Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Health Information Science

Program

Health Information Science

Supervisor

Dr Pamela McKenzie

2nd Supervisor

Dr Mark Goldszmidt

Abstract

This study seeks to provide insights on how patient education (PE) is enacted in an inpatient Internal Medicine Inpatient Unit at an academic teaching hospital in Ontario, Canada that has adopted Patient Oriented Discharge Summaries (PODS). A constructivist grounded theory methodology was conducted for 106 participant observations and 25 field interviews. We found that (1) patient education was not a single event but occurred at multiple moments throughout the course of care, and many components were required for PE to be effective (2) In addition to needing everyone in the same room, there needed to be an alignment of goals and concerns between the health care providers (HCPs), patients (Pts) and family advocates (FAs) (3) Team logistics and schedules meant that the same category of HCPs were present but not the individuals themselves (4) Though PODS functioned poorly as a boundary object, we found other documents/people who played the role of boundary. This study identifies a host of features that need to be attended to for effective re-engineering of inpatient PE throughout a hospital stay. Designing a better system for PE in the IMIU requires addressing all the levels of complexity as the current re-engineered discharge tools do not adequately address the barriers to having a PE conversation at the point of discharge.

Summary for Lay Audience

The internal medicine inpatient unit (IMIU) cares for patients who are experiencing multiple health conditions at the same time. There are many health care providers (HCPs) involved in the care of these patients. With multiple moving parts to this setting, this study seeks to provide insights on how patient education (PE) is enacted in an IMIU at an academic teaching hospital in Ontario, Canada that has adopted Patient Oriented Discharge Summaries (PODS). The PODS is a quality improvement initiative delivered by the HCPs and provides patients with an easy to understand summary of instructions upon discharge. In order to understand how patient education happened in this setting, the researcher used direct observations and field interviews. In total, there was 106 participant observations and 25 field interviews conducted. We found that (1) patient education was not a single event but occurred at multiple moments throughout the course of care, and many components were required for PE to be effective (2) In addition to needing everyone in the same room, there needed to be an alignment of goals and concerns between the health care providers (HCPs), patients (Pts) and family advocates (FAs) for effective PE encounters (3) Team logistics and schedules meant that the same category of HCPs were present but not the individuals themselves (4) Though PODS wasn’t an effective discharge tool in relation to PE, we identified other documents/people who were able to contribute to the underlying principles of PODS. This study identifies many features that need to be attended to for effective PE to happen throughout a patient’s stay. Designing a better system for PE in the IMIU requires addressing all the levels of complexity as the current discharge tools do not adequately address the barriers to having a PE conversation at the point of discharge.

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