Electronic messaging system and the challenges for professional judgement

Abstract

Background: This study concerns the collaboration between a hospital and three municipalities when it comes to allocation of municipal rehabilitation services. In order to make the transitions from the hospital to the municipal health service fast and effective, the professionals has started using electronic messaging system This study examines how the electronic messaging systemaffected the collaboration between the hospital and the municipal health service. Methods: The researchers conducted group interviews with professionals at the hospital, at the municipal service offices and at the municipal rehabilitation clinic. There were totally 25 participants divided into 7 interviews. Results: The municipalities experienced that with the use of electronic messaging system, they got the information faster than earlier, and some of the content was more precise. Nevertheless, not all of the information was satisfactory. The municipalities experienced that the information lacked sufficient information about the patients functioning level, which they needed to know for decisions about what kind of rehabilitation service the patient should receive. The assessments that the hospital provided was not always satisfactorily explained, or connected to the service offers that the municipality provided. The municipalities therefore had little trust in the hospitals recommendations. After a while, all of the municipalities chose to have a professional of their own at the hospital, in order to meet the patients and professionals in in the hospital in cases where the information was insufficient. Discussion: The results from this study implies that the transfer of actual and accurate information from the hospital to the municipalities improves with the use of electronic messaging system. However, when it comes to professional assessments and judgements, there seems as though the electronic communication not always works optimally. A possible explanation is that the professional assessments often builds on some kind of implicit knowledge that can`t be disseminated in writing. This is a problem because it seems as the hospitals information is rooted in “cure” while the municipalities` information is rooted in “care”. Consequently, the municipality creates a stereotypic picture of the professionals at the hospital as a messenger of information that is not relevant to the situation. An assessment of what is sensible measures in a rehabilitation process is based on the patient's medical situation, motivation, wishes, and also the possibilities and limitations in the patient's environment. This becomes a wicked problem, a problem where there aren`t one possible solution, but through discussions between patient and professional one can come up with concrete suggestions. Theories about wicked problems recommends meetings and teams as arenas for such discussions. This is achievable first when the municipalities meets the patient and the professionals at the hospital. Lessons learned: Electronic medical record systems can improve the information exchange between the hospital and the municipalities, but in situations where one has to collaborate about the solution of wicked problems, it looks as though there still is a need for personal contact.

Keywords

• electronic messaging system
• professional judgment
• wicked problems