Keenan, Marina Grace (2019) Exploring the Role of Communication Structures and Networks of Senior Staff in a Public Hospital’s Clinical Directorate. Other Degree thesis, Victoria University.

Abstract

The clinical directorate (CD) governance structure of contemporary tertiary healthcare facilities was introduced to Australian hospitals three decades ago. The principle reasons for the change from the previous traditional professional model were to streamline patient care, reduce the costs of providing healthcare, and to ensure a patient-centred approach to healthcare for all Australians. Thirty years on, hospital executives continue to refine structures while paying close attention to the strategic aims and goals of their organisations. However, the effect of these structures on communication between executives, and the likely impact on their managerial roles and relationships, has received limited attention. To address this problem, this study employed a mixed methods approach to understand the influence of the CD structure on executive communication behaviours. The focus of enquiry was the communication structures and networks of senior staff. The approach enabled an interactional view of executive communication networks in a tertiary healthcare facility in Melbourne. Three theories underpinned the study design that methodologically employed a social constructivist and social network analysis approach to answer the research questions. The constructivist position was taken because the focus was individuals’ understanding of processes. Internally generated understandings of the world are distinct from social constructionism where understanding processes is an interactive, collaborative domain (Raskin & Debany 2018). Ten members of the facility’s executive team provided data, which when analysed showed that communications were an intricately balanced phenomenon influenced by the structure of the organisation, their own agency, and that of their colleagues and peers. The project was undertaken in a time of change for the project organisation. The structure of the organisation was evolving under focused refinements by the executive team to create a fit for purpose. Findings suggest that apart from structural rebuilding, executives were personally challenged in establishing communication relationships with others in the context of a changing hospital structure. Noting the importance of wider hierarchical communication, this study focused on intra- executive team communication within the CD, the rationale being that if the executive team communicated well, a consistent message would be conveyed to reports (Keyton et al. 2013). Outcomes from the project demonstrated the importance of trust relationships to achieve effective communication and diffuse information. Effective communication is defined as having skills to transfer knowledge in a complex, cross-functional environment and to be competent in the transfer of knowledge to engage others (Waldeck et al. 2012). Enabling communication was dependent on established relationships, which were influenced by previous work collaborations, proximity, and familiarity. Hindrances to communication were excessive workloads, less time to establish and maintain contact between peers, geographical separation, presence of silos, and behavioural factors, which included limiting contact with other disciplines, exclusion from meetings, and limiting avenues for the development of long-term relationships. The findings contribute to the extant literature by developing the inchoate knowledge of agentive human behaviours within the CD. The emphasis on theoretical integration provides a robust account on which to build further research. Communication pathways and processes have implications for leadership effectiveness, which in turn affects the practice of teams and subsequent staff, system, and patient outcomes. Recommendations for action and future research are discussed.

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