Taking note: A qualitative study of implementing a scribing practice in team-based primary care clinics

Area of Science:

• Healthcare Management
• Medical Practice Innovation
• Ethnographic Research

Background:

• Limited understanding of how medical scribes integrate into existing care workflows.
• Medical scribing offers potential benefits like reduced provider documentation time and increased patient engagement.
• Need to explore the practical implementation and team dynamics of medical scribing.

Purpose of the Study:

• To conduct an ethnographic process evaluation of medical scribing in Veterans Health Administration (VHA) primary care.
• To identify barriers and facilitators to implementing medical scribing practices.
• To understand how care workers integrate scribing into their daily routines.

Main Methods:

• Semi-structured interviews and direct observations at five VHA clinic sites.
• Data collection occurred 3-6 months post-scribing implementation.
• Analysis involved matrix analysis and deductive coding using Normalization Process Theory.

Main Results:

• Scribing practice fostered an organizing effect by centering the shared goal of note creation among provider, scribe, and patient.
• Scribing practice had a generative effect, facilitating valuable interpersonal and inter-professional relationships among care workers.
• The practice highlighted the complementarity of professional roles and leveraged existing team interactional possibilities.

Conclusions:

• Medical scribing can forge interprofessional fit and create opportunities for interpersonal connection within primary care teams.
• The perceived benefits of scribing are influenced by individual professional expectations and organizational roles.
• Implementing scribing requires understanding its impact on team dynamics and professional interactions.