Poster #13 - Burnout, Turnover, and EHR Usability: A Mixed Methods Study in Public Health Policy Implementation

• In Event: Friday Poster Reception

Abstract

 Jourdan Banks, Ph.D Candidate, Florida International University, Steven J. Green School of International and Public Affairs 

Introduction:
Despite billions in federal investment, Electronic Health Records (EHR)—a cornerstone of the HITECH Act—have faced persistent challenges in adoption and use. Emotional and cognitive burdens placed on healthcare staff—especially burnout, stress, and dissatisfaction—have undermined EHR’s intended impact on care quality and administrative efficiency. These frontline challenges highlight how behavioral and psychological factors influence public policy implementation and workforce outcomes in public health settings.

Research Question:
Research asks: (1) What well-being-related barriers affect the implementation of EHR systems under the HITECH Act? (2) Does EHR usability moderate the relationship between burnout and turnover among public health workers?

Methods:
This mixed methods study integrates two approaches. First, a systematic literature review (2009–2024) follows the PRISMA framework and is grounded in behavioral public administration and governance theory. Second, the study uses previously publicly available data from the national Health Resources and Services Administration (HRSA) Worker Wellbeing Survey. HRSA administered this survey from November 2022 to February 2023 across 694 health centers in U.S. states and territories, with 52,568 respondents including clinical and non-clinical hospital staff. Regression models assess whether EHR usability (moderator) weakens the relationship between staff-reported burnout (predictor) and turnover intention (outcome), controlling for clinical role and organizational factors. Although the survey was publicly accessible at the time of collection, the dataset has since been taken offline. The author downloaded the data prior to its removal and continues to analyze it under the original public use terms.

Results:
The systematic review revealed that emotional and cognitive well-being factors—such as burnout, dissatisfaction, stress, and administrative overload—are consistently linked to poor EHR usability and reduced implementation. Across diverse healthcare settings, workers reported that poorly designed EHR systems contributed to emotional exhaustion, frustration, and intentions to leave. Studies emphasized that user experience and organizational support significantly influenced whether EHR was adopted as intended. Notably, variation in burnout and implementation challenges across clinical roles suggests that policy design must better account for frontline perspectives. Preliminary quantitative results using HRSA data suggest that EHR usability may moderate the relationship between burnout and turnover intention, particularly among clinical staff, reinforcing the review’s findings.

Implications:
This study deepens the techno-stress framework by examining how stressors like digital overload and blurred work-life boundaries manifest uniquely in healthcare environments implementing EHR under federal mandates. Rather than treating techno-stress as a general phenomenon, it shows how policy-driven technologies like EHR intensify burnout through excessive administrative demands. By centering emotional well-being and frontline discretion in implementation, this research provides a behaviorally grounded lens for understanding gaps between policy intent and organizational outcomes. A concrete policy takeaway is the potential to mandate burnout-monitoring and well-being reporting as part of health IT policy compliance. Linking technology to the relationship between emotional well-being and employee performance adds a new dimension to how digital systems shape implementation success.

Author

• Jourdan Banks, Florida International University
  Presenting Author