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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 125-130

Quantifying face-to-face communication among multidisciplinary medical professions in a convalescent rehabilitation ward by using a name tag-type information communication device: A pilot study


1 Department of Physical Medicine and Rehabilitation, Tohoku University Graduates School of Medicine, Sendai, Miyagi, Japan
2 Department of Physical Medicine and Rehabilitation, Tohoku University Graduates School of Medicine; Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering, Sendai, Miyagi, Japan
3 Department of Physical Medicine and Rehabilitation, Tohoku University Graduates School of Medicine, Sendai, Miyagi; Center for Graduate Medical Education, Okayama University Hospital, Okayama, Japan

Date of Submission03-Oct-2020
Date of Decision12-Dec-2020
Date of Acceptance10-Jan-2021
Date of Web Publication10-Aug-2021

Correspondence Address:
Dr. Shin-Ichi Izumi
2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPRM-000118

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  Abstract 


Context: Although quantitative analyses of human behavior data collected through wearable sensors have uncovered principles of complex human behaviors and organization performances, quantitative assessment has not been conducted on communication among the medical team, despite its importance. Aims: The aim of the study is to quantify face-to-face communication in a multiprofessional medical team using a sociophysical method and wearable sensors. Settings and Design: The study was conducted at a rehabilitation ward in Japan; this was a pilot study. Subjects and Methods: The amount of time spent on face-to-face communication among 36 multidisciplinary medical professional in a rehabilitation ward was recorded using name tag-type sensors for 2 weeks. The average communication time per week for each pair of participants was calculated; the network diagrams were drawn by using Cytoscape software. The unpaired t-test and Welch's F-test used together with the Games–Howell post hoc test were performed to compare the communication times between two groups and among three groups, respectively. Results: The following three groups emerged: ward staff (nurses and care workers), rehabilitation therapists, and physicians/medical social workers. The communication time between physicians and ward staff (mean, 8.0 min/week) did not differ from that between the physicians and rehabilitation therapists (5.5). The communication time was longer among rehabilitation therapists (61.7) than among the ward staff (45.7), both of which were longer than that between the ward staff and rehabilitation therapists (4.8). Conclusions: Quantitative measurement of face-to-face communication time using wearable sensors characterized the staff behavior in a multiprofessional medical practice in a rehabilitation ward, which may affect medical team performance, such as patient outcomes.

Keywords: Communication, convalescent rehabilitation ward, interprofessional work, sociophysics, wearable sensor


How to cite this article:
Li Z, Izumi SI, Sato A. Quantifying face-to-face communication among multidisciplinary medical professions in a convalescent rehabilitation ward by using a name tag-type information communication device: A pilot study. J Int Soc Phys Rehabil Med 2021;4:125-30

How to cite this URL:
Li Z, Izumi SI, Sato A. Quantifying face-to-face communication among multidisciplinary medical professions in a convalescent rehabilitation ward by using a name tag-type information communication device: A pilot study. J Int Soc Phys Rehabil Med [serial online] 2021 [cited 2021 Oct 24];4:125-30. Available from: https://www.jisprm.org/text.asp?2021/4/3/125/323563

Zhiguang Li and Shin.Ichi Izumi contributed equally to this work.





  Introduction Top


Team care is essential in medical practice besides rehabilitation medicine.[1],[2],[3] Appropriate healthcare requires sufficient face-to-face communication, with communication errors being closely related to medical malpractice.[4] However, no study has yet quantitatively investigated face-to-face communication within the medical team. The use of sociophysical methods, such as communication equipment and algorithms, has made it possible to record events wherein individuals meet and exchange words.[5],[6],[7],[8],[9],[10] The present study aimed to measure and characterize the amount of face-to-face communication among various professions in a rehabilitation ward. Quantifying face-to-face communication may help identify communication characteristics affecting medical team performance.


