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theses

This study focused on two novel elements: studying the phenomenon of ‘clinician anonymity’ and its effects on inter-professional communication in hospital practice and applying design science theory and methodology to understand and address communication problems. Healthcare is characterized by “more to do, more to know, more to manage, and more people involved than ever before.” This reality brings challenges to staff working in rapidly changing teams and stressful environments. The inability to recognize colleagues and the general lack of familiarity within teams undermines the effective collaboration that is critical to the delivery of patient care. This phenomenon, termed ‘clinician anonymity,’ was neither well defined nor understood, and few studies focused on interventions that addressed its causes and effects. In order to evaluate how an intervention, both the design of an artifact and the process of its design, influence the phenomenon of clinician anonymity, a longitudinal, mixed methods (observations, interviews, surveys) study was conducted at a large urban teaching hospital in Toronto, Canada. Based on existing frameworks and drawing from initial observations, a theoretical model of clinician anonymity was developed. The model informed the initial requirements for ‘Face2Name,’ a tool designed to act on the communication practices linked to anonymity. Pre- and post-intervention data comprising of 158 hours of observations over 8 months, 14 semi-structured interviews, and over 250 surveys were collected at four points in time. Results showed strong evidence of clinician anonymity in hospitals and revealed that the predominant cause is the nature of teaching hospitals, characterized by rapidly changing fluid teams, organizational structures and power dynamics between professions that dictate how collaborative processes and standard procedures are performed. Evaluation of the intervention confirmed the benefits of a visual tool on recall and staff satisfaction and user feedback contributed to making each subsequent iteration better suited to staff workflow and the hospital environment. Results also revealed that the process of designing and deploying the tool was more effective in addressing the problem of anonymity than the artifact itself, confirming a main tenet of design science that the intervention is both process and resulting product. Findings from this study are of value within and also outside the hospital, generalizable to other environments with fluid teams or with similar institutional cultures. Moreover, the reflective process intrinsic to design science provided considerable insights on how to conduct future design studies in the context of communication research.

ETD_7120

Ph.D.

Includes bibliographical references

by Lora Appel

doi:10.7282/T3GT5Q9B

ETD doctoral

The author owns the copyright to this work.