Interdepartmental Communication in Respect to Work Place

Safety in Trauma Situations

A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree of

Doctor of Business Administration, Management

By

Nicole T. Walton-Trujillo, R.T. (R) (CT), ASRT, ARRT, BSRS, NMSRT, MBAH, MOL

Colorado Technical University

September 15, 2019

Committee

[Research Supervisor name], [Degree], Chair

[Committee Name], [Degree], Committee Member

[Committee Name], [Degree], Committee Member

_________________________________Date Approved

© Nicole T. Walton-Trujillo, 2019

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Abstract

Insert your Abstract here in a single, double spaced paragraph using the following:

1. Includes a statement highlighting the problem under study.

2. Identifies the design (i.e., exploratory, phenomenological, quasi-experimental, correlation,

etc.) NOTE: Do not mention the method (qualitative/quantitative/design science) in the

abstract.

3. Identifies the study’s population and geographical location.

4. Identifies theoretical framework (quantitative) or conceptual framework (qualitative) that

grounded the study; theory/conceptual framework names are lower case.

5. Describes the data collection process (e.g., interviews, surveys, etc.).

6. Describes the data analysis process (e.g., modified van Kaam method) to identify themes in

qualitative studies; (e.g., t test, ANOVA, or multiple regression) to report statistical data in a

quantitative study. Do not present the names of software such as SPSS.

7. Identifies the themes that emerged from the study (qualitative) or presents the statistical

results from the study (quantitative).

8. Ensures the first line in the abstract is not indented.

9. Ensures Abstract does not exceed one page.

10. Uses plural verbs with data (e.g., the data were - the word data is the plural of datum).

Keywords: …

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Dedication

Add a Dedication, if desired.

iii

Acknowledgements

Add Acknowledgements.

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Table of Contents

Acknowledgements........................................................................................................iv

Table of Contents.............................................................................................................v

List of Tables..................................................................................................................ix

List of Figures..................................................................................................................x

Chapter One.........................................................................................................................1

Topic Overview/Background...........................................................................................1

Problem Statement...........................................................................................................2

Purpose Statement...........................................................................................................2

Research Question...........................................................................................................3

Hypotheses/Propositions..................................................................................................3

Theoretical Perspectives/Conceptual Framework...........................................................4

Assumptions/Biases.........................................................................................................4

Significance of the Study.................................................................................................5

Delimitations....................................................................................................................5

Limitations.......................................................................................................................5

Definition of Terms.........................................................................................................6

General Overview of the Research Design......................................................................5

Summary of Chapter One................................................................................................7

Organization of Dissertation (or Proposal)......................................................................7

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Chapter Two........................................................................................................................9

Patient Experience...........................................................................................................9

Proof it Happens............................................................................................................14

Communication..............................................................................................................18

Management..................................................................................................................28

Change Management......................................................................................................33

Conceptual Framework..................................................................................................38

Summary of Literature Review.....................................................................................39

Chapter Three....................................................................................................................41

Research Tradition.........................................................................................................41

Research Question.........................................................................................................41

Hypotheses (Quantitative Study Only)..........................................................................42

Research Design............................................................................................................42

Population and Sample..............................................................................................42

Sampling Procedure...................................................................................................43

Instrumentation..........................................................................................................44

Validity......................................................................................................................45

Reliability..................................................................................................................45

Data Collection..........................................................................................................45

Data Analysis.............................................................................................................47

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Ethical Considerations...............................................................................................48

Summary of Chapter Three...........................................................................................48

Chapter Four........................................................................................................................*

Participant Demographics (if appropriate)......................................................................*

Presentation of the Data...................................................................................................*

Presentation and Discussion of Findings.........................................................................*

Summary of Chapter Four...............................................................................................*

Chapter Five.........................................................................................................................*

Findings and Conclusions................................................................................................*

Limitations of the Study..................................................................................................*

Implications for Practice..................................................................................................*

Implications of Study and Recommendations for Future Research................................*

Conclusion.......................................................................................................................*

References..........................................................................................................................49

Appendix A........................................................................................................................58

Appendix B..........................................................................................................................*

Appendix C..........................................................................................................................*

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List of Tables

Table 1 Table Name Here................................................................................................................#

Table 2 Table Name Here................................................................................................................#

Table 3 Table Name Here................................................................................................................#

Table 4 Table Name Here................................................................................................................#

Table 5 Table Name Here................................................................................................................#

viii

List of Figures

Figure 1. Figure caption here...........................................................................................................#

Figure 2. Figure caption here...........................................................................................................#

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CHAPTER ONE

Communication between departments is an ever-changing work process. Managing the

communication between departments is what creates the most everlasting change across the

healthcare environment. The main issue that will be reviewed across this work is the idea that

workplace trauma occurs to clinicians every day in the healthcare environment. How the

communication about potential dangers to the staff in the clinical environment will be addressed

as well as potential effective changes that could increase the mental and physical well-being to

the clinician. There is very little communication when there is a violent patient or potentially

violent patient being treated by clinicians across multiple departments in emergency medicine.

The overriding research question is as follows: How to increase interdepartmental

communication in respect to work place safety in trauma situations.

Topic Overview/Background

Within the current body of knowledge; the reaction and long-lasting effects of work place

trauma, the current process for communication between departments, as well as how change

management can be applied to creating long lasting change. It is known that these issues exist in

medicine today and that to increase the health and safety of the population; changing the way

departments communicate is key.

When an engaged department is communicating effectively this creates an environment

that is safer for the staff which decreases work place trauma and thus reduces workman’s

compensation claims. A happier and safer department creates teams that provider better patient

care, this increases patient care scores and that creates better revenue from Medicaid and

Medicare plans (Rajpal, Peruchi, & Sawhney, 2013).

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Problem Statement

The problem to be addressed in the proposed study is there is very little communication

when there is a violent patient or potentially violent patient being treated by clinicians across

multiple departments in emergency medicine. There is a documented history over the last five

years of clinical experiences of work place trauma (Gillespie, Gates, Miller, & Howard, 2010).

There is a current lack of interdepartmental communication that exists within the clinical

environment (Wolf, Delao, & Perhats, 2014).

On the national level, there is a prevalence of post-traumatic stress disorder that arrives

from the exposure to traumatic events such as workplace traumas and assaults by patients to

health care providers and other first responders. This causes a loss of productivity and

unfortunately the worst thing we can experience which is freezing up at work. Time is the

enemy in trauma situations, and any delay can be detrimental to the care of our patients and

communities (DeLorme, 2014).

When looking at the gap in the literature; the researcher can narrow it down to

communication and then again to safety in the work place. Safety in the workplace is an

important topic the researcher has been diligently researching. The researcher has personally

been assaulted by a patient in the hospital and it affected the researcher’s future as well as the

researcher’s education. There is not a lot of research done that has affected the front lines of

trauma medicine in today’s clinical environment.

Communication in the medical field is critical to the continuity of care for the patients but

also for the interdepartmental dependency of various departments. The proposed study will have

the effect of creating a healthier environment by managing the communication between

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departments. This aligns with the doctorate of management degree currently being pursued at

Colorado Technical Institute.

Purpose Statement

The goal of the research is to manage improved communication techniques between

departments in respect to work place safety in trauma situations. The benefit to the medical

community as well as to the patients is a more controlled and healthier environment for both the

clinician and the patient within the healthcare environment. The work within the study that

relates to managing change within and organization will be beneficial in all management areas.

The research that will be done is qualitative phenomenological research. The specific

population that will be interviewed are clinicians in all aspects of medicine; from outpatient to

inpatient, rural to urban environments across multiple states. There will be approximately 20

participants within the study.

Research Question

The research question for the study is as follows: How to increase interdepartmental

communication in respect to work place safety in trauma situations? The specifics of the research

question will keep a guiding path along the project.

Propositions

The proposition of the research in question are based on qualitative phenomenological

research. The concepts in the literature review that make up the current body of knowledge are

based on the overall lived experiences of the patients, healthcare providers, and leadership teams

in healthcare environments today.

The research was started due to the lived experiences of the researcher while working in

the acute emergency medicine hospital-based environment. The problem has been

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acknowledged and discussed in peer reviewed literature over the last five years and will be

discussed with in the literature review. The current state of interdepartmental communication or

lack thereof has led to many examples of trauma to clinicians.

Conceptual Framework

The conceptual framework within the study on interdepartmental communication starts

with the patient experience. The patient and clinician experience directly connect to

understanding how these trauma situations not only occur but how the effect the future work that

occurs within the healthcare environment. The literature shows the current climate within the

healthcare environment. Managing the communication between environments creates a stable

and safe work environment. Using the concepts of change management allows for the effective

changes that can occur within the healthcare community.

The theory under which the research falls is based on the Nascent theory where the

qualitative approach usies a phenomenological style. This will allow the research to analyze the

lived experiences of the research subjects (Kraus, Bakanas, Gursahani, & DuBois, 2014). Other

research that has been done in the body of knowledge within the literature review are based on

the lived experience of others as well as current work processes within the last five years.

