Center for Healthcare Organization and Implementation Research, Boston, VA, USA.
The Pulmonary Center, Department of Medicine, Boston University, Boston, MA, USA.
J Gen Intern Med. 2023 Oct;38(Suppl 4):1040-1048. doi: 10.1007/s11606-023-08284-3. Epub 2023 Oct 5.
Healthcare organizations regularly manage external stressors that threaten patient care, but experiences handling concurrent stressors are not well characterized.
To evaluate the experience of Veterans Affairs (VA) clinicians and staff navigating simultaneous organizational stressors-an electronic health record (EHR) transition and the COVID-19 pandemic-and identify potential strategies to optimize management of co-occurring stressors.
Qualitative case study describing employee experiences at VA's initial EHR transition site.
Clinicians, nurses, allied health professionals, and local leaders at VA's initial EHR transition site.
We collected longitudinal qualitative interview data between July 2020 and November 2021 once before and 2-4 times after the date on which the health system transitioned; this timing corresponded with local surges of COVID-19 cases. Interviewers conducted coding and analysis of interview transcripts. For this study, we focused on quotes related to COVID-19 and performed content analysis to describe recurring themes describing the simultaneous impact of COVID-19 and an EHR transition.
We identified five themes related to participants' experiences: (1) efforts to mitigate COVID-19 transmission led to insufficient access to EHR training and support, (2) clinical practice changes in response to the pandemic impacted EHR workflows in unexpected ways, (3) lack of clear communication and inconsistent enforcement of COVID-19 policies intensified pre-existing frustrations with the EHR, (4) managing concurrent organizational stressors increased work dissatisfaction and feelings of burnout, and (5) participants had limited bandwidth to manage competing demands that arose from concurrent organizational stressors.
The expected challenges of an EHR transition were compounded by co-occurrence of the COVID-19 pandemic, which had negative impacts on clinician experience and patient care. During simultaneous organizational stressors, health care facilities should be prepared to address the complex interplay of two stressors on employee experience.
医疗保健组织经常应对威胁患者护理的外部压力源，但处理并发压力源的经验尚未得到充分描述。
评估退伍军人事务部 (VA) 临床医生和工作人员应对同时发生的组织压力源的经验-电子健康记录 (EHR) 过渡和 COVID-19 大流行-并确定优化并发压力源管理的潜在策略。
描述 VA 初始 EHR 过渡地点员工经验的定性案例研究。
VA 初始 EHR 过渡地点的临床医生、护士、联合健康专业人员和当地领导人。
我们在 2020 年 7 月至 2021 年 11 月期间收集了纵向定性访谈数据，在医疗系统过渡之前和之后各进行了一次或两次；这一时间与当地 COVID-19 病例激增相对应。访谈者对访谈记录进行了编码和分析。在这项研究中，我们专注于与 COVID-19 相关的引述，并进行内容分析，以描述描述 COVID-19 和 EHR 过渡同时影响的反复出现的主题。
我们确定了与参与者经历相关的五个主题：(1) 减轻 COVID-19 传播的努力导致对 EHR 培训和支持的获取不足，(2) 大流行期间对临床实践的改变以意想不到的方式影响了 EHR 工作流程，(3) 缺乏明确的沟通和对 COVID-19 政策的不一致执行加剧了对 EHR 的原有不满，(4) 管理并发组织压力源增加了工作不满和倦怠感，(5) 参与者管理因并发组织压力源而产生的竞争需求的带宽有限。
EHR 过渡的预期挑战因 COVID-19 大流行的同时发生而加剧，这对临床医生的体验和患者护理产生了负面影响。在同时发生的组织压力源期间，医疗机构应做好准备，应对两个压力源对员工体验的复杂相互作用。