  Subjects and Methods Top


Participants

Participants comprised two physicians (certified rehabilitation specialists, hereinafter referred to as physicians), one medical social worker, nine physical therapists (PTs), nine occupational therapists (OTs), four speech therapists (STs), nine nurses, and two care workers, who were working in a convalescent rehabilitation ward (45 beds) and were in charge of 49 patients, including 39 patients with stroke, eight with hip fracture, one with traumatic brain injury, and one with brain tumor. The total number of medical staff in the ward included two physicians, 13 PTs, 12 OTs, five STs, 24 nurses, and five care workers. Full-time night-shift workers and those who had been assigned to the ward for less than a year were excluded. Participant characteristics (age, sex, and occupation) are summarized in [Table 1] and [Table 2]. Among the included participants, 88.9% were in their 20s and 30s, and 72.2% were female.
Table 1: Age distribution

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Table 2: Sex distribution

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Measuring device

The present study recorded face-to-face communication time using name tag-type infrared sensors (height 58.7 mm × weight 82.0 mm × diameter 23.0 mm; 39 g; Hitachi Ltd., Tokyo). As shown in [Figure 1], the wearable sensor was attached to the upper torso of each subject upon arrival at work (08:30) and removed upon leaving work (17:30), over a period of 14 consecutive days. The sensor identified subjects engaging in face-to-face interactions within a horizontal angle range of 120°, vertical angle range of 60°, and radius of 3 m. To measure the communication time, data were organized into 1-min blocks of time such that the device recorded a score of one block when face-to-face contact was detected at least once during a 1-min period.
Figure 1: Name tag-type infrared sensor. The device was attached to the upper torso of the subject, enabling the identification of subjects involved in each face-to-face communication within the range of infrared communication (a horizontal angle of 120 degrees, vertical angle of 60 degrees and radius of 3 m)

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Analysis method

Collected data were recorded as the communication time between all participant pairs. The following analyses were then performed by using the collected face-to-face time data and working days when the participants worked with wearable sensors. Statistical analyses were conducted using IBM SPSS Statistics 21 (IBM Corp., Armonk, NY, USA), with a P < 0.05 indicating statistical significance.

Our working hypotheses are as follows:

  1. The communication time within the same professions, such as ward staff and rehabilitation therapists, would be longer than that between different professions, whereas the communication time within each professional group would not differ from that between different professional groups
  2. Rehabilitation physicians would have longer communication time with ward staff than with rehabilitation therapists, given that medical management of patients is an essential role of physicians.


Drawing a network diagram using communication time

The average communication time per week for each participant pair was calculated and subsequently used to create a network diagram using Cytoscape version 3.3.1 (National Institute of General Medical Sciences 45 Center Drive MSC 6200 Bethesda, MD 20892-6200, USA), an open source bioinformatics software platform used to visualize metabolic pathways and integrate gene expression profiles with associated data.[11]

The present study created a network diagram of the convalescent rehabilitation ward using Force Directed Layout, a drawing method wherein individuals with long communication time are placed closer to one another. Using Allegro Layout, an application for Cytoscape, symbols representing individual participants were deployed with the Allegro Edge-Repulsive Strong Clustering algorithm.

Comparison of communication time between ward staff and physicians and rehabilitation therapists and physicians

The communication time between physicians and rehabilitation therapists (PTs, OTs, and STs) and between physicians and ward staff (nurses and care workers) was compared using the unpaired t-test.

Comparison of communication time among rehabilitation therapists, among ward staff, and between rehabilitation therapists and ward staff

Welch's F-test together with Games–Howell post hoc test was used to compare the communication time among rehabilitation therapists, among ward staff, and between both groups.

Ethics

This study was conducted after approval from the Ethics Committee of the Tohoku University School of Medicine (Approval No. 2016-1-203), and written informed consent was obtained from all participants.