Assumptions/Biases

The assumptions that are in place at the beginning of the study and during the initial

interview process come from the researcher’s experience. The researcher experienced workplace

trauma in the emergency medical environment. This was caused due to a lack of communication

within departments. The assumption is that it occurs to everyone being interviewed and that it is

the norm within medicine.

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The biases that are in place at the beginning of the study are that there is not a current

appropriate workplace policy that discusses communication between departments.

Both the assumptions and the biases will be managed within the framework of the study

by not allowing the assumptions or biases to be exposed during the interview process. This will

be done through the framework of the interview questions being neutral.

Significance of the Study

The study will be beneficial to all stakeholders within the healthcare environment. This

includes patients, frontline clinicians, leadership teams, providers, executive teams, governing

boards, as well as insurance providers. Globally this study, will help to create stability for

patients and their quality of care. The study is unique in that although we can see the problem

and its effects on others, there is not enough on how change can be managed in communication.

The goal of progressive change to the work process will show how moving forward instead of

maintaining the status quo; just because it has always been this way; does not allow for a safer

and more clear level of communication for the clinician in the clinical care environment.

Delimitations

The boundaries of the study set by the researcher are current clinicians in nursing and

imaging across inpatient, outpatient, rural, and urban medical environments. Indicates the

boundaries of the study set by the researcher. This population has seen and have reported a

measurable amount of experiences with these issues (Gillespie et al., 2010).

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Limitations

The limitations of the study are in creating an environment that will allow for the

research subjects to be transparent in their experiences. The memories of the research subjects

are the key to clearly defining the current interdepartmental communication landscape in

healthcare today. The memory variable is not one that the researcher will be able to control.

Definition of Terms

The key operational terms that are unique to the reader understanding the body of work

within this study are as follows and are referenceable in Andreoli and Carpenter's Cecil

Essentials of Medicine (Cecil Medicine) by Benjamin MD FACC FAHA, Ivor, Griggs MD

FACP FAAN, Robert C., et al. | May 22, 2015:

Term: The term is clinician. This is a word that represents employees within the

healthcare environment that provide care to patients.

Term: The term is provider. This is a word that represents Doctors within the healthcare

environment.

Term: The term is order. This is a word that represents a request for a procedure to be

done on a patient. An example is an order for labs such as bloodwork, or an x-ray such as a chest

x-ray.

Term: The term is modality. This is a word that represents internal departments within

the imaging or radiology department. An example is Computed Tomography or CT, MRI,

Ultrasound or US.

Term: The term is portable. This is a word that represents a way of doing an imaging or

lab procedure. A portable would involve bringing the imaging or lab testing equipment to the

patient’s bedside on doing the study or procedure at the bedside.

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General Overview of the Research Design

The overall goal of the research design is to asking pointed questions within a

phenomenological qualitative interview. The same questions will be used regardless of the

research subjects work history or clinical care environment. The research data will be analyzed

and compared for continuity as well we opportunities for managing the communication needed

to affect change.

Summary of Chapter One

The composition for the doctoral project is Interdepartmental Communication in Respect

to Workplace Safety in Respect to Trauma Situations in Healthcare Facilities. The research

question will be; “How to increase workplace safety in the midst of trauma situations in the

healthcare environment concerning interdepartmental communications?” This topic will be

reviewed in a multifaceted approach. The researcher will observe the current policies and

practices in interdepartmental communication currently being practiced in hospital systems. The

researcher will review the current histories of acute trauma situations aimed towards clinicians.

The researcher will build thru research a hypothesis that will increase communications and

workplace safety for clinicians in high-stress trauma situations.

Proposal for the Proposal submittal and Dissertation for the Final Manuscript

The final manuscript for the dissertation will be organized into 5 chapters as follows:

Chapter 1 - Chapter one discusses about the definition of the problem, significance of the study

and the methodology.

Chapter 2 - Chapter two outlines the literature review. Further breaks down the topic into

subtopics: Patient Experience, Proof it Happens, Communication, Management, Change

Management.

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Chapter 3 - Chapter three discuss about the methodology and research plan. This further breaks

down the topic into subtopics: Research Tradition, Research Question, Research Design,

Population and Sample, Sampling Procedure, Instrumentation, Validity, Reliability, Data

Collection, and Data Analysis.

Chapter 4 - Chapter four outlines the results of the research on workplace trauma to clinicians

and current communication processes.

Chapter 5 - Chapter five states the discussion and conclusions and recommendations for future

research.

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CHAPTER TWO

There is very little communication when there is a violent patient or potentially violent

patient being treated by clinicians across multiple departments in emergency medicine. The

current climate between departments in the healthcare environment fosters communication but

not to the extent that is needed for the overall safety of the clinicians in the clinical environment.

To manage improved communication techniques between departments in respect to work place

safety in trauma situations is the overall purpose of this body of work. Within the literature

review the following areas will be reviewed: The patient experience, proof that work place

trauma to clinicians happens, the current communication within departments in the clinical

environment, how communication is currently managed, and the current climate of change

management within the clinical environment. By the completion of the literature review we will

see where there is a lack in the current body of knowledge that will allow us to find how to better

manage interdepartmental communication in respect to work place safety in trauma situations.

Patient Experience

Communication in a work environment plays an integral part in the sense that it

determines the success or failure of any process. In healthcare, particularly, in the emergence

room, there need to be effective communication between medical practitioners and the patient to

achieve the desired outcome. Previous cases that involved violent patients have inhibited

effective communication, thus, hampering the efforts of medical practitioners to deliver the

required due care. The point of contention that seems more of a dilemma to medical practitioners

is that patients have a right to proper medication in all its forms (Hogerzeil, Samson, Casanovas,

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& Rahmani-Ocora, 2006). This is regardless of whether they turn out violent or cooperative.

Violent patients are likely to subject clinicians to harm. Thus, there is need for obligatory

protection.

A study pursued by Stuttaford, et al. (2014) aimed at establishing essential contributions

towards the development of the concept and practice of the right to health in all its forms,

exploring the right to traditional, complementary and alternative health across different context.

Using primary data from interviews, as well as secondary data from the studies undertaken

previously in 2010, the investigation uncovered a gap that needed more research to determine the

legal basis, perform a comparison on various legal frameworks, as well as carry out an extensive

exploration of patients and healthcare providers’ understanding of the laid down rules and

regulations. The main goal was to attain a proper comprehension on how to balance protection to

the involved parties and ensure the delivery of services in accordance to cultural values.

Some of the reasons a patient may turn out to be violent is when they consider an

infringement being done to their beliefs. They tend to apply the principle of autonomy to decide

whether they would accept the medication or not. This might undermine the legal duty of the

medical practitioners as stipulated in various federal laws when it comes to the duty to rescue.

Accordingly, Stuttaford, et al (2014) findings are backed up by support from Padgett (2011)

research, which enhanced the awareness of safety and quality aspects that medical practitioners

ought to pay close attention in a healthcare environment to achieve the desired outcomes. This

would only be possible if the clinicians have a high level of morale, and subjected to a stress-free

environment that can enable them concentrate adequately and minimize the chances of making

errors in an effort to promote patient safety culture.

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A study done by Ahmed, Burt, & Roland (2014) advocated for the need to provide

patients with proper experience in an effort to deliver due care to patients. This is one of the

aspects that patient advocates promote as established in another study pursued by Heiman

(2015). The focus of healthcare providers is to deliver quality treatment to patients. The concept

of quality is more diverse and a dependent variable to various elements such as patient

experience, safety and clinical effectiveness. These elements relate to each other indirectly. Each

patient has got different expectations from a care giver. It is the reason Ahmed, Burt, & Roland

(2014) argued that the realization of an overall improved quality in healthcare relies on various

strategies that require time to be sustained. Padgett (2011) emphasized the complexity involved

in attaining the required quality service delivery in the healthcare, citing that the process of

ensuring patient safety is multi-faceted. Accordingly, it is one of the reasons patient advocacies

has emerged as an important area of focus.

Achieving the Triple AIM in healthcare is determined mostly by the rate of client

satisfaction. In this respect, Heiman (2015) emphasized the need to comprehend the influence

that patient advocates have on patient safety and satisfaction, their financial impact and how the

healthcare provider perceive the advocacy. The primary aim was to create an equilibrium level

between the care giver and patients by understanding the extent to which violence can be

withstood during emergency medication to facilitate delivery of the required care. All of the

efforts should be considerate of the complexities associated with the healthcare setting.

