Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2022

Open Access 01-12-2022 | Research

Electronic health record implementation and healthcare workers’ work characteristics and autonomous motivation—a before-and-after study

Authors: Gepke L. Veenstra, Eric F. Rietzschel, Eric Molleman, Erik Heineman, Jan Pols, Gera A. Welker

Published in: BMC Medical Informatics and Decision Making | Issue 1/2022

Login to get access

Abstract

Background

Technological innovation in healthcare is often assumed to contribute to the quality of care. However, the question how technology implementation impacts healthcare workers has received little empirical attention. This study investigates the consequences of Electronic Health Record (EHR) implementation for healthcare workers’ autonomous work motivation. These effects are further hypothesized to be mediated by changes in perceived work characteristics (job autonomy and interdependence). Additionally, a moderating effect of profession on the relationship between EHR implementation and work characteristics is explored.

Methods

A quantitative uncontrolled before-and-after study was performed among employees from a large university medical centre in the Netherlands. Data were analysed following the component approach for testing a first stage moderated mediation model, using Generalized Estimating Equations (GEE).

Results

A total of 456 healthcare workers (75 physicians, 154 nurses, 145 allied healthcare professionals, and 82 administrative workers) finished both the baseline and the follow-up survey. After EHR implementation, perceived job autonomy decreased, whereas interdependence increased. In line with our hypothesis, job autonomy was positively associated with autonomous motivation. In contrast to our expectations, interdependence also showed a positive association with autonomous motivation. Autonomous motivation was stable over the course of EHR implementation. This study did not provide support for a moderating effect of profession: no differences were observed between the various professions regarding the changes in their experienced job autonomy and interdependence after EHR implementation.

Conclusions

Our study showed that healthcare professionals’ perceptions of their work characteristics, but not their autonomous motivation, were changed after EHR implementation, and that these experiences were relatively similar for physicians, nurses, and allied healthcare professionals. The stability of healthcare workers’ autonomous motivation may be explained by the opposite effects of decreased job autonomy and increased interdependence, and by the EHR being in line with healthcare workers’ values. The changes in job autonomy and interdependence may have consequences beyond motivation, for example by affecting clinical decision-making, proactive behaviour, and the quality of teamwork. These potential consequences of EHR implementation warrant further research.
Appendix
Available only for authorised users
Footnotes
1
Only 5% of the respondents completed the survey later than 30 days after the first invitation for the follow-up questionnaire. Therefore, the length of use of the system was approximately equal for most (95%) of our respondents.
 
