Full length articleUsing tablets in medical consultations: Single loop and double loop learning processes
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
References (68)
- et al.
An evaluation of medical residents utilization of tablet computers
Computers in Human Behavior
(2015) - et al.
The general causality orientations scale: Self-determination in personality
Journal of Research in Personality
(1985) - et al.
The effect of physician triage on emergency department length of stay
The Journal of Emergency Medicine
(2010) - et al.
Health information technology and physician-patient interactions: impact of computers on communication during outpatient primary care visits
Journal of the American Medical Informatics Association
(2005) Student's perceptions of effective clinical teaching revisited
Nurse Education Today
(2007)- et al.
Clinical trials of patient education for chronic conditions: a comparative meta-analysis of intervention types
Preventive Medicine
(1985) - et al.
Filling the waiting time in the clinic with education about glaucoma
Insight-the Journal of the American Society of Ophthalmic Registered Nurses
(2001) - et al.
Health promotion in primary care: a survey of US family practitioners
Preventive Medicine
(1985) Compliance with physician advice to quit smoking: a review of the literature
Preventive Medicine
(1982)- et al.
Theory in practice: Increasing professional effectiveness
(1974)
Organizational learning: A theory of action approach
Organizational learning: A theory of action approach
Medical applications for pharmacists using mobile devices
The Annals of Pharmacotherapy
Interprofessional practice-based education. Practice-based education
Impact of patient feedback on residents' handheld computer use: a multi-site study
Studies in Health Technology and Informatics
Understanding information systems continuance: an expectation-confirmation model
MIS Quarterly
Doctors in a wired world: can professionalism survive connectivity?
Milbank Quarterly
Analyzing models with unobserved variables: analysis of covariance structures
Social Measurement: Current Issues
How do primary care physicians seek answers to clinical questions? A literature review
Journal of the Medical Library Association: JMLA
Patient satisfaction with ambulatory healthcare services: waiting time and filling time
Hospital & Health Services Administration
Can a surge in physicians' use of smartphones ripple to health IT adoption
American Medical News
Obstacles to answering doctors' questions about patient care with evidence: qualitative study
BMJ (Clinical Research Ed.)
Internet to hit 3 billion users in 2015
The wireless industry: the essential engine of us economic growth
Recon Analytics
Evaluating structural equation models with unobservable variables and measurement error
Journal of Marketing Research
Validity assessment: a structural equations approach using partial least squares
Proceedings American Marketing Association Educators' Conference
Smartphone app use among medical providers in ACGME training programs
Journal of Medical Systems
21st-century health care: the effect of computer use by physicians on patient satisfaction at a family medicine clinic
Family Medicine-Kansas City
Health education planning: A diagnostic approach
Multivariate data analysis Pearson Prentice Hall Upper Saddle River, NJ
Inaccuracies in physicians' perceptions of their patients
Medical Care
Measuring the use of examination room time in oncology clinics: a novel approach to assessing clinic efficiency and patient flow
Journal of Oncology Practice/American Society of Clinical Oncology
Rethinking construct reliability within latent variable systems
Structural Equation Modeling: Present and Future
Compliance in health care
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