TY - GEN
T1 - Implementing video consultations in Danish general practice. GPs’ and staff’s interpretations, care practices, and invisible work related to use and non-use
AU - Lüchau, Elle Christine
PY - 2024/11/25
Y1 - 2024/11/25
N2 - In Denmark, healthcare is increasingly provided using digital technologies,
including in general practice. Danish general practice already conducts around a
quarter of consultations remotely through telephone and e-mail. Now, video
consultations have been introduced as yet another way for patients to consult
with their general practitioner remotely. Video consultations were introduced
nationally in Denmark in March 2020 due to the COVID-19 pandemic, and
video software was publicly developed and provided free of charge to patients
and general practitioners. In 2022, video consultations were officially incorporated as a permanent offer to patients in general practice. It is a requirement that
by the end of 2024, all general practitioners offer video consultations to their
patients. There is a strong political push for the use of video consultations based
on expectations of e.g., increased efficiency and optimized use of healthcare
resources. Yet, the adoption rate of video consultations is low, and their use differs significantly between clinics. It is not known how and why general practitioners and
practice staff use or do not use video consultations as they do. This makes it
difficult to qualify and understand the reasons for the use or non-use of video
consultations.The purpose of this dissertation is to explore the implementation, use, and nonuse of video consultations in Danish general practice. This dissertation is an
ethnographic study, approaching video consultations through an overall sociomaterial lens. In doing so, video consultations are explored as situated activities
that gain their meaning and function through the entanglement of social and
material arrangements and general practitioners and practice staff in their specific organizational settings.The data corpus in this dissertation consists of 30 semi-structured interviews
with general practitioners, three interviews with practice staff, and 132 hours of
fieldwork conducted in seven clinics across various locations in Denmark. Data
was generated between June 2021 and August 2022. The dissertation comprises three papers. In each paper, video consultations are
explored from a different theoretical perspective, which all contribute to understanding how and why video consultations are implemented, used or not used
the way they are. The papers focus on general practitioners’ interpretations of
video consultations and how these affect their use or non-use, based on Orlikowski’s concept of “technological frames” (Paper A), how general practitioners and practice staff fit their use of video consultations to align with what they
conceptualize as good care, based on Pols’ concept of “fitting” (Paper B), and
the work performed by general practitioners and practice staff to embed video
consultations into their daily work life, based on Star’s and Strauss’ concept of
“invisible work” (Paper C).Overall, this dissertation demonstrates how the implementation and use of video
consultations is a process of organizational change. Contributing to the literature
on the suitability and appropriateness of video consultations, the inclusion of a
variety of video consultation users and non-users demonstrates how the value of
video consultations relies on a complex web of relationships and interactions.
This includes existing values, opinions and the occupational identity of general
practitioners, general practitioners’ and staff’s conceptualizations of good care,
workflows, temporal resources, and financial incentives. Furthermore, this dissertation emphasizes the importance of staff in video consultation practices,
particularly in relation to the sustainability of video consultations and the inclusion of patients. Additionally, this dissertation adds to ongoing discussions about
inequality in healthcare by describing the decisions made in practice regarding
which patients to video consult with, including descriptions of how video consultations are often used for working people and those who are least sick, but
also how video consultations are used to reach patients who are otherwise difficult to care for. The dissertation emphasizes that implementing and using video
consultations requires time and work by general practitioners and staff. Video
consultations are situated in everyday settings where different practicalities and
priorities influence how they are used, including GPs’ and staff’s job satisfaction
and work conditions.This dissertation providesinsights into video consultation practices that enhance
the understanding of general practitioners’ and practice staff’s reasons for using
or not using video consultations. Moreover, it illuminates the various ways video consultations are used. This may inspire potential ways forward regarding
their use in general practice.
AB - In Denmark, healthcare is increasingly provided using digital technologies,
including in general practice. Danish general practice already conducts around a
quarter of consultations remotely through telephone and e-mail. Now, video
consultations have been introduced as yet another way for patients to consult
with their general practitioner remotely. Video consultations were introduced
nationally in Denmark in March 2020 due to the COVID-19 pandemic, and
video software was publicly developed and provided free of charge to patients
and general practitioners. In 2022, video consultations were officially incorporated as a permanent offer to patients in general practice. It is a requirement that
by the end of 2024, all general practitioners offer video consultations to their
patients. There is a strong political push for the use of video consultations based
on expectations of e.g., increased efficiency and optimized use of healthcare
resources. Yet, the adoption rate of video consultations is low, and their use differs significantly between clinics. It is not known how and why general practitioners and
practice staff use or do not use video consultations as they do. This makes it
difficult to qualify and understand the reasons for the use or non-use of video
consultations.The purpose of this dissertation is to explore the implementation, use, and nonuse of video consultations in Danish general practice. This dissertation is an
ethnographic study, approaching video consultations through an overall sociomaterial lens. In doing so, video consultations are explored as situated activities
that gain their meaning and function through the entanglement of social and
material arrangements and general practitioners and practice staff in their specific organizational settings.The data corpus in this dissertation consists of 30 semi-structured interviews
with general practitioners, three interviews with practice staff, and 132 hours of
fieldwork conducted in seven clinics across various locations in Denmark. Data
was generated between June 2021 and August 2022. The dissertation comprises three papers. In each paper, video consultations are
explored from a different theoretical perspective, which all contribute to understanding how and why video consultations are implemented, used or not used
the way they are. The papers focus on general practitioners’ interpretations of
video consultations and how these affect their use or non-use, based on Orlikowski’s concept of “technological frames” (Paper A), how general practitioners and practice staff fit their use of video consultations to align with what they
conceptualize as good care, based on Pols’ concept of “fitting” (Paper B), and
the work performed by general practitioners and practice staff to embed video
consultations into their daily work life, based on Star’s and Strauss’ concept of
“invisible work” (Paper C).Overall, this dissertation demonstrates how the implementation and use of video
consultations is a process of organizational change. Contributing to the literature
on the suitability and appropriateness of video consultations, the inclusion of a
variety of video consultation users and non-users demonstrates how the value of
video consultations relies on a complex web of relationships and interactions.
This includes existing values, opinions and the occupational identity of general
practitioners, general practitioners’ and staff’s conceptualizations of good care,
workflows, temporal resources, and financial incentives. Furthermore, this dissertation emphasizes the importance of staff in video consultation practices,
particularly in relation to the sustainability of video consultations and the inclusion of patients. Additionally, this dissertation adds to ongoing discussions about
inequality in healthcare by describing the decisions made in practice regarding
which patients to video consult with, including descriptions of how video consultations are often used for working people and those who are least sick, but
also how video consultations are used to reach patients who are otherwise difficult to care for. The dissertation emphasizes that implementing and using video
consultations requires time and work by general practitioners and staff. Video
consultations are situated in everyday settings where different practicalities and
priorities influence how they are used, including GPs’ and staff’s job satisfaction
and work conditions.This dissertation providesinsights into video consultation practices that enhance
the understanding of general practitioners’ and practice staff’s reasons for using
or not using video consultations. Moreover, it illuminates the various ways video consultations are used. This may inspire potential ways forward regarding
their use in general practice.
U2 - 10.21996/7mad-c554
DO - 10.21996/7mad-c554
M3 - Ph.D. thesis
PB - Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet
ER -