Human Impact on Health Care Technology

There's a deeper, human side to health care improvements many hope will be ushered in by the $19 billion stimulus package financing electronic medical recordkeeping in health care facilities.

Preliminary results of an ILR study of 20 downstate nursing homes suggest that management style and specific adoption strategies influence the impact of technological innovation on health care costs, employee outcomes and resident care.

In short, good workplace practices set the stage for optimal results from sophisticated technology.

"We don't have all the evidence yet, but we're pretty confident organizations that empower employees to participate in workplace decision making will be better positioned to effectively implement new technology," David Lipsky said.

Lipsky is director of the Scheinman Institute on Conflict Resolution, which is leading the New York Nursing Home Quality Care Technology Demonstration Project.  Lipsky and Ariel Avgar, ILR Ph.D. '08, are examining the effects of the technology on employment and labor relations.

Researchers from the College of Human Ecology are also participating in the study. They are focusing on quality of care issues.

In February, the medical recordkeeping stimulus package was passed by Congress and signed by President Barack Obama.

Computerizing more of America's patient data is expected by many to lower health care costs, decrease errors and improve patient care.  Most nursing homes and hospitals are not online.

Early findings from the Cornell study show electronic records will lead to lower costs, improved employee perceptions and attitudes, and better resident care in nursing homes with a clear vision of how this technology is linked to broader organizational goals and objectives.

In addition, positive organizational outcomes associated with the electronic medical records technology appear to be related to greater levels of staff empowerment and involvement.

By contrast, the benefits of electronic records are less apparent in homes managed in a traditional, top-down style.  In those nursing homes, the new technology is seen as another tool to track mistakes and control employees, Lipsky said.

It follows that investment of billions of federal dollars in technology for more progressive nursing homes would have a bigger payoff than in more traditional homes, Lipsky said.

As a result, he said, improving organizational factors such as employee relations in preparation for receiving funds makes sense.

Lipsky and Avgar believe the public policy implication is clear – some homes will be more suitable for the investment than others.

Guidelines should be developed for selecting homes that will receive funding, the researchers recommend.

Funders should consider using some of the stimulus money to make sure homes are prepared – from an organizational design and leadership perspective – to receive the money.

Most of the health care record stimulus money is slated for distribution from 2011 to 2015.

The Cornell study began two years ago with a phone survey of more than 1,000 nurses, aides and other workers in non-computerized facilities.

Handheld, wireless computers were then distributed to workers in 20 homes.  Five homes served as a research control group.

A second survey is in its final stages.  A third survey will be conducted next year.

Face-to-face interviews have been conducted with administrators, front-line staff, and union representatives in 10 of the homes both before and after the introduction of the technology.

The study will measure the new technology's impact on employee job satisfaction, stress and commitment, resistance to change and conflict, labor relations and workforce retention and recruitment.

"The hope is that homes will have an easier time recruiting and retaining employees than before the technology, but we won't know that for sure until we complete our follow-up survey," said Lipsky, the Anne Estabrook Evans Professor of Dispute Resolution at ILR.

A final report is slated to be ready late this year.

The study is funded by money allocated by New York state to support the introduction of the technology in the nursing homes and also by the Commonwealth Fund, a private foundation.  All certified nursing assistants and licensed practical nurses in the nursing homes surveyed are members of 1199SEIU.

Nursing homes with authoritative management styles tend to see the new technology almost exclusively as a way to control staff and mete out punishment, according to the researchers.  An administrator in an authoritative home said, "If there’s a problem, I want to know which nurses are involved.  I may give them an in-service, then a warning.  If they don’t like that, they can find a job somewhere else."

In traditional homes, the researchers believe the technology will increase financial returns, but will not improve resident care or employment outcomes.

In nursing homes where managers value the new technology for its added efficiency and cost containment, resident care and financial returns are likely to improve.  But employee recruitment, retention, teamwork and job satisfaction might not improve, according to researchers.

Another group sees improved technology, researchers said, as a way to increase staff skills, heighten job satisfaction, lower turnover and improve patient care.

An administrator in that group said, "We are trying to give people the opportunity to manage themselves, which means giving them the tools to work as best they can in their environment."