Editorial- Communicating to improve quality of care

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Efficient quality healthcare is highly dependent on effective clinical communication. However, healthcare systems can struggle with the safe, timely coordination of messaging between its component stakeholders. This edition focuses on communication and knowledge sharing between different clinicians within and between healthcare services and how Information and Communications Technology (ICT) supports knowledge development, information transfer and inter-professional communication.

Two linked papers focus on the pilot trial of an Information and Communications Technology (ICT) intervention to improve clinical communication within a New Zealand District Health Board hospital. The first paper by Blair and Orr is a report describing the trial of iBleep, a UK based “intelligent bleeping” system that can be rapidly deployed via hosting over the internet. The trial, in keeping with the typical use of iBleep, focused on the prioritisation of communications from nursing staff to junior doctors, with the aim of doctors being more able to effectively triage or coordinate requests for service. The content of Blair and Orr’s paper is primarily taken from the internal Waitemata District Health Board (DHB) iBleep management outcome report that describes the motivations, process and outcomes of the trial as perceived at the Organisational level.

The second of the linked papers, by Liang and Day et al, places these motivations, process and outcomes within the context of the wider academic literature on clinical communication, innovation and project management. Liang is a doctoral student at the University of Auckland, and Clinical Director of ICU at the hospital where the iBleep trial was conducted. Liang extended the iBleep trial as part of her doctoral research on the use of ICT to facilitate inter-professional communication, hence the second article. Together the two papers aim to contribute to the building of best practice innovation and education in the health informatics community.

The trial at different levels could be considered both a failure and success. The negative clinical feedback is at odds with other deployments of iBleep both in the UK and the neighbouring Auckland DHB. However, both papers highlight that significant learning to inform any future development of a smart paging system was gained. The related recommendations are likely to be relevant to many hospitals including those where iBleep has been reportedly successfully implemented. ICT can act as catalyst for change and help empower or transform systems. However, a remotely hosted rapidly deployable technology does not equate to a rapidly deployable total solution. Typically, changing the related human processes is also core to success and emphasised again by this trial is the importance of shared vision, shared motivation and a total, integrated, system change approach.

Social media is a relatively new phenomenon in healthcare, creating new opportunities for patients to communicate with one another and their clinicians and for clinicians to communicate among themselves. The article by Emmanuel and Day describes a literature review about the history of social media in healthcare, its potential to link patients and clinicians to one another to support quality healthcare delivery. This review was completed as an Honours dissertation for Emmanuel’s Bachelor of Health Sciences. They conclude that social media has a role to play in healthcare, especially where distance is an issue.

The following two articles have been written by students of The University of Auckland’s Knowledge Management course. This is a distance course that explores concepts of Knowledge Management using student experiences and prior knowledge to gain an understanding of the principles of knowledge management. The students write a set of essays that build their insight, culminating in an article written in publication format.

Tian discusses e-Referrals as a knowledge process that turns the referral process into explicit knowledge. A review of the literature reveals that conversion of referrals into electronic form is more difficult and slower than one would expect. Evaluation of e-referral implementation plays an essential role in future projects, turning tacit, loosely defined lessons learned into tacit, practical recommendations for fine-tuning the referral process. When done well, e-Referrals connect clinicians more reliably and effectively, improving the quality and nature of data used in the process.

A clinical audit project is described by Broome in terms of making the distinction between knowledge and information in the peer review process. She argues that people prefer to pull information when they need it, and convert the information they find useful into knowledge. Understanding the interplay between tacit knowledge (what’s in people’s heads) and explicit knowledge (what’s written down), and the transfer processes is essential for integrating evidence becomes into everyday clinical practice. ICT-enabled communication occurs in the form of clinical audit coupled with peer review discussions forms the basis of the knowledge transfer process.
These papers emphasise that communication in healthcare is part and parcel of quality care. ICT innovations add value in many ways. The iBleep trial, social media, e-referrals and peer review serve two functions: they enable discourse on the nature of inter-professional and patient-clinician communication, and they attempt to propose solutions to aspects of the problems uncovered during implementation and exploration of their value to healthcare delivery.
 

Karen Day & Martin Orr