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Ahlness EA, Orlander J, Brunner J, Cutrona SL, Kim B, Molloy-Paolillo BK, Rinne ST, Rucci J, Sayre G, Anderson E. "Everything's so Role-Specific": VA Employee Perspectives' on Electronic Health Record (EHR) Transition Implications for Roles and Responsibilities. J Gen Intern Med 2023; 38:991-998. [PMID: 37798577 PMCID: PMC10593626 DOI: 10.1007/s11606-023-08282-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Electronic health record (EHR) transitions are increasingly widespread and often highly disruptive. It is imperative we learn from past experiences to anticipate and mitigate such disruptions. Veterans Affairs (VA) is undergoing a large-scale transition from its homegrown EHR (CPRS/Vista) to a commercial EHR (Cerner), creating a unique opportunity of shedding light on large-scale EHR-to-EHR transition challenges. OBJECTIVE To explore one facet of the organizational impact of VA's EHR transition: its implications for employees' roles and responsibilities at the first VA site to implement Cerner Millennium EHR. DESIGN As part of a formative evaluation of frontline staff experiences with VA's EHR transition, we conducted brief (~ 15 min) and full-length interviews (~ 60 min) with clinicians and staff at Mann-Grandstaff VA Medical Center in Spokane, WA, before, during, and after transition (July 2020-November 2021). PARTICIPANTS We conducted 111 interviews with 26 Spokane clinicians and staff, recruited via snowball sampling. APPROACH We conducted audio interviews using a semi-structured guide with grounded prompts. We coded interview transcripts using a priori and emergent codes, followed by qualitative content analysis. KEY RESULTS Unlike VA's previous EHR, Cerner imposes additional restrictions on access to its EHR functionality based upon "roles" assigned to users. Participants described a mismatch between established institutional duties and their EHR permissions, unanticipated changes in scope of duties brought upon by the transition, as well as impediments to communication and collaboration due to different role-based views. CONCLUSIONS Health systems should anticipate substantive impacts on professional workflows when EHR role settings do not reflect prior workflows. Such changes may increase user error, dissatisfaction, and patient care disruptions. To mitigate employee dissatisfaction and safety risks, health systems should proactively plan for and communicate about expected modifications and monitor for unintended role-related consequences of EHR transitions, while vendors should ensure accurate role configuration and assignment.
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Affiliation(s)
- Ellen A Ahlness
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle VA Medical Center, Seattle, WA, USA.
| | - Jay Orlander
- Medical Service, VA Boston Healthcare System, Boston, MA, USA
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Julian Brunner
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health Care, Los Angeles, CA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Division of Health Informatics & Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Brianne K Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Justin Rucci
- Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - George Sayre
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle VA Medical Center, Seattle, WA, USA
- University of Washington School of Public Health, Seattle, WA, USA
| | - Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Division of Health Informatics & Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Blijleven V, Hoxha F, Jaspers M. Workarounds in Electronic Health Record Systems and the Revised Sociotechnical Electronic Health Record Workaround Analysis Framework: Scoping Review. J Med Internet Res 2022; 24:e33046. [PMID: 35289752 PMCID: PMC8965666 DOI: 10.2196/33046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Electronic health record (EHR) system users devise workarounds to cope with mismatches between workflows designed in the EHR and preferred workflows in practice. Although workarounds appear beneficial at first sight, they frequently jeopardize patient safety, the quality of care, and the efficiency of care. OBJECTIVE This review aims to aid in identifying, analyzing, and resolving EHR workarounds; the Sociotechnical EHR Workaround Analysis (SEWA) framework was published in 2019. Although the framework was based on a large case study, the framework still required theoretical validation, refinement, and enrichment. METHODS A scoping literature review was performed on studies related to EHR workarounds published between 2010 and 2021 in the MEDLINE, Embase, CINAHL, Cochrane, or IEEE databases. A total of 737 studies were retrieved, of which 62 (8.4%) were included in the final analysis. Using an analytic framework, the included studies were investigated to uncover the rationales that EHR users have for workarounds, attributes characterizing workarounds, possible scopes, and types of perceived impacts of workarounds. RESULTS The SEWA framework was theoretically validated and extended based on the scoping review. Extensive support for the pre-existing rationales, attributes, possible scopes, and types of impact was found in the included studies. Moreover, 7 new rationales, 4 new attributes, and 3 new types of impact were incorporated. Similarly, the descriptions of multiple pre-existing rationales for workarounds were refined to describe each rationale more accurately. CONCLUSIONS SEWA is now grounded in the existing body of peer-reviewed empirical evidence on EHR workarounds and, as such, provides a theoretically validated and more complete synthesis of EHR workaround rationales, attributes, possible scopes, and types of impact. The revised SEWA framework can aid researchers and practitioners in a wider range of health care settings to identify, analyze, and resolve workarounds. This will improve user-centered EHR design and redesign, ultimately leading to improved patient safety, quality of care, and efficiency of care.