Typically, patient safety can be achieved when the patients themselves cooperate positively with

the providers. According to Heiman (2015), standard of care is very demanding, implying that

any absence of quality of care can cause harm to the patients. The point of contention is that

attaining a balanced care, and still operate efficiently and effectively might involve acceptance of

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some tradeoffs in quality, something that is not allowed in medical treatment. Increasing

efficiency and quality at the same time is a struggle that healthcare providers continue to

brainstorm upon to achieve the recommendations of patient advocates. There is need for

extensive research into appropriate methodologies that can facilitate the attainment of this

balance.

The complexities involved in ensuring quality care to patients can to some point be a

contributor to violence in medical settings. A recent probe into some causes of violence in the

healthcare environment was performed in one of the U.S Veterans Affairs healthcare systems. In

particular, Purcella, Shovein, Hebenstreit, & Drexler (2017) intent was to get a glimpse of the

staff’s perspective on the prevalence, causes and contributors of violence in a healthcare setting.

The results obtained could be evaluated and a generalizability approach employed to understand

the common causes of this problem in different work environments. Apparently, the respondents

revealed to the investigators that some of the contributors of violence included complex and

frustrating internal processes, stress due to overwhelming workload, and inadequate safety in the

external environment. These findings expounded on Ahmed, Burt, & Roland (2014) and Padgett

(2011) findings about the complexity nature of the healthcare environment, which inhibits the

effective attainment of the required quality service delivery to patients.

From a professional point of understanding, the source of complex internal processes and

overwhelming workloads should be the employer. In this regard, it is possible to handle these

problems using effective communication. A case where the organization utilizes either

democratic, transformational or participatory leadership style, employees’ opinions can be

integrated into the organizational processes and evaluated based on the possibility of attaining a

situation that suits the best interests of everybody. An organization that has a motivated

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workforce finds it easier to achieve the best performance, which include the required quality in

service delivery, valuing the clients’ well-being through ensuring their safety and teamwork.

Accordingly, Lewis (2015) tried to uncover the above views in his study about healthcare

leaders who influence the sustainability of high patient satisfaction scores. The themes that

emerged from this research included effective communication between the management and

employees to boost their morale, leadership effectiveness and engaged employees, leadership

qualities and leadership desire to educate and encourage its workforce. Accordingly,

participatory and visible leadership styles were identified as the best approaches to apply and

realize the required patient satisfaction. It is quite evident that those organizations that

experience most cases of violence have not been able to implement such leadership models.

Perhaps, there is a reliance on authoritative and dictatorship, which lowers the self-esteem of

employees, not forgetting that these styles are too outdated to be applied to millennials.

Bonalumi, et al (2017) performed a study that aimed at determining the various aspects

that improved the patient recovery process. As per the study findings, a workflow process that

boosted employees’ morale, enhanced communication and improved leadership effectiveness

accelerated the recovery process of patients. This clearly shows that patient satisfaction also

relies on conducive environment employees are subjected to. The rationale for this supposition is

that a stress-free environment helps employees to concentrate fully on their work and deliver the

required services in the right qualities. A stress-free environment is a concept that is also diverse

and depends on various elements such as good pay, effective communication, and respectful

leaders. Thus, balancing these elements in the most appropriate way and still meet the Triple

AIM goal might be a challenge and one of the sources of violence in the healthcare setting.

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Hogerzeil, Samson, Casanovas, & Rahmani-Ocora (2006) pursued an investigation that

aimed at determining whether the right to health could be enforced through courts. The results

showed that each individual was entitled legally to proper health. The investigation failed to

examine the finite and scarcity nature of the required resources to fulfill this right in the most

effective way. This means, patients would be entitled to this right theoretically, but not

practically unless the State facilitated healthcare providers with the required resources. As part of

the HIPAA provisions that are already out of date, Kumar, Henseler, & Haukaas (2009)

suggested that such provisions be updated with some wording for them to be met by the

healthcare providers as per the availability of the required resources.

Proof it Happens

Effective communication between different departments depends on a number of

elements. In a healthcare setting, the medical practitioners, patients and the management have a

role to play to achieve the required interdepartmental communication, especially during trauma

situations. One of the elements that facilitate the attainment of proper coordination between

different departments is the ability to uphold human rights. Amon, Baral, Beyrer & Kass (2012)

performed an investigation into human research and ethics. The regulations that govern health

researches provides that the subjects be protected. The predominant elements that are mostly

considered include autonomy of the participant to provide certain information or avoid it if it

might haunt them later. The second element is the anonymity aspect, whereby, it is the

participant’s right to have their identities remain unknown to avoid future discrimination or

conflicts. In reference to interdepartmental violence in the emergency room, no patient should be

abused during treatment. The failure to understand the rights of patients to fair treatment is one

of the sources of conflicts. In this respect, the authors emphasize the need for medical

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practitioners to enhance their attentiveness to human rights. This include engaging patients’

families and upholding ethical principles while handling patients.

Most assumptions that are made involve the failure of medical practitioners to uphold

patients’ human rights. This assumption undermines the protection of medical practitioners from

violent patients, as well as from rogue employers. On several instances, nurses have been

assaulted as it was anonymously reported in the healthcare traveler periodical (Anonymous,

2013). It came out clearly that nurses faced maltreatment from the employer and patients. The

fact is nurses have a responsibility to protect patients from any harm, especially those that are

under their care. It should be understood that they too have a right to operate from a work

environment that is safe and free from violence. Similar suppositions were made by Gillespie,

Gates, Miller & Howard (2010), having investigated workplace violence in healthcare setting,

primarily to establish the risk factors and their accompanying mitigation strategies. Evidently,

nurses faced violence from patients and visitors, a fact that has mostly been neglected, given

their duty to rescue and the provision of due care. The various protective strategies that Gillespie,

Gates, Miller & Howard (2010) suggested included practicing self-defence, carrying a mobile

form to alert others in case of violence, self and social support, and limiting interactions with

potential and known perpetrators of violence.

There are cases where medical practitioners must interact with patients, regardless of

whether they are violent or not such as pediatric patients in the emergency department who need

diagnostic imaging more often as observed by Hernanz-schulman (2008). This does not bar them

from applying Gillespie, Gates, Miller & Howard (2010) suggested protective strategies against

violence. It is only when medical practitioners are subjected to a friendly environment that is

stress free that they can deliver their best services and be able to promote the quality of life, as

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well as the safety of their patients. In fact, failing to understand and appreciate the safety of

medical practitioners against violent patients is one way of not recognizing and valuing their

needs. This can be a likely cause of conflicts and ineffective interdepartmental communication,

given that nurses might not be able to work under environments that are prone to violence.

The supposition is greatly emphasized by Karaahmet, Bakim, Altinbas & Peker (2014),

having evaluated the assaults that doctors in Canakkale had been exposed to in 2013. Using

survey research as a data collection technique, questionnaires were distributed to the participants

and the results evaluated using descriptive statistics. Evidently, the assumption that doctors or

any medical practitioners are responsible for the violent cases they face from their patients is

much worrying since is affect the performance of medical practitioners severely. As initially

noted by Anonymous, (2013) and Gillespie, Gates, Miller & Howard (2010), medical

practitioners are susceptible to violence from patients and visitors. The earlier this fact will be

acknowledged will play an integral role in developing sustainable solutions to this issue, which is

greatly undermined.

As noted by Kocabiyik, Yildirim, Turgut, Turk & Ayer (2015), cases of violence on

medical practitioners have increased greatly. In a study that was carried out to determine the

violence cases that healthcare practitioners in a mental facility get exposed to, a descriptive

design technique was used as the main methodology. The findings indicated that quite a number

of healthcare employees faced physical and verbal violence from patients. With the various

evidence regarding this issue as presented in this literature, medical; practitioners deserve

protection from any form of violence.

The same results were established from Burns (2014)’s findings after interviewing one of

the psychiatric nurses. Assaults leave nurses fearful, a good implication that they can never

16

deliver their best. The most worrying part from the interview was that whatever the nurses report

as an assault, never reaches the designated personnel to handle the issue in its original form. This

means, the proxies involved tend to alter the information as a way of refining it into something

else that may not come out as an assault. In doing so, the nurses never get the required justice or

attention, thereby, continue leaving in fear due to the unfriendly work environment they are

subjected to. While in such a situation, they may never be able to communicate or react

positively with patients in trauma situations, thus, a likely source of violence.

The same findings were demonstrated by Shiao, Tseng, Hsieh, Hou, Cheng & Guo

(2010) after pursuing a research on the assaults against nurses of general and psychiatric

hospitals in Taiwan. The main focus was to determine the risk of occupational assaults. Using a

cross-sectional study conducted to provide a proper understanding of the incidence of work-

related assaults in nurses, 842 nurses participated in the survey and completed the questionnaires

as required. The results indicated that nurses in the general and psychiatric units were vulnerable

to high risks of assaults. Accordingly, these assaults instilled fear into them just as established by

Anonymous (2013) and Burns (2014). Eventually, nurses experienced an increase in work-

related stress and a decline in their quality of life. Accordingly, Scott (1998) condemned the

assault of medical practitioners while performing their duties. she proposed severe sentencing to

the perpetrators of such mayhem.