  Results Top


Working days of the participants wearing the sensors

During the 2 weeks of the study period, the average (standard error [SE]) number of working days for the individual professions when wearing the sensors was 9.9 (0.2) days for PTs, 9.7 (1.3) days for OTs, 9.6 (0.4) days for STs, 9.8 (0.2) days for rehabilitation therapists (PTs, OTs, and STs), 5.9 (0.5) days for nurses, 7 (1) days for care workers, 6.1 (0.5) days for ward staff (nurses and care workers), 9 (0.4) days for physicians, and 10 (0) days for the medical social worker. Some ward staff worked outside the recording time (day shift), and the working days when the participants worked outside the recording time were excluded. The average number of working days was significantly longer for rehabilitation therapists than for the ward staff (t (31) = 8.30, P < 0.001, unpaired t-test).

Visualization of communication time among professions

The Force Directed Layout for individual participants showed that rehabilitation therapists were located close to each other, although individual professions did not create an isolated group [Figure 2]. Nurses were also located close to each other except one. Two care workers were far apart from each other. Two physicians and one medical social worker were close to each other.
Figure 2: Network diagram for the weekly face-to-face communication time of individual participants over the experimental period. Notations with “n” added to the last four digits indicate the ID of the measuring instruments

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The Force Directed Layout for individual professions showed the presence of three groups within the network: rehabilitation therapists, nurses and care workers, and physicians and the medical social worker [Figure 3]. The communication time between PTs and OTs, between PTs and STs, and between OTs and STs was 68.1, 43.8, and 38.5 min/week, respectively. The communication time between nurses and care workers was 41.6 min/week. The communication time between physicians and the medical social worker was 26.3 min/week. These communication times were far above those for other combinations of different professions, which ranged from 1.3 min/week between care workers and the medical social worker to 8.8 min/week between STs and the medical social worker, with an average and standard deviation of 5.7 and 2.0 min/week, respectively.
Figure 3: Network diagram for the weekly face-to-face communication time of individual professions over the experimental period. Line thickness, numerical values for which are shown on the corresponding line, is proportionate to the face-to-face time. Recurrent arrows indicate communication within each profession

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The communication time within each professional group was 81.9 (physicians), 81.3 (PTs), 59.0 (OTs), 80.3 (STs), 47.7 (nurses), and 14.5 (care workers) min/week. There were no significant differences between the communication times within each professional group (average: 61.8, SE: 11.3 min/week) and the communication times between the different professions within each of the three groups described above (average: 43.7, SE: 6.8 min/week; t(9) = 1.3, P = 0.226, unpaired t-test).

Comparison of communication time between ward staff and physicians and between rehabilitation therapists and physicians

The average (SE) communication time between physicians and ward staff (nurses and care workers) was 8.0 (1.5) min/week, while that between physicians and rehabilitation staff was 5.5 (1.1) min/week. No significant difference was observed between the two communication times (t (64) = −1.33, P = 0.187, unpaired t-test).

Comparison of communication time among ward staff, among rehabilitation therapists, and between ward staff and rehabilitation therapists

The average (SE) communication time among ward staff, among rehabilitation therapists, and between ward staff and rehabilitation therapists was 45.7 (6.3), 61.7 (2.0), and 4.8 (0.3) min/week, respectively [Figure 4]. Given that Levene's test showed no homogeneity of variance, Welch's F-test together with the Games–Howell post hoc test was used. Welch's F-test showed a significant difference between the groups (F (2, 118) = 428.85, P < 0.001), with communication time among rehabilitation staff being the longest, followed by that among ward staff (P < 0.05) and then that between ward staff and rehabilitation staff (P < 0.001).
Figure 4: Communication time among medical staff in a rehabilitation ward. Columns and bars indicate means and standard errors of communication time, respectively. Communication time among rehabilitation staff was longer than that among ward staff, both of which was longer than that between ward and rehabilitation staff. Welch's F-test together with the Games–Howell post hoc test was used. **<0.001; *<0.05 for adjusted P value in the Games–Howell test

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  Discussion Top


The current study measured the communication time and visualized face-to-face interactions in a convalescent rehabilitation ward using a mobile communication device. Accordingly, this has been the first study to elucidate the characteristics of face-to-face interactions within a real-world medical team.

