Assistant Professor, Public Health Policy and Management
Alden Lai studies how the jobs and work environments of health care workers can be improved to increase employee outcomes (e.g., wellbeing, retention) as well as organizational performance (e.g., program implementation, patient safety). He uses theories and frameworks from psychology, organization science, and health services research in his work. Dr. Lai's research has appeared in both management and health care journals, including Academy of Management Discoveries, Health Care Management Review, Medical Care Research and Review, and The Milbank Quarterly. He has an affiliated faculty appointment in the Department of Management and Organizations at NYU Stern.
At GPH, he teaches courses on management, leadership, and strategy in public health.
Dr. Lai has advised federal and state governments, health systems, international and non-profit organizations, corporations, and philanthropies internationally. His professional experiences include being a management consultant, social enterprise strategist, and education researcher. He currently serves as Executive Advisor to the Global Wellbeing Initiative, a collaboration between the Wellbeing for Planet Earth Foundation and Gallup Inc. to foster a more globally inclusive understanding of wellbeing for research, practice, and policy. Dr. Lai also serves as Chair of the Health Care Research Stream for the Industry Studies Association. He is Co-Editor of an upcoming book by Springer on professional development for early career researchers. Previously, he served as Chair of the European Health Psychology Society’s early career researcher division, and was an executive committee member in the Academy of Management's Division of Health Care Management.
BA, Psychology, National University of Singapore, SingaporeMPH, Social & Behavioral Sciences, The University of Tokyo, JapanPhD, Health Policy & Management (Organizational Behavior), Johns Hopkins University, Baltimore, MD
NYU GPH Leadership Development Award (2021)19 Washington Square North Faculty Fellowship (2021)Outstanding Paper based on a Dissertation Award, Division of Health Care Management, Academy of Management (2021)Show Chwan Scholar in Health Care Management (2018)Sir Arthur Newsholme Scholar (2015)The University of Tokyo President Award (2013)University of Copenhagen-International Alliance of Research Universities Scholar (2012)Government of Japan Monbukagakusho Scholar (2011)Sato-Yo International Foundation Scholar (2009)
Health Care WorkforceManagerial CognitionPatient SafetyPopulation HealthPrimary CareProactivity at WorkQualitative and Mixed MethodsQualitative ResearchWell-Being at Work
Asian Venture Philanthropy Network
Carnegie UK Trust
Clinical Directors Network Inc.
G1 Institute Japan
Harvard University Human Flourishing Program
John Templeton Foundation
National Healthcare Group
New York City Department of Health and Mental Hygiene
New York City Health + Hospitals
New York City Office of Labor Relations
OECD Statistics and Data Directorate
OECD Center for Well-Being, Inclusion, Sustainability and Equal Opportunity
Oxford University Wellbeing Research Centre
Physician Affiliate Group of New York
Templeton World Charity Foundation
The Consumer Goods Forum
Wellbeing for Planet Earth Foundation
Woodlands Health Campus
World Happiness Council
Racial/ethnic disparities in the availability of hospital based opioid use disorder treatmentChang, J. E., Franz, B., Cronin, C. E., Lindenfeld, Z., Lai, A. Y., & Pagán, J. A.
