The chat on 1177 has changed the work environment

The work environment has been affected both positively and negatively for the nurses at 1177 Vårdguiden who have contact with patients via chat instead of telephone shows a recent study from Uppsala University. The positive thing is that the time pressure is less and the chat has created a calmer emotional work environment. One thing that is perceived as difficult is to chat with many patients in parallel without knowing when the patients choose to answer.

The largets risk that we see is that in this type of digitalisation you forget the people who for various reasons can not chat but who need to talk to a nurse. Not everyone has access to a computer, does not know the language or has a functional variation that makes it impossible. The chat can be a compliment, but we need to continue to have many channels into healthcare because we live in a heterogeneous society, says Åsa Cajander, professor at the Department of Information Technology, Uppsala University.

Many regions today are investing in the digitization of some patient contacts in order to better meet the challenges of healthcare. In 2019, the Uppsala Region carried out a pilot project within the framework of Nära Vård Online, where patients were given the opportunity to chat with nurses in writing on 1177 Vårdguiden after secure login and registration of experienced symptoms. The purpose was to increase efficiency in providing advice on nursing and further care, and also to give the patient the opportunity to chat with a doctor if necessary.

Prior to the chat conversation with the nurses, the patients had to fill in a web form with their symptoms. The written information was used so that the nurses would get a better picture of the patient’s condition in advance in order to be able to focus on follow – up questions in the chat.

Increase the effectiveness of counseling
The purpose of the chat was to increase the effectiveness of counseling about nursing and further care, and also to give the patient the opportunity to chat with a doctor if necessary. The nurses could also give advice on where the patient should turn or pass them on directly to the emergency department or ambulance care. Within the framework of the service, there was also the opportunity to be referred via the chat to a doctor for diagnosis and treatment during the same evening. The chat was a so-called asynchronous chat, which means that there can be some time between questions and answers.

Previous research has shown that the care staff’s work environment is already problematic, and that stress is a major problem. One way of trying to deal with this has been to find digital solutions for some care contacts, such as 1177 Vårdguiden. In this study, the researchers want to study how digitalisation affects the healthcare staff’s work commitment and whether the workload increases or decreases with the chat function. Observations were made on site for five hours with nurses who used the chat and who normally use the telephone for medical advice to patients. In addition, semi-structured interviews were conducted with nine nurses who participated in the digitization project to gather knowledge about their experience of the work situations. The results were categorized into job requirements and job resources.

Less time pressure for the nurses
The results show that the transition to an e-service with the patients was linked to work commitment in several ways. The nurses experienced less time pressure during the period, which can probably be linked to the fact that not as many patients contacted 1177 via chat as by telephone. However, the nurses found it stressful to have many patients to chat with in parallel, and not to know how many more patients are about to start chatting with them. In addition, it was stressful to sometimes have to wait for the patient’s response for several hours. The researchers were also able to establish that the digital work environment became complex with the introduction of the new service, and that the nurses needed to manage up to five different systems simultaneously to carry out their tasks.

Do you know if the e-service streamlined the work for 1177 or not?

  • We did not investigate that issue specifically through, for example, time studies and comparisons, but the experience of most nurses was that the system did not provide greater efficiency. However, it is difficult to say for sure about the efficiency because it was a new way of working which always takes time to learn with new systems etc., and also that the number of patients was not so large which possibly contributed to the nurses choosing to let each patient take a little more time, says Åsa Cajander.

Less emotional stress
Several nurses also mentioned that the chat service created less emotional stress and that they experienced the work with the chat as calmer because they kept a distance more easily. The nurses were given the opportunity via the system to choose standardized phrases instead of writing themselves, but this part of the service was rarely used and was not appreciated. Several also pointed out weaknesses in the preset questions asked to patients.

What advice can be given to regions that want to introduce this type of e-services to patients?

  • The most important thing is that the staff is involved in this type of change work. During the development, nurses and doctors were able to continuously provide feedback that was used and it contributed to a positive experience. It is also important to carefully evaluate this type of change work and to work with pilot projects to understand the problems and opportunities of change, says Åsa Cajander.

(This blog is a translation of a recent press release.)

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