Streamlining a Patchwork - Exploring the Challenges of Digital Transformation in Pathology: Ethnographic Study.

BACKGROUND

To transition to a fully digital workflow, a pathology department in a German university hospital reorganized its processes, upgrading and integrating new technologies such as an updated laboratory information system and high-throughput scanners. While the visions of digital pathology follow a "promissory rhetoric" of improved patient care, studies name technological and professional challenges of digital pathology. We examined the experiences of the pathology staff with the digital transformation process from an occupational health perspective, focusing on the mutual influences between digital transformation and work-related psychosocial demands and resources.

OBJECTIVE

The purpose of this study was to explore the interactions between occupational health and digital transformation in the workplace based on a holistic analysis of an ongoing digital transformation process.

METHODS

We conducted participant observation, focus groups, qualitative interviews, and document analysis using an ethnographic research design. The pathology department had approximately 100 employees. More than 30 pathology staff members and supervisors from the diagnostics, laboratory, quality management, administration, and IT areas participated. Data were collected in 3 field phases between July 2022 and December 2023, representing different stages of the digital transformation. Data were analyzed using the reflexive thematic analysis method of Braun and Clarke. In addition, 2 member-checking workshops were conducted with the entire pathology team.

RESULTS

We identified 2 key themes and 7 subthemes. The 2 key themes were (1) highly demanding work in a complex system that does not fit and (2) striving for steadiness in an open-ended process. What we found was that the pathology department under study experienced a digital transformation process with scarce human, time, and technological resources. The results showed that the process was at the expense of the people. Digital transformation remained a compromise and did not (yet) deliver on the promise of increased work efficiency and reduced workload. The demand-resource mismatch emerged as a major digital transformation stressor. However, the slower transformation was leveraged by the pathology staff to improve the organizational culture and (again) find creative workarounds. Digital transformation led to the renegotiation of work roles and identity. It also led to the creation of a new network of connections through the implementation of new technologies but also through the creation of new forms of team communication.

CONCLUSIONS

The modernization of the health care system is necessary, but it risks taking place under inadequate working conditions. Increased work intensity and perceived psychosocial stress during the transformation process threaten to drive even more people out of the health care system. Therefore, protecting the occupational health of the people implementing digital transformation should be at the core of planning digital transformation projects.