Journal titleJournal of Substance Abuse TreatmentAbstractIntroduction: While racial/ethnic disparities in the use of opioid use disorder (OUD) treatment in outpatient settings are well documented in the literature, little is known about racial/ethnic disparities in access to hospital-based OUD services. This study examines the relationship between hospital-based or initiated OUD services and the racial/ethnic composition of the surrounding community. Methods: We constructed a dataset marking the implementation of eight OUD strategies for a 20% random sample of nonprofit hospitals in the United States based on 2015–2018 community health needs assessments. We tested the significance of the relationship between each OUD strategy and the racial/ethnic composition of the surrounding county using two-level mixed effects logistic regression models that considered the hierarchical structure of the data of hospitals within states while controlling for hospital-level county-level, and state-level covariates. Results: In both unadjusted and adjusted models, we found that hospital adoption of several OUD services significantly varied based on the percentage of Black or Hispanic residents in their communities. Even after controlling for hospital size, the overdose burden in the community, community socioeconomic characteristics, and state funding, hospitals in communities with high percentage of Black or Hispanic residents had significantly lower odds of offering the most common hospital-based programs to address OUD – including programs that increase access to formal treatment services, prescriber guidelines, targeted risk education and harm reduction, and community coalitions to address opioid use. Conclusions: Hospital adoption of many OUD services varies based on the percentage of Black or Hispanic residents in their communities. More attention should be paid to the role, ability, and strategies that hospitals can assume to address disparities among OUD treatment and access needs, especially those that serve communities with a high concentration of Black and Hispanic residents.
Community Health Needs Predict Population Health Partnerships Among U.S. Children’s HospitalsFranz, B., Cronin, C. E., Wainwright, A., Lai, A. Y., & Pagán, J. A.
Journal titleMedical Care Research and Review
Page(s)771-779AbstractCross-sector collaboration is critical to improving population health, but data on partnership activities by children’s hospitals are limited, and there is a need to identify service delivery gaps for families. The aim of this study is to use public community benefit reports for all children’s hospitals in the United States to assess the extent to which children’s hospitals partner with external organizations to address five key health needs: health care access, chronic disease, social needs, mental health, and substance abuse. Strategies that involved partnering with community organizations were most common in addressing social needs and substance abuse. When adjusted for institutional and community characteristics hospitals in a multilevel regression model, hospitals had higher odds of partnering to address chronic illness and social needs. To encourage hospital engagement with complex social and behavioral health needs and promote health equity, support should be provided to help hospitals establish local population health networks.
Patient perceptions of safety in primary care: a qualitative study to inform careLasser, E. C., Heughan, J. A. A., Lai, A. Y., Yuan, C. T., Dy, S. M., Bittle, M., Oberlander, T., Pitts, S. I., Marsteller, J., & Hannum, S. M.
Journal titleCurrent Medical Research and Opinion
Page(s)1991-1999AbstractPatients’ perspectives on patient safety have rarely been incorporated into quality initiatives in primary care. Our objective was to understand the patient perspective on patient safety in patient-centered medical homes (PCMHs). We conducted 12 patient focus groups/interviews in nine sites with 65 patients at a geographically diverse sample of National Committee on Quality Assurance Level 3 recognized PCMHs across three states. Using a patient safety framework, we coded and analyzed interviews for overarching themes and subthemes across patient safety domains. Overarching themes focused on (1) both clear and timely communication with and between clinicians and (2) trust in the care team, including being heard, respected, and treated as a whole person. Other themes important to specific patient safety domains included sharing of and access to information, patient education and patient-centered medication reconciliation process, clear documentation for the diagnostic process, patient-centered comprehensive visits, and timeliness of care. Communication and trust are key to patient perceptions of safe primary care. Focusing on these themes across safety domains may help to make primary care both more patient-centered and safer, and should be considered in future ambulatory safety initiatives.
Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID EraChang, J. E., Lai, A. Y., Gupta, A., Nguyen, A. M., Berry, C. A., & Shelley, D. R.