Literature
1.
Greenhalgh T, Potts HWW, Wong G, Bark P, Swinglehurst D. Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. Milbank Q. 2009;87:729–88.PubMedPubMedCentralCrossRef
2.
Kanfer R, Frese M, Johnson RE. Motivation related to work: a century of progress. J Appl Psychol. 2017;102:338–55.PubMedCrossRef
3.
Tubaishat A. Perceived usefulness and perceived ease of use of electronic health records among nurses: application of Technology Acceptance Model. Inform Health Soc Care. 2018;43:379–89.PubMedCrossRef
4.
Cresswell K, Sheikh A. Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review. Int J Med Inform. 2013;82:e73–86.PubMedCrossRef
5.
Barrett AK. Electronic Health Record (EHR) organizational change: explaining resistance through profession, organizational experience, and EHR communication quality. Health Commun. 2018;33:496–506.PubMedCrossRef
6.
7.
Morris MG, Venkatesh V. Job characteristics and job satisfaction: understanding the role of enterprise resource planning system implementation. MIS Q Manag Inf Syst. 2010;34:143–61.CrossRef
8.
9.
10.
11.
Van der Heijden BIJM, Houkes I, Van den Broeck A, Czabanowska K. “I just can’t take it anymore”: how specific work characteristics impact younger versus older nurses’ health, satisfaction, and commitment. Front Psychol. 2020;11:762.PubMedPubMedCentralCrossRef
12.
Braithwaite J, Clay-Williams R, Taylor N, Ting HP, Winata T, Arnolda G, et al. Bending the quality curve. Int J Qual Heal Care. 2020;32:1–7.CrossRef
13.
Okuyama A, Wagner C, Bijnen B. Speaking up for patient safety by hospital-based health care professionals: a literature review. BMC Health Serv Res. 2014;14:61.PubMedPubMedCentralCrossRef
14.
Baumann LA, Baker J, Elshaug AG. The impact of electronic health record systems on clinical documentation times: A systematic review. Health Policy. 2018;122:827–36.PubMedCrossRef
15.
Parker SK, Grote G. Automation, algorithms, and beyond: why work design matters more than ever in a digital world. Appl Psychol. 2020; 1–45.
16.
Bergey MR, Goldsack JC, Robinson EJ. Invisible work and changing roles: Health information technology implementation and reorganization of work practices for the inpatient nursing team. Soc Sci Med. 2019;235: 112387.PubMedCrossRef
17.
18.
Campanella P, Lovato E, Marone C, Fallacara L, Mancuso A, Ricciardi W, et al. The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. Eur J Public Health. 2016;26:60–4.PubMedCrossRef
19.
Priestman W, Sridharan S, Vigne H, Collins R, Seamer L, Sebire NJ. What to expect from electronic patient record system implementation: lessons learned from published evidence. J Innov Health Inform. 2018;25:92–104.PubMed
20.
Shanafelt TD, Dyrbye LN, Sinsky C, Hasan O, Satele D, Sloan J, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc. 2016;91:836–48.PubMedCrossRef
21.
Nguyen L, Bellucci E, Nguyen LT. Electronic health records implementation: an evaluation of information system impact and contingency factors. Int J Med Inform. 2014;83:779–96.PubMedCrossRef
22.
Taylor SP, Ledford R, Palmer V, Abel E. We need to talk: An observational study of the impact of electronic medical record implementation on hospital communication. BMJ Q Saf. 2014;23:584–8.CrossRef
23.
Pinder CC. Work motivation in organizational behavior. 2nd ed. New York: Psychology Press; 2008.
24.
Baird KM, Tung A, Yu Y. Employee organizational commitment and hospital performance. Health Care Manage Rev. 2019;44:206–15.PubMedCrossRef
25.
Duprez V, van der Kaap-Deeder J, Beeckman D, Verhaeghe S, Vansteenkiste M, van Hecke A. Nurses’ interaction styles when supporting patients in self-management: a profile approach. Int J Nurs Stud. 2020;110: 103604.PubMedCrossRef
26.
Van den Broeck A, Leroy H, Howard J. A meta-analysis of different types of extrinsic work motivation. In: Presented at the European Association of Work and Organizational Psychology Congress, Dublin, Ireland, 17 May 2017–20 May 2017. 2017.
27.
Deci EL, Ryan RM. Facilitating optimal motivation and psychological well-being across life’s domains. Can Psychol Can. 2008;49:14–23.CrossRef
28.
Humphrey SE, Nahrgang JD, Morgeson FP. Integrating motivational, social, and contextual work design features: a meta-analytic summary and theoretical extension of the work design literature. J Appl Psychol. 2007;92:1332–56.PubMedCrossRef
29.
Hackman JR, Oldham GR. Motivation through the design of work: test of a theory. Organ Behav Hum Perform. 1976;16:250–79.CrossRef
