How mobile technology impacts interprofessional team-based care in an acute care setting: a realist perspective




Courville, Katheryn

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Background: There is wide spread confidence that mobile technology can enhance interprofessional teamwork leading to improved patient outcomes. Nevertheless, there are very few studies demonstrating success and limited explanatory models. The purpose of this study was to elucidate a foundation of knowledge on how and why mobile technology impacts interprofessional team-based care. Method: I used a realist-informed methodology (Pawson & Tilley, 1997) in a two-phased research design. I sought out how the functions and features offered by mobile technology change users’ actions and behaviors, and the outcomes that occur from that change. In Phase 1, I teased out components of a realist theory (mechanisms, outcomes, and context) from extant literature and from interviews with designers of an existing mobile application that is used to coordinate interprofessional acute stroke care. I used retroduction to uncover the causal mechanisms of our observed outcomes. In Phase 2, I tested these theories by interviewing users of the same mobile application in a large hospital in a midsized western U.S. city. Results: I interviewed four software representatives in Phase 1 and developed ten contingency theories. In Phase 2, I interviewed eight team members and tested and refined theories until I had eight fully supported theories using six mechanisms: Prioritizing, making quicker and more informed decisions, validation, support, critical appraisal of performance, and appropriate engagement. One contingency theory, interoperability, was found in the literature, but unsupported by my data. I found four emerging theories consisting of two mechanisms (shared goals and accountability) requiring more evidence. Conclusion: These results show that interprofessional teams using a well-designed mobile technology can improve upon the following outcomes: time management, optimized resources, team unity, performance metrics, job satisfaction, and self-learning and professional development.