Optimizing Employee Well-being and Retention during Electronic Health Record Modernization

在电子健康记录现代化过程中优化员工福祉和保留率

• 批准号: 10537213
• 负责人: Seppo T Rinne
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10537213
• 关键词: Absenteeism; Accounting; Address; Adverse effects; Affect; Age; Businesses; Caring; Characteristics; Collaborations; Complex; Contracts; Data; Data Files; Data Sources; Databases; Decision Making; Electronic Health Record; Elements; Employee; Ensure; Evaluation; Family; Generations; Goals; Health Personnel; Health Promotion; Health system plans; Healthcare; Healthcare Systems; Human Resources; Intervention; Interview; Knowledge; Leadership; Link; Methodology; Methods; Modeling; Modernization; Modification; Morale; Nurses; Occupations; Organizational Change; Outcome; Perception; Personal Satisfaction; Personnel Turnover; Physicians; Process; Provider; Qualifying; Qualitative Methods; Quality of Care; Quasi-experiment; Readiness; Research; Research Design; Resources; Running; Schedule; Selection Bias; Series; Services; Site; Strategic Planning; Structure; Subgroup; Surveys; System; Techniques; Testing; Variant; Veterans; Work; Workplace; burnout; clinical care; data integration; data warehouse; design; econometrics; empowerment; experience; high risk; human capital; improved; informant; innovation; insight; medical specialties; operation; product development; response; skills; success; tool; work-study

Background: VA’s ongoing electronic health record modernization (EHRM) represents one of the largest and complex organizational initiatives VA has undertaken. VA leadership recognizes the ability to consistently provide high quality care depends on a fully staffed and highly effective workforce. VA’s current EHRM initiative, if poorly implemented, is a major threat to this operational need. Early work indicates that EHRM at the first site to undergo transition (i.e., go-live) was profoundly disruptive to clinicians, adversely impacting perceptions of the EHR, employee morale and the ability to deliver clinical care. VA operational leaders are in urgent need of information to alter the course of EHRM to ensure the well-being of a fully staffed and high functioning health workforce. Significance: The proposed study will generate timely data-driven insights to enable operational and facility leaders to enact fast-paced decisions and strategies designed to mitigate undesirable workforce outcomes resulting from EHRM including turnover, absenteeism, burnout. Findings will also inform the strategic delivery of workplace intervention by identifying VA clinician subgroups at highest risk of adverse workforce outcomes. EHRM is expected to continue for several years, and study findings will provide actionable insights to support change readiness and improve EHRM processes at facilities awaiting go-live. Innovation and Impact: The key innovation of the study is the generation of new scientific knowledge that comprehensively identifies how EHRM affects four workforce outcomes: turnover, absenteeism, burnout, and engagement. New insights gained from this study will provide timely insights to meaningfully improve the course of EHRM in VA and guide other non-VA health systems planning their own EHRM. Specific Aims: Project specific aims include: 1) examine the association between EHRM implementation and workforce outcomes using econometric methods, 2) explore key EHRM related themes associated with workforce outcomes using longitudinal qualitative methods and 3) design and administer a survey to identify key EHRM factors associated with workforce outcomes. Methodology: This multi-methods study will examine the effects of EHRM across VA nationally. Data sources will include employee information from the VA Corporate Data Warehouse, Personnel and Accounting Integrated Data files, HR SMART database, the VA All Employee Survey, and semi-structured interviews. In Aim 1, a quasi-experimental study design will be applied to quantitatively identify overall and subgroup effects of EHRM by leveraging pseudo-random variation in the staggered implementation of EHRM. In Aim 2, we will collect and analyze qualitative data from key informant interviews to explore EHRM-related elements associated with workforce outcomes. Data will be collected from remaining and separated clinicians at sites expected to go-live in the proceeding months. Aim 3 will apply multivariable regression techniques to examine relationships between perceptions of EHRM elements and workforce outcomes using new survey data collected in this study. Implementation/Next Steps: Study findings will be used to inform the design and modification of tools to effectively implement the new EHR and/or promote positive workforce outcomes. This includes a new strategic playbook of bottom-up approaches to improve EHRM, to be developed in collaboration with a panel of VA stakeholders. Product development will capitalize on strong working relationships with operational partners developed in prior research including leaders of the Office of the Functional Champion.

背景：退伍军人管理局正在进行的电子健康记录现代化 (EHRM) 是规模最大、规模最大的现代化项目之一。 VA 领导层认可其持续实施的复杂组织举措。 提供高质量的护理取决于 VA 现有的 EHRM 人员配备齐全且高效的员工队伍。 早期工作表明，如果实施不善，EHRM 将会对这一业务需求构成重大威胁。 第一个进行过渡（即上线）的站点对叛军来说具有深远的破坏性，产生了不利影响 对 EHR、员工士气以及 VA 运营领导者提供临床护理的能力的看法。 迫切需要信息来改变 EHRM 的进程，以确保人员配备齐全且高水平的人员的福祉 运作良好的卫生人力。 意义：拟议的研究将及时生成数据驱动的见解，以支持运营和设施 领导者制定快节奏的决策和战略，旨在减轻不良的劳动力结果 EHRM 产生的结果（包括人员流动、缺勤、倦怠）也将为战略交付提供信息。 通过识别出现不良劳动力结果风险最高的 VA 临床医生亚组来进行工作场所干预。 EHRM 预计将持续数年，研究结果将提供可行的见解来支持 改变等待投入使用的设施的准备情况并改进 EHRM 流程。 创新和影响：该研究的关键创新是新科学知识的产生， 全面确定 EHRM 如何影响四种劳动力结果：流动率、缺勤、倦怠和 从这项研究中获得的新见解将为有意义地提高参与度提供及时的见解。 VA 的 EHRM 课程，并指导其他非 VA 卫生系统规划自己的 EHRM。 具体目标：项目具体目标包括：1）检查 EHRM 实施与 使用计量经济学方法评估劳动力成果，2) 探索与 EHRM 相关的关键主题 使用纵向定性方法评估劳动力成果，3) 设计和管理一项调查以确定 与劳动力成果相关的关键 EHRM 因素。 方法：这项多方法研究将研究 EHRM 在全国范围内 VA 数据源的影响。 将包括来自 VA 公司数据仓库、人事和会计的员工信息 综合数据文件、HR SMART 数据库、VA 所有员工调查和半结构化访谈。 目标 1，将应用准实验研究设计来定量识别总体和亚组效应 在目标 2 中，我们将通过利用 EHRM 交错实施中的伪随机变化来实现 EHRM 的目标。 收集和分析来自关键知情人访谈的定性数据，以探索 EHRM 相关要素 将从现场剩余和离职的上级那里收集与劳动力成果相关的数据。 预计将在接下来的几个月内上线，目标 3 将应用多变量回归技术进行检查。 使用新调查数据对 EHRM 要素的看法与劳动力成果之间的关系 本研究中收集。 实施/后续步骤：研究结果将用于指导工具的设计和修改 有效实施新的电子病历和/或促进积极的劳动力成果，这包括新的战略。 改进 EHRM 的自下而上方法的剧本，将与 VA 小组合作开发 产品开发将利用与运营合作伙伴的牢固工作关系。 包括功能冠军办公室领导者在内的先前研究中开发的。