Ashley K. Barrett

Making Electronic Health Records (EHRs) Work: Informal Talk and Workarounds in Healthcare Organizations

ABSTRACT A key provision of the American Recovery and Reinvestment Act of 2009 mandated that electronic health records (EHR) be adopted in US healthcare organizations by 2015. The purpose of this study is to examine the communicative processes involved as healthcare workers implement an EHR and make changes, known as workarounds. Guided by theories in social influence, and diffusion of innovations, we conducted a survey of healthcare professionals using an EHR system in an organization. Our structural equation modeling (SEM) and multiple regression results reveal coworker communication, in the form of informal social support and feedback, play an important role in whether people engage in workarounds. Understanding this relationship is important because our study also demonstrates that workarounds predict healthcare employees’ overall satisfaction with the EHR system. Specifically, workarounds are associated with higher perceptions of the EHR’s relative advantage, higher perceptions of EHR implementation success, and lower levels of resistance to EHR change. This study offers a health communication contribution to the growing research on EHR systems and demonstrates the persuasive effects that coworkers have on new technology use in healthcare organizations.

Communicating Briefly Technically

People and organizations often communicate through technologies that restrict their communication to very few characters: a difficult task when the content is highly technical and specialized. This study relies on the theoretical work of informative and explanatory communication, and it expands the utility of this theory into new communication technology environments where brevity is valued and practically forced on the user. We content analyzed 1,367 Twitter messages spanning a 6-month time following a highly technical and controversial organizational event. The analyses reveal that even though Twitter is limited to 140 alphanumeric characters, almost one third of all messages contained some type of technical details. The technical translation strategies—direct, elucidating, or quasi-scientific—used in the microblog were either self-contained or briefly introduced with expanded details available by accessing hyperlinks. Furthermore, the specific types of technical translation strategies that this organization used changed over time.

“Playing Hooky” Health Messages: Apprehension, Impression Management, and Deception

ABSTRACT This study investigates playing hooky in higher education classrooms and associates this behavior with students’ communicative dispositions, instructor perceptions, and language use. We define “playing hooky” as students skipping class and explaining their absence to their instructor with deceptive health messages. The purpose of Study 1, an online survey (N = 177), is to further understand the characteristics of students who engage in this type of deceptive health communication. Study 1 measures communication apprehension and perceived instructor credibility in students who had played hooky from class and those who had not. Findings reveal that students who communicate playing hooky health messages (a) reported more instructor communication apprehension and (b) perceived the instructors with whom they had played hooky to be less credible. Study 2 uses facework theory and MEH analysis to reveal the different linguistic strategies students use to communicate (a) truthful health messages (N = 165) and (b) deceptive heath messages (N = 82) to their instructor following an absence. Results demonstrate that students’ facework strategies are more geared toward saving instructors’ negative face in the deceptive health message condition. Implications of both studies are offered.

Electronic Health Record (EHR) Organizational Change: Explaining Resistance Through Profession, Organizational Experience, and EHR Communication Quality

ABSTRACT The American Recovery and Reinvestment Act passed by the U.S. government in 2009 mandates that all healthcare organizations adopt a certified electronic health record (EHR) system by 2015. Failure to comply will result in Medicare reimbursement penalties, which steadily increase with each year of delinquency. There are several repercussions of this seemingly top-down, rule-bound organizational change—one of which is employee resistance. Given the penalties for violating EHR meaningful use standards are ongoing, resistance to this mandate presents a serious issue for healthcare organizations. This study surveyed 345 employees in one healthcare organization that recently implemented an EHR. Analysis of variance results offer theoretical and pragmatic contributions by demonstrating physicians, nurses, and employees with more experience in their organization are the most resistant to EHR change. The job characteristics model is used to explain these findings. Hierarchical regression analyses also demonstrate the quality of communication surrounding EHR implementation—from both formal and informal sources—is negatively associated with EHR resistance and positively associated with perceived EHR implementation success and EHR’s perceived relative advantage.

Breaking Boundaries: Temporality and Work–Life Practices in Hospital Organizations

Hospitals are typically perceived as bureaucratic, fast-paced, complex, and exigent organizations in which one wrong diagnosis or misread chart can potentially harm a patients life. The hefty legal and health consequences this type of organization faces make it an exceptional place to study work–life interference, identity and boundary negotiation, and conceptions of time. The sociotemporal patterns perceived by employees in hospital organizations broaden our understanding of the work–life interference levels that hospital employees experience on a daily basis. This cross-organizational study relies on work–life interference and practice theory to predict variables that account for the levels of urgency and work–life interference perceived by 91 hospital employees. Survey results reveal that scheduling and linearity are positively correlated predictors of work–life interference while embracing a future orientation at work is a negatively correlated predictor. Implications for perceived workplace temporal norms and work–life interference are provided and theoretical contributions are discussed.

