Digital Health Communications

Benoit Cordelier, Olivier Galibert, Benoit Cordelier, Olivier Galibert

• Publisher: Wiley-ISTE
• Year: 2021
• ISBN:
  9781119842606
• Edition: 1
• Topic: Tecnología e ingeniería
• Subtopic: Ciencias biomédicas

ECHNOLOGICAL PROSPECTS AND SOCIAL APPLICATIONS SET Coordinated by Bruno Salgues There are many controversies with respect to health crisis management: the search for information on symptoms, misinformation on emerging treatments, massive use of collaborative tools by healthcare professionals, deployment of applications for tracking infected patients. The Covid-19 crisis is a relevant example about the need for research in digital communications in order to understand current health info communication. After an overview of the challenges of digital healthcare, this book offers a critical look at the organizational and professional limits of ICT uses for patients, their caregivers and healthcare professionals. It analyzes the links between ICT and ethics of care, where health communication is part of a global, humanistic and emancipating care for patients and caregivers. It presents new digitized means of communicating health knowledge that reveal, thanks to the Internet, a competition between biomedical expert knowledge and experiential secular knowledge.

PART 1
Digital Patient Records: Organizational Adaptations

1
Paradoxical Changes and Injunctions in an Implementation Project of the Digital Patient Record

1.1. Introduction

Project-based change management methods rely on participation to generate support. At the same time, they multiply the activities of individuals shared between projects and operations. They place them in heterogeneous and evolving work situations, which sometimes even lead them to experience tensions in their engagement methods. The project promotes the development of complex organizational arrangements through a “myriad of locally negotiated practices and interactions” [POL 04, p. 36] that attempt to deal with what can be identified as paradoxical injunctions [MOR 09, WIT 08].

The implementation of a new tool such as the digital patient record (DPR) is an example of a project we are working on that is based mainly on document reviews and staff interviews.

The project seeks to rationalize and standardize the modalities of interaction through a specific cooperation process delimited in time. This process of cooperation implies different temporalities [COR 05], leads to disturbances in the activities of the personnel targeted by the project and generates contradictions [COR 13] to the point that some perceive a degradation of their activity and others contribute to its disappearance. For example, healthcare staff must be able to monitor patients using their records and, at the same time, let the same records go outside the health center as part of the digitization project. These requirements, which are perceived as paradoxical, force the organization’s actors to arbitrate between the project’s activities and their primary activities or operations. They give rise to practices and discourses of justification that can echo individual strategies in relation to the injunctions for change, already worked on by Crozier and Friedberg [CRO 77].

1.2. Organizational paradoxes and paradoxical injunctions

The study of paradoxes and contradictions can be thought of in three strands, which, although they may be complementary and have some intersections, develop in parallel: the study of organizational paradoxes in organizational development; discursive approaches; and the mobilization, more common in information and communication sciences, of the notion of paradoxical injunction from the concept proposed by the Palo Alto school.

1.2.1. Organizational development and paradoxes

The trend of studying organizational paradoxes has developed more in management [HAR 17] from works such as those of [POO 89, QUI 88]. The paradox is defined there as “contradictory but [with] interdependent elements – elements that seem logical in isolation, but absurd and irrational when they appear simultaneously” [LEW 00, p. 760]. For this strand, the challenge is to find a way to reconcile contradictory elements in order to optimize the productivity of the organization [CLE 02, LEW 02, LEW 14, SMI 11]. The contradictions are integrated into the material and cultural structures of the organization [JOH 06, SMI 11]. Paradoxes are then all the more easily exercised since there is a functional interdependence that cannot be circumvented because of the speed of change or the scarcity of resources [SMI 11]. Actors cannot adapt, suffer from confusion or resist [JAR 13] until they give up and try to overcome the paradox by creating a new frame of reference [SMI 11]. For Lüscher and Lewis [LUS 08], the situation forces the actors towards a form of reflexivity that pushes them to disperse the perception of the paradox and to normalize the situation in a form of paradoxical cognition [LEW 00].

