Tensions in Community Health Improvement Initiatives: Communication and Collaboration in a Managed Care Environment

Between the years 1993 and 2000, the W. K. Kellogg Foundation sponsored the Comprehensive Community Health Models (CCHMs) Initiative in three Michigan counties. CCHMs was comprised of three closely related community initiatives carried out in the midst of a failed national health care reform effort and the continued penetration of managed care arrangements into many health care systems. This experimental initiative set out to test the hypothesis that traditional healthcare system animosities and exclusionary practices could be overcome by stakeholder participation in an ongoing, structured, collaborative dialogue about improving access to health services. In the process of collecting data through surveys, interviews, content analysis, and observation, we were struck by the occurrence of several overarching tensions that we perceive to exist in our data. The present article elucidates five such tensions and suggests how third parties such as communication researchers, evaluators, and practitioners can facilitate community health improvement initiatives and better their own data interpretation by acknowledging and understanding these tensions.     

Collaboration for Compliance: Identity Tensions in the Interorganizational and Interdisciplinary Regulation of a Toxic Waste Storage Facility

Safely securing toxic waste necessitates collaboration across organizational and disciplinary boundaries. This study focused on the Waste Compliance Team (WCT), an interorganizational and interdisciplinary collaboration of a team of experts responsible for the regulatory documentation of a toxic waste storage facility. The results distill four coherent premises for self-definition evident in their collaboration: knowledge creating/scientist, knowledge checking/regulator, knowledge applying/engineer, and knowledge scheduling/project manager. Our analysis emphasized the implications of identity tensions among these competing premises for how the WCT made sense of their documentation work, safety concerns, and conflict and decision-making. Integrating multiple data sources, including interviews, observations, and a workshop with participants, we employed mosaic portraiture, a methodology developed through the study, to understand and convey the polyphony of the site. We conclude by discussing implications of the findings for theory and practice and the utility of mosaic portraiture for engaged scholarship.     

Participative Democracy and Voice: Rethinking Community Collaboration Beyond Neutral Structures

Decision-making in community-based, interorganizational collaboration often influences educational, environmental, and other civic policies thereby constituting it as politically and socially consequential. As such, we rethink collaboration through the lens of participative democracy rather than as a neutral organizational structure or process. We sought to understand how participative democracy was hindered and accomplished in an interpretive case study of two community collaborations. Data indicate the normative processes and structures of communication practiced by stakeholders primarily deterred voice and participation by prioritizing information exchange, practicing invisible decision-making, and emphasizing harmonious relationships. These findings: (1) add to theories of interorganizational collaboration by establishing voice as both a discursive and political feature of shared decision-making; (2) provide empirical exemplars that extrapolate political and social implications from specific communication practices; and (3) inform the development of a heuristic to improve collaborative participation and increase political accountability. Flowing from these data, we recommend practitioners utilize the heuristic of VOICE—promoting visibility and ownership of decision-making processes, less emphasis on informing, and purposeful fostering of gracious contestation—ultimately delimiting expressive modes of communication that decrease participative democracy and political accountability.     

Exploring Dialectical Tensions of Leading Volunteers in Two Community Choirs

Leaders of volunteers face different challenges than leaders of paid employees due to different motivations and reward expectations. After synthesizing previous research applying dialectical theory to group members or leaders, this study examines the dialectical tensions that leaders of volunteers experienced and the communication they used to manage those tensions as reported by both the leaders and the volunteers. A constant-comparison method was used to analyze observations and interviews of members and leaders of two community choirs. The findings suggest that leaders of volunteers face eight dialectical tensions representing three broad categories: (a) task and relationship; (b) process and outcome; and (c) internal and external. Leaders negotiated these dialectical tensions through communication strategies including use of humor and appeals to artistic spirituality. These strategies represent hybridization and dualistic discourse rather than a monologic emphasis of one course of action over another.     

