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

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  • Hilligoss, Brian

Abstract

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

Suggested Citation

  • Hilligoss, Brian, 2014. "Selling patients and other metaphors: A discourse analysis of the interpretive frames that shape emergency department admission handoffs," Social Science & Medicine, Elsevier, vol. 102(C), pages 119-128.
  • Handle: RePEc:eee:socmed:v:102:y:2014:i:c:p:119-128
    DOI: 10.1016/j.socscimed.2013.11.034
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    References listed on IDEAS

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    1. Nugus, Peter & Carroll, Katherine & Hewett, David G. & Short, Alison & Forero, Roberto & Braithwaite, Jeffrey, 2010. "Integrated care in the emergency department: A complex adaptive systems perspective," Social Science & Medicine, Elsevier, vol. 71(11), pages 1997-2004, December.
    2. Nugus, Peter & Braithwaite, Jeffrey, 2010. "The dynamic interaction of quality and efficiency in the emergency department: Squaring the circle?," Social Science & Medicine, Elsevier, vol. 70(4), pages 511-517, February.
    3. Mitchell, Penelope Fay, 2009. "A discourse analysis on how service providers in non-medical primary health and social care services understand their roles in mental health care," Social Science & Medicine, Elsevier, vol. 68(7), pages 1213-1220, April.
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    Cited by:

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    2. Chang, Yu-Che & Nkambule, Nothando S. & Xiao, Xaviera & Ngerng, Roy Y.L. & Monrouxe, Lynn V., 2021. "Safety net, gateway, market, sport, and war: Exploring how emergency physicians conceptualize and ascribe meaning to emergency care," Social Science & Medicine, Elsevier, vol. 287(C).
    3. Cotton, Matthew & Barkemeyer, Ralf & Renzi, Barbara Gabriella & Napolitano, Giulio, 2019. "Fracking and metaphor: Analysing newspaper discourse in the USA, Australia and the United Kingdom," Ecological Economics, Elsevier, vol. 166(C), pages 1-1.
    4. Allen, Davina, 2024. "Why is hospital discharge so difficult? Reconsidering patient trajectories in theory and practice: Insights from an ethnographic study of transitions in hip fracture care," Social Science & Medicine, Elsevier, vol. 347(C).

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