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Through a qualitative study in six hospital departments in the Northern Region of Denmark, this article aims to shed light on how a non-clinical group, medical secretaries, supports clinical-administrative documentation as they translate between the clinical and administrative domains. This article shows how this demands context-sensitive knowledge and skills acquired through deep engagement with the full scope of clinical-administrative work at the department level. We argue that, given the increasing ambitions for secondary uses of healthcare data, specific clinical-administrative competencies beyond those of clinicians are increasingly necessary in the skillmix in hospitals. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the vaccine hesitancy, anti-vaccination, and anxiety levels of medical secretaries during the pandemic. Methods: This cross-sectional study was conducted on 161 medical secretaries working at the time of the Study. Sociodemographic characteristics form, Coronavirus Anxiety Scale (CAS), Vaccine Hesitancy Scale (VHS) adapted to the pandemic, and Anti-vaccination Scale (AVS) were used in the questionnaire form used to collect the data of the study. Results: Median (IQR) CAS, VHS, and AVS scores of the participants were 2 (IQR=3), 32 (IQR=10), and 58 (IQR=16), respectively. 35.4 % of the participants were exposed to the COVID-19, and 87% were vaccinated against COVID-19. Participants' hesitations about the childhood and COVID-19 vaccines were 15.5 % and 49.1%, respectively. A significant relationship was found between the presence of Coronavirus anxiety and educational status (p=0.035), hesitancy against childhood vaccine (p=0.016), and working in COVID-19 Units (p=0.044). A statistically significant relationship was found between VHS scores and hesitancy against childhood vaccine (p=0.001), hesitancy against COVID-19 vaccine (p<0.001), vaccination against COVID-19 (p=0.014), belief that the COVID-19 vaccine is protective (p<0.001), and make COVID-19 vaccination mandatory (p<0.001). A significant relationship was found between AVS scores and vaccination against COVID-19 (p=0.002), hesitancy against COVID-19 vaccine (p<0.001), and belief that the COVID-19 vaccine is protective (p<0.001), making COVID-19 vaccination mandatory (p<0.001). Conclusion: The concern about their parents' exposure to COVID-19 is high among secretaries. COVID 19 vaccine hesitancy is high among secretaries. During the pandemic, higher rates of anxiety were detected in secretaries and those working in COVID-19 units and lower in the high school education. [ABSTRACT FROM AUTHOR]

Background and Objectives: General practitioners (GPs), nurses and medical secretaries (practice staff) are responsible for the continuous provision of safe care in rural general practice. Little is known about their role in situations where patients were or could have been harmed in a rural setting. Therefore, we sought to investigate rural general practice staff experiences of patient safety incidents and low quality of care.Methods: Descriptive qualitative interviews using the critical incident technique. Systematic text condensation analysis involving GPs and practice staff in eight rural municipalities in Norway.Results: Sixteen participants (eight GPs, one nurse and seven medical secretaries) with mean work experience of 11.8 years were interviewed for a total of 11.5 hours. We identified three main factors that make rural GP clinics vulnerable to patient safety incidents and low quality of care: use of locums, work overload and rough weather and distance to hospital. There was a wide range of patient safety incidents. The healthcare personnel explained how they used local knowledge about people and context and greater awareness of risk of error in order to prevent these incidents from happening.Conclusion: Rural GP clinics that suffer from frequent use of GP locums and work overload are vulnerable to patient safety incidents. Practice staff use various forms of continuity of care to prevent safety incidents from happening; this highlights the strengths but also some major safety concerns in these GP clinics. Staff at these clinics proved to be a resource for patient safety research.Podcast: An accompanying podcast on patient safety is available as Supplementary Data, in which Martin Bruusgaardf Harbitz and Per Stensland provide insights into the context of this study. [ABSTRACT FROM AUTHOR]

This paper investigates the often neglected area of data work by medical secretaries, specifically in the context of hospitals in Denmark. Since the 1930s medical secretaries have played a steadily more central role in meeting the growing need for health data. With electronic health records (EHRs) and promises of data automation, the profession has been put at risk of redundancy. While there is a considerable base of research on the datafication of health care, the data work emerging from datafication remains undescribed. Hence, we are conducting a socio-technical study of clinical-administrative data work in contemporary Danish public hospitals. In this paper we present early insights of this research, indicating the vital role of medical secretaries' data work in securing clinical information at the point of care. [ABSTRACT FROM AUTHOR]

