Journal article
Taking note: A qualitative study of implementing a scribing practice in team-based primary care clinics
BMC health services research, Vol.19(1), 574
08/14/2019
DOI: 10.1186/s12913-019-4355-z
PMCID: PMC6694617
PMID: 31412861
Abstract
Background
Though much is known about the benefits attributed to medical scribes documenting patient visits (e.g., reducing documentation time for the provider, increasing patient-care time, expanding the roles of licensed and non-licensed personnel), little attention has been paid to how care workers enact scribing as a part of their existing practice. The purpose of this study was to perform an ethnographic process evaluation of an innovative medical scribing practice with primary care teams in Veterans Health Administration (VHA) clinics across the United States. The aim of our study was to understand barriers and facilitators to implementing a scribing practice in primary care.
Methods
At three to six months after medical scribing was introduced, we used semi-structured interviews and direct observations during site visits to five sites to describe the intervention, understand if the intervention was implemented as planned, and to record the experience of the teams who implemented the intervention. This manuscript only reports on semi-structured interview data collected from providers and scribes. Initial matrix analysis based on categories outlined in the evaluation plan informed subsequent deductive coding using the social-shaping theory Normalization Process Theory.
Results
Through illustrating the slow accumulation of interactions and knowledge that fostered cautious momentum of teams working to normalize scribing practice in VHA primary care clinics, we show how the practice had 1) an organizing effect, as it centered a shared goal (the creation of the note) between the provider, scribe, and patient, and 2) a generative effect, as it facilitated care workers developing relationships that were both interpersonally and inter-professionally valuable. Based on our findings, we suggest that a scribing practice emphasizes the complementarity of existing professional roles, which thus leverage the interactional possibilities already present in the primary care team. Scribing, as a skill, forged moments of interprofessional fit. Scribing, in practice, created opportunities for interpersonal connection.
Conclusions
Our research suggests that individuals will notice different benefits to scribing based on their professional expectations and organizational roles related to documenting patient visits.
Details
- Title: Subtitle
- Taking note: A qualitative study of implementing a scribing practice in team-based primary care clinics
- Creators
- Jennifer M. Van Tiem - Iowa City VA Health Care SystemKenda R Stewart Steffensmeier - 601 Hwy 6 West, Building 42, Iowa City, Iowa, 52246 USA 601 Hwy 6 West, Building 42, Iowa City, Iowa, 52246 USABonnie J. Wakefield - University of MissouriGreg L. Stewart - University of IowaNancy A. Zemblidge - Iowa City VA Health Care SystemMelissa J. A. Steffen - Iowa City VA Health Care SystemJane Moeckli - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- BMC health services research, Vol.19(1), 574
- DOI
- 10.1186/s12913-019-4355-z
- PMID
- 31412861
- PMCID
- PMC6694617
- NLM abbreviation
- BMC Health Serv Res
- ISSN
- 1472-6963
- eISSN
- 1472-6963
- Publisher
- BioMed Central
- Grant note
- VISN 23 Patient Aligned Care Team Demonstration Lab / ;
- Language
- English
- Date published
- 08/14/2019
- Academic Unit
- Management and Entrepreneurship ; Internal Medicine
- Record Identifier
- 9984380431302771
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