Carr (2017) probed an investigation that aimed at evaluating the effectiveness of training

for non-law enforcement personnel about the pre-behaviour indicators of the active shooter. The

relevance of this research was on enlightening workers on how to deal with violence in their

respective areas of operations. As seen from Burns (2014)’s study, most cases of violence that

are reported never arrive at the top management in their right form. The biasness introduced in

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the original information hampers appropriate development of the solutions to these problems. In

this respect, Carr (2017)’s active shooting will likely help nurses to defend themselves to their

level best before handing the case if turns complex to the relevant personnel for further

assistance. The worker’s initial effort to defend themselves will provide sufficient proof of a

possible violation or infringement of human rights, thus, reduce the current alteration in the

message being exhibited.

These findings are backed up by Ellies (2015), who evaluated an active shooter

curriculum for institutions of higher learning. The ascertainment was motivated by the increased

cases of institution shootings in the U.S. thus, the researcher aimed at providing the lessons from

such incidents, alternative measures against active shooting, and alternative active shooter

training. Evidently, active shooting subject individuals to unwelcoming situations that can inhibit

their performance in whatever they venture in. It is a form of violence that may make medical

practitioners to lose their entire concentration when attending to patients in the emergency

situations. As a preventive measure, Carr (2017)’s study supports Ellies (2015)’s propositions on

training individuals about alternative measures that can help them counter active shooting. The

point of importance to ensure individuals operate from a friendly environment to help them attain

the required concentration in productivity.  

Deflorio, Coughlin, Coughlin, Santoro, Akey & Favreau (2008) pursued an investigation

that aimed at demonstrating the influence that changes in technology, staffing and departmental

processes on service levels would pose to the emergency department. Apparently, it was revealed

that various modifications to emergency department radiology processes can enhance the

emergency department radiology turnaround time. The most valuable finding was about

measuring and improving the processes by analysing the needs and resources by the joint effort

18

from the emergency medicine and radiology crew, and the top management of the facility. This

shows positive coordination from different departments, which can only come into play if there

is effective communication between these departments. Eventually, such coordination

contributes appropriately to better quality and safety of the patients.

Communication

Effective communication is an element that is pivotal to positive cooperation in the work

environment, may it be between clients vs. employees, employees vs. the management, or

employees vs. employees. As noted by Kozeal & Bean (2010), poor communication between

departments results from misunderstanding other people’s needs. This finding is backed up

strongly by the results of Coffey (2001), who probed an investigation into relational coordination

between nursing units, emergency department, and in-patient transfers. The source of most

conflicts was associated with patient overcrowding, which shows, the organization did not

understand adequately how to take care of patients’ needs with utmost diligence. Kozeal & Bean

(2010) established that poor coordination among the different units of the healthcare affect the

organization adversely in the form of client and employee dissatisfaction. A case where the

workforce is not satisfied, the likelihood of poor performance and failure to meet the desired

outputs increase, which is the primary cause of customer dissatisfaction.

Angeli (2012) probed an investigation into networks of communication in emergency

medical services. She suggested an approach of enhancing communication between clients and

employees, as well as among employees through positive collaboration between different

specialists, who include physicians, nurses, and social workers. This can be referred to as

networking and may involve working together and making follow ups to patients and their

families to ensure that they adhere to the prescription to prevent the chances of relapse. This

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approach backs up Kozeal & Bean (2010) observations about the sources of misunderstandings

that results in poor communication. When specialists work together, it becomes easier to

understand the needs of each other, thus, minimize the rate of miscommunication. This might

involve strategies such as daily flash rounds as posited by Fredonia (KS) Regional Hospital

(2010). When effective communication is ensured in the emergency department, the cases of

violent patients will reduce since all the problem as noted earlier by Kozeal & Bean (2010) are

attributed to inadequate understanding of other people’s needs.

Cappell (2009) provided a case study in which a supervisor coerced her into engaging in

what she presumed was medically contraindicated and could constitute a malpractice. The task

involved performing an emergency percutaneous liver biopsy on a client who she had never had

an encounter with before, but was on the general medicine ward service. The dilemma came in

when the practitioner realized that the patient was very unstable to withstand a liver biopsy. The

same opinion as hers was provided by a colleague whom she consulted. In this case, a medically

incorrect order by a direct clinical supervisor was the cause of the problem and could result in

violence due to a misdiagnosis. This is a clear case of lack of consultation that could be easily

countered using Angeli (2012) suggested approach of having different practitioners work

together when helping the patient. The clinical supervisor relied on his knowledge, which in this

case, was not sufficient, only to end up undermining the Hippocratic Oath as defined by

Antoniou, et al (2010). Quite evidently, he looked down-upon the contribution of a junior

employee, which on the contrary, was right.

In reference to healthcare code of ethics and its underpinning regulations, the case

exhibited in the Cappell (2009) report concerns HIPAA noncompliance, which has turn out as a

normal occurrence in the medical industry. From Basile (2014) empirical investigation on the

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increasing rate of HIPAA compliance, it is quite clear that the clinical supervisor was hired into

the field, but the employer was inconsiderate of evaluating the practitioner’s knowhow in regard

to individual implication of HIPAA noncompliance. Such a malpractice can end up the clinical

supervisor in jail or into incurring fines as compensation to the client and the State. It is the

reason Basile (2014) had to pursue her study to help in minimizing this unending internal

noncompliance to HIPAA. Using survey instruments, it was established that medical

practitioners who had information about the laid down regulations managed to uphold HIPAA

compliance compared to those who had little information. In an effort to reduce patient violence

in the emergency room due to misdiagnosis, the healthcare industry needs to take HIPAA

compliance literacy with utmost seriousness. It is the only way the current cases of

noncompliance as the one experienced with the clinical supervisor will reduce. From an

intellectual point of view, you might realize that the clinical officer’s intentions were not related

to committing malice, but rather, to meet his duty to rescue as provided by the federal laws. His

insufficient knowhow in regard to evaluating the patient’s stability to undergo the diagnosis

might have resulted into something else that could be equated to a malpractice.

Eadie, Carlyon, Stephens, & Wilson (2012) pursued a study on communication in the

pre-hospital emergency environment. The primary goal was to come up and ascertain the

execution of a communication board for paramedics to apply with patients as either an

augmentative or alternative communication methodology towards meeting the communication

demands of clients in a pre-hospital environment. The study’s methodology involved designing a

double-sided A4-size communication board to be used in the pre-hospital setting. The front side

of the board included expressive messages that could be utilized by the patient and paramedic,

whereas the other side comprised messages that would be used to support patients’

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comprehension and interaction tips for the paramedic. The board was placed in each ambulance

and patient transport vehicle for easy access. The findings indicated that patients from culturally

and linguistically diverse backgrounds benefited from the board. The paramedics supported the

move for being effective in enhancing communication between medical practitioners and

patients since it was easy to use, reduced patient frustration and enhanced communication.

Accordingly, this is one of the efforts geared towards minimizing misunderstanding, while

improving the ability to understand other people’s needs as suggested earlier by (Kozeal & Bean,

2010). Just as the networking model proposed by Angeli (2012), the communication board has

the potential to enhance communication among patients. An extensive research needs to be done

to establish whether the board can improve communication between the clients and practitioners,

practitioners vs. their colleagues, as well as with the management. The rationale for this proposal

is based on the fact that patient violence in the emergency room concerns each participant,

ranging from other patients, to employees and to the management.

Delupis, et al (2014) probed an investigation into communication during handover in the

pre-hospital/hospital interface using Italy as a case study. Using multidisciplinary handover

simulations and debriefings as the methodology, the common problems of the

pre-hospital/hospital handovers included absence of standardization of handover communication

process between pre-hospital providers and emergence department personnel, perception by

emergence personnel and nurses that rescuers do not transfer patient care responsibility.

Individuals involved with patient safety during emergencies (rescuers) argued that nurses did not

take into consideration the information communicated to them during handover as required.

These findings are in concurrent with Kozeal & Bean (2010) about the source of conflict in the

emergency room. It is all about poor communication and the inadequacy to understand other

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people’s needs. The Angeli (2012) model of specialist networking, where we can have the

rescuers and triage nurses work hand-in-hand while attending to patients during emergencies has

the viability to reduce this problem significantly.

Davenport (2010) delved on defining integrated healthcare as perceived differently by

various stakeholders. This idea was motivated by the resurfacing of the medical industry in the

U.S. Accordingly, different people have come up with comprehensive definitions to this term

based on their understanding of what it entails. Using a phase concept analysis, the researcher

investigated the existing literature, and performed interviews to determine a working definition

to this notion. From the findings, integrated healthcare involved many people whose inclusion

was vital. They included diverse staff, patient and family, whole personal treatment, community

service integration, cost and insurance issues, medical home concept, and consideration of issues

related to time. The researcher derived the following definition from these elements, “integrated

healthcare is patient-family centered and it is facilitated by diverse healthcare teams under a

single coordination, while taking a close consideration of cost, reimbursement, community, time

and healthcare resources.” In reference to the research objective, violence can only ensue if all

these aspects are not considered, which imply, the failure to recognize other people’s importance

in patient recovery and the attainment of the Triple AIM.

