Kristin Halvorsen

Questions as Interactional Resource in Team Decision Making

This study explores how professionals in an operational planning meeting in the petroleum industry employ questions as an interactional resource in team decision making. The empirical site is characterized by considerable uncertainty and frequent change as it is tightly bound to the sharp end of high-risk industrial production. A weekly meeting for optimizing well service plans was observed and recorded on nine occasions. The data were analyzed within the framework of Activity Analysis, emphasizing the relevance of the activity type for the analysis and interpretation of interactional features, in this case questions. Structural and interactional mapping of the meeting data provide an interpretive frame in which the role of questions in decision-making trajectories can be understood in light of the activity-specific context. The article presents one extended decision-making episode from opening to closure to show how questions play a role in decision making in this setting. Analysis shows that the questions are characterized by being brief and unelaborated, topically implicit, and fact-oriented, which is seen to be an efficient format in a setting that requires frequent adjustments of the commitments made in response to changes in the operational situation. While questions can function collaboratively by opening up the conversational space and seeking the expertise of others, they are also seen to function strategically, driving the decision-making trajectory in specific directions by setting the agenda and constraining subsequent interaction. The study contributes to the investigation of team decision making and professional reasoning in a setting rarely studied from a discourse analytic viewpoint.

Rhetorical accounts of risk: interprofessional risk assessment in operational planning meetings

In the context of high-risk industries, risk assessment takes place not only through standardized methods for risk analysis, but is frequently negotiated and discussed as an integral part of operational decision-making. This is not least the case in the context of operational planning. Frequent changes in operations require ongoing assessment of risk as tasks are rescheduled and resources reallocated. The current study explores how professionals account for the presence or absence of risk in a setting in which risk analysis is not the primary objective. With data from the offshore petroleum industry, the rhetorical aspects of risk assessments are examined. A series of interprofessional planning meetings were video recorded, transcribed, and analyzed using a rhetorical discourse analytic framework. The data are analyzed at a micro-interactional level in order to study how accounts of risk are presented and negotiated in this particular setting. The meaning and consequences of operational plan changes, and their implications for safety, are seen as negotiated discursively through interprofessional meeting talk. The analysis shows that accounts of risk are characterized by shifting rhetorical strategies that can be heard to echo established risk discourses often referred to as ‘technico-scientific’ and ‘contextualized’ conceptions of risk. Rhetorical devices are used interchangeably and strategically by the participants as they account for risk from their respective institutional positions and their specific areas of expertise and responsibility. The accounts are found to be increasingly persuasive and rhetorical in style as disagreements over risk and prioritizations surface. Accounts of risk, then, are not simply objective presentations of probability and consequence, but rather powerful tools for achieving specific professional outcomes. The study contributes to the understanding of risk assessment at its most concrete and practical level; as it takes place through professional interaction in an operational setting.

Users' perceptions on digital visualization of neuropathic cancer-related pain

Quality pain management implies a thorough pain assessment with structured communication between patients and healthcare providers. Pain distribution is an important dimension of cancer pain. Assessment of pain distribution is commonly performed on a pain body map. This study explores how a computerized pain body map may function as a communication tool and visualize pain in patients with advanced cancer. In previous studies, we have developed a tablet-based computerized pain body map for use in cancer patients. The aim of this study was to adapt the computerized pain body map program to patients with neuropathic cancer-related pain, and to develop a separate interface for healthcare providers. We also wanted to investigate the perceived usefulness of this system among patients and healthcare providers. Both patients and healthcare providers perceived that the visualization of pain in the computerized pain body map system had potential to be a positive contribution to clinical pain management, and to improve collaboration between healthcare providers.

Participation across distance: Claiming the floor in multiple-location video meetings

Team decision-making across geographical distance is increasingly common in the global workplace, often taking place via multiple location videoconference. Participation in these meetings is challenging, as claiming the floor requires coordination with numerous other participants and occurs in the absence of nonverbal information such as direct gaze. The present study examines how participants in a daily morning meeting in the offshore oil and gas industry claim the floor and how these turns at talk contribute to the daily adjustment of operational decisions. A discourse analytic approach emphasizing the relevance of the activity type (Levinson 1979) is taken. A systematic mapping of the encounter shows a highly structured and routinized activity type. Micro-analysis of interaction shows the meeting’s collaborative nature, evidenced in participants claiming the floor without having been assigned speaking turn and thematically orientating to a shared communicative project. By offering local information and operational details that have consequences for other participants, the speakers contribute to the continuous adjustment of inter-related decisions. The study contributes to our understanding of team decision-making in an empirical site rarely studied, with relevance for professional practice. The connection between activity type structure and the participants’ ability to claim the floor might encourage practitioners to reflect on the availability of the floor in existing activity types.

Strengthening patient safety in transitions of care: an emerging role for local medical centres in Norway

BackgroundPatient safety has gained less attention in primary care in comparison to specialised care. We explore how local medical centres (LMCs) can play a role in strengthening patient safety, both locally and in transitions between care levels. LMCs represent a form of intermediate care organisation in Norway that is increasingly used as a strategy for integrated care policies. The analysis is based on institutional theory and general safety theories.MethodsA qualitative design was applied, involving 20 interviews of nursing home managers, managers at local medical centres and administrative personnel.ResultsThe LMCs mediate important information between care levels, partly by means of workarounds, but also as a result of having access to the different information and communications technology (ICT) systems in use. Their knowledge of local conditions is found to be a key asset. LMCs are providers of competence and training for the local level, as well as serving as quality assurers.ConclusionsAs a growing organisational form in Norway, LMCs have to legitimise their role in the health care system. They represent an asset to the local level in terms of information, competence and quality assurance. As they have overlapping competencies, tasks and responsibilities with other parts of the health care system, they add to organisational redundancy and strengthen patient safety.