Understanding clinician deviance: A systematic review of text messaging practices

Clinicians in the United States often prefer quick, efficient, and convenient ways to communicate with colleagues. However, using standard text messaging without a secure text messaging system (STMS) constitutes a violation of Health Insurance Portability and Accountability Act regulations.

This systematic review aims to investigate why clinicians might choose not to use STMSs when sharing patient health information (PHI) with their peers. This research will explore whether these clinicians are consciously disregarding federal guidelines concerning the texting of PHI and the reasons behind this choice. Deliberate noncompliance could be classified as a form of deviant behavior within the workplace.

We conducted a Preferred Reporting Items for Systematic Review and Meta-Analysis-guided systematic literature review across four databases, examining 10 empirical studies from the United States published in English between January 2017 and August 2024.

We identified deviant behaviors associated with the unsecured text messaging of PHI through a deductive approach. These behaviors were classified based on Lawrence and Robinson's workplace deviance framework, which includes the need for autonomy, social identity, and perceived organizational justice. We also found inductive themes, which included training needs and increased workloads.

The findings of this study demonstrate a number of areas hospital leaders might examine relevant to this topic, including reluctance to use STMSs, a choice to adopt it, or a tendency to blame issues on inadequate policies or insufficient training. This situation emphasizes the necessity of offering comprehensive training and clear policies to address both the psychological barriers and practical challenges faced by clinicians.