Caspar, S., Ratner, P. A., Phinney, A., & MacKinnon, K. (2016). The influence of organizational systems on information exchange in long-term care facilities: An institutional ethnography: An institutional ethnography. Qualitative Health Research, 26(7), 951–965. https://doi.org/10.1177/1049732315619893
Person-centred care is heavily dependent on effective information exchange among health care team members. We explored the organizational systems that influence resident care attendants’ (RCAs) access to care information in long-term care settings.
We began to see these microsystems as if they were divided by a fence. The RCAs were on one side, and the regulated health care team members and management were on the other. On the regulated staff side, information exchange about care planning was highly textually mediated; here, the adage “if it’s not documented, it didn’t happen” reigned supreme. On the other side, the intricacies and individualized information about the care provided by the RCAs were not captured in written format and were shared through oral exchange between RCA staff. Further exploration found that RCA’s lacked practical access to care planning texts. Organizational systems mandated written exchange of information and did not formally support an oral exchange. Thus, oral information exchanges were largely dependent on the quality of workplace relationships.
As a result, knowledge about each resident’s idiosyncrasies, gained through proximity and familiarity (e.g., knowing that singing a favorite song reduced a resident’s resistance during bathing), was neither captured nor shared by a formal institutional text. Instead, the sharing of this information, which could mean the difference between successfully and safely providing care to a resident or not, was predominantly accomplished through unplanned and coincidental oral exchanges.
Key Recommendation: Formal systems are needed to support structured oral information exchange within and between the microsystems of care found in LTC.