30.
McCrorie C, Benn J, Johnson OA, Scantlebury A. Staff expectations for the implementation of an electronic health record system: a qualitative study using normalisation process theory. BMC Med Inform Decis Mak. 2019;19:1–14.CrossRef
31.
Kenny D, Adamson B. Medicine and the health professions: issues of dominance, autonomy and authority. Aust Heal Rev. 1992;15:319–34.
32.
Rao AD, Kumar A, McHugh M. Better nurse autonomy decreases the odds of 30-day mortality and failure to rescue. J Nurs Scholarsh. 2017;49:73–9.PubMedCrossRef
33.
Degeling P, Zhang K, Coyle B, Xu L, Meng Q, Qu J, et al. Clinicians and the governance of hospitals: a cross-cultural perspective on relations between profession and management. Soc Sci Med. 2006;63:757–75.PubMedCrossRef
34.
Molleman E, Van Knippenberg A. Work redesign and the balance of control within a nursing context. Hum Relations. 1995;48:795–814.CrossRef
35.
36.
Molleman E, Broekhuis M, Stoffels R, Jaspers F. How health care complexity leads to cooperation and affects the autonomy of health care professionals. Heal Care Anal. 2008;16:329–41.CrossRef
37.
Baumeister RF, Leary MR. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995;3:497–529.CrossRef
38.
Bossen C, Jensen LG, Udsen FW. Boundary-object trimming: on the invisibility of medical secretaries’ care of records in healthcare infrastructures. Comput Support Coop Work. 2014;23:75–110.CrossRef
39.
Molleman E. Attitudes toward flexibility: the role of task characteristics. Gr Organ Manag. 2009;34:241–68.
40.
Brodbeck F. Criteria for the study of work group functioning. In: West M, editor. Handbook of work group psychology. Chichester: Wiley; 1996. p. 283–315.
41.
Cresswell KM, Worth A, Sheikh A. Integration of a nationally procured electronic health record system into user work practices. BMC Med Inform Decis Mak. 2012;12:15.PubMedPubMedCentralCrossRef
42.
Vos JFJ, Boonstra A, Kooistra A, Seelen M, Van Offenbeek M. The influence of electronic health record use on collaboration among medical specialties. BMC Health Serv Res. 2020;20:676.PubMedPubMedCentralCrossRef
43.
Kuvaas B. A test of hypotheses derived from self-determination theory among public sector employees. Empl Relations. 2009;31:39–56.CrossRef
44.
45.
Mijin N, Jang H, Choi B, Khongorzul G. Attitude toward the use of electronic medical record systems: exploring moderating effects of self-image. Inf Dev. 2019;35:67–79.CrossRef
46.
47.
Lambooij MS, Drewes HW, Koster F. Use of electronic medical records and quality of patient data: different reaction patterns of doctors and nurses to the hospital organization. BMC Med Inform Decis Mak. 2017;17:1–11.CrossRef
48.
Koch SH, Proynova R, Paech B, Wetter T. The perfectly motivated nurse and the others: workplace and personal characteristics impact preference of nursing tasks. J Nurs Manag. 2014;22:1054–64.PubMedCrossRef
49.
Noordegraaf M. Protective or connective professionalism? How connected professionals can (still) act as autonomous and authoritative experts. J Prof Organ. 2020;7:205–23.
50.
Konttila J, Siira H, Kyngäs H, Lahtinen M, Elo S, Kääriäinen M, et al. Healthcare professionals’ competence in digitalisation: a systematic review. J Clin Nurs. 2019;28:745–61.PubMedCrossRef
51.
Gagné M, Forest J, Vansteenkiste M, Crevier-Braud L, van den Broeck A, Aspeli AK, et al. The Multidimensional Work Motivation Scale: validation evidence in seven languages and nine countries. Eur J Work Organ Psychol. 2015;24:178–96.CrossRef
52.
Gorgievski MJ, Peeters P, Rietzschel EF, Bipp T. Betrouwbaarheid en validiteit van de Nederlandse vertaling van de Work Design Questionnaire. Gedrag en Organ. 2016;29:273–301.
53.
Morgeson FP, Humphrey SE. The Work Design Questionnaire (WDQ): Developing and validating a comprehensive measure for assessing job design and the nature of work. J Appl Psychol. 2006;91:1321–39.PubMedCrossRef
54.
Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.CrossRef
55.
Ballinger GA. Using generalized estimating equations for longitudinal data analysis. Organ Res Methods. 2004;7:127–50.CrossRef
56.
Yzerbyt V, Muller D, Batailler C, Judd CM. New recommendations for testing indirect effects in mediational models: the need to report and test component paths. J Pers Soc Psychol. 2018;115:929–43.PubMedCrossRef
57.
Muller D, Judd CM, Yzerbyt VY. When moderation is mediated and mediation is moderated. J Pers Soc Psychol. 2005;89:852–63.PubMedCrossRef
