Healthcare providers communication mechanisms using a case management model of care: implications for information systems development, implementation and evaluation

This thesis addresses a fundamental problem within health care, namely communication. Major outcomes of the research include the importance of understanding the relationship between information exchange and communication and how this can impact and influence cooperation and collaboration between and among healthcare providers. The thesis has contributed to an increase in the knowledge of the integration and convergence of different theories related to; communication behaviours and patterns, information exchange, organisational change, and social systems. The application of this knowledge is to better understand the interaction among and between healthcare providers. Ultimately the end point is to bring about change that meets many needs at a multiplicity of levels or layers (across the health care arena), translating research into action that results in quality outcomes for health care consumers. There are four main components of the study that address the problem domain (communication): (i) care delivery model (Case Management Model of Care) and quality improvement; (ii) research methodology; (iii) the theoretical considerations around communication and social systems theories, and the use of, and contribution by (iv) Soft Systems Methodology plus (SSM+) to innovation and change management involving the use of information technology. The design of the research is as follows: 1. A mixed methods, mixed methodology approach framed as an action research project in a quality improvement program, and a Case Management Model of Care (CMMC) written up as a case study and carried out using SSM+. 2. The case study is used to focus on communication and information exchange issues and is reinterpreted using social systems and communication theories. Emphasis is placed on the work of Robert Craig (1999) and his reconstruction of communication theory as a dialogical-dialectical field based on the constitutive model of communication as a metamodel and theory as a metadiscursive practice. Finally the role of technology in establishing communication systems is highlighted, with particular reference to the rapidly evolving implementation of government initiatives in NSW, Australia.