Journal titleMilbank Quarterly
Page(s)340-368AbstractPolicy Points Telehealth has many potential advantages during an infectious disease outbreak such as the COVID-19 pandemic, and the COVID-19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode. Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Without proactive efforts to address both patient- and provider-related digital barriers associated with socioeconomic status, the wide-scale implementation of telehealth amid COVID-19 may reinforce disparities in health access in already marginalized and underserved communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them. Context: The COVID-19 pandemic has catalyzed fundamental shifts across the US health care delivery system, including a rapid transition to telehealth. Telehealth has many potential advantages, including maintaining critical access to care while keeping both patients and providers safe from unnecessary exposure to the coronavirus. However, not all health care providers and patients are equally ready to take part in this digital revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Methods: The study analyzed data about small primary care practices’ telehealth use and barriers to telehealth use collected from rapid-response surveys administered by the New York City Department of Health and Mental Hygiene's Bureau of Equitable Health Systems and New York University from mid-April through mid-June 2020 as part of the city's efforts to understand how primary care practices were responding to the COVID-19 pandemic following New York State's stay-at-home order on March 22. We focused on small primary care practices because they represent 40% of primary care providers and are disproportionately located in low-income, minority or immigrant areas that were more severely impacted by COVID-19. To examine whether telehealth use and barriers differed based on the socioeconomic characteristics of the communities served by these practices, we used the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) to stratify respondents as being in high-SVI or low-SVI areas. We then characterized respondents’ telehealth use and barriers to adoption by using means and proportions with 95% confidence intervals. In addition to a primary analysis using pooled data across the five waves of the survey, we performed sensitivity analyses using data from respondents who only took one survey, first wave only, and the last two waves only. Findings: While all providers rapidly shifted to telehealth, there were differences based on community characteristics in both the primary mode of telehealth used and the types of barriers experienced by providers. Providers in high-SVI areas were almost twice as likely as providers in low-SVI areas to use telephones as their primary telehealth modality (41.7% vs 23.8%; P <.001). The opposite was true for video, which was used as the primary telehealth modality by 18.7% of providers in high-SVI areas and 33.7% of providers in low-SVI areas (P <0.001). Providers in high-SVI areas also faced more patient-related barriers and fewer provider-related barriers than those in low-SVI areas. Conclusions: Between April and June 2020, telehealth became a prominent mode of primary care delivery in New York City. However, the transition to telehealth did not unfold in the same manner across communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.
Work Engagement and Patient Quality of Care: A Meta-Analysis and Systematic ReviewWee, K. Z., & Lai, A. Y.
Journal titleMedical Care Research and Review
Page(s)345-358AbstractPast research has demonstrated that work engagement among health care professionals influences patient quality of care. There is, however, no estimate of the strength of this relationship, and existing reviews have not always explained conflicting findings. We conduct a meta-analysis and review of 25 articles, and find a small to medium mean effect size (r =.26, p <.01) for the positive association between engagement and quality of care. Moderator analyses on five factors (type, data source, level of analysis of the quality of care measure, profession, and work engagement measure) indicate that only data source is significant, providing preliminary evidence that the relationship is stronger if quality of care is measured via self-assessments. Although a more consistent conceptualization of quality of care is needed to better determine its association with work engagement, our findings suggest that work engagement is as important as burnout in predicting quality of care.
COVID-19 and primary care physicians:: Adapting to rapid change in clinical roles and settingsLai, A., Thomas, S. C., Sullivan, E. E., Fleuren, B. P. I., Raj, M., DePuccio, M. J., Stephenson, A. L., & McAlearney, A. S.
Journal titleJournal of Hospital Management and Health Policy
Patient safety in primary care: Conceptual meanings to the health care team and patientsLai, A. Y., Yuan, C. T., Marsteller, J. A., Hannum, S. M., Lasser, E. C., Heughan, J. A. A., Oberlander, T., Berger, Z. D., Gurses, A. P., Kharrazi, H., Pitts, S. I., Scholle, S. H., & Dy, S. M.
Journal titleJournal of the American Board of Family Medicine
Page(s)754-764AbstractIntroduction: Patient safety in primary care is an emerging priority, and experts have highlighted medications, diagnoses, transitions, referrals, and testing as key safety domains. This study aimed to (1) describe how frontline clinicians, administrators, and staff conceptualize patient safety in primary care; and (2) compare and contrast these conceptual meanings from the patient’s perspective. Methods: We conducted interviews with 101 frontline clinicians, administrators and staff, and focus groups with 65 adult patients at 10 patient-centered medical homes. We used thematic analysis to approach coding. Results: Findings indicate that frontline personnel conceptualized patient safety more in terms of work functions, which reflect the grouping of tasks or responsibilities to guide how care is being delivered. Frontline personnel and patients conceptualized patient safety in largely consistent ways. Discussion: Function-based conceptualizations of patient safety in primary care may better reflect frontline personnel and patients’ experiences than domain-based conceptualizations, which are favored by experts.
