No ordinary consultation - a qualitative inquiry of hospital palliative care consultation services.

PURPOSE: Considering the great need for palliative care in hospitals, it is essential for hospital staff to have palliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care. However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need for further knowledge about the process of palliative consultations. The purpose of this study therefore was to examine how palliative consultations in hospitals are practised, as perceived by consultants and health care professionals on receiving wards. DESIGN/METHODOLOGY/APPROACH: Focus groups with palliative care consultation services, health care personnel from receiving wards and managers of consultation services. Interpretive description and constant comparative method guided the analysis. FINDINGS: Variations were seen in several aspects of practice, including approach to practice and represented professions. The palliative consultants were perceived to contribute by creating space for palliative care, adding palliative knowledge and approach, enhancing cooperation and creating opportunity to ameliorate transition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultation services utilised proactive practices that took the initiative in relation to the receiving wards. ORIGINALITY/VALUE: A lack of policy and divergent views on how to conceptualise palliative care appeared to be associated with variations in consultation practices, tentative approaches and a bottom-up driven development. This study adds knowledge, implying theoretical transferability as to how palliative care consultations can be practised, which is useful when designing and starting new consultation services.

Cultural camouflage--a critical study of how artefacts are camouflaged and mental health policy subverted.

This study identifies hidden artefacts in a public organisation. In contrast to earlier studies, it focuses on artefacts as concealing rather than conveying meaning. Negligent behaviour caused by an unpopular culture was recognised in five psychiatric wards at a Swedish university hospital. Data comprising observations (87 h) and interviews (n = 60) were collected over a period of 48 months (2008-2011). Four different items used in everyday work representing a deeper meaning of the organisation were identified during the observations. The items selected were work attire, nametags, keys and restraint beds. These were considered particularly promising when it came to the aim of the study, namely, to find out how artefacts are camouflaged. The observations and the interviews revealed that these were controversial and contested artefacts in the organisation. The study uses the term 'cultural camouflage' for behaviour that ignores and consciously conceals symbols that have negative values. This concept contrasts with previous research that shows how artefacts are emphasised and how they contribute to the character of the activity in a transparent way. Conservative and backward-looking behaviour among staff provided one explanation as to why artefacts were concealed. Another was the need to establish harmonious internal interactions.

From artefact to effect: the organising effects of artefacts on teams.

PURPOSE: Earlier studies have identified artefacts, but have only to a lesser degree looked at their effects. The purpose of this paper is to investigate how artefacts contribute to organisation. DESIGN/METHODOLOGY/APPROACH: A trauma team at a university hospital has been observed and its members interviewed. FINDINGS: The trauma team showed itself to be rich on artefacts since it had strong internal driving forces, high legitimacy, and tried to live up to high expectations from the outside. Its members were motivated to be in the forefront of trauma care. Through renewal, the team succeeded in maintaining demarcation. It also succeeded in systemising internal work tasks and made for itself a position in relation to the outside. The team's capacity, however, came to be limited by internal conflicts and battles for prestige. PRACTICAL IMPLICATIONS: The study shows that informal logic has a strong influence on teams. Teamwork contributed to the development of organisational structure and motivation for the personnel. ORIGINALITY/VALUE: Earlier studies advocate the important role of artefacts in order to communicate, collaborate, negotiate or coordinate activities. The conclusion is that artefacts also have an organising and developing effect on teams in a fragmented and differentiated healthcare.

Synchronous work: myth or reality? A critical study of teams in health and medical care.

RATIONALE, AIMS AND OBJECTIVES: In this article, ideal conceptions about teamwork are tested. The research question posed is: How are teams in psychiatry formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while the parallel work mode is a transitional form between group and team. METHODS: Three psychiatric outpatient teams at a university hospital specialist clinic were studied. Data were collected through 25 personal interviews and 82 hours of observations. The data collection was carried out over 18 months (2008-2009). RESULTS: Results show: (1) that the three theoretical distinctions between group and team need to be supplemented with two intermediate forms, semiparallel and semisynchronous teamwork; and (2) that teamwork is not characterized by striving towards a synchronous ideal but instead is marked by an adaptive interaction between sequential, parallel and synchronous working modes. CONCLUSIONS: The article points to a new intermediate stage between group and team. This intermediate stage is called semiparallel teamwork. The study shows that practical teamwork is not characterized by a synchronous ideal, but rather is about how to adaptively find acceptable solutions to a series of practical problems. The study emphasizes the importance of the team varying between different working modes, so-called semisystematics.

The 20-minute team--a critical case study from the emergency room.

RATIONALE: In this article, the difference between team and group is tested empirically. The research question posed is How are teams formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while parallel cooperation is a transition between group and team. METHODS: To answer the question, a longitudinal case study has been made of a trauma team at a university hospital. Data have been collected through interviews and direct observations. Altogether the work of the trauma team has been studied for a period of 5 years (2002-2006). RESULTS: The results indicate that two factors are of central importance for the creation of a team. The first is related to its management and the other to the forms of cooperation. To allow for a team to act rapidly and to reduce friction between different members, clear leadership is required. CONCLUSIONS: The studied team developed cooperation with synchronous elements but never attained a level that corresponds to idealized conceptions of teams. This is used as a basis for challenging ideas that teams are harmonious and free from conflicts and that cooperation takes place without friction.