The invisible work in GP telemedicine consultations
While patients are well aware of the benefits of video consultation in primary care, one question often remains: what does this technology mean for healthcare professionals (HCPs)?
Video consultation in primary care is a well-researched topic. Yet, existing research primarily focusses on patients´ experiences, opinions and perceptions while comparatively less attention is given to organisational and infrastructural changes in medical practices when introducing new technology (1–4). However, it is precisely this implementation process that commonly results in more efficiency and productivity (5, 6) but also involves invisible work that deserves closer attention and understanding as a recent study shows (7).
Research on the invisible work of video consultation in primary care
Lüchau et al. (2024) aimed to identify the invisible effects that video consultations have on routines and work processes of general practitioners (GPs) and healthcare staff in Denmark (7). In their study, they conducted a multiple case study with semi-structured interviews with 33 GPs and staff members and ethnographic fieldwork across seven GP clinics, such as group practices or medical centers, with 132 hours of observation.
In this context, invisible work refers to tasks that occur in the background, often unnoticed by others due to their relative mundanity. Nonetheless, these tasks are crucial to the effective implementation and utilisation of video consultation in primary care (7). Lüchau et al. (2024) highlight four essential invisible work processes that emerge when adopting this technology (Figure 1).
Figure 1: The process of video consultation in primary care
First, in the introduction phase. The findings indicate that the extent of this task is not visible (7). Once the technology has been implemented, the responsibility then shifts to the secretary or medical assistance respectively, who performes the coordination phase. There the mainrole is to coordinate, instruct, and assist colleagues and patients, as well as to provide emotional support to ensure that patients feel at ease with the technology. The extent of this work is also not visible (7).
The final two processes, the process of stabilisation and repair, are performed by the entire medical practice team, and involve the implementation of strategies in order to avoid mistakes and misunderstandings as well as efforts to restore contact with patients in the event of technical breakdowns. Taken together, these tasks are largely invisible as even the individuals performing them are not usually aware of it themselves (7).
Conclusion
Video consultation in primary care is an effective communication tool for patients and healthcare professionals. However, its implementation and use includes largely invisible work tasks. When it comes to (general) practices in Germany, the study by Lüchau et al (2024) is a learning example of how to successfully implement new technologies such as video consultations. Therefore, before adopting such technology, medical practices should make themselves aware of these invisible tasks.
In order to ensure the efficient use of new technology without overwhelming users, it will be essential for medical practice owners to assign specific roles to team members for the stages of implementation and daily work. Furthermore, practice owners or practice managers should ensure that they prepare for the implementation process by developing structures and processes together with their teams in the pre-implementation and implementation phase. Examples of successful implementations and possible structures for the implementation process should also be provided by vendors. Moreover, there is an imperative to reconsider the role of HCPs. This should involve incorporating technology into the job, utilising it as a valuable tool to enhance process efficiency. Consequently, it is recommended that future healthcare professionals such as doctors, assistances, and practice managers receive education to prepare them for challenges connected with the digitalisation of healthcare.
Literature Cited
- Islind AS, Hult HV, Johansson V, Angenete E, Gellerstedt M. Invisible Work Meets Visible Work: Infrastructuring from the Perspective of Patients and Healthcare Professionals. 54th Hawaii International Conference on System Sciences 2021:3556–65.
- Jepsen C, Lüchau EC, Assing Hvidt E, Grønning A. Healthcare in the hand: Patients‘ use of handheld technology in video consultations with their general practitioner. Digit Health 2022; 8:20552076221104669.
- Assing Hvidt E, Christensen NP, Grønning A, Jepsen C, Lüchau EC. What are patients‘ first-time experiences with video consulting? A qualitative interview study in Danish general practice in times of COVID-19. BMJ Open 2022; 12(4):e054415.
- Nordtug M, Assing Hvidt E, Lüchau EC, Grønning A. General Practitioners‘ Experiences of Professional Uncertainties Emerging from the Introduction of Video Consultations in General Practice: Qualitative Study. JMIR Form Res 2022; 6(6):e36289.
- Ertner M. Enchanting, Evoking, and Affecting: The Invisible Work of Technology Implementation in Homecare. NJWLS 2019; 9.
- Ziebland S, Hyde E, Powell J. Power, paradox and pessimism: On the unintended consequences of digital health technologies in primary care. Soc Sci Med 2021; 289:114419.
- Lüchau EC, Olesen F, Atherton H, Søndergaard J, Hvidt EA. The invisible work of video consultation use in Danish general practice: An ethnographic study. Digit Health 2024; 10:20552076241291333.