Towards a greater global understanding of wellbeing: A proposal for a more inclusive measureLambert, L., Lomas, T., Weijer, M. P. D., Passmore, H. A., Joshanloo, M., Harter, J., Ishikawa, Y., Lai, A., Kitagawa, T., Chen, D., Kawakami, T., Miyata, H., & Diener, E.
Journal titleInternational Journal of Wellbeing
Page(s)1-18AbstractThe science of wellbeing has come a long way from the early days of measuring wellbeing via a nation’s GDP, and wellbeing measures and concepts continue to proliferate to capture its various elements. Yet, much of this activity has reflected concepts from Western cultures, despite the emphasis placed on wellbeing in all corners of the globe. To meet the challenges and opportunities arising from cross-disciplinary research worldwide, the Well-Being for Planet Earth Foundation and the Gallup World Poll have joined forces to add more culturally relevant constructs and questions to existing Gallup modules. In this white paper, we review the discussion from the international well-being summit in Kyoto, Japan (August 2019), where nine such additions were proposed and highlight why a more global view of wellbeing is needed. Overall, the new items reflect a richer view of wellbeing than life satisfaction alone and include hedonic and eudaimonic facets of wellbeing, social wellbeing, the role of culture, community, nature, and governance. These additions allow for the measurement of a broader conceptualization of wellbeing, more refined and nuanced cross-cultural comparisons, and facilitate a better examination of the causes of variation in global wellbeing. The new Gallup World Poll additions will be trialled in 2020, with additional inclusions from this summit to be made in 2021.
Collaborative Processes of Developing A Health Literacy Toolkit: A Case from Fukushima after the Nuclear Accident
Prescription drug monitoring program design and function: A qualitative analysisRutkow, L., Smith, K. C., Lai, A. Y., Vernick, J. S., Davis, C. S., & Alexander, G. C.
Journal titleDrug and alcohol dependence
Page(s)395-400AbstractBackground Opioid-related overdose deaths are a major public health challenge. Forty-nine states have implemented Prescription Drug Monitoring Programs (PDMPs) that collect information about individuals’ prescription medications. Little is known about state governments’ implementation of PDMPs. We conducted semi-structured interviews with PDMP staff, law enforcement officials, and administrative agency employees to learn about their attitudes and experiences with PDMPs. Methods From May 2015 to June 2016, we conducted 37 semi-structured interviews with state actors in four states. Questions focused on interviewees’ perceptions about PDMP goals, home agency characteristics, and future PDMP initiatives. States were selected purposively. Interviewees were identified through purposive and snowball sampling. Results Interviewees identified key PDMP goals as: improve patient treatment decisions; influence prescribing practices; assist in the identification of “doctor shoppers” and serve as a tool for law enforcement. Interviewees identified the following characteristics as key for a PDMP's home agency: regulatory and enforcement authority; intra- and inter-agency collaboration; and commitment to data quality and protection. Interviewees identified three promising areas for future PDMP efforts: data sharing and analysis; integration of PDMP data with electronic medical records; and training for current and potential PDMP users. Conclusions Our findings reveal areas that states may want to prioritize, including improving prescribers’ knowledge and use of the PDMP as well as fostering inter-agency collaborations that include PDMP staff. By capitalizing on these opportunities, state governments may improve the effectiveness of their PDMPs, potentially making them more useful tools to curb the morbidity and mortality associated with opioid use disorders.