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Affiliation(s)
- Vincent Blijleven
- Center for Marketing & Supply Chain Management, Nyenrode Business Universiteit, Breukelen, Netherlands
| | - Florian Hoxha
- Center for Human Factors Engineering of Health Information Technology, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Monique Jaspers
- Center for Human Factors Engineering of Health Information Technology, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, Netherlands
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Winckler D. Not another box to check! Using the UTAUT to explore nurses' psychological adaptation to electronic health record usability. Nurs Forum 2021; 57:412-420. [PMID: 34957564 DOI: 10.1111/nuf.12686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/28/2021] [Accepted: 12/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND As the integration of electronic health records (EHRs) continues to expand throughout healthcare organizations worldwide, nurses are faced with the challenge to acclimate to a dynamic technology-based environment of patient care. As technology advances, EHR usability may influence nurses' clinical performance and require nurses to adapt to a wide range of situations associated with electronic documentation. While perceived benefits of EHRs include improvements in healthcare delivery and patient outcomes, there are also unintended consequences associated with EHR usability. AIMS The aim of this article is to explore dimensions of EHR usability that may influence nurses' psychological adaptation to the use of EHRs in daily practice. MATERIALS AND METHODS The unified theory of acceptance and use of technology (UTAUT) consists of four constructs theorized to have a direct influence on end-user behavior and acceptance of technology: performance expectancy, effort expectancy, social influence, and facilitating conditions. The UTAUT provides the framework to explore EHR usability as found in literature and describe the positive and negative psychological responses of nurses related to the use of EHRs in daily practice. RESULTS Integration of EHRs into daily nursing practice can result in positive experiences or have a negative impact on nurses ability to perform their role as patient caregivers. DISCUSSION While integration of EHRs into healthcare systems can facilitate improvements in patient outcomes, the delivery of patient care and nurses' daily practices can simultaneously be complicated by EHR usability issues. CONCLUSION Although positive and negative experiences of nurses in relationship to EHR usability can be found in literature, there is limited evidence on nurses' psychological adaptation to use of EHRs. Further research on EHR usability is needed based on nursing perspectives and feedback to determine the psychological impact EHRs exert on nurses, discover effective methods for resolving issues, and promote positive trends associated with EHR usability.
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Heinsch M, Wyllie J, Carlson J, Wells H, Tickner C, Kay-Lambkin F. Theories Informing eHealth Implementation: Systematic Review and Typology Classification. J Med Internet Res 2021; 23:e18500. [PMID: 34057427 PMCID: PMC8204232 DOI: 10.2196/18500] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 10/22/2020] [Accepted: 04/15/2021] [Indexed: 01/23/2023] Open
Abstract
Background Theory-guided approaches to implementation science have informed translation efforts and the acceptance of eHealth (digital health) interventions in clinical care. However, there is scarce evidence on which theories are best suited to addressing the inherent complexity of eHealth implementation. Objective The objectives of this systematic review are to identify theories that inform and explain eHealth implementation and to classify these theories using the typology by Sovacool and Hess for theories of sociotechnical change. Methods An electronic search was conducted in the PsycINFO, MEDLINE, Embase, CINAHL, Scopus, Sociological Source Ultimate, Web of Science, ABI/INFORM, EBSCO, and ProQuest databases in June 2019. Studies were included if they were published between 2009 and June 2019; were written in English; reported on empirical research, regardless of study or publication type; reported on one or more theories in the context of eHealth implementation; and were published in a peer-reviewed journal. A total of 2 reviewers independently assessed the titles, abstracts, and full texts. Theories identified were classified using a typology for theories of sociotechnical change, which was considered a useful tool for ordering and analyzing the diverse theoretical approaches as a basis for future theory building. Results Of the 13,101 potentially relevant titles, 119 studies were included. The review identified 36 theories used to explain implementation approaches in eHealth. The most commonly used approaches were the Technology Acceptance Model (TAM) (n=33) and the Unified Theory of Acceptance and Use of Technology (UTAUT) (n=32). These theories were primarily concerned with individual and interpersonal elements of eHealth acceptance. Less common were theories that reflect the various disorderly social processes and structural dimensions of implementation, such as the normalization process theory (n=17) and the structuration theory (n=6). Conclusions Theories currently informing the implementation of eHealth interventions predominantly focus on predicting or explaining end-user acceptance. Theoretical perspectives that capture the dense and intricate relationships and structures required to enact sustainable change are less well represented in the eHealth literature. Given the growing acknowledgment of the inherent complexity of eHealth implementation, future research should develop and test models that recognize and reflect the multidimensional, dynamic, and relational nature of this process.
