Telemedicine Practices in Fast-Response Environments
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Abstract:
Telemedicine has grown exponentially over the last decade, opening up a wide range of possibilities for the future of healthcare delivery. Yet, despite its documented benefits, using it to deliver treatment in emergency environments is not without challenges. These challenges are mainly due to the system's technical limitations, time constraints, and uncertainty surrounding emergency conditions. In this thesis, I examine two of these challenges: The reliability paradox, and social presence.
The first paper focuses on telemedicine in a High-Reliability Organization (HRO) context. HROs are highly sensitive to errors, yet the increasing complexity of technological systems means that they need to face continuous disruptions to their routines. The need for reliable performance in the face of unpredictable disruptions creates tensions between improvised responses and those that draw on a repertoire of established routines. The tensions create what we call a reliability paradox. Our findings reveal that the responses to disruptions straddle three main dimensions of this paradox: choices around the flow of actions, distribution of attention, and redistribution of roles. We discuss implications for our understanding of organizational reliability in technology-mediated teams.
The second paper focuses on the need for social presence between medical team members in telemedicine systems. Prior literature highlights time (e.g. immediacy and duration of interactions) as a critical condition for the development of social presence, but it is not clear how this is achieved amidst time-sensitive medical practices. Thus, I aim to explore conditions mechanisms of achieving social presence under time pressure. To develop a theoretical understanding, I draw on sensemaking theory to analyze how the medical team members make sense of what is happening on the other side of the telemedicine system and consequently generate a sense of social presence. The findings reveal three main drivers for the need for social presence: Clinical ambiguity, knowledge gap, and criticality of the decision, which further trigger two interrelated forms of social presence on the Telestroke system: Informative and Performative Social Presence.
To achieve this thesis's objectives, I conducted an ethnographic study of a telemedicine system called Telestroke that links three healthcare institutes in Singapore. The system is designed to treat stroke patients in hospitals that lack neurologists who have the necessary skills to diagnose and treat acute stroke. Overall, the findings enhance our understanding of Telemedicine practices in time-sensitive settings.