Deskilling and adaptation among primary care physicians using two work innovations
Deskilling and adaptation among primary care physicians using two work innovations
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DOI：
10.1097/hmr.0b013e31821826a1
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发表时间：
2011-10-01
影响因子：
2.5
通讯作者：
Hoff, Timothy
中科院分区：
文献类型：
--
作者：
Hoff, Timothy
背景资料：在过去的十年里，美国的医疗保健系统在提高医疗质量的同时，加强了对医疗实践的管理控制。两个关键问题，在审查创新的实施是在何种程度上，医生可能会遇到deskilling的一部分，创新的使用，并在何种程度上，他们积极参与这种deskilling通过调整，他们使适应和利用的创新，在他们的日常work.Methodology：与78美国初级保健医生进行了采访。通过开放编码、理论采样、小插图构建和模式识别的交互过程，对数据进行转录和计算机分析。这两个创新研究是使用电子病历和临床guidelines.Findings：初级保健医生感知和体验的方式，表明deskilling结果的电子病历和临床指南的使用。已确定的去技能化结局包括临床知识减少、患者信任度降低、患者刻板印象增加以及做出临床决策的信心降低。医生积极参与去技能化过程，通过将创新纳入日常工作时所做的适应性选择。现有的初级保健的商业模式加剧了deskilling的影响，在study.Practice研究的两个创新：初级保健医生感知和经验deskilling作为一个有形的成果，使用特定的医疗创新。然而，这种去技能化在某种程度上是医生自己的行为以及周围工作环境中现存压力的一种功能。卫生保健组织和管理人员在试图减轻这些压力和减少与之相关的去技能化结果方面发挥了积极作用。这项研究支持使用不同的医疗保健创新的总成本和收益进行更仔细的检查，同时描绘创新的使用作为一组谈判的结果。
Background: The U.S. health care system has innovated over the past decade in ways aimed at improving quality of care while increasing managerial control over how medicine is practiced. Two key issues in examining innovation implementation is the extent to which physicians may experience deskilling as part of innovation use and to what extent they actively participate in this deskilling through adaptations they make to accommodate and take advantage of the innovations in their everyday work.Methodology: Interviews with 78 U.S. primary care physicians were conducted. Data were transcribed and computer analyzed through an interactive process of open coding, theoretical sampling, vignette construction, and pattern recognition that proceeded in several stages. The two innovations examined were the use of electronic medical records and clinical guidelines.Findings: Primary care physicians perceive and experience the use of electronic medical records and clinical guidelines in ways that indicate deskilling outcomes. The deskilling outcomes identified include decreased clinical knowledge, decreased patient trust, increased stereotyping of patients, and decreased confidence in making clinical decisions. Physicians are actively involved in the deskilling process through the adaptive choices made when incorporating the innovations into their everyday work. The existing primary care business model exacerbates the deskilling effects of the two innovations examined in the study.Practice Implications: Primary care physicians perceive and experience deskilling as a tangible outcome of using particular health care innovations. However, such deskilling is, in part, a function of physicians' own actions as well as extant pressures in the surrounding work context. Health care organizations and managers have a productive role to play in attempting to mitigate these pressures and lessen the deskilling outcomes associated with them. This study supports closer examination of the total costs and benefits deriving from using different health care innovations while portraying innovation use as a negotiated set of outcomes.