Balcanoff (2003) engaged in a study that examined the influence that communication had

on hospital nursing morale and retention. The researcher utilized the systems theory to get an

understanding of the nurses’ experiences in regard to miscommunication in a medical setting.

The results indicated that a positive input in communication by nurses resulted in both the

management’s, nurses’ and client satisfaction. There was increased morale, as well as retention

rate among employees. These observations depict an actual picture of what motivation does to an

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organization. In addition, they concur with Kozeal & Bean (2010) findings about the influence of

positive coordination to an organization. Thus, they are feasible to the research objective and can

be used to reduce violence in a hospital environment significantly.

Most health facilities continue to experience a deficit in communication. This was seen in

Grace Dotson’s efforts to enhance this aspect and eliminate silos immediately after joining

Greenville Hospital (Anonymous, 2010). Silos come into play when practitioners decide to

concentrate on their work only. As such, they forget the fundamental value of teamwork. This

issue can be handled using Hippocratic Oath, which comprises a synopsis of the moral code of

ethics that contribute positively to the stabilization of the tri-part relationship among

practitioners, patients and the diseases (Antoniou, Antoniou, Granderath, Mavroforou,

Giannoukas, & Antoniou, 2010). This argument is backed up by Fields (2015) who emphasized

the need to espouse the ethical value of empathy, given its benefits to the patients, practitioners

and the management. This virtue can be achieved through proper communication between

medical practitioners when delivering care to patients, especially in an acute medical

environment. Thus, Forbes (2017) emphasize the need for nurses and physicians to relate

positively and work cooperatively when attending to patients. Han (2015) supports this

argument, having pursued a study on communication and compliance in the context of extreme

events and healthcare. His findings revealed that effective communication and compliance was

integral in all walks of life. It gives the patients a sense of hope, thus, promote their recovery

process.

Hatva (2013) probed an investigation on how regular briefing enhances transparency and

patient safety in healthcare facilities. The researcher used Norton Suburban Hospital as a case

study. In the course of the facility’s transformation process, a number of challenges were

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uncovered. The problems experienced were all associated with ineffective communication. As

such, the research emphasized the vitality of maintaining open and effective communication

between and within the various departments of a health facility. This is essential when it comes

to maintaining adequate focus on patient care and safety.

Lancaster,  Kolakowsky-Hayner,  Kovacich & Greer-Williams (2014) investigated

interdisciplinary communication and collaboration among physicians, nurses and unlicensed

assistive personnel. Using qualitative semi-structured face-to-face interviews as the primary

methodology, it was revealed that most of the time, physicians, nurses and UAPs operate

independently. Staff speak to each other on rare cases, which is a sign of ineffective

communication. As seen earlier, effective communication among practitioners is an apparent

indicator of positive cooperation. A case where the employees of an organization work as a team

results in effective delivery of due care. Given the unique expertise each individual has, their

combined effort is essential for tackling the patient’s illness from a three-dimensional angle,

thus, facilitate the attainment of the Triple AIM as established earlier by Kozeal & Bean (2010)

and Coffey (2001). The same findings are emphasized by Kozeal & Bean (2010), having

indicated that the source of conflicts in a work environment is ineffective communication among

employees, which leads them to be unable to understand other people’s needs. Hatva (2013)

study is found relevant to these suppositions by emphasizing regular briefing, which enhances

communication and the ability to understand each other and promote positive patient care

outcomes.

Maughan, Lei, & Cydulka (2011) performed a research that aimed at identifying

emergency department handoff practices and described handoff communication errors among

emergency physicians. According to the research findings, errors and omissions committed by

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physicians in the emergency room were as a result of variation in handoff time per patient. This

can be attributed to poor communication among practitioners. As such, when deriving

standardized protocols, handoff error reduction techniques, and the influence that handoff has on

patients, it is essential to ensure effective communication among physicians is exhibited. The

same confusion experienced in handoff time is the same that was discussed by Delupis, et al

(2014) during handover between safety rescuers and nurses in case of an emergency. All these

problems are associated with poor communication.

McBeth (2015) investigated a study that worked towards implementing a daily morning

huddle at a certain children’s hospital by enhancing interprofessional and interdepartmental

communication and collaboration. The research reported on various changes in patient flow

before and after implementation of the daily huddle, as measured by pediatric emergency

department boarding times. Using non-random purposive sampling and inferential statistics,

huddles were found to be essential in enhancing patient flow through their ability to improve

interprofessional and interdepartmental cooperation and communication. The findings are in line

with the rest of the literature that has emphasized the need for effective communication among

different departments, as well as practitioners when handling patients in emergency rooms.

These findings were enhanced a little bit in another study that was carried out by McBeth,

Durbin-Johnson & Siegel (2017). The investigators added that admitting patients from the

emergency department to their respective units to receive the required specialty care on a

promptly basis posed a higher probability to enhance the quality and safety of patients. This can

only be achieved if there is effective communication and positive collaboration among the

involved medical practitioners.

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Naz & Gul (2014) pursued a study that investigated the relationship of communication

satisfaction and turnover intentions and to uncover the moderating role of organizational

commitment in the relationship of the two variables. The research findings indicated that

communication satisfaction was inversely correlated with turnover intentions. Organizational

commitment played the role of a moderator between communication satisfaction and turnover

intentions. As such, it became quite apparent that communication satisfaction among co-workers,

supervisors and the top management affected negatively the turn over intentions. As such,

organizational commitment, which implied working as a team towards the attainment of the set

objectives was found valuable to bring a balance between the two variables. This supposition

agrees with McBeth, Durbin-Johnson & Siegel (2017) and McBeth (2015) that have recognized

the importance of positive cooperation among employees to quality and positive patient care.

Sujan, Chessum, Rudd, Fitton, Inada-Kim, Spurgeon & Cooke (2015) carried out an

investigation on the emergency care handover across care boundaries, particularly, on the need

for a joint decision making and consideration of psychosocial history. Using audio recording of

interdepartmental conversations as the main data collection technique, it was discovered that

conversations associated with ambulance services were predominantly descriptive, unidirectional

and had a close focus on patient presentation. Referrals were all about collaborative talks in

regard to admitting and providing immediate care needs to patients. Very little conversation was

related to the patient’s social and psychological needs. Thus, it was quite apparent that the

practitioners could not understand the needs of the patients due to negligence. As posited by

Coffey (2001), the source of most conflicts in the emergency rooms is due to the inability of the

practitioners to understand other people’s needs. Even though the practitioners might have been

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putting in more efforts to provide care to patients, their inadequacy to understand their social

needs would be good enough to escalate conflicts between patients and medical practitioners.

Valecha (2015) performed a research on information and communication in mediated

crisis response. Three essays were explored with the first one delving on communication issues

in the dispatch-mediated local emergency response system. The second essay investigated

information issues in the crisis microblogs, whereby data was characterized by big-data driven

methodology. The last essay discussed quality issues in crowdsourced crisis response through the

development and validation of an information categorization system that would offer pragmatic

directives to crisis practitioners for crowdsourcing. Evidently, effective communication proved

to be essential in attaining the desired outcomes in all the three sources. The involved

practitioners had to cooperate positively through addressing issues as a team to achieve their

objectives.

Nagula, Lander, Rivero, Gomez & Srihari (2006) concentrated on investigating the use of

continuous quality improvement tools to streamline the workflow of ancillary departments.

Apparently, patients admitted to the emergency department required the services of both the

laboratory and radiology departments. In this regard, a positive correlation between the two

teams was essential to ensure the delivery of the required care to patients. In this study, process

mapping and time studies were utilized to determine the flow of operations between the two

departments. Just like it had been the case with other studies, ineffective communication was one

of the core sources of failure in delivering the required care. Conflicts between different

practitioners from different departments was predominant, primarily because each individual had

been used to focusing on their unique functions, thus, coordinating with others who were

handling other tasks to achieve the desired recovery outcome posed a challenge to them.

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Management

The success and attainment of organizational goal depends on proper coordination

between the management and employees. In addition, proper interdepartmental coordination is

key since different departments rely on one another, thus, must collaborate positively. This is

possible if the organization has an effective communication system that is used to pass

information across different departments. Effective leaders must be in a position to set up such a

communication system. Zack (2014) provides valuable insights in regard to three key skills that

leaders need to have. The first one is interdepartmental collaboration, whereby the management

must be in a position to link healthcare practitioners from the top down to make them think about

the big picture and how the overall processes in the healthcare system influence patient

outcomes. Another core characteristic that Zack (2014) discusses is diverse experience, which is

essential for understanding the various healthcare processes comprehensively. They also need a

data-centric approach, which is vital in facilitating a proper understanding of how patient data is

collected and measured. This eliminates data silos and ensures that data remain central to

business decisions.

