Informal communication in integrated primary health clinics

Background Effective integrated care requires healthcare professionals to collaborate across disciplines with and around the patient. The tribal nature of health professionals can make this a difficult task. Understanding how, when and where communication occurs in Integrated Primacy Health Clinics (IPHCs) can foster stronger integration, however communication patterns are not always predictable. Informal communication is often the most prominent form of communication in an IPHC, but is poorly understood due to its nature. Aim To articulate the role that informal communication plays in supporting integration, propose methods for measuring it, and discuss the results of our study in a community IPHC in Canberra, Australia. Method Aspects of informal communication are defined and their functions explained. The aspects of informal communication are: informal networks, informal relationships, and informal encounters. A mixed-methods approach to measuring and describing the role of informal communication is proposed: Social Network Analysis is a useful tool for examining key relationships across disciplines; ethnography is necessary to understand how these relationships emerged, what supports them, and how they contribute to integration. Results Our study revealed that informal communication is more prevalent and preferred to formal communication in the community IPHC we studied. Space, shared experiences and commitment to organisational ethos were key to building these relationships which allow for teams to more quickly respond to the needs of patients. Conclusion Informal mechanisms exist and influence both processes and outcomes in IPHC. The informal communications that occur within the IPHC are often vital to the process of integration as well as the outcomes of the patient. SNA can give us important insight, but we cannot see the entire picture unless this is complemented by focused qualitative research.