Introduction of telemedicine in emergency care: Impact of paramedics’ job satisfaction and workload on knowledge sharing and technology acceptance (Preprint)

BACKGROUND Tele-emergency physicians (TEP) take an increasingly important role in the need-oriented provision of emergency patient care. To improve emergency medicine in rural areas, we set up the project ‘Rural|Rescue’, which uses TEP to restructure professional rescue services using information and communication technologies (ICT) in order to reduce the therapy-free interval. Successful implementation ICT relies on user acceptance and knowledge sharing behavior. OBJECTIVE This study aims to show how changes in work load and job satisfaction influence knowledge sharing behavior and technology acceptance during introduction of ICT. METHODS We conducted a factorial design with active knowledge transfer and technology acceptance as a function of work satisfaction (high vs. low), work load (high vs. low) and point in time (prior to vs. after digitalization). Data were collected via machine readable questionnaires issued to 755 persons (411 pre, 344 post), of which 304 or 40.3% of these persons responded (194 pre, 115 post). RESULTS Technology acceptance was higher prior to digitalization than after the implementation of TEP. Also, technology acceptance was higher when the workload was low. Regarding the active knowledge sharing, employees with low work satisfaction are more likely to share their digital knowledge as compared to employees with high work satisfaction. Additional and more detailed analyses reveal that this is an effect of previous knowledge concerning digitalization. After implementing the new technology work satisfaction increased for the more experienced employees, but not for the less experienced ones. Results are discussed considering the Dunning-Kruger-effect. The Dunning-Kruger-effect describes a cognitive bias. People with pre-existing knowledge of the matter often underestimate their actual skill level. They have a more critical attitude towards their performance and feel the urgent need to fill possible knowledge gaps they notice. CONCLUSIONS Our research illustrates that employees’ work load has an impact on the intention using digital applications. The higher the work load, the less people are willing to use TEP. Regarding the active knowledge sharing, we see that employees with low work satisfaction are more likely to share their digital knowledge compared to employees with high work satisfaction. This might be attributed to the Dunning-Kruger-effect. Highly knowledgeable employees firstly feel uncertain about the alteration which translates in momentarily lower work satisfaction. They feel the urge for filling even small knowledge gaps which in return leads to higher work satisfaction. Those responsible need to acknowledge that digital change affects their employees’ workflow and work satisfaction. During those times, employees need time and support to gather information and knowledge in order to cope with digitally changed tasks. CLINICALTRIAL Ethical approval BB 044/17 from 21.03.2017, Ethics Commission University Medicine Greifswald INTERNATIONAL REGISTERED REPORT RR2-10.2196/14358