Accordingly, these skills can be applied in appropriate coordination of different

departments. Woodward (2008) pursued a study about radiologic procedures, policies and

protocols for paediatric medicine. Evidently, it was established that proper development of

protocols between different departments requires a multidisciplinary approach to meet the

required straightforwardness and any form of complexity that might arise, such as time-sensitive

needs for the emergency department patients. For instance, imaging evaluation requires

radiologic technologists to collaborate with other experts who include radiologists, transporters,

nurses and coordinators and work under an accelerated routine to achieve the desired outcomes.

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Wise (2014) elaborated on the importance of positive coordination between different

departments. The author drew from different case studies that involved analysis of partnership

between different companies. Apparently, it was clear that organizational success depended on

proper relationship among different processes. This can be achieved through having a well-

established communication system in place. In most cases, poor adoption of the required

processes causes miscommunication in the organization that eventually translates to low

productivity.

Virtue, Chaussalet & Kelly (2013) probed an investigation into healthcare planning and

its potential role in increasing operational efficiency in the healthcare sector. The primary

methodology used was the review of existing literature, as well as drawing information from

different viewpoints. The authors aimed at considering quite a number of issues that surrounded

poor adoption of healthcare simulation models and tried to reflect on whether or not, there had

been a significant failure of academic healthcare simulation modelers to develop approaches that

could reflect real medical challenges as uncovered by different stakeholders in the medical

sector. The study reviewed the role of healthcare planners within the medical sector and

proposed that they well suited to play the role of change agents to enhance the adoption of

simulation within the healthcare sector. Typically, the success of the planners was attributed to

positive coordination among themselves, which was enhanced through proper communication

and the urge to understand each other. In that respect, the planners managed to avoid creating

conflicts so that they could concentrate on the attainment of the desired outcomes. Accordingly,

the researchers established a strong link between healthcare planning and the stakeholders of the

healthcare. As such, they proposed that healthcare planning could play the best role in the

adoption of healthcare simulation modeling to improve operational efficiency.

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Most of the time, obstacles arise to disrupt effective management of processes.

Priesmeyer & Murray (2012) described new concepts and methodologies that managers can

utilize to counter the occurrence of disruptive obstacles in a large-scale hospital setting. In

particular, the authors aimed at addressing challenges with service quality that may be

experienced as a result of disruptive events. The researchers introduced the notion of “wholism”

as a fundamental basis of fostering interdepartmental responses. Also, the investigators presented

an instructional method for training interdepartmental interdependency in organizations.

Apparently, positive coordination among different individuals of the organization was core to

appropriate management of disruptive events.

The ability to manage processes through countering potential obstacles is a strategic

capability that managers need. Karadjova-Stoev & Mujtaba (2016) pursued a study on strategic

human resource management and global expansion lessons from the Euro Disney challenges in

France. Typically, the emphasis was to encourage managers to view the strategic role of human

resource management as a vital aspect of an organization’s success in attaining the desired

outcomes. Basically, the authors illustrated how organizational decisions from the HR

department were integral for an entity’s success. Evidently, strategic planning was demonstrated

through the Euro Disney case as a human resource imperative that ensured proper coordination

among different departments of the organization. The absence of strategic HR management

caused the organization not to achieve the desired results in its initial strategy. Thus, this aspect

is worth considering appropriate management and coordination of the organization’s resources.

Based on the Euro Disney case, it came out clearly that managers in different regions

apply varied management styles. In this respect, Culpan & Kucukemiroglu (1993) performed a

comparison of the U.S and Japanese management styles and unit effectiveness. They used a

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conceptual framework that comprised of six managerial dimensions that included; supervisory

style, communication pattern, decision making, interdepartmental relationships, control

mechanisms and paternalistic orientation. From their study findings, both U.S and Japanese

styles had salient features. The leaders from both ends demonstrated the desire to learn from

different management systems to gain effective aptitude for comparative studies. The

investigators still felt there was need for further researches in the future to advance on their

current findings, particularly, through developing alternative models with robust capabilities for

effective management of organizations.

There are quite a number of approaches and leadership styles that managers apply based

on what they think suit their personalities. Cooper, Porter & Endacott (2011) carried out a study

on mixed methods research for emergency care. Modern views on mixed method approaches

were considered with the main focus being directed on the design choice and amalgamation of

qualitative, as well as quantitative data that emphasized the timing of information collection for

each methodology, the relevant weight and how they would be utilized. The advantage of

applying mixed designs, especially in the emergency care is to meet the varying needs of

patients. The study presented best practices for consideration. Their findings indicated that the

application of mixed design in clinical settings had increased. The primary aim had been to

respond to the question “how many” and “why” in the same study? In the same respect, it is

questionable to apply more than one management style in the same organization. But still, it is

relevant when it comes to achieving the Triple AIM, which to some extent, requires a 3-

dimensional and multifaced efforts from the manager. The leader can apply different styles based

on the prevailing circumstance and the goals to be achieved.

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The available styles that leaders apply in the contemporary management arena include

transformational, transactional, participatory, democratic and servantiship styles. Golm (2009)

explored into some of these approaches, particularly, transformational, transactional and change-

oriented in reference to their influence on leadership effectiveness. Using a tagged multifactor

leadership questionnaire as the main methodology, the data was collected from the sample

population that had been selected randomly. It was then analyzed using correlation coefficient

and multiple regression. From the findings, there was a strong correlation between the three

leadership styles when it comes to management effectiveness. Both of them exhibited the trait of

motivating the staff to work as a team. This shows that either of the three styles can be applied

by leaders, even though they exhibit few variations. An important point to note is that their

application should be made relative to the ability to meet the prevailing organizational needs.

Thus, it is a good illustration of leadership skills diversity.

The three leadership styles demonstrate the capability of a leader to serve, follow and

lead. This concurs with the investigation pursued by Penny (2017) in a radiologic setting. The

main focus was to demonstrate the diverse skills that radiologists need to possess, given their

diverse roles that need at least minimal understanding of every aspect for effective delivery of

services and their effects on the organization and patients. The emphasis was on the ability of the

radiologists to work as a servant, follower and leader for the success of the organization.

Managers who work with millennials have found some of these styles essential in motivating the

staff. Middaugh, Grissom & Satkowski (2008) recommends managers to adapt their styles to the

approaches developed by Disney. The components of these approaches include safety, courtesy,

show and efficiency. According to these investigators, Disney’s philosophies and values take the

magic to the workplace, implying that they enhance effectiveness and efficiency. Thus, the

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peculiarities highlighted by Lettieri, Masella & Radaelli (2009) in their analysis as being

common in the workplace can be countered accordingly. The failure to eliminate these

peculiarities can result in errors as indicated by Porter, et al. (2008). Thus, effective leadership is

essential for an organization to succeed in its endeavors. The styles discussed herein can be

applied to any industry, whether it is service-oriented or commodity-based.

Change Management

Effective communication in a work environment ensures the attainment of the set

objectives. During change implementation, the management and staff coordinate properly

through appropriate communication. Dent, E. B., & Susan Galloway (1999) performed an

investigation that aimed at challenging resistance to change. The authors investigated the

existing hypothesis that employees exhibit resistance to change that managers must overcome.

This resistance can be attributed to poor communication that result in the fear of the unknown.

Managers should engage employees and elaborate to them the essence and rationale for the

proposed change implementation before executing it.

Accordingly, Doyle (2002), in his study that involved investigating issues of learning,

development and support from change novice to change expert established that most

organizations have turned to integrating more empowering structures and cultures into their

systems to facilitate their adaptation and transformation. Drawing on empirical evidence from

managers and employees charged with the role of executing change, the author identified

psycho-social stresses and traumas associated with managing change. As such, effective

communication is required to facilitate mutual collaboration between managers and employees to

have a swift transition from novice level to expert. Thus, appropriate human resource strategies

and policies are vital.

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Friestad-Tate & McCoy (2012) pursued a study about learning the reactions of people in

the midst of change. The main objective was to listen to the reactions of key stakeholders

experiencing profound organizational change. The author utilized a case study to gather data

from participants’ interview responses. The researcher identified two unique themes that

included constructive critique and ill-effects of good intentions. Apparently, listening,

understanding and appreciating reactions and emotions when implementing change facilitate the

development of important insights that build organizational community and enhance the success

of a change initiative. A 2016 study published by HT Media Ltd established unsuccessful

transitions to be attributed to the failure to generate a sense of urgency, establish a powerful

guiding coalition, develop a vision, communicate the vision clearly and often, remove obstacles,

plan for and create short-term wins (HT Media Ltd, 2016).