58.
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research. Conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173.PubMedCrossRef
59.
Van der Vegt GS, Emans B, Van de Vliert E. Motivating effects of task and outcome interdependence in work teams. Gr Organ Manag. 1998;23:124–43.
60.
61.
Kirkendall ES, Goldenhar LM, Simon JL, Wheeler DS, Andrew SS. Transitioning from a computerized provider order entry and paper documentation system to an electronic health record: Expectations and experiences of hospital staff. Int J Med Inform. 2013;82:1037–45.PubMedCrossRef
62.
Zegers M, Veenstra GL, Gerritsen G, Verhage R, van der Hoeven HJG, Welker GA. Perceived burden due to registrations for quality monitoring and improvement in hospitals: a mixed methods study. Int J Heal Policy Manag. 2022;11:183–96.
63.
Kjellström S, Avby G, Areskoug-Josefsson K, Andersson Gäre B, Andersson BM. Work motivation among healthcare professionals: a study of well-functioning primary healthcare centers in Sweden. J Heal Organ Manag. 2017;31:487–502.CrossRef
64.
Sulmasy LS, López AM, Horwitch CA. Ethical implications of the electronic health record: in the service of the patient. J Gen Intern Med. 2017;32:935–9.PubMedPubMedCentralCrossRef
65.
Molleman E, Broekhuis M, Stoffels R, Jaspers F. Consequences of participating in multidisciplinary medical team meetings for surgical, nonsurgical, and supporting specialties. Med Care Res Rev. 2010;67:173–93.PubMedCrossRef
66.
Hofer J, Busch H. Satisfying one’s needs for competence and relatedness: consequent domain-specific well-being depends on strength of implicit motives. Personal Soc Psychol Bull. 2011;37:1147–58.CrossRef
67.
Van Assche J, van der Kaap-Deeder J, Audenaert E, De Schryver M, Vansteenkiste M. Are the benefits of autonomy satisfaction and the costs of autonomy frustration dependent on individuals’ autonomy strength? J Pers. 2018;86:1017–36.PubMedCrossRef
68.
Martela F, Ryan RM, Steger MF. Meaningfulness as satisfaction of autonomy, competence, relatedness, and beneficence: comparing the four satisfactions and positive affect as predictors of meaning in life. J Happiness Stud. 2018;19:1261–82.CrossRef
69.
de Cooman R, de Gieter S, Pepermans R, Jegers M. A cross-sector comparison of motivation-related concepts in for-profit and not-for-profit service organizations. Nonprofit Volunt Sect Q. 2011;40:296–317.CrossRef
70.
Ployhart RE, Vandenberg RJ. Longitudinal research: The theory, design, and analysis of change. J Manag. 2010;36:94–120.
71.
Cho YI, Johnson TP, VanGeest JB. Enhancing surveys of health care professionals: a meta-analysis of techniques to improve response. Eval Heal Prof. 2013;36:382–407.CrossRef
72.
Mäkikangas A, Mauno S, Selenko E, Kinnunen U. Toward an understanding of a healthy organizational change process: a three-wave longitudinal study among university employees. Int J Stress Manag. 2019;26:204–12.CrossRef
73.
Parker SL, Jimmieson NL, Amiot CE. Reactions to changes in work control: implications for self-determined and non-self-determined individuals. J Occup Health Psychol. 2016;21:455–67.PubMedCrossRef
Metadata
Title
Electronic health record implementation and healthcare workers’ work characteristics and autonomous motivation—a before-and-after study
Authors
Gepke L. Veenstra
Eric F. Rietzschel
Eric Molleman
Erik Heineman
Jan Pols
Gera A. Welker
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2022
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-022-01858-x

Other articles of this Issue 1/2022

BMC Medical Informatics and Decision Making 1/2022 Go to the issue

Research

The test characteristics of a biased or ignorant diagnostician

Research

Developing machine learning-based models to predict intrauterine insemination (IUI) success by address modeling challenges in imbalanced data and providing modification solutions for them

Research

Machine learning in a real-world PFO study: analysis of data from multi-centers in China

Research

Survey of the patients' perspectives and preferences in adopting telepharmacy versus in-person visits to the pharmacy: a feasibility study during the COVID-19 pandemic

Research

Interpretable machine learning predicts cardiac resynchronization therapy responses from personalized biochemical and biomechanical features

Research

Monte Carlo cross-validation for a study with binary outcome and limited sample size