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Affiliation(s)
- Milena Heinsch
- Centre for Brain and Mental Health Priority Research Centre, The University of Newcastle, Callaghan, Australia.,School of Humanities and Social Science, The University of Newcastle, Callaghan, Australia
| | - Jessica Wyllie
- Newcastle Business School, The University of Newcastle, Callaghan, Australia
| | - Jamie Carlson
- Newcastle Business School, The University of Newcastle, Callaghan, Australia
| | - Hannah Wells
- Centre for Brain and Mental Health Priority Research Centre, The University of Newcastle, Callaghan, Australia
| | - Campbell Tickner
- Centre for Brain and Mental Health Priority Research Centre, The University of Newcastle, Callaghan, Australia
| | - Frances Kay-Lambkin
- Centre for Brain and Mental Health Priority Research Centre, The University of Newcastle, Callaghan, Australia
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Lee S, Lee MS. Nurses' Electronic Medical Record Workarounds in a Tertiary Teaching Hospital. Comput Inform Nurs 2021; 39:367-374. [PMID: 33675300 DOI: 10.1097/cin.0000000000000692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The objective of this study was to identify nurses' workarounds related to the use of electronic medical records in a tertiary teaching hospital. A total of 106 nurses (84.8%) using the electronic medical records completed 10-item questionnaires scored on a Likert scale and five open-ended questions with written responses. The numerical data were analyzed by descriptive statistics, and the written descriptions were categorized by meaning. The mean of the scored items ranged from 3.29 to 3.74. Approximately 38% to 50% of the participants reported (very) frequent workflow delays due to the use of the electronic medical records, and 46% to 64% reported (very) frequently using workarounds. Twenty-nine workarounds of the electronic medical records were due to electronic documentation, difficulty accessing the electronic medical records, medication administration, covering physician responsibilities, electronic communication with the physicians, respondents and physicians not skilled in using the electronic medical records, and connection failures between devices or machines and the electronic medical records. Although none of these identified workarounds were intended to be harmful, and certain workarounds were efficient for patient care and workflow, whether patient safety can be jeopardized by workarounds should be considered. This study contributes to the understanding of why and how workarounds occur in the hospital. It will be useful for achieving greater alignment between work contexts and the electronic medical record in the future.
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Affiliation(s)
- Seonah Lee
- Author Affiliations: College of Nursing, Chonnam National University (Dr S. Lee); and Department of Nursing, Nambu University (Ms M-S. Lee), Gwangju, South Korea
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Sheaff R, Morando V, Chambers N, Exworthy M, Mahon A, Byng R, Mannion R. Managerial workarounds in three European DRG systems. J Health Organ Manag 2021; 34:295-311. [PMID: 32364346 PMCID: PMC7406989 DOI: 10.1108/jhom-10-2019-0295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds. Managerial workarounds have seldom been analysed. This paper does so by extending and modifying existing knowledge of the causes and character of clinical and IT workarounds, to produce a conceptualisation of the managerial workaround. It further develops and revises this conceptualisation by comparing the practical management, at both provider and purchaser levels, of hospital DRG payment systems in England, Germany and Italy. Design/methodology/approach We make a qualitative test of our initial assumptions about the antecedents, character and consequences of managerial workarounds by comparing them with a systematic comparison of case studies of the DRG hospital payment systems in England, Germany and Italy. The data collection through key informant interviews (
N
= 154), analysis of policy documents (
N
= 111) and an action learning set, began in 2010–12, with additional data collection from key informants and administrative documents continuing in 2018–19 to supplement and update our findings. Findings Managers in all three countries developed very similar workarounds to contain healthcare costs to payers. To weaken DRG incentives to increase hospital activity, managers agreed to lower DRG payments for episodes of care above an agreed case-load ‘ceiling' and reduced payments by less than the full DRG amounts when activity fell below an agreed ‘floor' volume. Research limitations/implications Empirically this study is limited to three OECD health systems, but since our findings come from both Bismarckian (social-insurance) and Beveridge (tax-financed) systems, they are likely to be more widely applicable. In many countries, DRGs coexist with non-DRG or pre-DRG systems, so these findings may also reflect a specific, perhaps transient, stage in DRG-system development. Probably there are also other kinds of managerial workaround, yet to be researched. Doing so would doubtlessly refine and nuance the conceptualisation of the ‘managerial workaround’ still further. Practical implications In the case of DRGs, the managerial workarounds were instances of ‘constructive deviance' which enabled payers to reduce the adverse financial consequences, for them, arising from DRG incentives. The understanding of apparent failures or part-failures to transform a health system can be made more nuanced, balanced and diagnostic by using the concept of the ‘managerial workaround'. Social implications Managerial workarounds also appear outside the health sector, so the present analysis of managerial workarounds may also have application to understanding attempts to transform such sectors as education, social care and environmental protection. Originality/value So far as we are aware, no other study presents and tests the concept of a ‘managerial workaround'. Pervasive, non-trivial managerial workarounds may be symptoms of mismatched policy objectives, or that existing health system structures cannot realise current policy objectives; but the workarounds themselves may also contain solutions to these problems.