Pollack & Pollack (2015) proposed Kotter’s eight stage process to manage organizational

change. The authors described a change manager’s action research investigation into the use of

Kotter’s approach to manage significant organizational change. Kotter places much emphasis on

a top-led model for change. The researchers established the necessity to engage each other at

numerous levels of the organization to execute change effectively. Kotter’s approach was found

to exclude the complexities of the required action. This was due to the fact that change

management require the involved parties to facilitate multiple concurrent instances of Kotter’s

approach to re-create a relevant change. This means, the team must work together as proposed by

Cardez (2015) in his research about why some teams pull together and others don’t. It was

established that employee engagement was becoming a vital aspect when implementing

organizational change. Much coordination has not been uncovered yet, perhaps due to the fact

that leaders need to adopt a more servant like style to participate equally in the proposed change

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implementation. This can be derived in the phrase, “leaders eat last.” Being authoritative is the

reason some teams find it impossible to work together as required to attain a successful change

implementation.

Calabrese (2003) investigated into the ethical imperative to lead change by overcoming

resistance. The primary rationale was a motivation for school administrators to be forward

looking and recognize shifting paradigms in the contemporary society. As an effective

administrator, one has to be a change-driven agent. Also, a leader needs to be a team player and

have the capability to foster positive cooperation among employees. Successful attainment of

this process is based on effective communication. A leader needs to be flexible and a good timer

to understand when it is necessary to shift from one paradigm to the next one that seems feasible

for the prevailing circumstance. This is where ethical imperative of change come into play.

In the current century, most employees are millennials, who are characterized by

aggressiveness, technology oriented, team players and always ready to learn, as well as try new

models that seem feasible to facilitate the attainment of the required outcomes from a process.

Accordingly, Fructuoso (2015) probed an investigation on how millennials have changed the

way of learning through their integration of the state-of-the-art technology into education. Their

primary emphasis is on educational institutions to adapt to the needs of the youths. They suggest

the incorporation of educational technologies in the school curriculum. Thus, the reason there

has been a significant increase in computers and access to the web. Today, tutors try to replicate

conventional approaches to education and where e-learning is considered a complementary to

face-to-face education. Some may view the use of technology as a waste of time, especially if

they cannot uncover its significant revolution to the education system. Technology has changed

the way of learning by personalizing, collaborating and creating a shared learning environment.

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Millennials deliver their best and coordinate positively with one another if they are

motivated by the management. This means, organizational productivity and change

implementation is a variable that relies on an established good rapport between the management

and the staff. This is possible when there is an effective communication channel in place that

ensures each person’s grievances are heard and acted upon as required.

Baumeister (2016) probed an investigation into the determination of a general theory of

motivation. The study involved the identification of problems, challenges, opportunities and the

big picture. Typically, theories of motivation focus on particular motivations, while undermining

the intellectually and scientifically problem that regard the construction of a general theory of

motivation that can facilitate the meeting of millennials needs in the work environment. This

theory places much emphasis on emotion, cognition, and agency at the primacy of motivation.

According to the study findings, motivation respond positively to the local environment and has

the capability to adapt to it, especially if individual desires increase after being satiated, or

reduce when satisfaction is made chronically unavailable. In some cases, it can be viewed that

addiction is integral in motivation. Baumeister (2016) considers it to be a little bit less special to

the prevailing cultural stereotypes. According to the researcher, there is a conflict of interest

between liking and wanting, as well as self-regulatory management of motivational conflict that

require a comprehensive elaboration using an integrative theory.

Most employees love feeling entitled as established by Alexander & Sysko (2013). In

reference to change implementation, entitlement refers to the right to claim something.

Millennials, also called Generation Y prefer to have the right to entitlement as a way of being

responsible. They have the courage to confront scholars and employers in a manner that can

make them comfortable to deliver the duties assigned to them. Drawing from comprehensive

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reviews of appropriate literature, Alexander & Sysko (2013) validated the existing abstracts that

facilitate the development of an instrument that was used to evaluate antecedent cognitive

constructs and the final affective and behavioral influence that contribute to the entitlement

attitude among millennials.

The presence of millennials in the work environment make change to be considered a fact

of life as posited by Sherman & Garland (2007). The same generation are the ones who

spearhead its resistance, prompting the need for managers to handle them with due diligence for

effective implementation of the proposed change. In case managers fail to overcome resistance

from employees, their careers might be jeopardized, given the findings of Sherman & Garland

(2007) that indicated that resistance to change end up creating ex post or after-the-fact effects.

Individuals can fail to pull together as suggested by Cardez (2015), thereby, push back against

change agents, making their efforts to be considered unfruitful. Eventually, the affected

individuals end up leaving the organization either voluntarily or involuntarily. This is a clear

indication of poor communication that result in conflicts in the form of opposing forces towards

organizational change implementation.

Crouzet, Parker & Pathak (2014) responded to the existing resistance that work against

effective implementation of organizational change by probing into an investigation that aimed at

developing productive intervention initiatives that managers and employees who are considered

as change agents can utilize. The authors cited resistance as the main obstacle that cause change

implementation to fail. The researchers explored the knowledge of resistance to change and

sought to review the existing literature to provide a comprehensive understanding of the various

approaches that can be applied to manage change initiatives.

38

One of these initiatives is the induced variation in administrative systems as established

by Caldart, Vassolo & Silvestri (2014). The main focus was to experiment different

administrative systems concurrently on the selected firms in a bid to determine those systems

that could provide the most conducive context for innovation and capability development that

would facilitate effective change implementation. In the same respect, Ayanian & Markel (2016)

proposed Donabedian’s lasting framework for healthcare quality. These initiatives are meant to

provide a lasting solution to the increased resistance against the implementation of organizational

change.

Conceptual Framework

Interdepartmental communication starts with the patient experience. The overall question

is how to increase interdepartmental communication in respect to work place safety in trauma

situations. The patient experience is directly connected to the clinician’s experience.

Understanding the patient perspective within the trauma care environment can help us to

understand why trauma to clinicians occurs. Thru various articles there is documented proof that

trauma to clinicians is a documented event. The importance of these is to show how it effects the

continuity of care as well as the mentality of the clinician after the trauma. Communication

within the healthcare environment occurs from the minute the patient is first acknowledged by a

clinician to the moment they are discharged and leave the clinical environment. Healthy

communication should occur at each handoff. The management of the critical care environment

needs to be done in such a way as to encourage the effective communication between

departments for the safety of the clinician and the patient. Change management needs to be done

in such a way as to encourage the buy in for change so that the change process is done in such a

39

Patient Experience

way as to be productive. Managing the change of how we communicate between departments in

medicine will require sweeping changes to the current work process.

Summary of the Literature Review

There is very little communication when there is a violent patient or potentially violent

patient being treated by clinicians across multiple departments in emergency medicine. The

current climate between departments in the healthcare environment fosters communication but

not to the extent that is needed for the overall safety of the clinicians in the clinical environment.

To manage improved communication techniques between departments in respect to work place

safety in trauma situations is the overall purpose of this body of work. Within the literature

review the following areas will be reviewed: The patient experience, Proof that work place

trauma to clinicians happens, the current communication within departments in the clinical

environment, how communication is currently managed, and the current climate of change

management within the clinical environment. By the completion of the literature review we will

see where there is a lack in the current body of knowledge that will allow us to find how to better

manage interdepartmental communication in respect to work place safety in trauma situations.

40

Proof it Happens

CommunicationManagement

Change Management

CHAPTER THREE

Research Tradition

The research tradition that is the most applicable for the project is phenomenological

qualitative research. Specifically, a sampling style of research within this method. The work

being done is based on the first-person perspective. The lived experience is the essence of the

41

qualitative approach. The dissertation topic is based on Interdepartmental communication in

respect to work place safety in trauma situations. As the topic is based on the specific

communication between the clinician who is aware of patients who are a safety risk to

themselves and/or staff; or of a current unsafe situation in a specific department. What is

important is how to manage the communication between that clinician in the know verse the

clinicians who are completely unaware of any dangers in their clinical practice (Dojmi Di

Delupis et al., 2014).

A Qualitative approach is appropriate for my area of interest because it is a situation that

is based on the first-person perspective. It is not enough to know that traumas in the workplace

occur in medical practices across the globe. What is important is how clinicians communicate

those traumas. How those situations affect the clinician is what will be the key to creating the

buy in for change (Burns, 2014).

Research Question

Open ended questions are an important part of research for a couple reasons. When

questions are asked that do not have the option of a yes or no answer than people feel the need to

fill the empty silent spaces with talking. That can lead to people being open about experiences

which is the goal of phenological research. Learning and researching the lived experience of the

subject (Matua, 2015). The research question in this study is as follows: How can there be an

increase in interdepartmental communication in respect to work place safety in trauma

situations?

