Article Text

Original research
Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?
  1. Sayra Cristancho1,
  2. Emily Field2
  1. 1Department of Surgery, Faculty of Education and Centre for Education Research & Innovation, Western University, London, Ontario, Canada
  2. 2Centre for Education Research & Innovation, Western University, London, Ontario, Canada
  1. Correspondence to Dr Sayra Cristancho; sayra.cristancho{at}


Objectives This interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving ‘traces’ in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt. This paper brings awareness to its existence in the context of healthcare teamwork.

Design Interview-based study using Constructivist Grounded Theory methodology.

Setting This study was conducted in multiple team contexts at one of Canada’s largest acute-care teaching hospitals.

Participants 25 clinicians from across professions and disciplines. Specialties included surgery, anesthesiology, psychiatry, internal medicine, geriatrics, neonatology, paramedics, nursing, intensive care, neurology and emergency medicine.

Intervention Not relevant due to the qualitative nature of the study.

Primary and secondary outcome Not relevant due to the qualitative nature of the study.

Results The dataset was analysed using the sensitising concept of ‘traces’ from Swarm Intelligence. This study brought to light novel and unique elements of trace-based communication in the context of healthcare teamwork including focused intentionality, successful versus failed traces and the contextually bounded nature of the responses to traces. While participants initially felt ambivalent about the idea of using traces in their daily teamwork, they provided a variety of examples. Through these examples, participants revealed the multifaceted nature of the purposes of trace-based communication, including promoting efficiency, preventing mistakes and saving face.

Conclusions This study demonstrated that clinicians pervasively use trace-based communication despite differences in opinion as to its implications for teamwork and safety. Other disciplines have taken up traces to promote collective adaptation. This should serve as inspiration to at least start exploring this phenomenon in healthcare.

  • quality in health care
  • qualitative research
  • medical education & training

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Supplementary materials


  • Twitter @scristaM

  • Contributors SC designed the study, collected the data and led the writing of the manuscript. Both SC and EF conducted data analysis and EF further participated in writing for the revised manuscript.

  • Funding This work was supported by Physicians Services Incorporated Foundation in the grant category ‘Health Research Grants’. Grant title: Building the collective competence of an interprofessional team.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Part of the anonymised data is shared in Appendix 2 to illustrate the coding framework used for data analysis.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.