Interdisciplinary Communication in the Hospital Setting: A Systematic Review and Thematic Synthesis of the Qualitative Literature

Abstract

Introduction: Communication is widely recognised toplay a key role in patient care. The US Institute of Medicine's2002 report, 'Crossing the Quality Chasm', stated that 'effective methods of communication, both among caregiversand between caregivers and patients, are critical to providinghigh-quality care'.(1) Interdisciplinary communication (IDC)can be challenging due to differences in training, educationand roles between healthcare professions. Due to the natureof IDC, the majority of research on this subject has beenqualitative, exploring the views of healthcare professionalson IPC. To date, however, the qualitative evidence on IDChas not been synthesised in a systematic manner. Therefore,a systematic review of the qualitative literature on healthcareproviders' experiences of interprofessional communicationwas conducted and registered with PROSPERO (registrationnumber CRD42020177967).Aim: The primary aim of this systematic review was tosynthesise the qualitative evidence regarding healthcareproviders' perceptions of IDC in the hospital setting. A secondary aim was to identify the barriers and facilitators toIDC in the hospital setting.Methods: Studies were eligible for inclusion in the review if they met the following criteria: 1) studies examininghealthcare professionals' experiences of IDC, 2) studies conducted in the hospital setting, and 3) studies conducted usingqualitative research methods. Four databases (PubMed,CINAHL, Web of Science and Embase) were searched frominception until May 2020. Quality appraisal of the identified studies was conducted using the Critical Appraisal SkillsProgramme (CASP) tool for qualitative research. Data fromthe results sections of eligible studies were synthesised usingthematic synthesis as described by Thomas and Harden.(2)Thematic synthesis consists of three stages: 1) line-by-linecoding of all text relevant labelled 'results' or 'findings' inthe included studies, 2) organisation of codes into descriptivethemes that reflect the results of the included studies, and3) development of descriptive themes into analytical themesthat address the review question.Results: Eighteen studies were identified as being eligible for inclusion in this review (Figure 1). Five descriptivethemes emerged during thematic synthesis: 1) 'Hierarchy',2) 'Interprofessional Ethos', 3) 'Healthcare Environment',4) 'Personal Factors' and 5) 'Methods of Communication',which were developed into two analytical themes: 'Barriersto IDC' and 'Facilitators to IDC'. Personal factors, such asstrong interprofessional relationships, were found to facilitate IDC, while organisational factors, such as challengingand hierarchical working environments, were found to posebarriers to IPC.Conclusion: We believe that this review makes a significant contribution to the literature. To our knowledge, it is thefirst study to synthesis the qualitative evidence on healthcareproviders' perceptions of IDC in hospitals. Maintainingan interprofessional ethos and building positive working relationships were identified as facilitators to IDC, while hierarchy and challenging working conditions were identified asbarriers. A key finding is the significance that healthcare providers associate with personal aspects of IDC, such as mutualrespect and understanding among healthcare professionals.Future research should involve the theory-and evidencedriven design of interventions to improve personal aspectsof IDC, such as interprofessional education and engagement.