‘We can only request what's in our protocol’: technology and work autonomy in healthcare

Nurses' and physicians' perceptions of the impact of eHealth and information systems on the roles of health care professionals: A qualitative descriptive study

The increased use of eHealth and information systems impacts health care work broadly, including cultural and social aspects of work such as the roles of health care professionals. This qualitative descriptive study examined the perceptions of health care professionals in terms of how eHealth and information systems have changed their roles. The data was collected via 15 semi-structured thematic interviews and analysed using content analysis with an inductive approach. The analysis indicated mainly unconscious changes in the roles of professional groups. The professionals perceived that the role of digitally competent professionals in the working community was important. Moreover, high digital competency was seen to have led to an increase or change in work tasks. Professionals' own working environments and job opportunities were seen to have affected to their roles when using information systems. eHealth was perceived to have created inequalities in work tasks, increased skills gaps and complicated work. However, eHealth made cooperation between professionals easier than before. Organisations should pay more attention to equal opportunities to increase professional's digital competency, even out workloads between professionals, and provide equal access to eHealth and information systems.

From "Local Control" to "Dependency": Transitions to Single-Vendor Integrated Electronic Health Record Systems and Their Implications for the EHR Workforce

BACKGROUND

Healthcare systems that previously used either a single legacy electronic health record (EHR) system or a "best-of-breed" combination of products from multiple vendors are increasingly adopting integrated, single-vendor EHR systems. Though healthcare leaders are beginning to recognize the dramatic collateral consequences of these transitions, their impact on the EHR workforce - internal actors most closely involved in governing and supporting the EHR - is poorly understood.

OBJECTIVE

Identify perceived impacts of adopting single-vendor, integrated EHR systems on the institutional EHR workforce.

DESIGN

In this qualitative study, we conducted semi-structured phone interviews in four healthcare systems in the USA that had adopted an integrated EHR within the previous five years.

PARTICIPANTS

Forty-two staff members of four geographically and organizationally diverse healthcare systems, including 22 individuals with formal informatics roles.

APPROACH

Transcribed interviews were coded and analyzed using qualitative content analysis methods.

KEY RESULTS

Across organizations, participants described a loss of autonomy by the EHR workforce at the individual and institutional level following the adoption of an integrated EHR. We also identified references to transformations in four key professional functions of the EHR workforce: communication, governance, optimization, and education.

CONCLUSIONS

Transitions to integrated EHR systems can have important implications for the autonomy and professional functions of the EHR workforce. These findings may help institutions embarking on similar transitions better anticipate and prepare for these changes through such practices as revising job descriptions, strengthening EHR governance structures, and reinforcing pathways to engage frontline clinicians in supporting the EHR. Findings may also help institutions structure vendor contracts in a way that anticipates and mitigates loss of autonomy.

DigiFuehr 2.0: Novel insights for digital leadership

OBJECTIVES

Against the background of e-government, it is discussed whether self-organization represents an independent component of digital leadership. Addressing this research question, the instrument "DigiFuehr" is being expanded to include the aspects of self-determination and coordination. The aim is to test the model quality of three adapted scales against the already established support-focusing version.

METHODS

Based on an online survey of n = 422 employees at visual display unit workstations in German municipal administrations in April 2022, the original version of DigiFuehr as well as one reduced and two extended versions were validated considering their local and global model fit.

RESULTS

All four scales show a good local fit with regard to internal consistency (Cronbach's α), discriminatory power, and dimensionality. Only the scale extended by two items also offers a sufficient global fit and is thus most suitable as a predictor for psychological stress, work satisfaction, and satisfaction with the professional exchange during homeworking.

CONCLUSIONS

With "DigiFuehr 2.0", an improved version of the original scale is available. Self-organization is not a component independent of the support dimension, but a further important indicator of a latent digital leadership culture. Neither should come at the expense of the other.

Conceptualizing the digitalization of healthcare work: A metaphor-based Critical Interpretive Synthesis

The digitalization of healthcare work has gained center stage in academic debates spanning disciplines as diverse as medicine, sociology and STS. The different analytical interests and methodological traditions of these three strains of scholarship have, however, resulted in quite diverging approaches to this issue. Points of interest have ranged from the (disattended) promise of increased efficiency of healthcare work, to dynamics of task delegation, (re-)professionalization and (re-)distribution of invisible work, to the disruption of informal organization. Instead of studying these dynamics in practice, in this paper we foreground the potentiality for theory-making inherent in the systematic cross-contamination of different theoretical and disciplinary perspectives. We perform a Critical Interpretive Synthesis (CIS) centering the ways the digitalization of healthcare work has been investigated in recent STS, sociological and medical literature. To open up assumptions and insights intrinsic to each body of literature for scholars and practitioners in other fields, we propose here a metaphor-based variation on CIS approaches. We probe, in turn, what slime molds can teach us about STS's focus on interconnections and materiality, how we can better understand sociological analyses of invisible work exploring them through theatrical performances, and which lessons river engineering offers concerning medical scholarship's discussion of efficiency and proper healthcare work. Thinking through these metaphors, we conceptualize the digitalization of healthcare work as a phenomenon spanning, at once, the directionality of technological innovation trajectories and the open-endedness of situated changes in work practices. Based on our analysis, we propose focusing on technological scripts, and various forms of invisible work and informal organization as entry points into the study of the tension between directionality and open-endedness in the context of the digitalization of healthcare work.

