JMIR Publications

ABSTRACT

Background:

Effective communication strategies, characterized by accuracy and urgency, are becoming increasingly important in wards where high-risk patients are treated, including intensive care units (ICUs) and emergency rooms. Additionally, effective communication among healthcare professionals benefits patient care, helps foster teamwork among them, and improves their workability and well-being in the workplace. Therefore, identifying the communication structures of healthcare professionals in the ICU is crucial.

Objective:

Wearable sensors were used to obtain face-to-face interaction data from the ICU medical staff at a university hospital in Japan that provides tertiary emergency care. We performed a social network analysis (SNA) to assess the characteristics of each healthcare professional in the network, identify the number of healthcare professional connections, and analyze four centralities that can measure a healthcare professional’s importance. Furthermore, data on the well-being of medical staff using the Center for Epidemiological Studies Depression (CES-D) questionnaire were collected to better understand the correlation between well-being and the four centralities.

Methods:

Overall, 247 healthcare workers in the ICU of Mie University Hospital participated in this clinical study for 4 weeks each year in February 2016, February 2017, and February 2018. All participants wore a badge in front of their clothing during working hours to measure the total frequency of face-to-face interactions. During the third week of the study, a CES-D questionnaire was administered to measure the well-being of healthcare professionals.

Results:

Most of the face-to-face interactions in the ICU were between nurses or nurses and other professionals. In 2016, 10 nurses could perform leadership tasks, which significantly increased to 24 and 20 in 2017 (P<.05) and 2018 (P<.05), respectively. Considering the increased number of nurses who could perform leadership duties and the collaboration created within the organization, the SNA in 2018 showed that betweenness (P=.001), degree (P<.001), and closeness (P<.001) centralities significantly increased compared to those in 2016. However, eigenvector centrality significantly decreased in 2018 compared to 2016 (P=.005). The CES-D scores in 2018 also significantly decreased compared to those in 2016 (P=.005). Furthermore, betweenness (R=0.269, P=.021), degree (R=0.262, P=.025), and eigenvector (R=0.261, P=.026) centralities and CES-D scores were positively correlated in 2016, whereas closeness centrality and CES-D scores were negatively correlated (R=-0.318, P=.006). In 2018, when the distributed leadership structure was established, degree (R=-0.280, P=.010) and eigenvector (R=-0.284, P=.009) centralities were negatively correlated with CES-D scores.

Conclusions:

Face-to-face interactions of healthcare professionals in the ICU were measured using wearable sensors, and nurses were found to be centrally located. However, the distributed leadership introduction created collaboration and informal leadership in the organization, altering the social network structure of healthcare professionals and increasing organizational well-being. Clinical Trial: This clinical trial was registered in the UMIN Clinical Trial Registry System (UMIN000037046).