Health Care Providers' Confidentiality Practices and Perceptions: Expanding a Typology of Confidentiality Breaches in Health Care Communication

Confidentiality breaches of health information can affect every person who seeks medical care. To better understand this phenomenon, breaches of confidentiality by employees in a health care organization were examined and compared to the perceived confidentiality maintenance actions of the organization's health care providers. The study, using observation and interviews of a health promotion department, supported Brann and Mattson's (2004) typology of confidentiality breaches, provided evidence for another type of communicative breach, and revealed inconsistencies between health care providers' actions and their perceptions of those actions. Future research should address the prevalence of such discrepancies in other health contexts and its impact on patient care.     

Cultural Identity Tensions in a Post-Acquisition Organization

This study examines the problems associated with cultural integration in the aftermath of a corporate acquisition. Based on focus groups and one-on-one interviews with members of a post-acquisition organization (PAO), the results reveal three identity tensions used by organization members to reconcile conflicting pulls toward identification and disidentification: collaboration/competition, assimilation/autonomy, and consensus/command. Findings indicate that members across the four sites of the PAO reconcile these identity tensions differently, resulting in more evidence of disidentification at the two sites that had been acquired by the larger organization, than at the other two sites which had been long-standing locations of the acquiring organization. Implications are discussed relative to cultural and identity issues during periods of organization mergers and acquisitions.     

Piloting Consumer Health Information Services in Collaboration with a Community Research Engagement Program

At an academic health science center, librarians partnered with a community research engagement program to offer a suite of consumer health information services. The services included training staff in the use of online consumer health resources, purchasing a print collection of monographs, and creating a guide to both the online and print resources for staff use. Focus groups were conducted to assess information needs, and the workshop attendees’ online health information competency was assessed presession and postsession. This article details planning and intervention efforts, and proposes future activities to meet the information needs of HealthStreet and its clients.     

Branching Out: Communication and Collaboration Among Librarians at Multi-Campus Institutions

ABSTRACT

Communication and collaboration are vital aspects of 21st century librarianship, particularly for librarians in branch and regional settings who are often separated from their system colleagues by both physical distance and administrative structures. For this study, the authors conducted an exploratory survey to examine collaboration, communication, networking behaviors, and perceptions among librarians in multi-campus academic library systems. Results of this investigative study will lead to better understanding of these issues within the profession, suggest possible approaches and solutions for better models of communication and collaboration, and lay the groundwork for future research on these topics.     

Communication as Ventriloquism: A Grounded-in-Action Approach to the Study of Organizational Tensions

Tension-centered analyses are increasingly popular in organizational communication studies. Hence, how tensions emerge and are dealt with by organizational members in their work activities are key issues of debate in our field. The purpose of this article is to develop a ventriloqual approach for investigating how organizational tensions (whether expressed in the form of contradictions, dilemmas, paradoxes, or situational ironies) are communicatively constituted through the mobilization of figures that contradict or clash with each other. To demonstrate the theoretical and empirical value of this approach, we use it to analyze two fieldwork cases from a seven-year ethnographic study of Médecins sans Frontières, and thus show how tensions shape organizational members' realities by being felt and sensed in interactions.     

Managing Dialectics to Make a Difference: Tension Management in a Community-Building Organization

This article is an ethnographic report of the dialectic tension management practices of a community-building organization called the Nehemiah Group. ¹ The Nehemiah Group, in 2009, changed their name to the Nehemiah Network to reflect their expanded involvement of business leaders (Our History, n.d. Our History . ( n.d. ). Retrieved from http://www.nehemiahnetwork.org/about  [Google Scholar]). This group unites local churches to serve the community. This three-year participant-observation study documents how group members manage two primary and intertwined dialectic tensions: noncooperation-cooperation and unity-division. Members use multiple practices to manage these tensions and other intertwined tensions: They construct narratives to voice moral issues, to alternate between tension poles to address pragmatic obstacles, to frame tensions as complementary through segmentation, and rely on prayer rituals to reframe tensions. From this analysis, three implications follow: (a) moral narratives serve to construct framing options, (b) a larger discursive history is utilized to create counternarratives, and (c) metadiscursive practices rely on rituals to manage tensions.     