The Impact of Information and Communication Technology on Doctors' and Registered Nurses' Working Conditions and Clinical Work - A Cross-Sectional Study in a Norwegian Hospital

Purpose

Previous studies indicate that the introduction of information and communication technology (ICT) in health care organizations impairs health care professional’s working conditions and diminishes job discretion. Most of these studies, however, were designed to explore the influence of ICT exclusively on a single group of health care professionals and thereby did not consider the influence of the same technology on other groups of health care professionals. The aim of this article is to explore the influence of a fully integrated ICT system on both doctors and registered nurses within the same working environment: a high-tech hospital.

Methods

This is a cross-sectional study conducted in a high-tech Norwegian hospital. Data were collected in 2016. In total, 264 registered nurses and 172 doctors responded to a questionnaire on their working conditions and experiences with ICT in clinical work. Descriptive statistics, compare means, cross-tables, Chi-square and bivariate correlation analysis were used to analyze the data. Statistical significance was set at p < 0.05.

Results

The findings revealed differences in doctors' and registered nurses' working conditions. Registered nurses reported a statistically significant higher workload and better job content than doctors. There was no difference in job discretion between doctors and registered nurses. Both occupational groups experienced that the ICT system impairs patient contact and the quality of health services. We found statistically significant correlations between registered nurses’ and doctors’ experiences with ICT in clinical work and working conditions, whereof the strongest correlation was related to job discretion in clinical work.

Conclusion

This study concludes that the impact of ICT on doctors’ and registered nurses’ working conditions in a hospital depends on the experiences of ICT in clinical work. In consequence, it is recommended to involve doctors and registered nurses in the implementation of ICT in hospitals.

Digitalization and Labor Market—A Perspective within the Framework of Pandemic Crisis

The current pandemic crisis, which is far from being over, has led to a significant paradigm shift in economics. In a turbulent environment in which the labor market has encountered a long series of changes generated by the processes of automation, robotization and digitalization, the COVID-19 pandemic has revealed that a workforce with digital skills can quickly adjust to new circumstances. Since novel issues, such as restrictions on internal movement and distorted supply chains, put major stress on the labor market, it seems that there is an urgent need for reshaping economies and following up-to-date technological trends. Moreover, prior to the COVID-19 pandemic, a significant number of scholars and policymakers expressed their concerns about the volatility of employment and the weak ability of labor to adapt to new types of jobs. Within this framework, our paper aims to analyze the plausible impacts of digital efficiency on the future development of the labor market. Based upon the assumption that employment is facing ongoing challenges and the labor market is constantly being reshaped by technological trends, our study attempts to provide a pragmatic analysis of the effects of digital skills and the use of the Internet on salaries and wages in EU member states. Since, according to our results, the levels of salaries and wages are strongly correlated with digital proficiency and Internet usage, a consistent effort to increase the digital skills of individuals may be required to achieve a more effective and flexible labor market.

Role reconfiguration: what ethnographic studies tell us about the implications of technological change for work and collaboration in healthcare

New technologies including digital health and robotics are driving the evolution of healthcare. At the same time, healthcare systems are transitioning from a multiprofessional model approach of healthcare delivery to an interprofessional model. The concurrence of these two trends may represent an opportunity for leaders in healthcare because both require renegotiation of the complex division of work and enhanced interdependency. This review examines how the introduction of new technologies alters the role boundaries of occupations and interdependencies among health occupations. Based on a scoping review of ethnographic studies of technology implementation in a variety of contexts (from primary care to operating room) and of diverse technologies (from health informatics systems to robotics), we develop the concept of role reconfiguration to capture simultaneous adjustments of multiple, interdependent roles during technological change. Ethnographic and qualitative studies provide rich, detailed accounts of what people actually do and how their work and role is changed (or not) when a new technology arrives. Through a synthesis of these studies, we develop a typology of four types of role reconfiguration: negotiation, clarification, enlargement and restriction. We discuss leadership challenges in managing role reconfiguration and formulate four leadership priorities. We suggest that leaders: redesign roles proactively, paying attention to interdependencies; offer opportunities for collective learning about new technologies; ensure that knowledge of new technologies is distributed across roles and prepare to address resistance.