Communication Breakdown Research Articles

An exploratory qualitative study of inter-agency health and social service partnerships focused on Aboriginal and Torres Strait Islander clients

BackgroundThe siloed nature of the health and social service system threatens access for clients engaging numerous organisations. Many Aboriginal and Torres Strait Islander people face adverse circumstances which contribute to multiple health and social needs. Effective relationships between health and social services are integral to coordinated service provision to meet the diverse needs of Aboriginal and Torres Strait Islander clients. Place-specific insights into inter-agency relationships are needed to inform targeted strategies that bolster service coordination to benefit Aboriginal and Torres Strait Islander people.MethodsThis study sought to understand experiences of inter-agency partnerships among health and social service providers on Kaurna Country in northern Adelaide using semi-structured interviews and yarning circles to explore partnership actions, outcomes, enablers, challenges, and identify strategies to strengthen partnerships. Fifty-nine service providers (78% female, 62% Aboriginal) participated including six from non-government organisations, 17 from Aboriginal community-controlled services and 36 from government organisations.ResultsA content analysis identified partnership actions such as client advocacy, referrals, sharing information, case management meetings and collaborative tender submissions which were seen to improve client access, navigation and outcomes and strengthen worker connectedness and job satisfaction. Motivated workers, listening to Aboriginal people, shared goals and values, and partnership agreements (e.g., memorandum of understanding, service contracts) were identified enablers of partnerships. Racism and ignorance, lack of networking events, communication breakdown, red tape and administrative barriers, competition between services, short-term funding, high turnover of staff and a focus on key performance indicators rather than community needs were among the challenges. Effective partnerships to benefit Aboriginal communities in northern Adelaide was reported to require aligned intersectoral strategic intentions, reforms to service commissioning processes, sustainable funding, regular network events for management and frontline workforce, Aboriginal practitioner-led service coordination approaches and a network of Aboriginal and Torres Strait Islander workers across organisations.ConclusionsThis study identified key leverage points for action on inter-agency partnerships to benefit Aboriginal and Torres Strait Islander communities on Kaurna Country. System drivers such as funded inter-agency networks and reforms to commissioning of services must support organisational- and practitioner-level enablers to strengthen partnerships between health and social services across northern Adelaide.

Framing Strategic Risk and a Look at the Calf Retention Decision

A business strategy is a plan of action designed to achieve specific goals and objectives using available resources. For most businesses, profitability is a primary objective. When a farm or ranch develops a business strategy to increase profits, it creates a roadmap that informs future decisions for financial success. But when does a business strategy become a risk? At first glance, this may seem like a trivial question. However, in the unpredictable world of agriculture, understanding how uncertainty affects the achievement of strategic goals is fundamental to managing an operation successfully. This is the essence of managing strategic risk. Strategic risks arise from uncertainties that can derail a business strategy. Internal uncertainties, such as poor communication or financial challenges, are common culprits. Communication breakdowns often hinder the implementation of strategies within agricultural operations. Similarly, financial uncertainties, especially low cash flow, are a leading cause of business failure. Even the best ideas cannot succeed without adequate financial resources.

Problems of adapting the linear model of communication when describing dynamic processes (based on studies of communication breakdown in speech interaction)

Problems of adapting the linear model of communication when describing dynamic processes (based on studies of communication breakdown in speech interaction)

Challenges and perceived impacts of ambulance diversions during emergency department overcrowding: a multi-stakeholder study

ABSTRACT OBJECTIVES Ambulance diversion has emerged as a strategy to address Emergency Department (ED) overcrowding, but the question of when or whether diversion should be triggered is widely debated. Although the positive and adverse impacts of diversion have been primarily studied using quantitative data, little is known about the experience and perceptions of key stakeholders involved in diversions. Our study aims to explore the challenges and impacts of ambulance diversion as experienced by key stakeholders and their suggestions for improving the diversion process. METHODS We conducted semi-structured interviews with key stakeholders including physicians, nurses and paramedics across two EDs and four fire stations. All interviews were audio-recorded following consent and transcribed verbatim. The transcripts were subjected to thematic analysis to identify key themes and sub-themes. Coding discrepancies were resolved through iterative discussions until no new themes were identified. RESULTS A total of 33 stakeholders were interviewed. The primary reasons for ambulance diversions were perceived to be resource constraints in EDs, overcrowding and bed block situations. Challenges during diversions included communication breakdowns, operational delays, lack of clarity in diversion criteria and emotional stress for both Emergency Medical Services (EMS) and hospital staff. Participants felt diversions impacted patient safety, staff morale, system efficiency and could generate inter-institutional conflict. Suggestions on improvements focused on use of alternative care pathways, improving hospital’s flow issues, better information sharing, and optimizing the diversion process through strategizing the timing and duration of diversions. Reworking the hierarchical approach of dissemination of information to ground staff was also suggested. CONCLUSIONS This study highlights that while diversions may offer temporary relief for overwhelmed hospitals, they also pose challenges and negative impacts on receiving hospitals and EMS operations. Our findings underscore the need for systemic improvements to address the root causes of ED overcrowding and enhance understanding among stakeholders involved in diversions.