Medical secretaries may have several separate electronic nursing information systems in use, but regardless of the systems, their task is to make sure that the patient information is correct and usable. The purpose of this study is to describe the support provided by the hospital information systems for the work of medical secretaries in patient administration tasks in different phases of the care process. The data were collected in a central hospital where medical secretaries had long been using partly electronic information systems. The data were collected using an abridged version of the Hospital Information System Monitor (HIS-monitor). The majority of the secretaries (N=60) gave a positive assessment for the support provided by the information system for their work at patient admission, when ordering diagnostic or therapeutic examinations or procedures, and at patient discharge. In the planning and organization of care, most thought that the systems provided poor support for informing all those involved in patient care. At patient admission, nearly half considered that the support for ensuring data protection (46%) and the systems’ compliance with legal obligations (44%) was poor. In connection with ordering diagnostic and therapeutic examinations and procedures, nearly half (43%) thought that information on the availability in ancillary units was not readily and easily available. At patient discharge, 40% considered that the systems did not support the identification of missing or incorrect information. The hospital information system provides partial support for medical secretaries’ work. The implementation of fully electronic systems and their functions may improve the support.

Sağlık kurumlarında çalışanların iş sağlığı ve güvenliğini (İSG) tehdit eden biyolojik, kimyasal, psikolojik, çevresel, mekanik ve biyomekanik risk ve tehlikeler bulunmaktadır. Söz konusu risk ve tehlikelerin meydana getirdiği ekonomik ve sosyal kayıplar devlet, sağlık kurumları ve sağlık çalışanları açından önemli kayıplar yaratmaktadır. Bu çalışmanın amacı, sağlık çalışanı bakış açısı ile bir üniversite hastanesindeki iş güvenliği(İG) uygulamalarının değerlendirmektir. Kesitsel olarak planlan bu çalışmanın evrenini İzmir ilinde, Dokuz Eylül Üniversitesi Hastanesi’nde (DEÜH) çalışan 299 tıbbi sekreter oluşturmaktadır. Bu sekreterlerden 168 kişi örneklem olarak seçilmiştir. Verilerin toplanmasında Öztürk ve Babacan (2012) tarafından geliştirilen “Hastanelerde Çalışan Sağlık Personeli İçin İş Güvenliği Ölçeği” (İGÖ) (1= Kesinlikle Katılmıyorum, 6=Kesinlikle Katılıyorum) kullanılmıştır. Araştırma verilerinin analizinde SPSS 23.0 paket programı kullanılmıştır. Ölçeğin yapılan güvenilirlik analizinde Chronbach Alpha katsayısı 0,95 olarak hesaplanmıştır. Araştırma bulguları, DEUH’nde iş güvenliğinin orta düzeyde sağlandığını (147,3±40), İG’nin en çok sağlandığı boyutun “Mesleki Hastalıklar ve Şikâyetler” (32,8±13,7), en az sağladığı boyutun ise “Fiziksel Ortam Uygunluğu” (14,4±6,1) olduğunu ortaya koymaktadır.

Background: Hospital manager have crucial responsibilities with regard to the monitoring of mobbing for the establishment of safe and peaceful work environment, and taking necessary measures accordingly. Objective: The aim of this study is to identify the factors that affect the mobbing levels of medical secretaries, who are the officers that patients meet the first. Methodology: The population of this research is a total number of 282 employees working as medical secretaries at a university hospital in Ankara, Turkey. The sample size is calculated as 163 people, and a random stratified sampling method was performed in the selection of samples. Mobbing levels of employees were measured by the Leymann Inventory of Psychological Terrorization (LIPT) scale. Results: According to the logistic regression, the marital status and age of medical secretaries were identified as statistically significant on the mobbing level (p<0.05). Hence, the single medical secretaries have the possibility to encounter with mobbing with 3.357 times more than married secretaries, and the level for the possibility to encounter with mobbing diminishes with 0,891 times as the age increases by one unit. Conclusion: Considered to lead the measures that would be taken by the hospital managers in order to diminish the mobbing behaviours at the hospital. [ABSTRACT FROM AUTHOR]