Network diagram constructed using face-to-face communication time

The network diagram allowed us to intuitively quantify the amount of face-to-face interactions among the medical team. The Force Directed Layout diagram for the individual participants showed that rehabilitation therapists were close to each other as were nurses and that two physicians and a medical social worker were close to each other. Physicians were similarly distanced from ward staff and rehabilitation therapists. Moreover, the diagram revealed that PTs, OTs, and STs did not create an isolated cluster of their own professions and that two care workers were far away from each other.

To demonstrate the relationship between professions, we herein created the Force Directed Layout diagram for individual professions, which subsequently showed the presence of three clusters within the medical team: rehabilitation therapists, nurses/care workers, and physicians and one medical social worker.

It is reasonable that rehabilitation therapists and nurses/care workers formed clusters considering the proximity of their working places. Regarding the physicians and the medical social worker, we assumed that physicians often contacted the medical social worker for rehabilitation management, such as when planning patient discharge. However, such contact may be accomplished via telephone or e-mail. Further research is therefore needed to clarify the function of face-to-face interactions during interprofessional work.

These findings appear to be consistent with what is expected of medical professionals working at rehabilitation wards. However, no quantitative data have been available regarding face-to-face interactions, which will be essential when planning for interaction changes among team members to improve performance.[6]

Comparison of communication time between ward staff and physicians and between rehabilitation therapists and physicians

We hypothesized that rehabilitation physicians would have longer communication time with ward staff than with rehabilitation therapists considering that medical management is an essential role of physicians. However, as shown in the Forced Directed Layout diagram for individual professions, physicians were similarly distanced from ward staff and rehabilitation therapists. This had been confirmed after comparing communication time between ward staff and physicians and that between rehabilitation therapist and physicians. Since all of the physicians in the ward participated in this study, the results reflect the face-to-face interactions of physicians with the ward staff and rehabilitation staff to a reasonable extent.

Considering that the number of working days of the ward staff was about 60% that of the rehabilitation therapists, we assumed that more face-to-face interactions between physicians with ward staff than with rehabilitation therapists occurred on each working day, although rehabilitation physicians are involved with rehabilitation management, such as evaluating patient function, determining treatment goals, and making therapeutic plans with therapists. We assumed that physicians might often contact rehabilitation therapists in the ward by telephone or in writing on the electronic medical system.

Comparison of communication time among rehabilitation therapists, among ward staff, and between rehabilitation therapists and ward staff

The present study had quantitatively demonstrated, for the first time, the differences in the communication time among ward staff, among rehabilitation staff, and between both groups. Accordingly, our results showed that the communication time among ward staff and among rehabilitation staff was 10 times longer than that between both professional groups, suggesting that face-to-face interactions mainly occurred between the same professions even in the rehabilitation ward implementing interdisciplinary teamwork. One possible reason for the gap in the communication time between ward and rehabilitation staff may have been the separate working places of the two groups. Nurses and care workers worked in the ward, whereas rehabilitation staff worked in the therapy room or in the individual patients' room. Moreover, both groups had separate break rooms.

The communication time among rehabilitation staff was 35% longer than that among ward staff, despite the seemingly closer working proximity among ward staff. Part of this difference may be explained by the 60% greater number of working days for rehabilitation therapists than for the ward staff. The closer working proximity among the ward staff may have reduced the effects of fewer working days on communication time.

The present study did not record the content of face-to-face interactions. We assumed that the participants sometimes just chatted instead of exchanging information and opinions about the patient care. Watanabe et al.[6] reported that face-to-face interaction with active body movements during resting time rather than working time was related to team performance. Natural dialog not limited to work may contribute to teamwork. Thus, measuring communication time, including chatting, seems to reflect some aspect of interprofessional work.

