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

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.

Stimulated by Novelty? The Role of Psychological Needs and Perceived Creativity.

In the current research, we aimed to address the inconsistent finding in the brainstorming literature that cognitive stimulation sometimes results from novel input, yet other times from non-novel input. We expected and found, in three experiments, that the strength and valence of this relationship are moderated by people's psychological needs for structure and autonomy. Specifically, the effect of novel input (vs. non-novel input), through perceived creativity, on cognitive stimulation was stronger for people who were either low in need for structure or high in need for autonomy. Also, when the input people received did not fit their needs, they experienced less psychological cognitive stimulation from this input (i.e., less task enjoyment and feeling more blocked) compared with when they did not receive any input. Hence, to create the ideal circumstances for people to achieve cognitive stimulation when brainstorming, input novelty should be aligned with their psychological needs.

How educational innovations and attention to competencies in postgraduate medical education relate to preparedness for practice: the key role of the learning environment.

INTRODUCTION: Many training programmes in postgraduate medical education (PGME) have introduced competency frameworks, but the effects of this change on preparedness for practice are unknown. Therefore, we explored how elements of competency-based programmes in PGME (educational innovations, attention to competencies and learning environment) were related to perceived preparedness for practice among new consultants. METHODS: A questionnaire was distributed among 330 new consultants. Respondents rated how well their PGME training programme prepared them for practice, the extent to which educational innovations (portfolio, Mini-CEX) were implemented, and how much attention was paid to CanMEDS competencies during feedback and coaching, and they answered questions on the learning environment and general self-efficacy. Multiple regression and mediation analyses were used to analyze data. RESULTS: The response rate was 43 % (143/330). Controlling for self-efficacy and gender, the learning environment was the strongest predictor of preparedness for practice (B = 0.42, p < 0.001), followed by attention to competencies (B = 0.29, p < 0.01). Educational innovations were not directly related to preparedness for practice. The overall model explained 52 % of the variance in preparedness for practice. Attention to competencies mediated the relationship between educational innovations and preparedness for practice. This mediation became stronger at higher learning environment values. CONCLUSIONS: The learning environment plays a key role in determining the degree to which competency-based PGME prepares trainees for independent practice.

Blended working: for whom it may (not) work.

Similarly to related developments such as blended learning and blended care, blended working is a pervasive and booming trend in modern societies. Blended working combines on-site and off-site working in an optimal way to improve workers' and organizations' outcomes. In this paper, we examine the degree to which workers feel that the two defining features of blended working (i.e., time-independent working and location-independent working) enhance their own functioning in their jobs. Blended working, enabled through the continuing advance and improvement of high-tech ICT software, devices, and infrastructure, may be considered beneficial for workers' perceived effectiveness because it increases their job autonomy. However, because blended working may have downsides as well, it is important to know for whom blended working may (not) work. As hypothesized, in a sample of 348 workers (51.7% women), representing a wide range of occupations and organizations, we found that the perceived personal effectiveness of blended working was contingent upon workers' psychological need strength. Specifically, the perceived effectiveness of both time-independent working and location-independent working was positively related to individuals' need for autonomy at work, and negatively related to their need for relatedness and need for structure at work.

The selection of creative ideas after individual idea generation: choosing between creativity and impact.

It is commonly assumed that successful innovation depends on creative idea generation: the more ideas are generated, the higher the probability of selecting a very good idea should be. However, research has shown that people do not perform optimally at idea selection and that ideational output may not contribute much to creative idea selection. The present studies aim to explain this phenomenon. We identified the strong tendency of our participants to select feasible and desirable ideas, at the cost of originality, as the main reason for their poor selection performance. Two manipulations of participants' processing of the available ideas (exclusion instructions and quality ratings) had no effect on selection effectiveness. In contrast, explicitly instructing participants to select creative or original ideas did improve selection effectiveness with regard to idea originality, but at the same time decreased participants' satisfaction and the rated effectiveness of chosen ideas. Results are discussed in relation to an effectiveness-originality trade off.

Personal need for structure and creative performance: the moderating influence of fear of invalidity.

Previous research has suggested that personal need for structure (PNS) is negatively related to creative performance. In this article, it is argued that this relation, in fact, depends on another personality variable: personal fear of invalidity (PFI). When PFI is high, PNS should indeed be negatively associated with creativity. However, PNS should be positively associated with creativity when PFI is low, because this combination enables people to take a structured approach to creative tasks and this can be helpful to overcome their reliance on conventional and accessible task strategies. In four studies, this hypothesis is tested using different measures of creative performance. The expected interaction effect is found for measures of ideational fluency and measures of originality but not for measures of flexibility. Moreover, it is shown that the interaction effect between PNS and PFI is mediated by perseverance within thought categories.