This paper empirically investigates a Common Information Space (CIS) established by medical secretaries so they could support each other during their workplace's transition to a new comprehensive electronic health record, called the Healthcare Platform (HP). With the new system, the secretaries were expected to become partially obsolete, as doctors were to take on a significant load of the clerical work, such as documenting and coding. To handle their changing work situation, the medical secretaries set up an online support group in parallel to, but independent from, the official implementation support organization. The paper's contribution is a characterization of the support group as a common information space (CIS), and analysis of the specific qualities of aworker-drivenCIS as a forum for 1) articulation work required for re-grounding changing tasks and responsibilities, 2) archiving discussions (posts) and guidelines to further their collective interpretation, and 3) creating a space independent of management for employees to work out their new role in an organization in a situation of transition and change. [ABSTRACT FROM AUTHOR]

Résumé: Si pour favoriser l'accès aux soins en médecine générale, et en améliorer la qualité, il est indispensable de libérer du temps médical, la question du choix du type de secrétariat est essentielle. L'objectif de cet article est de préciser la place du secrétariat physique en médecine générale, en s'intéressant tout particulièrement à l'analyse de la relation triangulaire entre médecin, patient et secrétaire. Pour cela, il s'appuie sur les résultats de trois études qualitatives menées par entretiens individuels et focus groupes, dans le cadre de thèses d'exercice en médecine générale. Ces études s'intéressent aux attentes et points de vue des différents acteurs (médecins, patients, secrétaires) en matière de secrétariat médical. While it is essential to free up medical time in order to promote access to care in general medicine and improve its quality, the question of choosing the type of secretariat is essential. The objective of this article is to clarify the place of the physical secretariat in general medicine, by paying particular attention to the analysis of the triangular relationship between doctor, patient and secretary. For this, it relies on the results of three qualitative studies carried out by individual interviews and focus groups, as part of exercise theses in general medicine. These studies are interested in the expectations and points of view of the different actors (doctors, patients, secretaries) in terms of medical secretarial [ABSTRACT FROM AUTHOR]