In this study, we focused on the average face-to-face interactions per week for each pair of participants instead of limiting them to the working days when both participants of each pair worked. Varpio et al.[12] pointed out that for clarifying the relationship between interprofessional communication and medical malpractice, it is necessary to understand the complexity of team members having individual goals, personal problems, being bound by the rules of their department, and living in their communities. Thus, it would be useful to know the average interprofessional face-to-face interactions within a certain period, including off-duty days. Nonetheless, further studies are necessary to clarify teamwork characteristics in various professions.

Quantitative communication time data obtained in the present study showed parts of the actual situation during interprofessional work in a rehabilitation ward. Such quantitative data will be useful for identifying communication deficits within a medical team or evaluating interaction developments among team members. Furthermore, causative relationships between face-to-face interactions and team performance, such as functional outcomes and patient-reported outcomes,[13] possibly may be clarified by examining, for example, the effects of sharing a break room, which might increase the communication time between ward and rehabilitation staff.

Limitations

Some limitations of the present study are worth noting. First, this study did not include all medical staff in the convalescent rehabilitation ward, except for two physicians and one medical social worker. Thus, sampling bias may have affected the results.

Second, the present study measured face-to-face communication time over a period of 2 weeks. Studies have shown that the average hospitalization period in convalescent rehabilitation wards throughout Japan was 67.5 days.[14] Patients in convalescent rehabilitation wards usually have stable medical conditions, except for reattack of stroke or other emergency states. Thus, medical staff performs relatively regular work. However, face-to-face interaction may increase immediately after admission, at which point evaluations of patient disability are shared and treatment goals are discussed or during discharge planning. Overall, 49 patients were cared for in the ward with 45 beds in the present study, with at least four patients newly admitted during the 2 weeks. Further studies quantifying the amount of communication time throughout hospitalization might better characterize the rehabilitation process from the viewpoint of interprofessional work.

Third, given that the present study had been conducted at only one hospital, our findings may not be applicable to other convalescent rehabilitation wards. As such, future multicenter research is needed.

Fourth, given the sex difference in communications,[15] it is possible that the results were influenced by the fact that there were more women than men in this study.

Fifth, although sociophysical techniques were used to acquire data and create network diagrams, hypotheses were tested using conventional statistical methods. Future studies should therefore clarify the structure and behavior of the medical team network using network parameters, such as topological overlap,[16] node similarity,[17] analytical methods for complex networks dealing with time-varying graphs,[10] or dynamical strength of social ties.[18]

Finally, one limitation of measurement method used in the present study was its inability to evaluate the quality of face-to-face communication. A previous study[6] determined the duration of active state by measuring participants' action using acceleration sensors. Accordingly, active bodily movements with several gestures may be related to high quality face-to-face interactions. In addition, if a participant was standing nearby and facing, but not talking to, another participant, the sensor counted this event as a face-to-face interaction. In this situation, there might have been a kind of interaction, such as recognizing each other's existence. Furthermore, given that the total amount of face-to-face communication time was recorded for each participant pair, it was impossible to determine the length or frequency of each face-to-face interaction during the measurement period.


  Conclusions Top


The current study has been the first to quantify face-to-face interactions among medical staff in a convalescent rehabilitation ward. The network diagram revealed the presence of three groups according to communication time: physicians/medical social workers, nurses and care workers (ward staff), and rehabilitation therapists. Moreover, our results showed that the communication time among ward staff and among rehabilitation therapists was 10 times longer than that between both groups.

In conclusion, the current study was able to quantitatively characterize staff behavior in multiprofessional medical practice at a rehabilitation ward by measuring face-to-face communication time using wearable sensors. Nonetheless, further studies are warranted to clarify whether teamwork characteristics could affect patient outcomes.

Acknowledgments

The authors appreciate Mr. Mamoru Ito, a founder of COACH A Co., Ltd., for giving the authors insight into communication within medical organizations and the staff of Nagamachi Hospital for their cooperation with this research. The authors would also like to thank Enago (www.enago.jp) for their assistance with English-language editing.

Financial support and sponsorship

This work was partially supported by JSPS KAKENHI Grant Number 15K12571.

Conflicts of interest

There are no conflicts of interest.



 
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