Professional culture, information security and healthcare quality—an interview study of physicians’ and nurses’ perspectives on value conflicts in the use of electronic medical records

Abstract

Background: Digital healthcare information systems impose new demands on healthcare professionals, and information security rules may induce stressful value conflicts, which the professional culture may help professionals to handle. The aim of the study was to elucidate physicians' and registered nurses' shared professional assumptions and values, grounded in their professional cultures, and how these assumptions and values explain and guide healthcare professionals' handling of value conflicts involving rules regulating the use of electronic medical records. Methods: Healthcare professionals in five organisations in two Swedish healthcare regions were interviewed. Results: The study identified ensuring the patients' physical health and well-being as the overarching value and a shared basic assumption among physicians and registered nurses. A range of essential professional and organisational values were identified to help attain this goal. In value conflicts, different values were weighted in relation to each other and to the electronic information security rules. Conclusions: The results can be used to guide effective design and implementation of electronic medical records and information security regulations in healthcare.

Value conflicts and information security – a mixed-methods study in high-risk industry

“…Karlsson et al (2018a, 2018b) have suggested that information security is never the only organisational value to be considered and that it rarely is the value prioritised before all others. A previous study on information security in health care identified value conflicts between information security and the quality of care (Skyvell-Nilsson et al , 2018). The same study also found that information security rules could restrict the opportunities for learning and professional development.…”

“…Karlsson et al (2018aKarlsson et al ( , 2018b found that white-collar workers, particularly in organisations that handle sensitive information, commonly experience value conflicts regarding information security. Information security has often been found to be in conflict with values, such as privacy, openness and learning, as well as effectiveness and competitiveness (Hedström et al, 2011;Karlsson et al, 2018aKarlsson et al, , 2018bSkyvell-Nilsson et al, 2018). It has been suggested that the goal of securing information is always, to some extent, in conflict with the goals of maximising productivity and minimising costs, as information security makes the information system less usable (Van Niekerk and Von Solms, 2010).…”

“…The degree of conflict between information security demands and other organisational demands may vary depending on the organisational culture (Karlsson et al, 2018a(Karlsson et al, , 2018b. Also, the organisational culture has been found to influence how employees manage value conflicts involving information security (Skyvell-Nilsson et al, 2018). Organisational culture is closely related to organisational climate (Schneider, 1990;Schneider et al, 2017).…”

The impact of psychosocial working conditions on information security behaviour in the nuclear industry

“…When two or more values, with competing implications for behaviour, simultaneously influence actors, value conflicts occur (Mulligan, 2004). There is some literature focusing on how value conflicts at work influence information security and its management (Karlsson et al , 2018; Skyvell-Nilsson et al , 2018). Information security has been found to conflict with organisational values such as effectiveness and competitiveness, as well as privacy, openness and learning (Hedström et al , 2011; Karlsson et al , 2018; Skyvell-Nilsson et al , 2018; Gyllensten et al , 2021).…”

“…There is some literature focusing on how value conflicts at work influence information security and its management (Karlsson et al , 2018; Skyvell-Nilsson et al , 2018). Information security has been found to conflict with organisational values such as effectiveness and competitiveness, as well as privacy, openness and learning (Hedström et al , 2011; Karlsson et al , 2018; Skyvell-Nilsson et al , 2018; Gyllensten et al , 2021). Indeed, it has been suggested that information security is always, to some degree, in conflict with the values of maximising productivity and minimising costs (Van Niekerk and Von Solms, 2010; Kirlappos et al , 2013).…”