School of Medicine, University of St Gallen (HSG), St Gallen, Switzerland.
Institute for Implementation Science in Health Care, University of Zurich (UZH), Zurich, Switzerland.
JMIR Hum Factors. 2023 Oct 17;10:e50357. doi: 10.2196/50357.
The digitalization of health care has many potential benefits, but it may also negatively impact health care professionals' well-being. Burnout can, in part, result from inefficient work processes related to the suboptimal implementation and use of health information technologies. Although strategies to reduce stress and mitigate clinician burnout typically involve individual-based interventions, emerging evidence suggests that improving the experience of using health information technologies can have a notable impact.
The aim of this systematic review was to collect evidence of the benefits and challenges associated with the use of digital tools in hospital settings with a particular focus on the experiences of health care professionals using these tools.
We conducted a systematic literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to explore the experience of health care professionals with digital tools in hospital settings. Using a rigorous selection process to ensure the methodological quality and validity of the study results, we included qualitative studies with distinct data that described the experiences of physicians and nurses. A panel of 3 independent researchers performed iterative data analysis and identified thematic constructs.
Of the 1175 unique primary studies, we identified 17 (1.45%) publications that focused on health care professionals' experiences with various digital tools in their day-to-day practice. Of the 17 studies, 10 (59%) focused on clinical decision support tools, followed by 6 (35%) studies focusing on electronic health records and 1 (6%) on a remote patient-monitoring tool. We propose a theoretical framework for understanding the complex interplay between the use of digital tools, experience, and outcomes. We identified 6 constructs that encompass the positive and negative experiences of health care professionals when using digital tools, along with moderators and outcomes. Positive experiences included feeling confident, responsible, and satisfied, whereas negative experiences included frustration, feeling overwhelmed, and feeling frightened. Positive moderators that may reinforce the use of digital tools included sufficient training and adequate workflow integration, whereas negative moderators comprised unfavorable social structures and the lack of training. Positive outcomes included improved patient care and increased workflow efficiency, whereas negative outcomes included increased workload, increased safety risks, and issues with information quality.
Although positive and negative outcomes and moderators that may affect the use of digital tools were commonly reported, the experiences of health care professionals, such as their thoughts and emotions, were less frequently discussed. On the basis of this finding, this study highlights the need for further research specifically targeting experiences as an important mediator of clinician well-being. It also emphasizes the importance of considering differences in the nature of specific tools as well as the profession and role of individual users.
PROSPERO CRD42023393883; https://tinyurl.com/2htpzzxj.
医疗保健的数字化具有许多潜在的好处,但也可能对医疗保健专业人员的幸福感产生负面影响。倦怠部分可能是由于与卫生信息技术实施和使用不理想相关的低效工作流程所致。尽管减轻压力和减轻临床医生倦怠的策略通常涉及基于个人的干预措施,但新出现的证据表明,改善使用卫生信息技术的体验可以产生显著的影响。
本系统评价的目的是收集与在医院环境中使用数字工具相关的益处和挑战的证据,特别关注使用这些工具的医疗保健专业人员的体验。
我们按照 PRISMA(系统评价和荟萃分析的首选报告项目)指南进行了系统文献综述,以探讨医疗保健专业人员在医院环境中使用数字工具的体验。我们采用严格的选择过程,以确保研究结果的方法学质量和有效性,纳入了描述医生和护士体验的定性研究,这些研究具有独特的数据。一个由 3 名独立研究人员组成的小组进行了迭代数据分析,并确定了主题结构。
在 1175 项独特的初级研究中,我们确定了 17 项(1.45%)出版物,重点关注医疗保健专业人员在日常实践中使用各种数字工具的体验。在 17 项研究中,有 10 项(59%)侧重于临床决策支持工具,其次是 6 项(35%)侧重于电子健康记录,1 项(6%)侧重于远程患者监测工具。我们提出了一个理论框架,以理解数字工具的使用、体验和结果之间的复杂相互作用。我们确定了 6 个包含医疗保健专业人员使用数字工具时的积极和消极体验的结构,以及调节因素和结果。积极体验包括感到自信、有责任感和满意,而消极体验包括沮丧、不知所措和感到恐惧。可能增强数字工具使用的积极调节因素包括充足的培训和充分的工作流程整合,而消极调节因素包括不利的社会结构和缺乏培训。积极的结果包括改善患者护理和提高工作流程效率,而消极的结果包括增加工作量、增加安全风险和信息质量问题。
尽管普遍报告了积极和消极的结果以及可能影响数字工具使用的调节因素,但医疗保健专业人员的体验,如他们的想法和情绪,却很少被讨论。基于这一发现,本研究强调了进一步研究专门针对体验作为临床医生幸福感的重要中介因素的必要性。它还强调了考虑特定工具的性质以及个别用户的职业和角色差异的重要性。
PROSPERO CRD42023393883;https://tinyurl.com/2htpzzxj。