Communication Capacities and Mutual Connection System of Teachers in Public Elementary Schools

This study examined the communication capabilities and mutual connection system of public elementary school teachers in the Davao Central District, Division of Davao City. A universal sampling method was employed using a non-experimental quantitative research design with a correlational approach. The respondents were 132 public elementary school teachers. Statistical tools utilized included the mean, Pearson Product-Moment Correlation Coefficient (Pearson r), and regression analysis. The findings revealed that the communication capabilities of public elementary school teachers—measured in terms of connections, compelling communication, stability, manners, listening, and charm—were often demonstrated. Similarly, the mutual connection system, assessed through revision, goal achievement, unification, and potential, was also frequently evident. A significant relationship was found between the teachers' communication capabilities and their mutual connection system. Furthermore, specific domains of communication capabilities significantly influenced the mutual connection system. These results underscore the synergistic relationship between communication capabilities and a mutual connection system, where effective communication enhances mutual connections, and a well-structured connection system fosters continuous and efficient communication. Conversely, weaknesses in these areas could result in communication breakdowns, misunderstandings, or diminished group cohesion. The study highlights the importance of fostering both robust communication skills and a supportive connection system among public elementary school teachers to promote collaboration and effectiveness in the educational setting. This study was limited to public elementary school teachers in the Davao Central District, which may affect the generalizability of the findings to other contexts. Future research could explore other educational levels or regions and consider mixed methods to provide deeper insights and validate the results.

Navigating High-Stakes Collaboration: A Critical Analysis of Team Dynamics Among Medical Staff in Pressure-Driven Surgical Operations

In high-stakes surgical operations, effective teamwork among medical staff is critical for ensuring patient safety and positive outcomes. This article presents a critical analysis of team dynamics under pressure, focusing on communication, role clarity, leadership, stress management, and team cohesion. Using case studies and an extensive review of existing literature, the analysis examines the challenges faced by surgical teams, including breakdowns in communication, hierarchical barriers, and stress-induced errors. Additionally, the article explores successful interventions that promote collaborative skills and resilience, such as closed-loop communication protocols, role-flexibility training, and leadership development. The findings suggest that structured teamwork training and stress-management strategies significantly enhance collaborative performance in pressure-driven surgical scenarios. This analysis underscores the importance of continuous team development and adaptive leadership in mitigating risks and improving patient outcomes.

Literatur Review Tentang Manajemen Konflik: Sumber, Gejala, dan Penyebab Konflik

Conflict is an inseparable part of human interaction and occurs at various levels of life, from individuals, groups, to society. This article discusses the sources, signs and factors that trigger conflict which are often interrelated in creating disputes. Conflicts can arise due to differences in interests, values, unequal distribution of resources, or imbalances of power. Signs of conflict generally appear through tension between individuals or groups, communication breakdowns, and the emergence of aggressive or resistive attitudes. Factors causing conflict are further understood as the result of structural and psychological elements such as misunderstanding, stereotypes, injustice and dissatisfaction. Understanding the sources, signs and causes of conflict provides valuable insight into efforts to manage and resolve conflict effectively, whether through dialogue, mediation or sustainable conflict transformation approaches.

Watch Out! It Is Not Delirium—It Is Wernicke's Aphasia!

Purpose: This case report aims to raise awareness among health care professionals and students that acute onset Wernicke's aphasia could be misinterpreted as delirium. In such a context, a patient's psychological/emotional reactions (e.g., agitation, anger) to aphasia associated communication breakdowns can be mismanaged as primary psychiatric concerns. Conclusion: Preliminary suggestions for relevant clinical practice are offered.

