Kelley M Skeff, Cati G Brown-Johnson, Steven M Asch, Dani L Zionts, Marcy Winget, Yaniv Kerem
{"title":"职业行为和价值侵蚀:医生和电子健康记录的定性研究。","authors":"Kelley M Skeff, Cati G Brown-Johnson, Steven M Asch, Dani L Zionts, Marcy Winget, Yaniv Kerem","doi":"10.1097/JHM-D-21-00070","DOIUrl":null,"url":null,"abstract":"<p><strong>Goal: </strong>Occurrences of physician burnout have reached epidemic numbers, and the electronic health record (EHR) is a commonly cited cause of the distress. To enhance current understanding of the relationship between burnout and the EHR, we explored the connections between physicians' distress and the EHR.</p><p><strong>Methods: </strong>In this qualitative study, physicians and graduate medical trainees from two healthcare organizations in California were interviewed about EHR-related distressing events and the impact on their emotions and actions. We analyzed physician responses to identify themes regarding the negative impact of the EHR on physician experience and actions. EHR \"distressing events\" were categorized using the Accreditation Council for Graduate Medical Education (ACGME) Physician Professional Competencies.</p><p><strong>Principal findings: </strong>Every participating physician reported EHR-related distress affecting professional activities. Five main themes emerged from our analysis: system blocks to patient care; poor implementation, design, and functionality of the EHR; billing priorities conflicting with ideal workflow and best-practice care; lack of efficiency; and poor teamwork function. When mapped to the ACGME competencies, physician distress frequently stemmed from situations where physicians prioritized systems-based practice above other desired professional actions and behaviors. Physicians also reported a climate of silence in which physicians would not share problems due to fear of retribution or lack of confidence that the problems would be addressed.</p><p><strong>Practical applications: </strong>Physicians and administrators need to address the hierarchy of values that prioritizes system requirements such as those required by the EHR above physicians' other desired professional actions and behaviors. Balancing the importance of competing competencies may help to address rising burnout. We also recommend that administrators consider qualitative anonymous interviews as an effective method to uncover and understand physician distress in light of physicians' reported climate of silence.</p>","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.7000,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/d1/jhcma-67-339.PMC9447433.pdf","citationCount":"3","resultStr":"{\"title\":\"Professional Behavior and Value Erosion: A Qualitative Study of Physicians and the Electronic Health Record.\",\"authors\":\"Kelley M Skeff, Cati G Brown-Johnson, Steven M Asch, Dani L Zionts, Marcy Winget, Yaniv Kerem\",\"doi\":\"10.1097/JHM-D-21-00070\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Goal: </strong>Occurrences of physician burnout have reached epidemic numbers, and the electronic health record (EHR) is a commonly cited cause of the distress. To enhance current understanding of the relationship between burnout and the EHR, we explored the connections between physicians' distress and the EHR.</p><p><strong>Methods: </strong>In this qualitative study, physicians and graduate medical trainees from two healthcare organizations in California were interviewed about EHR-related distressing events and the impact on their emotions and actions. We analyzed physician responses to identify themes regarding the negative impact of the EHR on physician experience and actions. EHR \\\"distressing events\\\" were categorized using the Accreditation Council for Graduate Medical Education (ACGME) Physician Professional Competencies.</p><p><strong>Principal findings: </strong>Every participating physician reported EHR-related distress affecting professional activities. Five main themes emerged from our analysis: system blocks to patient care; poor implementation, design, and functionality of the EHR; billing priorities conflicting with ideal workflow and best-practice care; lack of efficiency; and poor teamwork function. When mapped to the ACGME competencies, physician distress frequently stemmed from situations where physicians prioritized systems-based practice above other desired professional actions and behaviors. Physicians also reported a climate of silence in which physicians would not share problems due to fear of retribution or lack of confidence that the problems would be addressed.</p><p><strong>Practical applications: </strong>Physicians and administrators need to address the hierarchy of values that prioritizes system requirements such as those required by the EHR above physicians' other desired professional actions and behaviors. Balancing the importance of competing competencies may help to address rising burnout. We also recommend that administrators consider qualitative anonymous interviews as an effective method to uncover and understand physician distress in light of physicians' reported climate of silence.</p>\",\"PeriodicalId\":51633,\"journal\":{\"name\":\"Journal of Healthcare Management\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2022-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/d1/jhcma-67-339.PMC9447433.pdf\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Healthcare Management\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/JHM-D-21-00070\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"HEALTH POLICY & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Healthcare Management","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JHM-D-21-00070","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
Professional Behavior and Value Erosion: A Qualitative Study of Physicians and the Electronic Health Record.
Goal: Occurrences of physician burnout have reached epidemic numbers, and the electronic health record (EHR) is a commonly cited cause of the distress. To enhance current understanding of the relationship between burnout and the EHR, we explored the connections between physicians' distress and the EHR.
Methods: In this qualitative study, physicians and graduate medical trainees from two healthcare organizations in California were interviewed about EHR-related distressing events and the impact on their emotions and actions. We analyzed physician responses to identify themes regarding the negative impact of the EHR on physician experience and actions. EHR "distressing events" were categorized using the Accreditation Council for Graduate Medical Education (ACGME) Physician Professional Competencies.
Principal findings: Every participating physician reported EHR-related distress affecting professional activities. Five main themes emerged from our analysis: system blocks to patient care; poor implementation, design, and functionality of the EHR; billing priorities conflicting with ideal workflow and best-practice care; lack of efficiency; and poor teamwork function. When mapped to the ACGME competencies, physician distress frequently stemmed from situations where physicians prioritized systems-based practice above other desired professional actions and behaviors. Physicians also reported a climate of silence in which physicians would not share problems due to fear of retribution or lack of confidence that the problems would be addressed.
Practical applications: Physicians and administrators need to address the hierarchy of values that prioritizes system requirements such as those required by the EHR above physicians' other desired professional actions and behaviors. Balancing the importance of competing competencies may help to address rising burnout. We also recommend that administrators consider qualitative anonymous interviews as an effective method to uncover and understand physician distress in light of physicians' reported climate of silence.
期刊介绍:
The Journal of Healthcare Management is the official journal of the American College of Healthcare Executives. Six times per year, JHM offers timely healthcare management articles that inform and guide executives, managers, educators, and researchers. JHM also contains regular columns written by experts and practitioners in the field that discuss management-related topics and industry trends. Each issue presents an interview with a leading executive.