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Affiliation(s)
- Rod Sheaff
- School of Law, Criminology and Government, Plymouth University, Plymouth, UK
| | - Verdiana Morando
- CERGAS Research Centre, SDA Bocconi Scuola di Direzione Aziendale, Milano, Lombardia, Italy.,GSD Healthcare, Dubai, United Arab Emirates
| | - Naomi Chambers
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | | | - Ann Mahon
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Richard Byng
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
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Bryan AL, Lammers JC. Professional fission in medical routines: medical scribes and physicians in two US hospital departments. JOURNAL OF PROFESSIONS AND ORGANIZATION 2020. [DOI: 10.1093/jpo/joaa023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
In this study we argue that professionalism imposed from above can result in a type of fission, leading to the ambiguous emergence of new occupations. Our case focuses on the US’ federally mandated use of electronic health records and the increased use of medical scribes. Data include observations of 571 patient encounters across 48 scribe shifts, and 12 interviews with medical scribes and physicians in the ophthalmology and digestive health departments of a community hospital. We found substantial differences in scribes’ roles based on the pre-existing routines within each department, and that scribes developed agency in the interface between the electronic health record and the physicians’ work. Our study contributes to work on occupations as negotiated orders by drawing attention to external influences, the importance of considering differences across professional task routines, and the personal interactions between professional and technical workers.
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Affiliation(s)
- Ann L Bryan
- Department of Communication, University of Illinois at Urbana Champaign, MC456, 3001 Lincoln Hall, 702 S. Wright Street, Urbana, IL 61801, USA
| | - John C Lammers
- Department of Communication, University of Illinois at Urbana Champaign, MC456, 3001 Lincoln Hall, 702 S. Wright Street, Urbana, IL 61801, USA
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Fraczkowski D, Matson J, Lopez KD. Nurse workarounds in the electronic health record: An integrative review. J Am Med Inform Assoc 2020; 27:1149-1165. [PMID: 32651588 PMCID: PMC7647365 DOI: 10.1093/jamia/ocaa050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/29/2020] [Accepted: 04/06/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The study sought to synthesize published literature on direct care nurses' use of workarounds related to the electronic health record. MATERIALS AND METHODS We conducted an integrative review of qualitative and quantitative peer-reviewed research through a structured search of Academic Search Complete, EBSCO Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Engineering Village, Ovid Medline, Scopus, and Web of Science. We systematically applied exclusion rules at the title, abstract, and full article stages and extracted and synthesized their research methods, workaround classifications, and probable causes from articles meeting inclusion criteria. RESULTS Our search yielded 5221 results. After removing duplicates and applying rules, 33 results met inclusion criteria. A total of 22 articles used qualitative approaches, 10 used mixed methods, and 1 used quantitative methods. While researchers may classify workarounds differently, they generally fit 1 of 3 broad categories: omission of process steps, steps performed out of sequence, and unauthorized process steps. Each study identified probable causes, which included technology, task, organizational, patient, environmental, and usability factors. CONCLUSIONS Extensive study of nurse workarounds in acute settings highlights the gap in ambulatory care research. Despite decades of electronic health record development, poor usability remains a key concern for nurses and other members of care team. The widespread use of workarounds by the largest group of healthcare providers subverts quality health care at every level of the healthcare system. Research is needed to explore the gaps in our understanding of and identify strategies to reduce workaround behaviors.