Unpacking the Role of Interdisciplinary Collaboration in Surgical Teams: A Critical Analysis of Operational Efficiency and Patient Outcomes

Interdisciplinary collaboration is essential for effective surgical operations, impacting both operational efficiency and patient outcomes. This critical analysis explores the dynamics of teamwork within surgical teams, focusing on how structured collaboration can streamline procedures, enhance resource management, and reduce surgical errors. Drawing from existing literature and recent empirical data, the article examines key factors that contribute to successful interdisciplinary collaboration, including role clarity, communication protocols, and mutual respect among team members. Findings reveal that well-coordinated interdisciplinary efforts lead to improved patient safety, reduced postoperative complications, and increased patient satisfaction. However, barriers such as hierarchical structures and communication breakdowns remain significant challenges. This analysis highlights actionable recommendations for fostering effective collaboration in surgical settings, such as targeted training, standardized communication strategies, and clear role definitions. Ultimately, strengthening teamwork within surgical teams not only optimizes operational efficiency but also enhances patient care quality, underscoring the importance of collaborative practices in modern healthcare.

Cost benefit analysis of flood risk in the area of Thrace in Greece

Cost-benefit analysis can significantly aid the decision-making process for flood risk reduction and mitigation. Decision-makers can use it to weigh the expenses of various flood mitigation strategies against their possible upside in terms of lowering the risk of losses and damage. Decisions regarding how to allocate resources for flood risk management can be made more intelligently with the use of this information by policymakers and stakeholders. During severe rainfall or snowfall, these rivers are prone to flooding, which can harm structures such as homes, businesses, and infrastructure, have negative impacts to land uses and as a result they can cause high opportunity costs. Flooding in the Thrace region can have indirect and direct expenses, including property damage and lost commercial activity. These costs can include communication breakdowns and higher insurance rates. The predicted total economic losses from erosion for all of Greece are €356 million and €649 million for a 0.5- and 1-meter sea level increase, respectively.

Code-ifying the Law: How Disciplinary Divides Afflict the Development of Legal Software

Proponents of legal automation believe that translating the law into code can improve the legal system. However, research and reporting suggest that legal software systems often contain flawed translations of the law, resulting in serious harms such as terminating children's healthcare and charging innocent people with fraud. Efforts to identify and contest these mistranslations after they arise treat the symptoms of the problem, but fail to prevent them from emerging. Meanwhile, existing recommendations to improve the development of legal software remain untested, as there is little empirical evidence about the translation process itself. In this paper, we investigate the behavior of fifteen teams---nine composed of only computer scientists and six of computer scientists and legal experts---as they attempt to translate a bankruptcy statute into software. Through an interpretative qualitative analysis, we characterize a significant epistemic divide between computer science and law and demonstrate that this divide contributes to errors, misunderstandings, and policy distortions in the development of legal software. Even when development teams included legal experts, communication breakdowns meant that the resulting tools predominantly presented incorrect legal advice and adopted inappropriately harsh legal standards. Study participants did not recognize the errors in the tools they created. We encourage policymakers and researchers to approach legal software with greater skepticism, as the disciplinary divide between computer science and law creates an endemic source of error and mistranslation in the production of legal software.

Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic review of the qualitative literature

ObjectiveDiagnostic delay is a pervasive patient safety problem that disproportionately affects historically underserved populations. We aim to systematically examine and synthesise published qualitative studies on patient experiences with diagnostic delay...

English for Medical Purposes: The Case of Korean Cosmetic Surgeons

EMP (English for medical purposes) has received more interest in South Korea to enhance the English competence of professionals working in medical contexts. Consequently, this study is based on two objectives: 1) to clarify cosmetic surgeons’ English needs and 2) to delve into cosmetic surgeons’ views regarding EMP courses they attended, focusing on the extent to which those courses met their English language needs. Data were gathered from 21 cosmetic surgeons through semi-structured interviews. The participants work at four hospitals in Seoul, which receive cosmetic surgery clients worldwide. The results conclude that most participants have to sharpen their communicative skills and strategies to establish effective doctor-client relationships and give outstanding health care. Nevertheless, the participants encountered English communication breakdowns because of the need for more productive vocabulary, unusual accents, and pronunciation issues. The cosmetic surgeons stated that the EMP courses they attended were not as helpful as expected, as the content did not match their English language needs at work. Therefore, the results imply that EMP courses’ teachers and designers have to create programs to meet the cosmetic surgeons’ English language needs.

