Understanding IS Impacts in Mandatory Environments: Usage, Compatibility Beliefs, Stress and Burnout

Information systems usage is often conceptualized as the behavior that signifies technology adoption or system success; however, little research has focused on the possibility that there are negative individual outcomes to IS use. This research proposal is designed to examine the circumstances under which mandated information systems usage contributes to work stress and, subsequently, employee burnout—an individual’s response to chronic work stressors. In particular, it examines the extent to which conflicts between users’ beliefs about the compatibility of information systems with their work and their actual usage behavior contributes to perceptions of role conflict, a type of work stress that has been previously linked to burnout. Those experiencing burnout report high levels of emotional exhaustion, an increased sense of cynicism toward their work, and low levels of personal accomplishment. From an organizational viewpoint, burnout is important because of its association with such outcomes as job satisfaction, absenteeism, intention to leave, and actual turnover (Maslach, Schaufeli, & Leiter 2001). To the extent that information systems usage contributes to employee burnout, it is important that MIS practitioners and researchers are able to identify the problem and work to mitigate the potentially negative personal and organizational outcomes. One context where the potential for negative individual and organizational outcomes exists is healthcare. Information technology is often touted as a means of improving the quality and reducing the costs of healthcare (Bates 2002). As such, many healthcare organizations are adopting clinical information systems as part of the patient care process. Evidence exists that healthcare workers do not necessarily believe such systems can deliver the results promised (Likourezos et al. 2004; Loomis et al. 2002). This belief is substantiated by research indicating information systems might, in fact, be detrimental to patient care in some cases (Koppel et al. 2005). Hennington IS Impacts in Mandatory Environments 2 As these systems are adopted by healthcare organizations, their routine use by frontline healthcare workers is often mandated. In some organizations, mandatory technology use goes beyond social pressures. Jasperson, Carter, and Zmud (2005) described a mandatory adoption decision as one in which the organization integrates the information system into the work system such that users must use the system in order to accomplish their work tasks. When the technology is wholly integrated into the system, usage is no longer a choice or the result of social pressure. Rather, it is the only way in which work can be accomplished. In such a context, the question of interest ceases to be whether beliefs are predictive of usage, but rather whether beliefs are congruent with usage, and, if not, what impact that has on individuals who are mandated to behave in a manner that is potentially inconsistent with their beliefs. The hospital setting in which this research will be conducted is an example of just such a mandatory context and thus provides an excellent setting in which to explore this research question. The research proposed herein seeks to discover if and how the combined effect of registered nurses’ use of a clinical information system and their beliefs regarding the compatibility of information systems with their values is related to burnout. Within the healthcare context, burnout has been linked to outcomes such as patient safety and patient satisfaction (Leiter et al. 1998; Vahey et al. 2004). Given the link between burnout and turnover, it is a phenomenon of especial importance due to the current nursing shortage (Lynn & Redman 2005). Nurses are in short supply in the healthcare industry and are projected to remain so for the foreseeable future. In light of this fact, Cohen (2006) argued that organizations must take measures to enhance both job satisfaction and organizational commitment in order to retain nurses. From a theoretical standpoint, this proposal contributes to the MIS literature in a number of important ways: 1) It introduces burnout as a new, previously-untested individual impact resulting from the combination of IS use and personal beliefs regarding information systems; 2) It extends the compatibility literature into the post-adoptive context by using a newly developed compatibility with values construct to examine how potential mismatches between users’ values and their behavior are related to burnout; and 3) It contributes to the growing body of literature on information systems usage in a postadoptive, mandatory environment—a relatively under-examined context given the likelihood that it is, in reality, the predominant organizational usage context. Drawing upon the information systems, organizational behavior, and individual psychology literature, the research model in Figure 1 is proposed. It is asserted that the combined effect of an information system’s compatibility with users’ values and actual use of the system is related to users’ perceptions of role conflict, defined as users’ perceptions of conflicting job demands. It has been studied as an antecedent of burnout, most often associated with higher levels of emotional exhaustion and depersonalization, but also in some studies to decreased personal accomplishment (Cordes & Dougherty 1993). This proposal will test the relationship between role conflict and each of the three sub-dimensions of burnout, as well Hennington IS Impacts in Mandatory Environments as previously suggested relationships between the three sub-dimensions. Figure 1. Research model Compatibility with Values Usage Role Conflict Burnout Emotional Exhaustion Depersonalization Personal Accomplishment The research hypotheses will be tested in a field study employing a survey methodology for data collection. Quantitative data will be collected via a cross-sectional survey and research hypotheses will be tested using structural equation modeling. The survey will be electronically administered to participants as part of a larger survey being conducted by the sponsoring organization. Participants for this study will be registered nurses employed with a large urban hospital system located in the southeastern United States. The research will be conducted within one organization (a large hospital system), focusing on one type of healthcare worker (nurses) who have been using the same information system for approximately three years. The information system is used by the nurses for electronic charting purposes. In addition to providing them a means to complete patient care documentation, it also allows nurses to view physician orders, as well as laboratory and radiology results. This setting is a mandatory usage environment in the sense that the information system is completely integrated into the nurses’ work system. There is no other way for them to enter and/or access necessary data other than to use the system. This is a convenience sample, which will limit the generalizability of the findings; however, there are some benefits to its use. Collecting data from one organization improves the homogeneity of the sample, thus decreasing the likelihood that extraneous variables might influence the results. Further, as burnout is a process that occurs over time, the use of a sample that has been using the same information system for approximately the same extended period of time allows for the examination of burnout as the result of combined systems usage and compatibility beliefs. Although the ability to make causal references is limited by the cross-sectional nature of the data collection (there is no way to control for burnout levels prior to system implementation), the length of time that nurses have been using the system strengthens the argument that ISrelated belief and behavior conflicts contribute to role conflict and subsequent burnout.