Dataset Information

Computer templates in chronic disease management: ethnographic case study in general practice.

ABSTRACT:

Objective

To investigate how electronic templates shape, enable and constrain consultations about chronic diseases.

Design

Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry-an approach called linguistic ethnography.

Setting

Two general practices in England.

Participants and methods

Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-four consultations were directly observed and 12 consultations were video-recorded alongside computer screen capture. Consultations were transcribed using conversation analysis conventions, with notes on body language and the electronic record. The analysis involved repeated rounds of viewing video, annotating field notes, transcription and microanalysis to identify themes. The data was interpreted using discourse analysis, with attention to the sociotechnical theory.

Results

Consultations centred explicitly or implicitly on evidence-based protocols inscribed in templates. Templates did not simply identify tasks for completion, but contributed to defining what chronic diseases were, how care was being delivered and what it meant to be a patient or professional in this context. Patients' stories morphed into data bytes; the particular became generalised; the complex was made discrete, simple and manageable; and uncertainty became categorised and contained. Many consultations resembled bureaucratic encounters, primarily oriented to completing data fields. We identified a tension, sharpened by the template, between different framings of the patient-as 'individual' or as 'one of a population'. Some clinicians overcame this tension, responding creatively to prompts within a dialogue constructed around the patient's narrative.

Conclusions

Despite their widespread implementation, little previous research has examined how templates are actually used in practice. Templates do not simply document the tasks of chronic disease management but profoundly change the nature of this work. Designed to assure standards of 'quality' care they contribute to bureaucratisation of care and may marginalise aspects of quality care which lie beyond their focus. Creative work is required to avoid privileging 'institution-centred' care over patient-centred care.

SUBMITTER: Swinglehurst D

PROVIDER: S-EPMC3533031 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Publications

Computer templates in chronic disease management: ethnographic case study in general practice.

Swinglehurst Deborah D Greenhalgh Trisha T Roberts Celia C

BMJ open 20121128 6

<h4>Objective</h4>To investigate how electronic templates shape, enable and constrain consultations about chronic diseases.<h4>Design</h4>Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry-an approach called linguistic ethnography.<h4>Setting</h4>Two general practices in England.<h4>Participants and methods</h4>Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-fo ...[more]

PMID: 23192245

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Dataset Information

Computer templates in chronic disease management: ethnographic case study in general practice.

Objective

Design

Setting

Participants and methods

Results

Conclusions

Publications

Computer templates in chronic disease management: ethnographic case study in general practice.

Similar Datasets

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