The work performed through interprofessional meeting discourse: an observational study

The effectiveness of work performed through interprofessional practice is contingent on the nature and extent of communication between professionals. To date, there is little research exploring how the patterns of communication may impact interprofessional work. This study focused on communication during interprofessional meetings to better understand the interprofessional work performed through these encounters. Specifically, it examined how interactional discourse, that is, the patterns of language, influenced work performed during interprofessional meetings. A series of four interprofessional meetings in a rehabilitation unit were observed. Twenty-one participants were observed, including medical, nursing, allied health clinicians, and health professions students. Follow-up stimulated-recall interviews were conducted with five meeting participants. The data collection consisted of video and audio recordings and detailed field notes. Data were analyzed using a combination of genre analysis, a form of discourse analysis, and activity system analysis, drawing on Cultural Historical Activity Theory. This facilitated an in-depth examination of the structure of discourse and its influence on meeting outcomes. The meeting structure was defined and predictable. Two distinct forms of discourse were identified and labeled s<i>cripted</i> and <i>unscripted</i>. Scripted discourse was prompted by standardized documents and facilitated the completion of organizational work. In contrast, unscripted discourse was spontaneous dialogue used to co-construct knowledge and contributed to collaboration. There was constant shifting between scripted and unscripted discourse throughout meetings which was orchestrated by experienced clinicians. Rather than fragmenting the discussion, this shifting enabled shared decision making. This research provides further insights into the interprofessional work performed during interprofessional meetings. The scripted discourse was highly influenced by artifacts (communication tools) in meetings, and these were used to ensure organizational imperatives were met. Unscripted discourse facilitated not only new insights and decisions but also social cohesion that may influence work within and outside the meeting.跨专业实践（interprofessional practice）开展工作的成效，取决于专业人员之间沟通的性质与广度。迄今为止，鲜有研究探讨沟通模式如何对跨专业协作工作产生影响。本研究聚焦跨专业会议中的沟通行为，以期更深入理解此类互动场景下开展的跨专业协作工作。具体而言，本研究考察了互动话语（interactional discourse），即语言模式，如何影响跨专业会议中的工作开展。本研究对某康复科室的四场跨专业会议进行了全程观察，共纳入21名参会人员，涵盖医师、护士、辅助医疗临床人员以及卫生专业学生。随后对5名参会者开展了激发式回忆访谈。数据收集手段包括音视频录制与详尽的实地笔记。本研究结合类型分析（genre analysis，话语分析（discourse analysis）的分支方法）与活动系统分析（activity system analysis），并依托文化历史活动理论（Cultural Historical Activity Theory）开展数据分析。该分析框架有助于深入剖析话语结构及其对会议结果的影响。会议流程具有明确性与可预测性。研究识别出两种截然不同的话语形式，并分别标记为脚本化话语（scripted discourse）与非脚本化话语（unscripted discourse）。脚本化话语由标准化文档触发，用于推进组织性工作的完成。与之相对，非脚本化话语为自发式对话，用于共同建构知识并推动协作开展。整场会议中，脚本化与非脚本化话语始终处于动态转换之中，这一转换由经验丰富的临床人员统筹协调。该转换并未割裂讨论进程，反而助力实现共同决策。本研究进一步深化了对跨专业会议中跨专业协作工作的认知。脚本化话语高度依赖会议中的人工制品（artifacts），即沟通工具，此类载体被用于确保组织要务得以落实。而非脚本化话语不仅催生了新的认知与决策，还增进了群体凝聚力，这种凝聚力或对会议内外的工作均产生影响。