Overcoming paradoxes requires actors to be creative [QUI 88] and to put their different identities (to be understood as corresponding to their organizational affiliations) in synergy [PRA 00] in order to learn and develop [ARG 78, ARG 95]. In this way, they will be able to overcome uncertainties that block them [LUS 08]. They must then enter into a dynamic and virtuous equilibrium [SMI 11], such as double-loop learning, even if the actors may need support [VAS 17]. Behaviors that allow us to overcome are not themselves without contradictions [AND 09, AND 10, VAS 17]. They are the result of contextual adaptations where actors use tactics to deal with the main principles or organizational lines that should be imposed on them [AND 10].

1.2.2. Discursive approaches to the organizational paradox

The discursive approach, also called dialectic [BEN 77, FAI 18, HAR 17], is concerned with the relationship between the discursive and material elements of the organization [PUT 15a, PUT 15b]. The originality of this perspective is that it is integrated into an approach to the constitutive communication of the organization [PUT 09].

The paradox appears in the contradiction between the practices and discourses of the organization or the entities that compose it. The contradictions are eminently social [BEN 77] and societal [SEO 02] in the sense that they are also rooted in the rhetoric that permeates society institutionally. For example, as Hargrave and Van de Ven [HAR 17] illustrate by echoing the debate between Milton Friedman and Michael Porter’s views on corporate social responsibility, a particular organizational contradiction, such as the pressure exerted both to make high profits and to invest in environmental protection, is accompanied by tensions in the organization’s interactions with various external stakeholders in relation to the place and role of the firm with respect to its obligations and public policies.

While the organizational development approach focuses on overcoming and on optimizing the organization, the discursive or dialectical one makes it possible to linger on the power relations between actors who confront each other through different valuations of their interests. It is therefore not so much the efficiency or productivity of the organization that is emphasized, but the rhetorical games that reflect conflicting worldviews. As interesting as organizational development approaches may be, by focusing on best practices, they oversimplify the notion of paradoxes; they neutralize it, and lead us to believe that only the convergence of actors is possible and not the crushing of one position by another, and that emotions are not an issue [PIN 19, PUT 15]. This presupposes that the individual level is taken into account.

1.2.3. The pragmatic paradox: a return to the systemic approach of Palo Alto

In the work of the Palo Alto school and its successors (see [WAT 79, WIN 00, WIN 01]), communication is considered a social process [LAL 15], a complex interaction that can be subject to blockages and contradictions that are difficult to overcome and therefore create distress. Non-verbal communication [BIR 70, HAL 92] may be the most obvious example of the difficulty of understanding communication that is not very explicit, or even sometimes received as contradictory. Communication is treated there as an interaction that can suffer from many modalities qualified as pathogenic. Moreover, the individual has difficulty in extracting themself from it because they do not have control over it due to the interactional nature of the exchanges. As a result, they cannot relinquish responsibility for the exchanges without breaking the relationship, which is not without negative consequences. Bateson et al. [BAT 56] propose the notion of a double bind in studies of schizophrenia to conceptualize one of the pathological modes of communication they have identified.

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DOUBLE BIND. –

In a very important relationship, a speaker (1) makes an assertion (2) which they complement with an assertion about that assertion (3) so that the two are mutually exclusive. An example is “be spontaneous”. The order and the invitation to spontaneity, in other words the exercise of free will, are not compatible. Because of the paradox this creates, it is impossible for the interlocutor to conform to the message and this generates great tension, even a crisis.

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METACOMMUNICATION. –

Gregory Bateson developed the notion of metacommunication to identify the corrective mechanisms of communication by drawing on cybernetic concepts where it was necessary to distinguish between information about coding elements and information about the code as a whole. Computer scientists had realized that they had to distinguish two aspects: the cues, that is, the content, and the order, that is, the relationship that will allow a command to be executed. The second level of information makes it possible to act on the understanding of the first level.

Metacommunication is therefore a communication about the set o...