Résumé: Les sociétés de la modernité sont des espaces d'interactions dans lesquels le temps est soumis à un processus d'accélération. Si le temps se réfère habituellement à une durée, la temporalité peut nous rapprocher de la notion de rhythme, de tempo. La relation de soin en médecine générale se trouve confrontée à l'accélération technique, sociale et du rhythme de vie. Comment concilier, synchroniser, les temporalités respectives de la maladie, de la personne malade, du médecin et de la société ? La temporalité dans le soin peut s'appréhender selon un modèle avec quatre axes : temporalité de la maladie, du patient, du médecin et temporalité sociale. Le temps de la modernité, du fait de l'accélération, est porteur de nuisances potentielles pour les personnes les plus vulnérables au rang desquelles se comptent les malades. La concordance des temps est un défi pour le médecin généraliste qui passe par l'ajustement de sa propre temporalité à celle de la personne malade dans la mise en jeu de ses compétences et le respect des valeurs du patient. En médecine générale, la relation de soin suppose souvent une résistance par décélération afin de se dégager du temps de la modernité. The societies of the modernity are fields of interactions inside which the space-time is submitted to an acceleration process. Time usually refers to a duration, whereas temporality is closer to the idea of pace and tempo. The primary healthcare relation is facing with technical, social acceleration and also the one of the pace of life. How to reconcile, to synchronize the temporalities of each, the disease, the patient, the general practitioner and of the society. It is possible to apprehend the healthcare temporality in four areas: The one of the diseases, of the patient, of the general practitioner and the social temporality. Because of the acceleration, the temporality of modernity brings potential damages to the persons more vulnerable because of disease. The concordance of the times is a challenge for the general practitioner who goes through the adjustment of his temporality to that of the sick person, in the putting into play his competences and the respect of the patient's values. The healthcare relation often involves a resistance by deceleration in order to get away from the temporality of modernity. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences of general practitioners (GPs), nurses and medical secretaries in providing multi-professional diabetes care and their perceptions of professional roles. Design, setting and subjects: Semi-structured interviews were conducted with six GPs, three nurses and two medical secretaries from five purposively sampled diabetes teams. Interviews were analysed thematically. Main outcome measures: Healthcare professionals' (HCPs') experiences of multi-professional diabetes care in general practice. Results: The involvement of nurses and medical secretaries (collaborating health care professionals) was mainly motivated by GPs' time pressure and their perception of diabetes care as easy to standardize. GPs reported that diabetes care had become more structured and continuous after the involvement of collaborating health care professionals (cHCPs). cHCPs defined their role differently from GPs, emphasizing that their approach included acknowledging patients' need for diabetes education, listening to their stories and meeting their need for emotional support. GPs appeared less involved in patients' emotional concerns and more focused on the biomedical aspects of illness. There was little emphasis on teamwork among GPs and cHCPs, and none of the practices used care plans to involve patients in decisions or unify treatment among professionals. Participants stated that institutional structures including a discriminatory remuneration system, lack of role descriptions and missing procedures for collaborative approaches were an obstacle to MPC. Conclusions: cHCPs worked independently under delegated leadership of the GPs. Although cHCPs had a complementary role, HCPs in general practice may not take full advantage of the potential of sharing patient responsibility and learning with, from and about each other. Contextual barriers for team-based care approaches should be addressed in future research. It has been suggested that multi-professional approaches improve quality of care in people with long-term conditions. In this study, nurses and medical secretaries perceived to have a complementary role to general practitioners (GPs) in diabetes care, focusing on patient education, building trusting relationships and providing patients with emotional support. As multi-professional collaboration was minimal, GPs, nurses and medical secretaries in the included practices may not take full advantage of the potential of sharing care responsibility and learning with, from and about each other. [ABSTRACT FROM AUTHOR]

Our medical secretaries and office administrative staff work closely with the clinical team to deliver safe and efficient care to our patients. Medical secretaries and administrative staff may undertake a medical secretary or medical terminology course as part of their induction into their role in the National Health Service. We conducted a Trust-approved service evaluation study to explore the secretarial staff's perceived learning needs, followed by a 1-h, consultant-led, didactic-style skin cancer teaching workshop about the patient journey from diagnosis through to multidisciplinary team discussion of management outcome. [Extracted from the article]

In-between 2016 and 2017 a new hospital information system (HIS) was introduced at several hospitals in Denmark radically changing the core work practices for a majority of the healthcare professionals. Promptly, the new HIS began to receive criticism from healthcare professionals for failing to live up to proclaimed expectations. To fully understand the problems experienced by the healthcare professionals we need to understand the fundamental nature of the work prior to the implementation. In this paper, we investigate patient consultations as they were performed prior to the implementation of the HIS at an oncology department. Reporting from a 1.5 year-long study, we find patient consultations were organized in three sequential activities: review, interaction, and documentation. Further, we find that the dictaphone served as a key artifact allowing physicians to enact flexibility in documentation while simultaneously providing them with the capability to communicate and coordinate with the medical secretaries. Our empirical findings suggest that the medical secretaries are critical for structured documentation of variations in health data and are the cornerstones that allow physicians to enact sentimental efforts when interacting with patients. These insights prove important in understanding the criticism aimed at the new HIS implementation since the implementation removed the dictaphone as a key artifact and instead introduced a new organizational structure where documentation was assumed accomplished in parallel with patient interaction. The transformation consequently shifted work, previously performed by the medical secretaries, to the physicians. [ABSTRACT FROM AUTHOR]