Research Design

42

Using qualitative phenomenological research will allow that first person story to be able

to be told. When people are asked to share something deeply personal; as is the case when it

comes to experiences of work place trauma to clinicians who know that change is necessary to

create a better clinical environment for the patient and the clinician.

The reason a qualitative approach has been chosen is that the acknowledgement of the

lived experience and the guiding of the conversation to questions of communication between

departments is the key to see where the change management of interdepartmental

communications has a foundation to grow from (Kraus et al., 2014).

Population and Sample

The population for the proposed research is front line clinicians in the healthcare

environment. Clinicians such as nurses, imaging professionals, EMT’s and Paramedics that

work in emergency medicine are the focus of the study. Currently there are over 70,000

members in the American Society of Radiologic Technologists or ASRT. Imaging Professionals

have the unique perspective of being on the receiving end of orders that cross the

interdepartmental line. The researcher has access to 20 Paramedics and EMT’s. These first

responders are the critical first team that have interactions with patients that pose a critical threat

to clinicians in the healthcare environment. The researcher has access to a pool of 20

emergency room nurses and Providers within the Presbyterian Healthcare System in New

Mexico as well as nurses within the University Medical Center of Nevada Healthcare system that

have offered to be interviewed for the research aspect of my dissertation. Nurses within

emergency medicine are usually the ones entering the orders and are dealing with the patients on

a more long-term process that are potential risks to the healthcare providers. In all of these

43

groups there are examples of how people have been assaulted within healthcare by patients and

how that has affected the quality of their work.

Based on the population and conventions found in the literature, the appropriate sample

size for my research is approximately twenty people. Specifically; a mix of 6 Imaging

Professionals, 6, Paramedics/EMTs, 6 Nurses, and 2 Providers; specifically, Emergency

Medicine Physicians; would be the correct mix of perspectives on both the current work

processes as well as the need for change. Clinicians and first responders become numb the work

place traumas that tend to occur regularly. The purposeful sampling of this group (n=20) will

tend to show that the shared experiences that all of the participants have will help to strengthen

the body of work that already exists in the field.

Sampling Procedure

Purposive sampling uses a group based on preselected criteria. Quota sampling is a way

of creating a survey where there is a preconceived idea of how many and what type of criteria

that is to be used, with respect to the preselected criteria of clinicians who work in trauma

medicine. That makes the most since as there is a need to be able to question people who have

specific knowledge of the clinical experience (O'Cathain, Nicholl, & Murphy, 2009).

The permissions that need to be obtained in writing before conducting my research will

be signed documents from each of the research subjects about the work that the researcher is

doing and that their responses will be made a part of a doctoral work. If the researcher goes thru

the ASRT to obtain permission to reach out to their members then the researcher would need

permission from them to access their member database. The researcher firmly believes that the

researcher knows enough people that they have met at the national level of imaging professionals

44

that the researcher will not need to reach out to the ASRT for permissions to access their

members.

Instrumentation

The instrument that will be used to accomplish the phenomenological qualitative research

will be the interview questions. Digital recording equipment will be used to capture the full

interview. The interview questions that will be asked as follows:

Can you tell me about a patient in your department that was violent? In my own

clinical experience, everyone has had ‘that’ patient. Going with the assumption

that everyone in my focus group has as well, will open the thought processes for

memories of their experiences.

Can you remember the first time you experienced a violent patient or workplace

trauma? This will open the conversation and a direct that should date back to the

beginning of their experience. There is a chance it can open the door to what was

the facilities policies at the time for charting or communicating those experiences.

How does that make you feel about how you clinically care for your next

workplace trauma? This opens the conversation about how workplace traumas

create a form of PTSD on the clinicians in question and how it manifests.

What interdepartmental communication is available on the orders between

departments? This creates the bridge of what is current policy and the current

level of interdepartmental communication.

Have you ever had to go to a code in another department from a patient that was

violent in your ER? Can you tell me about that situation? This creates the bridge

45

in the research on the cause and effect of communication on the clinicians in other

ancillary departments.

Throughout the interview process the researcher will encourage and take notes of the

stories and lessons learned from the experiences of the subjects of the research.

Validity and Reliability

The researcher will ensure the validity and reliability of my qualitative research by

having my research subjects sign a consent form as well as by explaining the how the work we

are doing will help to create a better work process that will eventually create a safer work

environment for both the patient and the clinician. At the end of the research process the

researcher will offer to those that want to be made aware, the ability to reach out for a copy of

the finished study. This way they can see how their participation has affected the finalized body

of work. See Appendices A.

Data Collection

The process that will be used to collect the data will be as follows:

One. Create the list of the perspective research subjects

Two. Reach out by text, call, or email to each of the subjects to confirm their

participation.

Three. Schedule the interviews at a Starbucks if locally, via facetime, or skype if out of

town or more convenient for the research subject. Setting aside one hour for each participant.

46

Four. Interview each subject with the same preset list of questions. The questions being

asked will be as follows:

Can you tell me about a patient in your department that was violent? In my own

clinical experience, everyone has had ‘that’ patient. Going with the assumption that

everyone in my focus group has as well, will open the thought processes for

memories of their experiences.

Can you remember the first time you experienced a violent patient or workplace

trauma? This will open the conversation and a direct that should date back to the

beginning of their experience. There is a chance it can open the door to what was the

facilities policies at the time for charting or communicating those experiences.

How does that make you feel about how you clinically care for your next workplace

trauma? This opens the conversation about how workplace traumas create a form of

PTSD on the clinicians in question and how it manifests.

What interdepartmental communication is available on the orders between

departments? This creates the bridge of what is current policy and the current level of

interdepartmental communication.

Have you ever had to go to a code in another department from a patient that was

violent in your ER? Can you tell me about that situation? This creates the bridge in

the research on the cause and effect of communication on the clinicians in other

ancillary departments.

Five. Notes will be taken throughout the interview process and the same follow-up

questions will be asked to all participants so that the answers can be analyzed collectively.

47

Six. At the end of each interview the research subject will be invited to reach out to the

researcher for a copy of the final doctoral dissertation that they had a hand in working towards.

Seven. All of the data collected will be organized and correlated by date, name and

occupation of the interviewee (Stephens, Barton, & Haslett, 2009).

Data Analysis

The phenomenological nature of the qualitative research will generate a lot of recordings,

transcripts and notes. Analyzing the data for the research project will be done as follows

(Kohlbacher, 2006):

One. Reading thru all of the collected research.

Two. Listen to all available recordings from the one on one interviews.

Three. Organize the research into First responder, Imaging Professionals, Providers.

Four. Take notes while analyzing the information gathered into common themes.

Five. All aspects of the information gathered will be reviewed based on common

themes that cannot be changed throughout a shared experience.

Six. The common themes will be organized and coded into sections that will keep the

information objective.

Seven. The data collected with go thru a triangulation method where the information

gathered from the various sources will be separated into the groups they came from (i.e. ASRT

members, nurses, hospital-based clinicians). The review of the various groups’ information can

be analyzed within their sections and then analyzed against the overall group interviewed. This

will capture different dimensions of the same phenomenon.

48

Ethical Consideration

The human subjects for the qualitative phenomenological research project on

interdepartmental communication in the respect to work place safety in trauma situations will be

protected by respecting the autonomy and anonymity of the research subject. Each of the

participants will sign a consent form at the onset of the one on one interview process. The goal

of ‘doing no harm’ that is the staple of all actions in the healthcare environment is equally

imperative in the research being done in this project. All risks will be minimized and the

benefits of the research will be explained to the research subjects; specifically, how the research

will benefit them and the healthcare community (Amon, Baral, Beyrer, & Kass, 2012).

Summary of Chapter Three

The goal of the research design is one of asking pointed questions and learning from the

past so that the we can analyze the results and present them for the future growth of the

management of communication. Working with industry leaders and front-line clinicians to learn

from their current work processes and what has worked and was has not will allow for future

changes to the management of communication in healthcare organizations.

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Appendix A:

Study Title: How to increase interdepartmental communication in respect to work

place safety in trauma situations

Study Participant: _______________________________ Date: ________________

58

You are invited to participate in a research study conducted by Nicole T. Walton-Trujillo,

R.T. (R) (CT), ASRT, ARRT, BSRS, NMSRT, MBAH, MOL; from Colorado Technical

University.

We are asking you to take part in this study because you are or have been a member of

the Patient Care Center team of Desert Radiology.

Your participation is voluntary and will consist of one on one interviews that will be

recorded as well as there will be notes taken by the researcher throughout the interview.

There are no anticipated risks to your participation and there are no direct benefits to you

for taking part in this study.

You will receive no reimbursement for your participation and it is completely voluntary

on your part. You will be given a copy of this form. If you have any questions about this

research study, please contact:

Nicole T. Walton-Trujillo, R.T. (R) (CT), ASRT, ARRT, BSRS, NMSRT, MBAH, MOL

at 505-975-0091 or nicole.waltontrujillo@student.ctuonline.edu.

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