Elsevier

Computers in Human Behavior

Volume 61, August 2016, Pages 415-426
Computers in Human Behavior

Full length article
Using tablets in medical consultations: Single loop and double loop learning processes

https://doi.org/10.1016/j.chb.2016.03.020Get rights and content

Highlights

  • Use of tablet computers before and during medical consultations.

  • Tablet use as a means of promoting single-loop and double-loop learning.

  • Increasing patient satisfaction during medical consultations.

  • Patients' perceptions of the information they receive when seeking medical advice.

Abstract

Objective

This paper investigates the influence of using tablet in waiting rooms and medical examinations on how physicians give information and how patients learn. It further assesses the factors that impact patient satisfaction.

Methods

Patients and physicians in a primary care clinic were given a tablet device to search for health information in the waiting room, and when interacting with the physician, while physicians used the tablet device to share information with patients during the medical consultation. 82 patients completed a ‘pre’ survey on using tablets to search for health related information and a ‘post’ survey after their visit. Structural equation modeling was employed to analyze patient's perceptions.

Results

Tablet use during consultation has a negative effect on patients' perceptions of physician information giving, but using the tablet in the waiting room has a positive impact on patient learning, perceptions of physicians' information giving and patient satisfaction.

Conclusions

This study indicates the importance of tablet use in ensuring information giving and patient learning. It further highlights the potential for tablets to promote single-loop learning in the medical encounter by better preparing patients for the physician's information giving. Tablets also enable double-loop learning, which leads to greater patient satisfaction.

Introduction

In healthcare, the encounter between the patient and the doctor is critical to the quality of care provided as well as the satisfaction of patients and doctors. Each patient is unique, and patients' needs are often complex, given that they may experience multiple concurrent acute and chronic health problems. Therefore, and unlike other specialty services, primary care physicians deal with a range of problems, amidst uncertainty regarding the issues that may arise.

Physicians often encounter greater time pressure due to their busy schedules and closely packed appointments, with the traditional 10- to 15-min appointments often not providing adequate time to address all the questions a patient may ask. Sometime patients feel rushed during the clinical encounter. The perceptions that physicians are under time constraints may discourage patients from seeking advice from physicians (Wolff et al., 2010). Lack of time has also been shown to be the single largest barrier to evidence-based practice in primary care (McColl, Smith, White, & Field, 1998). The patient-doctor consultation might end with unanswered questions and incomplete information. This is because physicians spend the bulk of their consultation time eliciting signs and symptoms from patients in order to conduct the diagnosis. This allows less time to explain to patients the nature of their conditions, which might leave the patients feeling confused and overwhelmed, and doctors feeling ineffectual and frustrated.

The above constraints can limit the ability of doctors to provide information, and patients' ability to learn and seek information during a patient-doctor interaction. Patient information seeking and learning are important indicators of the levels of quality of healthcare service delivery. Learning within healthcare service delivery is at the core of the quality improvement process (Kelly, 2007). The use of mobile technologies is changing the learning process during patient-doctor consultation. Mobile technologies, such as smartphones and tablets, can influence knowledge seeking, perceived information giving by the physician, and perceived patient learning with or without a professional control (Miller, Ziegler, Greenberg, Patel, & Carter, 2012).

Thus, the aim of this study is to investigate the patient-doctor encounter and explain how the integration of mobile technologies impact the information seeking and learning process during a medical encounter. The patient-doctor encounter is a complex, dynamic interaction. The visit workflow – a process that includes booking an appointment, seeing the doctor, and following up – is filled with obstacles and opportunities that may impede or improve patients and providers' satisfaction (Wetterneck et al. 2012).

The knowledge shared and the outcome of patient-doctor consultation can be explored using two learning processes. Patients initiate a single-loop learning process when they seek information from physicians. In single-loop learning, physicians provide information by responding to questions from patients. Double-loop learning is the second learning process that influences shared knowledge and the outcome of patient-doctor consultation. Patient learning is greater in the double-loop learning process, because the physician initiates the process and plays a mentorship role in the learning process. In this study, we investigate the impact of mobile technologies on those two learning processes, and their consequent impacts on patient satisfaction.

Section snippets

Background

Research into hospital waiting rooms has occurred primarily in physical settings. For example, the effectiveness of triage strategies and patient education has been evaluated in emergency waiting rooms (Han et al., 2010). Existing evidence indicates the waiting room experience to be key to patient satisfaction (Dansky and Miles, 1997, Oermann et al., 2001).

More recently, it has been argued that the use of a touch-screen computer by patients prior to the consultation leads to improved quality

Theoretical development

Learning is an important aspect of the patient-physician interaction that unfolds when a patient consults with a physician. This study draws on Argyris and Schon, 1978a, Argyris and Schon, 1978b) conceptualization of single and double-loop learning to examine information seeking and patient learning during consultation. Learning occurs as individuals pursue their intended goals; that is, there is a match between design for action and the actuality or outcome. Learning also occurs when there is

Research hypotheses

As presented in the research model in Fig. 1, this study examines the impact of tablet usage in the waiting room and during medical consultations on physician information giving and patient learning. Physician information giving and patient learning represent two different types of learning; the first may be viewed as single-loop, while the second may be viewed as double-loop. In this section, we advance the hypotheses and provide supporting arguments.

Methods

The study was conducted at the Maccabi Healthcare Services (MHS), which is the second largest Health Maintenance Organization (HMO) in Israel. Data collection was conducted between March and June 2014 in two major clinics with 100,000–150,000 patients. The experiment was conducted during scheduled meeting between primary care physicians and their patients during the week. The research team collected data early in the morning from 7 a.m. to 1 p.m., and from 4 p.m. to 7 p.m. every day during the

Descriptive statistics

Descriptive statistics for each item are shown in Table 2. All mean scores are above the midpoint of 3.00, with a range of 3.09–4.18. Standard deviations range from 0.80 to 1.11. The skewness index and kurtosis index show acceptable ranges. Following Markus's (2012) recommendations that the skew and kurtosis indices should not exceed |3| and |10| to ensure normality of the data, the data in this study is regarded as normal for the purposes of SEM.

Test of the measurement model

Confirmatory factor analysis was conducted to

Discussion

This study explores the relationship between the use of electronic medical records and patient satisfaction, specifically the use of mobile technologies during physician-patient interaction. In spite of the contributions to the understanding of physician-patient interaction and use of EMR, the focus on patient-physician interaction in the premise of a primary healthcare provider imposed limitations on the design of the study. As a result, the study did not limit, vary or restrict the use of EMR

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