“You're My Parent but You're Not”: Dialectical Tensions in Stepchildren's Perceptions About Communicating with the Nonresidential Parent

The nonresidential parent plays a role in the lives of stepchildren and in stepfamily households. The focus of the present study was on the interaction between the nonresidential parent and his/her child who resides as part of a stepfamily household. Grounded in relational dialectics theory, the researchers performed an interpretive analysis of 50 transcribed interviews with college-aged stepchildren. Stepchildren's perceptions of communication with the nonresidential parent were animated by two contradictions: parenting/nonparenting and openness/closedness. These two contradictions form a totality, interwoven with one another. The parenting/nonparenting contradiction reflected stepchildren's ambivalence over parenting attempts of nonresidential parents. Stepchildren wanted nonresidential parent involvement and parenting, and at the same time they resisted it, often finding communication to be awkward and challenging. In addition, stepchildren wanted open and intimate communication with their nonresidential parents, yet they found openness to be problematic and managed these contradictory demands via segmentation. Implications of these findings are discussed, along with insights to guide professionals working with stepfamilies and adults co-parenting children to better understand and interact in ways that promote healthy stepfamilies.     

Quality Improvement and Health Care

W. Edwards Deming's theories of continuous quality improvement, using statistical analysis to identify problems or errors in operational processes, are in the early stages of development in service organizations after substantial success in industry, especially in Japan. Information on continuous quality improvement for libraries is sparse. The articles in this annotated bibliography will help interested readers learn more about this theory and its application in the health care business.     

A Patient-centered Approach to Breaking Bad News: Communication Guidelines for Health Care Providers

This investigation takes a patient-centered approach to examining strategies physicians use to deliver bad news to patients. Qualitative data were obtained from 68 patients who had received a message they perceived as negative information from a health care provider. Through grounded theory methodology, patient accounts were examined to reveal four provider strategies for breaking bad news. This investigation underscores the importance of using effective communication strategies to achieve patient satisfaction and compliance.     

Communication and Social Exchange Processes in Community Theater Groups

This study explores the communication experiences of two volunteer groups involved in the production of community theater musicals. Based on social exchange theory, it examined what group members perceived to be the positive benefits (primarily meeting people and having an opportunity to perform) and the negative costs (primarily disorganization, lack of coordination, and time issues) of participating in the groups. The study found that peer support and opportunity for social interaction, along with positive audience response, were the best predictors of positive reactions to their experiences and commitment to the show and community theater in general. These results provide insight into social exchange theory in group settings and can be applied to other community theater groups, as well as other volunteer organizations.     

A Patient-centered Approach to Breaking Bad News: Communication Guidelines for Health Care Providers

This investigation takes a patient-centered approach to examining strategies physicians use to deliver bad news to patients. Qualitative data were obtained from 68 patients who had received a message they perceived as negative information from a health care provider. Through grounded theory methodology, patient accounts were examined to reveal four provider strategies for breaking bad news. This investigation underscores the importance of using effective communication strategies to achieve patient satisfaction and compliance.     

Facilitating Collaboration and Research in Sex and Gender Differences and Women's Health: Year One Experiences

Librarians at the University of Florida Health Science Center Libraries partnered with faculty to promote awareness of and access to research on women's health and sex and gender resources in an outreach project funded by the National Library of Medicine and the National Institutes of Health Office of Research on Women's Health. The project featured elements that facilitated cross-disciplinary collaboration (using CoLAB Planning Series®, or CoLABs), instruction to various groups (including faculty, undergraduate students, graduate students, and professional students), collection development, and information dissemination. Librarians leveraged existing partnerships with faculty and built new ones. Success in this project demonstrates that libraries can partner effectively with their faculty on emerging trends and new initiatives.     

Managing Health Care in Oregon: The Search for a Civic Bioethics

Managed health care deliberations in Oregon point to a "civic bioethics" model to resolve allocation issues through publicly articulated community values and priorities that influence legislative action. Communication practices in the Oregon experiment provide data to develop an evaluative framework to assess public moral deliberation in value-laden contexts such as health care distribution. The Oregon experience also points to dialogical virtues to heighten citizens' ethical sensibilities and political will, discursive tools to inform ethical communication practices in a civic bioethics model.