A new normal? Competing national cultural discourses and workers’ constructions of identity and meaningful work in Norway

ABSTRACT We examine how conceptions of identity and meaningful work are influenced by a nations changing economic and political environment. We collected research in Norway – a country with a rich economy that has heavily relied upon oil production since the 1980s. Yet depleting oil resources are prompting an economic transformation. Twenty-seven interviews and a thematic analysis revealed how Norwegian workers safeguarded their traditional, collective workplace values, yet were simultaneously confronted with modern – more masculinized – workplace performances ushered in with the oil era. We contribute to theory by suggesting that works meaningfulness is constructed by competing national cultural discourses that evolve over time. These discourses become narratives that citizens draw upon to evaluate work and to negotiate their personal and professional identities.

The Pivotal Role of Change Appropriation in the Implementation of Health Care Technology

The implementation of electronic health records (EHRs) is a major transformation in health care organizations. This study uses adaptive structuration theory to build and test an organizational change appropriation model. We tested this model in a health care organization that had recently implemented an EHR system. We find that social interaction with coworkers has a negative direct effect on employees’ change attitudes, perceived change success, and perceived change communication quality. While these findings suggest that interacting with coworkers can actually increase negative perceptions of EHR implementation, the direction of these relationships is inverted when change appropriation is included in the model as a mediating variable. As health care workers adapt this particular technology system to meet their needs, they perceive the EHR implementation more positively and have more positive attitudes toward the change. Implications and future directions are also discussed.

Technological appropriations as workarounds: Integrating electronic health records and adaptive structuration theory research

Purpose The purpose of this paper is to further adaptive structuration theory (AST) by associating technological appropriations with health information technology workarounds. The author argues that appropriating electronic health record (EHR) technology ironically – in a way other than it is designed to be used – and divergently across an organization results in enhanced perceptions of EHR technology and its implementation. Design/methodology/approach Data were collected from 345 healthcare employees in a single healthcare organization that was switching to EHRs from paper records. Two major constructs of AST – unfaithfulness and dissension in appropriation – were operationalized and analyzed using multivariate regressions to test the relationship between the type of appropriation and perceptions of EHR technology’s relative advantage and implementation success. Findings Results reveal that both ironic (unfaithful) technological appropriation and dissension in technological appropriation across the organization predicted employees’ perceptions of EHR’s relative advantage and perceptions of EHR implementation success. Furthermore, physicians are the least likely to perceive EHR’s relative advantage or EHR implementation success. These results exemplify that EHR workarounds are taking place and reaffirm AST’s principle that employees evolve technology to better suit their working environments and preferences. Originality/value The survey and scales used in this study further demonstrate that there are meaningful statistical measures to accompany the qualitative methods frequently used in the AST literature. In addition, this paper expands AST research by exploring the positive outcomes that follow ironic and divergent technology appropriations.

Information-Seeking From Organizational Communication Sources During Healthcare Technology Change

This study collects survey data (n = 345) from a healthcare organization in the early stages of electronic health record (EHR) implementation to understand how a series of organizational communication sources—managers, coworkers, IT personnel, and online organizational sources—impact healthcare employees’ (a) EHR resistance and (b) perceptions of EHR’s relative advantage. Regression results reveal that the levels of EHR information employees sought from coworkers did not predict EHR resistance or perceived relative advantage. Seeking information from managerial sources enhances EHR’s perceived relative advantage and decreases affective EHR resistance but is not related to behavioral or cognitive EHR resistance. Seeking information from IT staff decreased all types of EHR resistance and increased EHR’s perceived relative advantage. Finally, seeking information from online organizational sources increased EHR’s perceived relative advantage and decreased behavioral and cognitive resistance but is not related to affective EHR resistance. Study implications and limitations are offered.

Heroes or Health Victims?: Exploring How the Elite Media Frames Veterans on Veterans Day

ABSTRACT We examine the frames the elite news media uses to portray veterans on and surrounding Veterans Day 2012, 2013, 2014, and 2015. We use mental health illness and media framing literature to explore how, why, and to what extent Veterans Day news coverage uses different media frames across the four consecutive years. We compiled a Media Coverage Corpora for each year, which contains the quotes and paraphrased remarks used in all veterans news stories for that year. In our primary study, we applied the meaning extraction method (MEM) to extract emergent media frames for Veterans Day 2014 and compiled a word frequency list, which captures the words most commonly used within the corpora. In post hoc analyses, we collected news stories and compiled word frequency lists for Veterans Day 2012, 2013, and 2015. Our findings reveal dissenting frames across 2012, 2013, and 2014 Veterans Day media coverage. Word frequency results suggest the 2012 and 2013 media frames largely celebrate Veterans as heroes, but the 2014 coverage depicts veterans as victimized by their wartime experiences. Furthermore, our results demonstrate how the prevailing 2015 media frames could be a reaction to 2014 frames that portrayed veterans as health victims. We consider the ramifications of this binary portrayal of veterans as either health victims or heroes and discuss the implications of these dueling frames for veterans’ access to healthcare resources.