Table 1

Relational coordination (RC) framework applied to narrative survey data

Dimension of RC frameworkExamples of factors related to strong tiesExamples of factors related to weak ties
Shared goals“I really like if there are updates and summaries and then setting goals. So after 5 or 10 min sum it up, where do we stand, and where do we go from here?”
“All groups arrived prior to patient arrival, and were able to make plans as to what would happen when pt arrived. Clearly defined roles and plans make the collective job easier”.
“Everyone (was) doing their own thing without any coordination, people having conflicting opinions on management”.
“Key things that were lacking:
  • Preparation. Especially an overview of how it was likely to play out.

  • Leadership—shared mental model of what the scenario was and the goals of treatment”.

Shared knowledge“When we know what imaging is expected to be required, any complications that may be present. This allows us to appropriately triage room and keep the scanner clear”.
“The overarching theme that improved these (traumas) was effective communication, an understanding of the individual roles on the trauma team, a focus on handover of care”.
“[Trauma care would improve with] a better understanding of the roles/skills other teams have and how they can be used in the first hour so that the ED team don’t feel like that have to manage everything (especially invasive procedures where anaesthetists and surgeons could be managing these procedures in tandem to take some of the pressure off the ED doctors) on their own”.
“[in a trauma that went poorly] I was the circulation nurse but the consultant only communicated his plans of care to an airway nurse, that made me confused and feeling left behind about the treatment for the patient”.
Mutual respect“I don't know how you build relationships but that is what it is about. If you actually care about the person you are speaking to as a human being then you are solution oriented”.
“Even if the scenario is completely different but you look up from the patient and you see a face that you just worked with before. It just gives you a lift towards comfort and easiness to communicate”.
“As a radiographer we seem to be quite invisible in a lot of situations. When we are scanning doctors come in and take over our computers and monitors with little or no communication with us”.
“[in a trauma that went poorly we cared for] an unstable trauma patient with a vascular injury to the right arm and a tourniquet on, where the vascular surgery registrar was difficult to deal with. He arrived and was rude, critical of management so far, and disruptive to the ongoing team based management of the patient. As the medical team leader I found this challenging to deal with”.
“The greatest issue is forming strong relationships with some departments, maintaining good consultant input and getting to know people”.
 Timely“With good pre-hospital management and timely accurate communication with hospital teams, we were able to follow red blanket protocol, activating this prior to patients arrival. This meant we were able to bypass ED and take the patient straight to OT where a surgeon was ready to operate straight away”.
“Timely and accurate communication about the nature of the trauma to myself in CT. After performing the initial assessment contact was made with me to confirm the availability in the CT scanner”.
“ [a case went poorly] when it was difficult to get involvement anaesthetics/ICU/surgical team with delays to OT due to difficulty contacting teams”.
“Communication with the majority of surgical teams is well-done, however it can be challenging identifying and communicating with the senior orthopaedic surgeon when their involvement is required in cases, and often despite patients being quite sick and clearly benefiting from senior involvement, there is no senior orthopaedic surgeon in attendance”.
“Sometimes a delay to important findings on imaging being reported to treating team whilst entire pan scan is being looked at. Could be helped by radiology calling ED with results as they find them or ED going to radiology to ask specifically what they are worried about”.
 Accurate“[a trauma went well with] accurate handover via phone call from QAS to Triage staff. Accurate relaying information from triage to resuscitation team (doctors and nurses). Accurate codes alerted and correct teams responded within a timely manner”.
“[traumas go well when there are] clear instructions regarding patient management”.
“[traumas] can become extremely difficult for nursing staff as we have 2–3 and sometimes 4 doctors giving different orders which are all conflicting”.
“I have memories pre-trauma team of a stab wound bleeding significantly and the surgical registrar not conveying the severity of the situation to the surgical consultant and being in a situation where a man was slowly (rapidly?) bleeding out without a surgeon coming to take him to OT”.
 Frequent“I really like if there are updates and summaries”.
“When a trauma arrives initially it is helpful for us in medical imaging to be notified. It is helpful if we are kept in the loop in regards to when the patient will be ready for scanning. As we are such a busy hospital we in CT are not in a position to just stop scanning and wait for a trauma patient to be ready to come over”.
“[traumas go well] when there has been complete calm and the leading MO is communicating regularly with all involved in the trauma care”.
“Staff arrive at multiple times—the story has to repeated frequently for new comers”.
“[traumas go poorly] when circumstances change and there is no communication”.
 Problem-solving based“Sometimes particularly in the major resuscitations, I found it’s important to have an exchange in information, not just in information but also sort of thought process exchange. What's going on. Because we can get tunnel vision”.
“[in a trauma that went well] the ICU consultant was present and helped with procedures and also politely made a suggestion for an omission on my part ensuring the patient got good care”.
“[there was] continued shared decision making between ED consultant and Surgeon resulting in diversion in plan to CT, directly to theatre as became unstable”.
“[traumas go poorly when] people having conflicting opinions on management and unwilling to have cordial discussions, everyone shouting over each other”.
“[there was] disagreement in treatment plan between ED and surgical teams. Obvious friction. Result[ed] in delay to definitive treatment”.
“[in a trauma that went poorly there was] confusing decision-making communication with team. Conflicting priorities without shared mental model of goals”.