Nurses and physicians in General Internal Medicine (GIM) work in a complex environment where patients present with complex (co)morbidities; management of such patients requires input from a full range of medical disciplines. In addition, there is regular resident physician changeover every 8-9 weeks in this teaching environment, and patient “flow” problems caused by overcrowding and placement issues. This complexity causes difficulties in the information exchange between nurses and physicians necessary to manage patient care. Multidisciplinary team meetings have been suggested as helpful to interprofessional communication, and in General Internal Medicine these take place in the form of daily “Bullet Rounds”. More recently the use of process engineering approaches has been suggested as a way to increase efficiency in healthcare; this dissertation evaluates its impact on communication between nurses and physicians. The initial observational field study showed that information exchange was the main focus of dialogue in Bullet Rounds, and identified information gaps between nurses and physicians. Script Theory (Schank and Abelson 1977) was used to propose that information gaps in Bullet Rounds are caused by different knowledge and goals, which result in inconsistent scripts. A process engineering intervention took place in General Internal Medicine. Process engineering methods have been proposed as being helpful in process design and improvement in healthcare but have not been systematically evaluated. The researcher conducted a pre and post intervention study of Bullet Rounds in order to identify and analyse the impacts of a process engineering intervention on information exchange between nurses and physicians. The results showed that information loss decreased after the intervention but that resident physicians were not satisfied with the nurses-physician information exchange. The staff and resident physicians appeared to have distinct and different information needs and perspectives, while the nurses felt that the Bullet Rounds process had improved, but that it needed revisiting, and were not aligned with staff physicians on respective roles and responsibilities. The overall results suggest that even after the process engineering intervention, there was still misalignment of goals and scripts between the two groups of physicians and between the physicians and nurses, and strategies for addressing these gaps are proposed.

Nurses and physicians in General Internal Medicine (GIM) work in a complex environment where patients present with complex (co)morbidities; management of such patients requires input from a full range of medical disciplines. In addition, there is regular resident physician changeover every 8-9 weeks in this teaching environment, and patient “flow” problems caused by overcrowding and placement issues. This complexity causes difficulties in the information exchange between nurses and physicians necessary to manage patient care. Multidisciplinary team meetings have been suggested as helpful to interprofessional communication, and in General Internal Medicine these take place in the form of daily “Bullet Rounds”. More recently the use of process engineering approaches has been suggested as a way to increase efficiency in healthcare; this dissertation evaluates its impact on communication between nurses and physicians. The initial observational field study showed that information exchange was the main focus of dialogue in Bullet Rounds, and identified information gaps between nurses and physicians. Script Theory (Schank and Abelson 1977) was used to propose that information gaps in Bullet Rounds are caused by different knowledge and goals, which result in inconsistent scripts. A process engineering intervention took place in General Internal Medicine. Process engineering methods have been proposed as being helpful in process design and improvement in healthcare but have not been systematically evaluated. The researcher conducted a pre and post intervention study of Bullet Rounds in order to identify and analyse the impacts of a process engineering intervention on information exchange between nurses and physicians. The results showed that information loss decreased after the intervention but that resident physicians were not satisfied with the nurses-physician information exchange. The staff and resident physicians appeared to have distinct and different information needs and perspectives, while the nurses felt that the Bullet Rounds process had improved, but that it needed revisiting, and were not aligned with staff physicians on respective roles and responsibilities. The overall results suggest that even after the process engineering intervention, there was still misalignment of goals and scripts between the two groups of physicians and between the physicians and nurses, and strategies for addressing these gaps are proposed.