JMIR Publications

ABSTRACT

Background:

In order to transform to a fully digital workflow, a pathology department in a German university hospital reorganized its processes, upgrading and integrating new technologies such as an updated laboratory information system and high-throughput scanners. We examined the experiences of pathology staff with the digital transformation process from an occupational health perspective, focusing on the mutual influences between digital transformation and existing working conditions.

Objective:

With the aim of developing a holistic understanding of the mutual influences of digital transformation and existing working conditions, our research questions were: How does digital transformation in pathology affect the working conditions of employees and supervisors, eg, in terms of work-related resources, stressors, job satisfaction, and thus work-related employee health? And in turn, how do existing working conditions, eg, characterized by insufficient time and human resources, affect digital transformation in pathology?

Methods:

We conducted participant observation, focus groups, qualitative interviews, and document analysis using an ethnographic research design. More than 30 pathology staff and supervisors from diagnostics, laboratory, quality management, administration, and IT participated. Data was collected in three field phases between summer 2022 and fall 2023, representing different stages of the digital transformation. Data was analyzed using Braun and Clarke's reflexive thematic analysis. In addition, two member checking workshops were conducted with the entire pathology team.

Results:

The pathology department under study had to perform demanding work in a complex system with scarce human, time, and technological resources. While the new technology required standardized processes, the reality of work in the pathology department as a key part of patient care often required individualized approaches. During the observation period, the digital transformation was significantly delayed and the department was not yet benefiting from its efforts. The demand-resource mismatch emerged as a major digital transformation stressor. However, the slower transformation gave the pathology department time to change the organizational culture, such as reflecting the competencies for future digital pathology and establishing new human-to-human and human-to-machine networks. The pathology department took the opportunity to focus on its core resources during this challenging time.

Conclusions:

Increased work intensity before and during digital transformation wears out both human and machine resources. To protect the mental health of healthcare workers, digital transformation should be considered not only at the technical level, but also at the level of work organization and social relations.