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influences on ICT system device or mode selection e.g. message receipt at different time of day or concurrent activities. The focus of most hospital communication technology intervention studies has been on quantifiable effects on communication metrics and clinician satisfaction, with the minority of studies looking at sociological impacts [22]. The latter study types can demonstrate how complex clinician ICT system requirements may not be well represented by an overall satisfaction metric. An example is Johnston et al [29] where clinicians agreed that electronic communication required adequate security systems. This can conflict with simultaneous demands for optimal efficiency [18], and rapid and accessible inter-doctor communication [30]. Consequently, there is precedent to research junior doctor communication. Deterioration Communication Management Theory (DCMT) [18] diverges from the RRS paradigm by explicitly focusing on junior doctor communication. By doing this, the intent is to inform the design and implementation of organisational and technological interventions to improve the care of deteriorating hospital patients. 2. Introduction to the Deterioration Communication Management Theory The purpose of DCMT is to improve the design and implementation of ICT systems for communication to and from junior hospital doctors, especially in situations where there is a deteriorating or potentially deteriorating ward patient. ICT system factors are not the sole cause of communication deficiencies in the latter context, although they add to its complexity. Nurses mostly send non-urgent messages so urgent messages about deteriorating patients need to be easy to prioritise. Clinicians may use more than one system during a communication episode. However, they may disagree on which system they prefer for which task, thereby risking missed messages. At the same time, ICT systems can be designed to improve information transmission, e.g. by enforcing better message content and structure. DCMT may also assist understanding where similar ICT system implementations are received differently at different hospitals [23]. DCMT is similar to Stewart’s [31] grounded theory of junior hospital doctors’ decision making regarding calling senior doctors for help on any matter. Where DCMT diverges is in that it concerns communication decision making by all doctors below the senior level. DCMT is also different in that it specifically addresses communication decision making about the deteriorating ward patient involving ICT systems. It does not encompass the enormity of hospital and medical team [32] communication at large. Rather, as a classical grounded theory is intended to do [33], DCMT is a substantive theory that is meant to explain and account for a pattern of behaviour i.e. how a junior doctor decides whether to communicate about a potential deteriorating patient. DCMT combines research about clinician usage of hospital ICT systems and links this to recipient junior doctor response to ensuing communication about deteriorating ward patients. It was derived from literature reviews and New Zealand hospital-based studies. The literature reviews [18] were of clinical ICT systems used by junior hospital doctors, and of interventions to improve the detection and management of the deteriorating ward patient. Inter-clinician communication about deteriorating ward patients and ICT systems used in this clinical context were investigated at the primary study hospital [18]. This included pre-existing ICT systems in the primary study hospital such as locators, landline and mobile phones, and two new task manager systems implemented during the research period. The developers of two other task manager J.Liangetal. / JuniorDoctorCommunicationSystemsand theDCMT 125