Effects of divorce on nurses' performance in patient care

Divorce is a life-altering event that affects individuals and their professional lives [1]. For nurses who work in a highly demanding and emotionally charged environment, the impact of divorce can be particularly significant. Nurses are expected to maintain high levels of compassion, patience, and emotional stability while caring for patients. However, the emotional turmoil and stress that come with divorce may interfere with their ability to perform effectively at work. This article explores how divorce can affect nurses' performance, focusing on emotional, psychological, and physical aspects and strategies for coping and support [2]. One of the most immediate effects of divorce on a nurse's performance is the emotional toll it takes. Divorce can lead to feelings of sadness, anger, anxiety, and frustration, which may carry over into the workplace. Nurses, who are typically responsible for providing emotional support to their patients, may find it challenging to maintain a compassionate demeanor when experiencing emotional distress in their personal lives. This emotional strain can lead to burnout, reduced empathy, and a lack of patient engagement, negatively affecting the quality of care provided [3, 4]. The emotional stress of divorce can also contribute to communication breakdowns in the workplace. Effective communication is crucial for nurses to collaborate with other healthcare professionals and ensure patient safety. When emotionally overwhelmed, nurses may become more irritable, less focused, and prone to misunderstandings, leading to mistakes or conflicts with colleagues

Improving Patient Handoffs and Transitions in Care Among Residents: A Chief Resident-Led Initiative.

Effective handoff between pediatric residents is crucial to ensure continuity of care and patient safety.Omissions in information and communication breakdowns can be associated with uncertainty in clinical decision-making and adverse patient events. In our role as chief residents, we were notified of an increase in patient safety alerts due to communication failures and gaps during handoff. We aimed to identify areas for improvement and implement strategies to improve competence in handoff among pediatric residents. We also explored pediatric residents' confidence levels regarding handoff procedures and the effectiveness of our interventions in the transfer of care. Two chief residents conducted direct handoff observations of residents during the transfer of care of inpatients over six months. Residents were scored using a handoff checklist, and formative feedback was provided to each resident after the observation session. Deficits and barriers to properly executed handoff were noted and used to develop a series of handoff workshops. Pre- and post-workshop confidence in handoff skills was calculated from an average of each five-point Likert scale item (1=not at all confident, 5=very confident). Forty pediatric residents were assessed performing inpatient handoff. We observed 38 handoff sessions. All of these involved face-to-face interactions with verbal and written communication in the I-PASS (illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by the receiver) format, allowing the receiver of the information to clarify issues and ask questions. Protocol failures were identified in 50% of the handoffs observed. This included disruptions during handoff (5%), incorrect relay of patient information (26%), prioritizing sick patients (26%), omission of care tasks (10%), and provision of contingency planning (31%).Forty residents participated in the handoff workshops. Regarding confidence in handoff before and after the workshop, 67% of residents initially reported feeling "very confident" or "fairly confident" in their patient handoff skills. After the completion of the workshops, 98% of residents reported "fairly confident" or "very confident" in their ability to perform handoff.Pre- and post-workshop surveys demonstrated self-perceived increases in confidence (P<0.001). Following the completion of the workshops, we conducted observations and found that residents properly executed handoffs, and we received no further patient safety alerts regarding communication breakdowns. We identified several protocol failures in effective handoff among pediatric residents. Chief resident-led targeted workshops addressed these lapses, improved the effectiveness of patient handoffs, and reduced patient safety events related to breakdowns in communication. Our interventions increased confidence in handoff among pediatric residents, and these effects were sustained over time.

Telepractice-delivered communication training for informal caregivers of people with aphasia: A pilot study

Purpose To establish proof of concept of a student-led, telepractice-delivered communication partner training towards enhancing communication between people with aphasia and their informal caregivers in everyday conversations. Method Two dyads were recruited, each consisting of a person with aphasia and their caregiver. A pre-training questionnaire was completed by caregivers, followed by a weekly communication training session delivered by graduate student clinicians via telepractice to each dyad over 12 weeks. The caregivers then completed a post-training questionnaire. Both questionnaires included 13 Likert-scale questions and one open-ended question requiring an extended response. Result Pre- to post-training improvements for both dyads were identified on two domains of the questionnaire: (a) frustrations of the caregiver and person with aphasia and (b) caregivers’ knowledge and confidence in using communication strategies. This quantitative data was supported by additional extended responses regarding informal caregivers’ current communication strategies when communicating with the person with aphasia. Conclusion Both informal caregivers reported integrating communication strategies learned as part of the training in their interactions with the person with aphasia and experiencing fewer communication breakdowns during the two weeks following the training. The pilot study offers proof of concept for incorporating telepractice-delivered caregiver communication training as part of aphasia rehabilitation.

