Video Recordings of Interactions.

Video recordings are an important resource for capturing in-dept social interaction and collaboration in workplace studies. Video-recorded observations can be used to analyse knowledge expansion in collaborative work when practitioners use videoconferences (VCs). Interaction analysis of a problem-solving activity is carried out, pointing to sequences in the work where knowledge expand, and problems are solved. Systematic observations using video recordings provide access to analysis of complex forms of interaction among professionals.

Creating Learning Opportunities by Using Videoconferencing in Surgical Education.

Access to mentors for education in surgical subspecialties is a challenge in many hospitals. Videoconferencing (VC) provides real-time communication between mentors and mentees despite dispersed geographical locations. In Norway, an educational pathway of a specific laparoscopic surgical procedure was carried out using VC. The surgical training lasted for three months and was video recorded. The dataset covers the educational procedure, constituting of a trajectory of eight patient cases. During a model of stepwise distancing of the physical presence of the mentor, the collaborative work using VC leads the mentee to become an expert. VC is a tool for both collaboration and representation, as the picture on the VC offers the same information to both the mentor and the mentee. The communication is characterized by guidance and explanations of why specific actions are necessary for problem-solving. The use of VC was a presumption for becoming an expert in this procedure.

Implementing eHealth Technologies: The Need for Changed Work Practices to Reduce Medication Errors.

Medication errors are a significant health problem and a serious threat to patient safety. In Norway, an estimated one-third of the elderly population has been exposed to potentially inappropriate medications. The Norwegian government has assumed a pivotal role in reducing medication errors and providing safer medication management for its citizens, particularly through the national eHealth system's e-prescription and Summary Care Record. In the present study, we depart from the governmental eHealth initiatives and examine why access to pharmaceutical information is not sufficient to solve the problem with medication errors. Empirical data were collected from 2015 to 2019 through the conduction of 56 qualitative interviews that were transcribed, thematically coded and analysed. The results illustrate how eHealth systems are helpful, at the same time, we emphasise changed work practices and professional knowledge-sharing as a basis for solving the issue of medication errors.

eHealth initiatives; the relationship between project work and institutional practice.

BACKGROUND: Large-scale, national eHealth services, such as the summary care record (SCR) and electronic prescriptions (e-prescriptions), have been implemented by project managers as Norwegian health authority initiatives. Few studies have been conducted on the large-scale implementation of eHealth services and the relationship between the implementers' work and the use of the tools in healthcare practices. Hence, there was a need to determine the project work with a focus on changes in practice. This study explores the implementation of the SCR and e-prescriptions from the perspective of project managers; how does the implementation work by project managers relate to institutional practices in large-scale initiatives? METHODS: Twenty-two semi-structured interviews were held with project managers in 2016 and 2018 and were recorded, transcribed, and coded according to the content. The analytical concepts of the "project" and "practice" were used to focus on tensions between the dimensions of time connecting historically established social practice and in situ actions. RESULTS: The eHealth initiatives were demonstrated to have been implemented as a part of the national strategy and achieved through close collaboration with the Norwegian Directorate of eHealth (NDE). Tensions arose in relation to task-oriented actions during the implementation of the project and the daily management thereafter. Further, the work tasks of the project managers were related to the dissemination of the tools while, in practice, the tools were related to actual use by professionals. The implementation of several projects simultaneously created tensions between the implementation of a tool and a specific practice, as well as between tools. CONCLUSION: The objectives set out by the project managers in relation to their work should be viewed as temporary, whereas a long-term objective should apply to the use of the tools. Hence, the work of implementing eHealth initiatives might call for a renewed definition of the empirical object. Identifying factors that affect uptake, such as gaps between the intended use of an object and in situ actions or historically established activities, might expedite the future success of national eHealth initiatives. The social aspect of institutional practice has a direct bearing on the potential of a project to be implemented successfully.

The Impact of Telementoring.

Telementoring is a well-known practice in surgical training, and its impact is traditionally related to individual surgeons' performance and the quality of the procedure. The objective of this study was to explore telementoring in a wider organisational context. This paper reports on an ethnographic study carried out during 2014-2016 in Norway, combining observations, interviews, focus groups and field notes. We followed the surgical training of a specialist candidate at a medium-sized surgical ward. The training successfully took place through the use of telementoring, comprising updated standards for a surgical procedure that ensured minimum invasive surgery for a vulnerable patient group. We observed that telementoring was a necessary and important element in ongoing quality improvement processes at the ward, and its impact at the organisational level was important. In fact, a series of co-existing interwoven elements was necessary to normalise the new procedure in question. We conclude that the use of telementoring linking international expertise to local contexts is one of the factors that can facilitate and speed up quality improvement processes in small- to medium-sized surgical wards.

The Norwegian National Summary Care Record: a qualitative analysis of doctors' use of and trust in shared patient information.

BACKGROUND: This paper explores Norwegian doctors' use of and experiences with a national tool for sharing core patient health information. The summary care record (SCR; the Kjernejournal in Norwegian) is the first national system for sharing patient information among the various levels and institutions of health care throughout the country. The health authorities have invested heavily in the development, implementation and deployment of this tool, and as of 2017 all Norwegian citizens have a personalised SCR. However, as there remains limited knowledge about health professionals' use of, experiences with and opinions regarding this new tool, the purpose of this study was to explore doctors' direct SCR experiences. METHODS: We conducted 25 in-depth interviews with 10 doctors from an emergency ward, 5 doctors from an emergency clinic and 10 doctors from 5 general practitioner offices. We then transcribed, thematically coded and analysed the interviews utilising a grounded theory approach. RESULTS: The SCRs contain several features for providing core patient information that is particularly relevant in acute or emergency situations; nonetheless, we found that the doctors generally used only one of the tool's six functions, namely, the pharmaceutical summary. In addition, they primarily used this summary for a few subgroups of patients, including in the emergency ward for unconscious patients, for elderly patients with multiple prescriptions and for patients with substance abuse conditions. The primary difference of the pharmaceutical summary compared with the other functions of the tool is that patient information is automatically updated from a national pharmaceutical server, while other clinically relevant functions, like the critical information category, require manual updates by the health professionals themselves, thereby potentially causing variations in the accuracy, completeness and trustworthiness of the data. CONCLUSION: Therefore, we can assume that the popularity of the pharmaceutical summary among doctors is based on their preference to place their trust in - and therefore more often utilise - automatically updated information. In addition, the doctors' lack of trust in manually updated information might have severe implications for the future success of the SCR and for similar digital tools for sharing patient information.