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Caring for the patient, caring for the record: an ethnographic study of ‘back office’ work in upholding quality of care in general practice

Overview of attention for article published in BMC Health Services Research, April 2015
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (95th percentile)
  • High Attention Score compared to outputs of the same age and source (98th percentile)

Mentioned by

blogs
1 blog
twitter
55 tweeters
facebook
1 Facebook page

Citations

dimensions_citation
11 Dimensions

Readers on

mendeley
73 Mendeley
citeulike
1 CiteULike
Title
Caring for the patient, caring for the record: an ethnographic study of ‘back office’ work in upholding quality of care in general practice
Published in
BMC Health Services Research, April 2015
DOI 10.1186/s12913-015-0774-7
Pubmed ID
Authors

Deborah Swinglehurst, Trisha Greenhalgh

Abstract

The quality of information recorded about patient care is considered key to improving the overall quality, safety and efficiency of patient care. Assigning codes to patients' records is an important aspect of this documentation. Current interest in large datasets in which individual patient data are collated (e.g. proposed NHS care.data project) pays little attention to the details of how 'data' get onto the record. This paper explores the work of summarising and coding records, focusing on 'back office' practices, identifying contributors and barriers to quality of care. Ethnographic observation (187 hours) of clinical, management and administrative staff in two UK general practices with contrasting organisational characteristics. This involved observation of working practices, including shadowing, recording detailed field notes, naturalistic interviews and analysis of key documents relating to summarising and coding. Ethnographic analysis drew on key sensitizing concepts to build a 'thick description' of coding practices, drawing these together in a narrative synthesis. Coding and summarising electronic patient records is complex work. It depends crucially on nuanced judgements made by administrators who combine their understanding of: clinical diagnostics; classification systems; how healthcare is organised; particular working practices of individual colleagues; current health policy. Working with imperfect classification systems, diagnostic uncertainty and a range of local practical constraints, they manage a moral tension between their idealised aspiration of a 'gold standard' record and a pragmatic recognition that this is rarely achievable in practice. Adopting a range of practical workarounds, administrators position themselves as both formally accountable to their employers (general practitioners), and informally accountability to individual patients, in a coding process which is shaped not only by the 'facts' of the case, but by ongoing working relationships which are co-constructed alongside the patient's summary. Data coding is usually conceptualised as either a technical task, or as mundane, routine work, and usually remains invisible. This study offers a characterisation of coding as a socially complex site of moral work through which new lines of accountability are enacted in the workplace, and casts new light on the meaning of coded data as conceptualised in the 'quality of care' discourse.

Twitter Demographics

The data shown below were collected from the profiles of 55 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 73 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 5 7%
Sweden 1 1%
Canada 1 1%
Unknown 66 90%

Demographic breakdown

Readers by professional status Count As %
Researcher 17 23%
Student > Master 16 22%
Student > Ph. D. Student 10 14%
Other 5 7%
Student > Doctoral Student 4 5%
Other 15 21%
Unknown 6 8%
Readers by discipline Count As %
Medicine and Dentistry 26 36%
Social Sciences 18 25%
Nursing and Health Professions 7 10%
Agricultural and Biological Sciences 2 3%
Computer Science 2 3%
Other 7 10%
Unknown 11 15%

Attention Score in Context

This research output has an Altmetric Attention Score of 42. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 14 July 2016.
All research outputs
#446,433
of 14,178,562 outputs
Outputs from BMC Health Services Research
#104
of 4,813 outputs
Outputs of similar age
#9,466
of 228,982 outputs
Outputs of similar age from BMC Health Services Research
#3
of 158 outputs
Altmetric has tracked 14,178,562 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 96th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 4,813 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.6. This one has done particularly well, scoring higher than 97% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 228,982 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 95% of its contemporaries.
We're also able to compare this research output to 158 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 98% of its contemporaries.