An evaluation of the use of smartphones to communicate between clinicians: a mixed-methods study

Robert Wu1,2, MD FRCPC MSc; Peter Rossos3, MD FRCPC MBA;
Sherman Quan2, BSC; Scott Reeves4,5,6,7, PhD; Vivian Lo2,
MASc; Brian Wong8, MD FRCPC; Mark Cheung8, MD FRCPC;
Dante Morra1,2,9, MD FRCPC MBA

1University Health Network, Division of General Internal Medicine,
  Toronto, ON, Canada
2Centre for Innovation in Complex Care, University Health Network,
  Toronto, ON, Canada
3University Health Network, Department of Medicine, Toronto, ON,
  Canada
4Centre for Faculty Development, Li Ka Shing International Health
  Care Education Centre, St Michael's Hospital, Toronto, ON, Canada
5Keenan Research Centre, Li Ka Shing Knowledge Institute of St
   Michael’s Hospital, Toronto, ON, Canada
6Wilson Centre for Research in Education, University Health
   Network, Toronto, ON, Canada
7Department of Psychiatry, University of Toronto, Toronto, ON, 
  Canada
8Sunnybrook Health Sciences Centre, Department of Medicine,
  Toronto, ON, Canada
9Centre for Interprofessional Education, University of Toronto,
   Toronto, ON, Canada

Corresponding Author:
Robert Wu, MD FRCPC MSc

University Health Network
Division of General Internal Medicine
200 Elizabeth Street 14EN-222
Toronto, ON, M5G 2C4
Canada
Phone: 1 416 340 4567
Fax: 1 416 595 5826
Email: robert.wu [at] uhn.on.ca

ABSTRACT

Background: Communication between clinicians is critical to providing
quality patient care but is often hampered by limitations of current systems.
Smartphones such as BlackBerrys may improve communication, but studies
of these technologies have been limited to date.
Objective: Our objectives were to describe how smartphones were adopted
for clinical communication within general internal medical wards and
determine their impact on team effectiveness and communication.
Methods: This was a mixed-methods study that gathered data from the
frequency of smartphone calls and email messages, clinicians' interviews,
and ethnographic observations of clinical communication interactions.
Triangulation of qualitative and quantitative data was undertaken to develop
common themes that encompass comprehensive and representative
insights across different methods.
Results: Findings from our study indicated that over a 24-hour period,
nurses sent on average 22.3 emails to the physicians mostly through the
“team smartphone,” the designated primary point of contact for a specific
medical team. Physicians carrying the team smartphone received on
average 21.9 emails and 6.4 telephone calls while sending out 6.9 emails
and initiating 8.3 telephone calls over the 24-hour period. Our analyses
identified both positive and negative outcomes associated with the use
of smartphones for clinical communication. There was a perceived
improvement in efficiency over the use of pagers for clinical communication
for physicians, nurses, and allied health professionals. In particular,
residents found that the use of smartphones helped to increase their
mobility and multitasking abilities. Negative outcomes included frequent
interruptions and discordance between what doctors and nurses
considered urgent. Nurses perceived a worsening of the interprofessional
relationships due to overreliance on messaging by text with a resulting
decrease in verbal communication. Unprofessional behaviors were
observed in the use of smartphones by residents.
Conclusions: Routine adoption of smartphones by residents appeared to
improve efficiency over the use of pagers for physicians, nurses, and allied
health professionals. This was balanced by negative communication
issues of increased interruptions, a gap in perceived urgency, weakened
interprofessional relationships, and unprofessional behavior. Further
communication interventions are required that balance efficiency and
interruptions while maintaining or even improving interprofessional
relationships and professionalism.

(J Med Internet Res 2011;13(3):e59)

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Complex problems require complex solutions: the utility of social quality theory for addressing the Social Determinants of Health

By Paul R Ward1, Samantha B Meyer 1, Fiona Verity2, Tiffany K Gill3,
and Tini CN Luong1

1Discipline of Public Health, Flinders University, Australia

2Department of Social Work and Social Planning, Flinders University,
  Australia

3Population Research & Outcome Studies, Discipline of Medicine,
  University of Adelaide, Australia


BMC Public Health 2011, 11:630 doi:10.1186/1471-2458-11-630 August 2011

“…….In order to improve the health of the most vulnerable groups in society,
the WHO Commission on Social Determinants of Health (CSDH) called for
multi-sectoral action, which requires research and policy on the multiple and
inter-linking factors shaping health outcomes. Most conceptual tools available
to researchers tend to focus on singular and specific social determinants of
health (SDH) (e.g. social capital, empowerment, social inclusion).

