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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
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Buch Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners"
Applied Interdisciplinary Theory in Health Informatics
Knowledge Base for Practitioners
- Titel
- Applied Interdisciplinary Theory in Health Informatics
- Untertitel
- Knowledge Base for Practitioners
- Autoren
- Philip Scott
- Nicolette de Keizer
- Andrew Georgiou
- Verlag
- IOS Press BV
- Ort
- Amsterdam
- Datum
- 2019
- Sprache
- englisch
- Lizenz
- CC BY-NC 4.0
- ISBN
- 978-1-61499-991-1
- Abmessungen
- 16.0 x 24.0 cm
- Seiten
- 242
- Kategorie
- Informatik