Abstract
Introduction: In Western countries, more patients experience chronic conditions and a lack of continuity of care. In Denmark municipal healthcare is responsible for home care and rehabilitation services, however, demographic changes and a lack of personnel threaten the provision of healthcare services in municipalities. To address these challenges, healthcare organisations have electronic health records to organise and manage care and work routines. Based on the assumption that digitalisation is a solution to the above-mentioned problems in municipalities, Danish municipalities implemented a specific digital documentation method to guide healthcare professionals (HCP) in planning and registering the services delivered to patients. digital solutions are perceived as beneficial to all parties involved. This paper aims to investigate how HCPs make sense of digital documentation practice and how digital documentation practice influences municipal healthcare.
Theory and Methods: A qualitative single-case study design was chosen to explore digital documentation practice in home care in a medium size Danish municipality. Digital technologies
are enacted into practice and have implications for healthcare practices. Weick’s sensemaking theory was used to explore healthcare professionals' sensemaking processes and to analyse how institutional logics framed the enactment of documentation practice.
Data were generated using 124 hours of field observation of HCP practices in home care and 15 semi-structured with HCPs. Data from the user interface of the HCPs’ digital timetable showed care tasks and allocated time during a shift.
Results: Sensemaking processes of documentation practice were intertwined and occurred in a daily flow in three ways 1) making sense of planning, 2) making sense of tasks and 3) making sense of documentation. HCPs understood digital documentation practice as a managerial tool designed to control resources and work routines. This led to a task-oriented practice that focused entirely on delivering fragmented tasks according to a timetable. HCPs were also influenced by medical and care professional logics and responded to service users’ needs and their own professional judgments. Thereby HCP enacted a traditional documentation practice, centred on sharing information with colleagues. When this occurred, they justified their actions by labelling time spent on documentation as documenting ‘deviations’.
Discussion: The study can inform policymakers, HCPs and managers of how the digital solution affects HCPs documentation practices in municipal healthcare and the risk of being framed by the vision of achieving efficiency over trajectory awareness and coordination of care work.
Conclusion: HCPs mitigated fragmentation by responding to a care professional logic, where they documented to share information and carried out invisible work outside of timetables and scheduled tasks. However, HCPs were focused on solving specific tasks by the minute with the possible consequence that continuity and their overview of the service user’s care and treatment disappeared. In conclusion, the digital documentation in electronic health records makes it difficult to keep a holistic view of care trajectories despite HCPs efforts to obtain continuity for patients.