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CC BY-NC-ND 4.0 · Appl Clin Inform 2022; 13(05): 1079-1091
DOI: 10.1055/s-0042-1758482
Research Article

Understanding the Digital Disruption of Health Care: An Ethnographic Study of Real-Time Multidisciplinary Clinical Behavior in a New Digital Hospital

Oliver J. Canfell
1   Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
2   UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, St Lucia, Queensland, Australia
3   Digital Health Cooperative Research Centre, Australian Government, Sydney, New South Wales, Australia
4   Queensland Digital Health Centre, The University of Queensland, Herston, Queensland, Australia
,
Yasaman Meshkat
5   School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
,
Zack Kodiyattu
5   School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
,
Teyl Engstrom
1   Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
4   Queensland Digital Health Centre, The University of Queensland, Herston, Queensland, Australia
,
Wilkin Chan
5   School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
,
Jayden Mifsud
5   School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
,
Jason D. Pole
1   Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
4   Queensland Digital Health Centre, The University of Queensland, Herston, Queensland, Australia
,
Martin Byrne
6   Metro North Hospital and Health Service, Department of Health, Queensland Government, Herston, Queensland, Australia
,
Ella Van Raders
6   Metro North Hospital and Health Service, Department of Health, Queensland Government, Herston, Queensland, Australia
,
Clair Sullivan
1   Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
4   Queensland Digital Health Centre, The University of Queensland, Herston, Queensland, Australia
6   Metro North Hospital and Health Service, Department of Health, Queensland Government, Herston, Queensland, Australia
› Author Affiliations Funding O.J.C. was funded by the Digital Health Cooperative Research Centre (DHCRC-0083).
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Abstract

Background Understanding electronic medical record (EMR) implementation in digital hospitals has focused on retrospective “work as imagined” experiences of multidisciplinary clinicians, rather than “work as done” behaviors. Our research question was “what is the behavior of multidisciplinary clinicians during the transition to a new digital hospital?”

Objectives The aim of the study is to: (1) Observe clinical behavior of multidisciplinary clinicians in a new digital hospital using ethnography. (2) Develop a thematic framework of clinical behavior in a new digital hospital.

Methods The setting was the go-live of a greenfield 182-bed digital specialist public hospital in Queensland, Australia. Participants were multidisciplinary clinicians (allied health, nursing, medical, and pharmacy). Clinical ethnographic observations were conducted between March and April 2021 (approximately 1 month post-EMR implementation). Observers shadowed clinicians in real-time performing a diverse range of routine clinical activities and recorded any clinical behavior related to interaction with the digital hospital. Data were analyzed in two phases: (1) content analysis using machine learning (Leximancer v4.5); (2) researcher-led interpretation of the text analytics to generate contextual meaning and finalize themes.

Results A total of 55 multidisciplinary clinicians (41.8% allied health, 23.6% nursing, 20% medical, 14.6% pharmacy) were observed across 58 hours and 99 individual patient encounters. Five themes were derived: (1) Workflows for clinical documentation; (2) Navigating a digital hospital; (3) Digital efficiencies; (4) Digital challenges; (5) Patient experience. There was no observed harm attributable to the digital transition. Clinicians primarily used blended digital and paper workflows to achieve clinical goals. The EMR was generally used seamlessly. New digital workflows affected clinical productivity and caused frustration. Digitization enabled multitasking, clinical opportunism, and benefits to patient safety; however, clinicians were hesitant to trust digital information.

Conclusion This study improves our real-time understanding of the digital disruption of health care and can guide clinicians, managers, and health services toward digital transformation strategies based upon “work as done.”

Keywords

electronic medical records - eHealth - hospitals - digital hospital - digital health - health care professional - electronic health record - patients

Protection of Human and Animal Subjects

This study was granted ethical approval by the human research ethics committee (HREC) at the target hospital and health service setting (HREC/2020/QRBW/69963) and ratified by an academic institutional HREC (2020/HE003004). Site research governance approval was granted by the relevant hospital and health service governance committee (SSA/2021/QRBW/69963).


Supplementary Material



Publication History

Received: 23 May 2022

Accepted: 10 September 2022

Article published online:
09 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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