our pioneering research into health care organization communication over the last decade, and we have contributed to highlighting the importance of this topic, developing theoretical models to help understand communication, and contributing basic research that specifically highlights the very high communication loads under which health care workers have to operate.

Traditionally health informatics research has focussed on information system design, with an emphasis on the representation and storage of information, for example in the health record. The support of communication has received little attention, despite the fact that up to 90% of the information transactions in some health services do not involve stored electronic data, but are the exchange of information between clinicians, often in face-to-face conversation.

However, the importance of supporting effective communication in health care is growing. Health care is not always safe or effective, and the role of poor communication in generating avoidable error and poor outcomes is now widely discussed. For example, we have argued that the highly interruptive media such as the pager and the telephone, often the main means for communication between health professionals, can cause memory disruptions and lead to errors. Since communication inefficiency and failure may be a core generator of clinical error, supporting more effective communication practices may have great impact on the quality and safety of health service delivery.

Health informatics has a key role in shaping our understanding of the role of communication in health care processes, and in crafting interventions to support improved communication. Information and communication technology seems to be a promising means for restructuring many communication processes, and there currently are an increasing array of communication channels, media, and devices from which communication services can be constructed. Informatics is also interested in the socio-technical aspects of health services, and understanding the impact of organisational and cultural processes on poor communication is also crucial.

Communication research in other disciplines has historically been theory rich and data poor. In health informatics, where we are constantly reminded of the need to make pragmatic improvements to the outcomes of health care delivery, empirical evidence is needed to guide this research agenda. This evidence can be of two main types:

1. Demonstrations of the way communication processes are organized within health care, that can inspire the design and implementation of communication supporting systems;
2. Demonstrations of the effects of the deployment of communication supporting applications on communication processes within health care.

Recently funded projects

• Agent-based methods for communication system design in complex organizations
  
  Prof EW Coiera; A/Prof JI Westbrook; A/Prof WR Wobcke; Dr F Magrabi
  
  ARC Linakge Project LP0775532
  2007:$140,000
  2008:$160,000
  2009:$127,726

Key publications

• Coiera E, Communication systems in healthcare, Clin Biochem Rev 2006:27(ii):8
• Alvarez G, Coiera E, (2006) Interdisciplinary Communication: an uncharted source of medical error? Journal of Critical Care 21(3);236-242.
• Alvarez G, Coiera EW (2005) Interruptive communication patterns in the intensive care unit ward round, International Journal of Medical Informatics, vol.74, pp.791-796. Full thesis available here.
• Touissant PJ, Coiera EW (2005) Special issue: supporting communication in health care, International Journal of Medical Informatics Oct;74(10):779-81
• R. Spencer, E. Coiera, Variation in Communication Loads on Clinical Staff in the Emergency Department, Annals of Emergency Medicine 2004:44/3,268-273.
• E. Coiera, R. Jayasuriya, J. Hardy, A. Bannan, M. Thorpe, Communication loads on clinicians in the Emergency Department, Med J Aust 2002, 176:415-418.
• R. Spencer, P. Logan, E. Coiera, Communication Observation Method (COM) Manual, ISBN 0733420141, 38pp, 2002.
• R. Spencer, P. Logan, E. Coiera, Refinement and validation of observational and data analysis techniques to measure communication patterns in clinical settings, ISBN 0733419291, 24pp, 2002.
• E. Coiera, When Conversation is better than Computation. Journal American Medical Informatics Association. 7,277-286, 2000.
• J. Parker, E. Coiera, Improving Clinical Communication: a view from Psychology. Journal American Medical Informatics Association. 2000; 7:453-461.
• E. Coiera, V. Tombs, Communication behaviours in a hospital setting - an observational study, British Medical Journal, 316,673-677, (1998).
• E. Coiera, Clinical Communication - A New Informatics Paradigm, Proc. American Medical Informatics Association Autumn Symposium, 17-21, (1996).