Vital Researcher Conversations: Pivoting Past Impasses in Qualitative Research

Halling, Steen; Lilleleht, Erica; Krycka, Kevin C.; Sayre, George

doi:10.1177/0022167817722020

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…We separately performed keyword searches for “COVID,” “COVID-19,” and “pandemic” across all transcripts, to ensure all appropriate quotes were captured. We used content analysis and group discussion 22 to identify prevailing themes that described the experiences of clinicians and staff who simultaneously navigated the COVID-19 pandemic and the EHR transition. We selected representative quotes through group consensus at team meetings that were felt to be most emblematic of the identified themes.…”

Section: Methodsmentioning

confidence: 99%

“Like One Long Battle:” Employee Perspectives of the Simultaneous Impact of COVID-19 and an Electronic Health Record Transition

Rucci,

Ball,

Brunner

et al. 2023

J GEN INTERN MED

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Background Healthcare organizations regularly manage external stressors that threaten patient care, but experiences handling concurrent stressors are not well characterized. Objective To evaluate the experience of Veterans Affairs (VA) clinicians and staff navigating simultaneous organizational stressors—an electronic health record (EHR) transition and the COVID-19 pandemic—and identify potential strategies to optimize management of co-occurring stressors. Design Qualitative case study describing employee experiences at VA’s initial EHR transition site. Participants Clinicians, nurses, allied health professionals, and local leaders at VA’s initial EHR transition site. Approach We collected longitudinal qualitative interview data between July 2020 and November 2021 once before and 2–4 times after the date on which the health system transitioned; this timing corresponded with local surges of COVID-19 cases. Interviewers conducted coding and analysis of interview transcripts. For this study, we focused on quotes related to COVID-19 and performed content analysis to describe recurring themes describing the simultaneous impact of COVID-19 and an EHR transition. Key Results We identified five themes related to participants’ experiences: (1) efforts to mitigate COVID-19 transmission led to insufficient access to EHR training and support, (2) clinical practice changes in response to the pandemic impacted EHR workflows in unexpected ways, (3) lack of clear communication and inconsistent enforcement of COVID-19 policies intensified pre-existing frustrations with the EHR, (4) managing concurrent organizational stressors increased work dissatisfaction and feelings of burnout, and (5) participants had limited bandwidth to manage competing demands that arose from concurrent organizational stressors. Conclusion The expected challenges of an EHR transition were compounded by co-occurrence of the COVID-19 pandemic, which had negative impacts on clinician experience and patient care. During simultaneous organizational stressors, health care facilities should be prepared to address the complex interplay of two stressors on employee experience.

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Section: Methodsmentioning

confidence: 99%

“Like One Long Battle:” Employee Perspectives of the Simultaneous Impact of COVID-19 and an Electronic Health Record Transition

Rucci,

Ball,

Brunner

et al. 2023

J GEN INTERN MED

Self Cite

View full text Add to dashboard Cite

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“…Analysis was conducted simultaneously with data collection and continued until thematic saturation (e.g., the point at which subsequent data failed to produce new findings; Sandelowski, 1995). A priori categories focused on barriers and facilitators to TOP implementation (Halling et al., 2017). We used ATLAS.ti Windows (Version 8) for data management and analysis.…”

Section: Methodsmentioning

confidence: 99%

A mixed‐methods evaluation of why an implementation trial failed to engage veterans with posttraumatic stress disorder in trauma‐focused psychotherapy

Fortney

Rajan

Chen

et al. 2023

Journal of Traumatic Stress

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An effectiveness trial found that telemedicine collaborative care for posttraumatic stress disorder (PTSD) significantly increased engagement in trauma‐focused psychotherapy (TFP) and improved PTSD symptoms. However, in a subsequent implementation trial, very few veterans enrolled in collaborative care initiated TFP. We conducted a mixed‐methods evaluation to determine why veterans did not initiate TFP in the implementation trial. After conducting chart reviews of 1,071 veterans with PTSD enrolled in collaborative care, patients were categorized into four mutually exclusive TFP groups: TFP not discussed; TFP discussed, declined; TFP discussed, did not decline; and TFP initiated. We conducted semistructured interviews with 43 unique patients and 58 unique providers (i.e., care managers and mental health specialists). Almost half (48.6%) of the veterans had no documentation of discussing TFP with their care manager; another 28.9% discussed it but declined. Most veterans (77.1%) had an encounter with a mental health specialist, 36.8% of whom never discussed TFP, and 35.7% of whom discussed it but declined. Providers reported that many veterans were not able, willing, or ready to engage in TFP and that non–trauma‐focused therapies were better aligned with their treatment goals. Veterans gave numerous reasons for not initiating TFP, including having bad prior experiences with TFP and wanting to avoid thinking about past traumatic experiences.Commonly cited reasons for noninitiation were providers never discussing TFP with veterans and veterans declining TFP after discussing it with their provider. Interventions, such as shared decision‐making tools, may be needed to engage providers and patients in informed discussions about TFP.

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“…presented transcripts, codes, and analytic memos to the research team throughout coding and analysis to resolve discrepancies, gain consensus, and elaborate on preliminary findings to develop themes. 35,36 The experiences of the 5 physicians on the team (S.R., P.J.K., A.R., K.M.S., K.M.N.) were especially important to understanding and contextualizing findings.…”

Section: Methodsmentioning

confidence: 99%

Perspectives on Training and Working in the VHA: Implications for Primary Care Physician Recruitment and Retention

et al. 2022

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PurposeThe primary care physician shortage in the United States presents significant challenges for health systems seeking to maintain a sufficient primary care workforce. Perspectives on training or working in primary care in the Veterans Health Administration (VHA) may yield insights into strategic recruitment to make the VHA and other health systems more attractive to primary care physicians. The authors sought to understand the experiences of resident and staff physicians with limited tenure within VHA primary care to identify factors to guide health systems in improving recruitment and retention.

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Vital Researcher Conversations: Pivoting Past Impasses in Qualitative Research

Cited by 5 publications

References 25 publications

“Like One Long Battle:” Employee Perspectives of the Simultaneous Impact of COVID-19 and an Electronic Health Record Transition

“Like One Long Battle:” Employee Perspectives of the Simultaneous Impact of COVID-19 and an Electronic Health Record Transition

A mixed‐methods evaluation of why an implementation trial failed to engage veterans with posttraumatic stress disorder in trauma‐focused psychotherapy

Perspectives on Training and Working in the VHA: Implications for Primary Care Physician Recruitment and Retention

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