Khan Yasmin, Sanford Sarah, Sider Doug, Moore Kieran, Garber Gary, de Villa Eileen, Schwartz Brian
Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, Canada, M5G 1V2.
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
BMC Health Serv Res. 2017 Apr 28;17(1):312. doi: 10.1186/s12913-017-2220-5.
Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents.
A qualitative study was conducted using semi-structured interviews with 26 key informants from emergency departments and public health agencies in Ontario, Canada. Data were analyzed inductively and the analytic approach was guided by concepts of complexity theory.
Emergent themes corresponded to challenges and strategies for effective communication of public health guidance. Important challenges related to the coordination of communication across institutions and jurisdictions, and differences in work environments across sectors. Strategies for effective communication were identified as the development of partnerships and collaboration, attention to specific methods of communication used, and the importance of roles and relationship-building prior to an emerging public health incident. Following descriptive analysis, a framework was developed that consists of the following elements: 1) Anticipate; 2) Invest in building relationships and networks; 3) Establish liaison roles and redundancy; 4) Active communication; 5) Consider and respond to the target audience; 6) Leverage networks for coordination; and 7) Acknowledge and address uncertainty. The qualities inherent in local relationships cut across framework elements.
This research indicates that relationships are central to effective communication between public health agencies and emergency department clinicians at the local level. Our framework which is grounded in qualitative evidence focuses on strategies to promote effective communication in the emerging public health incident setting and may be useful in informing practice.
用于指导急诊科临床医生与公共卫生机构之间沟通的证据有限。在各种新出现的公共卫生事件背景下，沟通十分紧迫，因为急诊科临床医生必须执行相关建议以保护自己和公众。本研究的目的是：探索地方层面在新出现的公共卫生事件中向急诊科临床医生传达公共卫生指导意见的现行做法、障碍和促进因素；并制定一个框架，以促进在新出现的事件期间向临床医生有效传达公共卫生指导意见。
采用定性研究方法，对加拿大安大略省急诊科和公共卫生机构的26名关键信息提供者进行半结构化访谈。对数据进行归纳分析，分析方法以复杂性理论概念为指导。
新出现的主题对应于有效传达公共卫生指导意见的挑战和策略。重要挑战涉及跨机构和管辖区的沟通协调，以及不同部门工作环境的差异。有效沟通的策略包括建立伙伴关系和协作、关注所使用的具体沟通方法，以及在新出现的公共卫生事件发生前角色和关系建设的重要性。经过描述性分析，制定了一个框架，包括以下要素：1）预测；2）投资建立关系和网络；3）设立联络角色和冗余机制；4）积极沟通；5）考虑并回应目标受众；6）利用网络进行协调；7）承认并应对不确定性。地方关系中固有的特质贯穿于框架要素之中。
本研究表明，关系是地方层面公共卫生机构与急诊科临床医生之间有效沟通的核心。我们基于定性证据的框架侧重于在新出现的公共卫生事件背景下促进有效沟通的策略，可能有助于为实践提供参考。
