Journal of the Association for Information Systems (2025)
An Organizational Routines Theory of Employee Well-Being: Explaining the Love-Hate Relationship Between Electronic Health Records and Clinicians
Ankita Srivastava, Surya Ayyalasomayajula, Chenzhang Bao, Sezgin Ayabakan, Dursun Delen
This study investigates the causes of clinician burnout by analyzing over 55,000 online reviews from clinicians on Glassdoor.com. Using topic mining and econometric modeling, the research proposes and tests a new theory on how integrating various Electronic Health Record (EHR) applications to streamline organizational routines affects employee well-being.
Problem
Clinician burnout is a critical problem in healthcare, often attributed to the use of Electronic Health Records (EHRs). However, the precise reasons for this contentious relationship are not well understood, and there is a research gap in explaining how organizational-level IT decisions, such as how different systems are integrated, contribute to clinician stress or satisfaction.
Outcome
- Routine operational issues, such as workflow and staffing, were more frequently discussed by clinicians as sources of dissatisfaction than EHR-specific factors like usability. - Integrating applications to streamline clinical workflows across departments (e.g., emergency, lab, radiology) significantly improved clinician well-being. - In contrast, integrating applications focused solely on documentation did not show a significant impact on clinician well-being. - The positive impact of workflow integration was stronger in hospitals with good work-life balance policies and weaker in hospitals with high patient-to-nurse ratios, highlighting the importance of organizational context.
Host: Welcome to A.I.S. Insights — powered by Living Knowledge. I’m your host, Anna Ivy Summers. Today, we're exploring the friction between technology and employee well-being in a high-stakes environment: healthcare. With me is our expert analyst, Alex Ian Sutherland. Alex, welcome.
Expert: Great to be here, Anna.
Host: We're diving into a study titled, "An Organizational Routines Theory of Employee Well-Being: Explaining the Love-Hate Relationship Between Electronic Health Records and Clinicians". It investigates the causes of clinician burnout by analyzing a massive dataset of online employee reviews.
Expert: That’s right. It uses over 55,000 reviews from clinicians on Glassdoor to understand how the technology choices hospitals make impact the day-to-day stress of their staff.
Host: Clinician burnout is a critical issue, and we often hear that Electronic Health Records, or EHRs, are the main culprit. But this study suggests the problem is more complex, right?
Expert: Exactly. EHRs are often blamed for increasing workloads and causing frustration, but the precise reasons for this love-hate relationship aren't well understood. The real issue the study tackles is the gap in our knowledge about how high-level IT decisions—like which software systems a hospital buys and how they are connected—trickle down to affect the well-being of the nurses and physicians on the front lines.
Host: So it's not just about one piece of software, but the entire digital ecosystem. How did the researchers get to the bottom of such a complex issue?
Expert: They used a very clever, data-driven approach. Instead of traditional surveys, they turned to Glassdoor, where clinicians leave anonymous and often very candid reviews about their employers. They used topic mining and other analytical methods to identify the most common themes in what clinicians praised or complained about over a nine-year period.
Host: It’s like listening in on the real breakroom conversation. So what did they find? Was it all about clunky software and bad user interfaces?
Expert: Surprisingly, no. That was one of the most interesting findings. When clinicians talked about dissatisfaction, they focused far more on routine operational issues—things like inefficient workflows, staffing shortages, and poor coordination between departments—than they did on the specific usability of the EHR software itself.
Host: So it's less about the tool, and more about how the work itself is structured.
Expert: Precisely. And that led to the study's most powerful finding. When hospitals used technology to streamline workflows *across* departments—for example, making sure the systems in the emergency room, the lab, and radiology all communicated seamlessly—clinician well-being significantly improved.
Host: That makes perfect sense. A smooth handoff of information prevents a lot of headaches. What about other types of tech integration?
Expert: This is where it gets really insightful. In contrast, when hospitals integrated applications that were focused only on documentation, it had no significant impact on well-being. So, just digitizing paperwork isn’t the answer. The real value comes from connecting the systems that support the actual flow of patient care.
Host: That’s a crucial distinction. The study also mentioned that the hospital’s environment played a role.
Expert: It was a massive factor. The positive impact of that workflow integration was much stronger in hospitals that already had good work-life balance policies. But in hospitals with high patient-to-nurse ratios, where staff were stretched thin, the benefits of the technology were much weaker.
Host: So, Alex, this brings us to the most important question for our listeners. These findings are from healthcare, but the lessons seem universal. What are the key business takeaways?
Expert: There are three big ones. First, focus on the workflow, not just the tool. When you're rolling out new technology, the most important question isn't "is this good software?", it's "how does this software improve our core operational routines and make collaboration between teams easier?" The real return on investment comes from smoothing out the friction between departments.
Host: That's a great point. What's the second takeaway?
Expert: Technology is a complement, not a substitute. You cannot use technology to solve fundamental organizational problems. The best integrated system in the world won't make up for understaffing or a culture that burns people out. You have to invest in your people and your processes right alongside your technology.
Host: And the third?
Expert: Listen for the "real" feedback. Employees might not complain directly about the new CRM software, but they will complain about the new hurdles in their daily routines. This study's use of Glassdoor reviews is a lesson for all leaders: find ways to understand how your decisions are affecting the ground-level workflow. The problem might not be the tech itself, but the operational chaos it’s inadvertently creating.
Host: Fantastic insights. So to recap: Clinician burnout isn't just about bad software, but about broken operational routines. The key is to strategically integrate technology to streamline how teams work together. And critically, that technology is only truly effective when it's built on a foundation of a supportive work environment.
Host: Alex Ian Sutherland, thank you so much for breaking this down for us.
Expert: My pleasure, Anna.
Host: And thanks to our audience for tuning in to A.I.S. Insights — powered by Living Knowledge.