Selling patients and other metaphors: A discourse analysis of the interpretive frames that shape emergency department admission handoffs

Brian Hilligoss

Social Science & Medicine, 2014, vol. 102, issue C, 119-128

Abstract: This paper reports a discourse analysis of the language doctors used as they talked about and engaged in patient handoffs between the emergency department (ED) and various inpatient services at one highly specialized academic tertiary teaching and referral hospital in the Midwest United States. Although interest in handoff improvement has grown considerably in recent years, progress has been hampered, perhaps in part, because of a widely used but limiting conceptual model of handoff as an information transmission. The purpose of the study reported here is to analyze the way doctors make sense of handoff interactions, including uncovering the interpretive frames they use, in order to provide empirical findings to expand conceptual models of handoff. All data reported were drawn from a two-year ethnographic study (2009–2011) and include semi-structured interviews (n = 48), non-participant observations (349 h), and recorded telephone handoff conversations (n = 48). A total of eighty-six individuals participated, including resident and attending doctors from the ED, internal medicine and surgical services, as well as hospital administrators. Findings are organized around four metaphors doctors used: sales, sports and games, packaging, and teamwork. Each metaphor, in turn, reveals an underlying interpretive frame that appears to be influenced by organizational and social structures and to shape the possibilities for action that doctors perceive. The four underlying interpretive frames are: handoff as persuasion, handoff as competition, handoff as expectation matching, and handoff as collaboration. Taken together, these interpretive frames highlight the complex, socially interactive nature of handoff and provide an empirical basis for grounding and enriching the conceptual model of handoff that guides research and practice improvement efforts.

Keywords: United States; Ethnography; Discourse analysis; Interpretive frames; Transitions of care (search for similar items in EconPapers)
Date: 2014
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (4)

Downloads: (external link)
http://www.sciencedirect.com/science/article/pii/S0277953613006370
Full text for ScienceDirect subscribers only

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:eee:socmed:v:102:y:2014:i:c:p:119-128

Ordering information: This journal article can be ordered from
http://www.elsevier.com/wps/find/supportfaq.cws_home/regional
http://www.elsevier. ... _01_ooc_1&version=01

DOI: 10.1016/j.socscimed.2013.11.034

Access Statistics for this article

Social Science & Medicine is currently edited by Ichiro (I.) Kawachi and S.V. (S.V.) Subramanian

More articles in Social Science & Medicine from Elsevier
Bibliographic data for series maintained by Catherine Liu ().