A comparative study of how teachers communicate in deaf education classrooms.

This study investigates the communication practices of four teachers in 3rd to 6th grade classrooms with 9 deaf students with limited language proficiency and in stages of emergent writing development. Analyzing language modalities, utterance types, and class interactivity, we found that teachers using American sign language used student-centered approaches, generating a greater number of directives and responsive utterances. They persevered in increasing students' engagement and were successful in clarifying misunderstandings. Teachers using spoken English used teacher-centered approaches, making general comments directed at the whole class, which consequently reduced student participation and responsiveness. They also largely avoided repairing communication breakdowns with emergent writers, focusing instead on those with greater auditory and speaking abilities. These patterns reveal disparities in classroom communication that can affect student learning. Our findings highlight the need for teacher preparation programs to equip teachers with skill sets to employ accessible and effective communication during instruction, especially with deaf students who are still developing foundational language and writing skills.

Wait, What? What's Going On?- Pregnancy Experiences of Deaf and Hard of Hearing Mothers Who Do Not Sign.

Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH women who do not sign to better understand their barriers and facilitators to optimal perinatal health care. Qualitative study using thematic analysis. Semi-structured, individual remote, or in-person interviews in the United States. Twenty-two DHH English speakers (non-signers) who gave birth in the United States within the past 5 years. Semi-structured interviews explored how DHH women experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access, and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. The barriers and facilitators related to a positive perinatal care experience among DHH women. Five key themes emerged. For barriers, healthcare communication breakdowns and loss of patient autonomy highlighted DHH women's struggle with perinatal health care. In contrast, DHH participants outlined the importance of accessible health communication practices and accommodations, use of patient advocacy or self-advocacy, and assistive technologies for DHH parents for more positive perinatal care experiences. Perinatal healthcare providers and staff should routinely inquire about ways to ensure an inclusive and accessible healthcare experience for their DHH patients and provide communication accommodations for optimal care. Additionally, healthcare providers should be more aware of the unique parenting needs and resources of their DHH patients.

End-stage heart failure patients in ICU: the importance of advance planning and effective communication.

During the disease trajectory, patients with advanced heart failure are often hospitalised with a high probability of admission to the intensive care setting. Using a case study, this article explores the care given to a patient with decompensated heart failure in an intensive care unit (ICU). It will discuss the significance of holistic assessment and effective symptom management, in particular the research related to breathlessness management. The importance of effective communication within the ICU multidisciplinary team, including with the patient/family will be explored, as the ICU environment can often lead to communication breakdown, patients being unable to voice their wishes and over-medicalisation. The effectiveness of early involvement of the palliative care team in ICU will be examined, including the use of tools such advance care planning and a treatment escalation plan and whether use of these can enable a better patient and family experience at the end of life. The role of palliative care champions will be discussed.

The burden of sustaining communication: communication breakdowns experienced by deaf students and their communication support workers in a further education college

ABSTRACT The educational inclusion of deaf students in England is usually interpreted as placement in mainstream settings alongside hearing students, creating unintended pressure for assimilation to the communicative needs of hearing people. In this context, it is deaf students and their communication support staff who are left to deal with communicative disparities found in educational settings. This ethnographic study explored episodes of communication breakdown in communicative interactions of 5 deaf college students in a further education college in Northern England. Analysis coded what was the source of breakdown, who noticed it, who repaired communication and what strategy was used. Findings were organised into three themes, reflecting how breakdowns were dealt with either by deaf students or their Communication Support Workers, or as a shared concern with teaching staff. Overall, deaf students were noted to deal with miscommunication through translanguaging, deploying their multilingual and multimodal repertoires to engage with multiple audiences and repair communication. Findings reflect how deaf students are overburdened with responsibility for ensuring communication is sustained, which opens further questions regarding the pressure to assimilate to hearing normative ways of communicating. Restricting deaf students’ communication to English may limit their development as bi/multilinguals and their learning experiences.