Respecting the medical secrecy is one of the essential conditions underlying the protection of private life. Medical information obtained from patients in the context of a physician - patient relationship should be protected by confidentiality. Disclosure of personal health care data without the agreement of the person is a touch brought to private life. One particular feature of the health care system is the healthcare provided to patients in detention. Even though the doctor-patient relationship in the penitentiary environment has a number of peculiarities, it is coordinated according to the same ethical principles as in the public one. The penitentiary physician's duty is not limited to consultation and treatment, he often becomes the prisoner's personal physician, and the means of relationship must respect the fundamental rights of the patient, regardless of his or her status. In the penitentiary system, there are also many dilemmas arising from the duties of the medical staff, the first of the detainee's personal physician and the second of the penitentiary administration's counselor. The medical specialist in a penitentiary must take into account that communicating with the patient is essential in the doctor-patient relationship and she must be sincere. In determining the attitude of the patient towards the doctor and the medical act, the context of the first contact with the doctor, the way in which the first medical consultation takes place, is of great importance. Trust is gradually gaining, and medical staff must strive to demonstrate that they can ensure the protection of prisoners' medical records. [ABSTRACT FROM AUTHOR]

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Background: Expected growth in the demand for health services has generated interest in the more effective deployment of health care assistants. Programs encouraging German general practitioners (GPs) to share responsibility for care with specially qualified health care assistants in the family practice (VERAHs) have existed for several years. But no studies have been conducted on the tasks German GPs are willing to rely on specially qualified personnel to perform, what they are prepared to delegate to all non-physician practice staff and what they prefer to do themselves. Methods: As part of an evaluation study on the deployment of VERAHs in GP-centered health care, we used a questionnaire to ask about task delegation within the practice team. From a list of tasks that VERAHs are specifically trained to carry out, GPs were asked to indicate which they actually delegate. We also asked GPs why they had employed a VERAH in their practice and for their opinions on the benefits and limitations of assigning tasks to VERAHs. The aim of the study was to find out which tasks GPs delegate to their specially qualified personnel, which they permit all HCAs to carry out, and which tasks they do not delegate at all. Results: The survey was filled in and returned by 245 GPs (83%). Some tasks were exclusively delegated to VERAHs (e.g. home visits), while others were delegated to all HCAs (e.g. vaccinations). About half the GPs rated the assessment of mental health, as part of the comprehensive assessment of a patient’s condition, as the sole responsibility of a GP. The possibility to delegate more complex tasks was the main reason given for employing a VERAH. Doctors said the delegation of home visits provided them with the greatest relief. Conclusions: In Germany, where GPs are solely accountable for the health care provided in their practices, experience with the transfer of responsibility to other non-physician health care personnel is still very limited. When HCAs have undergone special training, GPs seem to be prepared to delegate tasks that demand a substantial degree of know-how, such as home visits and case management. This “new” role allocation within the practice may signal a shift in the provision of health care by family practice teams in Germany. [ABSTRACT FROM AUTHOR]

Misra-Hebert et al's study in this issue attests to the quality of scribes' notes. My personal experience is that charts are usually closed at the end of each half-day. [ABSTRACT FROM AUTHOR]

As health care IT gradually develops from being stand-alone systems towards integrated infrastructures, the work of various groups, occupations and units is likely to become more tightly integrated and dependent upon each other. Hitherto, the focus within health care has been upon the two most prominent professions, physicians and nurses, but most likely other non-clinical occupations will become relevant for the design and implementation of health care IT. In this paper, we describe the cooperative work of medical secretaries at two hospital departments, based on a study evaluating a comprehensive electronic health record (EHR) shortly after implementation. The subset of data on medical secretaries includes observation (11 hours), interviews (three individual and one group) and survey data (31 of 250 respondents were medical secretaries). We depict medical secretaries' core task as to take care of patient records by ensuring that information is complete, up to date, and correctly coded, while they also carry out information gatekeeping and articulation work. The importance of these tasks to the departments' work arrangements was highlighted by the EHR implementation, which also coupled the work of medical secretaries more tightly to that of other staff, and led to task drift among professions. Medical secretaries have been relatively invisible to health informatics and CSCW, and we propose the term 'boundary-object trimming' to foreground and conceptualize one core characteristic of their work: maintenance and optimization of the EHR as a boundary object. Finally, we reflect upon the hitherto relative invisibility of medical secretaries which may be related to issues of gender and power. [ABSTRACT FROM AUTHOR]