 

However, a new and innovative conceptual framework, known as social quality
theory, facilitates a more complex and complete understanding of the SDH, with
its focus on four domains: social cohesion, social inclusion, social empowerment
and socioeconomic security, all within the same conceptual framework. This
paper provides both an overview of social quality theory in addition to findings from
a national survey of social quality in Australia, as a means of demonstrating the
operationalisation of the theory.

 

Methods

Data were collected using a national random postal survey of 1044 respondents in
September, 2009. Multivariate logistic regression analysis was conducted.

 

Results

Statistical analysis revealed that people on lower incomes (less than $45000)
experience worse social quality across all of the four domains: lower socio-economic
security, lower levels of membership of organisations (lower social cohesion),
higher levels of discrimination and less political action (lower social inclusion) and
lower social empowerment. The findings were mixed in terms of age, with people
over 65 years experiencing lower socio-economic security, but having higher levels
of social cohesion, experiencing lower levels of discrimination (higher social
inclusion) and engaging in more political action (higher social empowerment). In
terms of gender, women had higher social cohesion than men, although also
experienced more discrimination (lower social inclusion).



Conclusions

Applying social quality theory allows researchers and policy makers to measure
and respond to the multiple sources of oppression and advantage experienced
by certain population groups, and to monitor the effectiveness of interventions
over time…………”




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Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

A Global Independent Commission The Lancet 2010

“……….One hundred years ago, a series of studies about the education
of health professionals, led by the 1910 Flexner report, sparked
groundbreaking reforms. Through integration of modern science into the
curricula at university-based schools, the reforms equipped health
professionals with the knowledge that contributed to the doubling of life
span during the 20th century. By the beginning of the 21st century, however,
all is not well.


Glaring gaps and inequities in health persist both within and between
countries, underscoring our collective failure to share the dramatic health
advances equitably. At the same time, fresh health challenges loom.


New infectious, environmental, and behavioural risks, at a time of rapid
demographic and epidemiological transitions, threaten health security of
all.
Health systems worldwide are struggling to keep up, as they become more
complex and costly, placing additional demands on health workers.


Professional education has not kept pace with these challenges, largely
because of fragmented, outdated, and static curricula that produce ill-
equipped graduates.


The problems are systemic mismatch of competencies to patient and
population needs; poor teamwork; persistent gender stratification of
professional status; narrow technical focus without broader contextual
understanding; episodic encounters rather than continuous care;
predominant hospital orientation at the expense of primary care;
quantitative and qualitative imbalances in the professional labour market;
and weak leadership to improve health-system performance. Laudable
efforts to address these deficiencies have mostly floundered, partly
because of the so-called tribalism of the professions—ie, the tendency of
the various professions to act in isolation from or even in competition
with each other.


Redesign of professional health education is necessary and timely, in
view of the opportunities for mutual learning and joint solutions offered by
global interdependence due to acceleration of flows of knowledge,
technologies, and financing across borders, and the migration of both
professionals and patients…”

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El recién nacido de Georges de la Tour, pintor de silencios

Georges de la Tour. El recién nacido, 1645-1648.
Óleo sobre lienzo 76 x 91 cm.
Musée des Beaux-Arts, Rennes, Brittany, France.

Georges de la Tour, artífice de obras de enigmática belleza, dota a esta delicada escena
de una cierta ambigüedad. Desviste al lienzo de atributos iconográficos sacros y a la vez
nos desconcierta sabiamente con el tratamiento de la luz y el extático clima.

La intimista escena atesora una "falsa simplicidad" técnica y figurativa. El tratamiento
aparentemente es casi minimalista, pero, en realidad, el artista trabajaba la forma y el
color con paciencia miniaturista y maduraba cada detalle para dotar a sus obras de
una notable fuerza psicológica. El intenso claroscuro y el estatismo gestual crean esa
tensión emocional, tan característica suya, que nos incita, más que a meramente
contemplar, a imaginar, a poner en acción nosotros mismos, con nuestro "punto de
vista", sus, sólo aparentemente, inmóviles actores. Su original "tenebrismo" resulta
cálido, gracias a la morbidez de los volúmenes y la intensidad de los colores
esculpidos por una luz genialmente orientada. El resultado es un ambiente de
serenidad, una atmósfera suspendida que invita a la meditación.

Fuente: Latour en la base de datos Joconde