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Affiliation(s)
- Dan Fraczkowski
- Information Services, UI Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey Matson
- Department of Anesthesia, Northwestern Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Karen Dunn Lopez
- Center for Nursing Classification & Clinical Effectiveness, College of Nursing, The University of Iowa, Iowa City, Iowa, USA
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Health care innovations across practice and academia: A theoretical framework. Nurs Outlook 2019; 67:596-604. [PMID: 31230741 DOI: 10.1016/j.outlook.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/23/2019] [Accepted: 05/15/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND An innovation scholarly interest group used the Jobs to Be Done Theory from the business literature to provide insight into the solution-focused progress that nurses are trying to make in challenging situations. PURPOSE This article presents a theoretical framework for understanding the progress nurses are trying to make through health care innovations across both practice and academic environments. METHOD This was a qualitative descriptive study using directed content analysis. We used the Jobs to Be Done Theory to guide the development of the semistructured questionnaire and the interpretation of findings. FINDINGS A theoretical framework of nursing innovations was derived to summarize and visually display the pathways and linkages of challenges, innovations, and impact domains of nursing innovations. Situations and opportunities arise within the context of interconnectedness and can lead to health care innovations in care delivery, patient care interventions, role transitions, research and translational methods, communication and collaboration, technology and data, teaching methods, and processes to improve care. DISCUSSION This theoretical framework offers insight into the dynamic interactions of academic-practice partnerships for innovation. Workplace situations are interconnected and can result in needed innovations designed to impact care delivery.
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Esmaeilzadeh P. Healthcare consumers' opt-in intentions to Health Information Exchanges (HIEs): An empirical study. COMPUTERS IN HUMAN BEHAVIOR 2018. [DOI: 10.1016/j.chb.2018.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Esmaeilzadeh P. Challenges and Opportunities of Health Information Exchange (HIE) From Health Consumers' Perspective. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2018. [DOI: 10.4018/ijehmc.2018070102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The implementation of HIE depends on a number of entities and one of the key participants is health consumers. All potential gains of HIE cannot be achieved without consumers' favorable beliefs and support. However, little is known about the factors affecting consumers to endorse electronic information exchange between healthcare organizations. The primary objective of this article is to identify how and why patients would support HIE used by healthcare providers. The author has conducted an online questionnaire-based survey in the U.S. This study has shown that perceived value of HIE is significantly related to consumers HIE supportive intention. Moreover, perceived value fully mediates the effects of perceived benefit and cost of HIE implementation on consumer tendency to endorse HIE. The findings also provide evidence to highlight that consumers' attitude toward exchange model moderates the relationship between value perception and intention to support HIE. Relying on the results, this study offers several practical and theoretical contributions.
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Affiliation(s)
- Pouyan Esmaeilzadeh
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, USA
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Liang H, Lin KY, Zhang S, Su Y. The Impact of Coworkers' Safety Violations on an Individual Worker: A Social Contagion Effect within the Construction Crew. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040773. [PMID: 29673149 PMCID: PMC5923815 DOI: 10.3390/ijerph15040773] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/09/2018] [Accepted: 04/12/2018] [Indexed: 11/23/2022]
Abstract
This research developed and tested a model of the social contagion effect of coworkers’ safety violations on individual workers within construction crews. Both situational and routine safety violations were considered in this model. Empirical data were collected from 345 construction workers in China using a detailed questionnaire. The results showed that both types of safety violations made by coworkers were significantly related to individuals’ perceived social support and production pressure. Individuals’ attitudinal ambivalence toward safety compliance mediated the relationships between perceived social support and production pressure and both types of individuals’ safety violations. However, safety motivation only mediated the effects of perceived social support and production pressure on individuals’ situational safety violations. Further, this research supported the differences between situational and routine safety violations. Specifically, we found that individuals were more likely to imitate coworkers’ routine safety violations than their situational safety violations. Coworkers’ situational safety violations had an indirect effect on individuals’ situational safety violations mainly through perceived social support and safety motivation. By contrast, coworkers’ routine safety violations had an indirect effect on individuals’ routine safety violations mainly through perceived production pressure and attitudinal ambivalence. Finally, the theoretical and practical implications, research limitations, and future directions were discussed.
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Affiliation(s)
- Huakang Liang
- School of Management, Harbin Institute of Technology, Harbin 150001, China.
- Department of Construction Management, University of Washington, Seattle, WA 98195, USA.
| | - Ken-Yu Lin
- Department of Construction Management, University of Washington, Seattle, WA 98195, USA.
| | - Shoujian Zhang
- School of Civil Engineering, Harbin Institute of Technology, Harbin 150090, China.
| | - Yikun Su
- School of Civil Engineering, Northeast Forestry University, Harbin 150040, China.
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