Published in:
Open Access 05-10-2023 | COVID-19 | Original Research: Qualitative Research
“Like One Long Battle:” Employee Perspectives of the Simultaneous Impact of COVID-19 and an Electronic Health Record Transition
Published in: Journal of General Internal Medicine | Special Issue 4/2023
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Background
Healthcare organizations regularly manage external stressors that threaten patient care, but experiences handling concurrent stressors are not well characterized.
Objective
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.
Design
Qualitative case study describing employee experiences at VA’s initial EHR transition site.
Participants
Clinicians, nurses, allied health professionals, and local leaders at VA’s initial EHR transition site.
Approach
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.
Key Results
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.
Conclusion
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.