Identifying teaching award criteria for health professional educators
Health literacy training for public health nurses in fukushima: A multi-site program evaluationGoto, A., Lai, A. Y., & Rudd, R. E.
Journal titleJapan Medical Association Journal
Page(s)69-77AbstractPublic health nurses (PHNs) are community residents’ access points to health information and services in Japan. After the Fukushima nuclear accident, they were challenged to communicate radiation-related health information to best meet community needs. We previously developed and evaluated the outcome of a single-site health literacy training program to augment PHNs’ ability to improve community residents’ access to written health information. This paper presents an evaluation of an identical training program using data combined from multiple sites, and further included proximal and distal evaluations to document the impact of health literacy training in a post-disaster setting. A total of 64 participants, primarily experienced PHNs, attended one of three multisession health literacy workshops conducted in multiple sites across Fukushima. Quantitative and qualitative data on PHNs’ training satisfaction, self-evaluation of achievements regarding training goals, and application of learned skills were collected and analyzed. Each workshop consisted of two 2-hour sessions introducing health literacy and assessment tools and developing skills to improve written materials, followed by a one-month follow- up assessment on PHNs’ application of the gained skills in the field. Post-training evaluations on the appropriateness and usefulness of the workshop were highly positive. At the end of the one-month follow-up, 45% of participants had gained confidence in assessing and revising written materials and had applied the skills they had gained to develop and communicate health information in various settings and modes. This increase in confidence was associated with further application of the learned skills at the municipal level. However, participants reported difficulties in explaining risks, and the need to learn more about plain language to be able to paraphrase professional terms. This paper highlighs the positive outcomes of health literacy training among PHNs. Practical strategies to reinforce their skills to use plain language and communicate the epidemiological concept of risk are also recommended.
Health literacy training for public health nurses in Fukushima: A case-study of program adaptation, implementation and evaluation
Leveraging public health nurses for disaster risk communication in Fukushima City: A qualitative analysis of nurses' written records of parenting counseling and peer discussionsGoto, A., Rudd, R. E., Lai, A. Y., Yoshida, K., Suzuki, Y., Halstead, D. D., Yoshida-Komiya, H., & Reich, M. R.
Journal titleBMC health services research
Issue1AbstractBackground: Local public health nurses (PHNs) have been recognized as the main health service providers in communities in Japan. The Fukushima nuclear disaster in 2011 has, however, created a major challenge for them in responding to mothers' concerns. This was in part due to difficulties in assessing, understanding and communicating health risks on low-dose radiation exposure. In order to guide the development of risk communication plans, this study sought to investigate mothers' primary concerns and possible solutions perceived by a core healthcare profession like the PHNs. Methods. A total of 150 records from parenting counseling sessions conducted between PHNs and mothers who have attended mandatory 18-month health checkups for their children at the Fukushima City Health and Welfare Center in 2010, 2011 (year of disaster) and 2012 were examined. Discussion notes of three peer discussions among PHNs organized in response to the nuclear disaster in 2012 and 2013 were also analyzed. All transcribed data were first subjected to text mining to list the words according to their frequencies and inter-relationships. The Steps Coding and Theorization method was then undertaken as a framework for qualitative analysis. Results: PHNs noted mothers to have considerable needs for information on radiation risks as they impact on decisions related to relocations, concerns for child safety, and experiences with interpersonal conflicts within the family owing to differing risk perceptions. PHNs identified themselves as the information channels in the community, recommended the building of their risk communication capacities to support residents in making well-informed decisions, and advocated for self-measurement of radiation levels to increase residents' sense of control. PHNs also suggested a more standardized form of information dissemination and an expansion of community-based counseling services. Conclusions: Inadequate risk communication on radiation in the Fukushima nuclear incident has resulted in multiple repercussions for mothers in the community. Empowerment of local residents to assume more active roles in the understanding of their environment, increasing PHNs' capacity in communication, and an expansion of health services such as counseling will together better address risk communication challenges in post-disaster recovery efforts.
Non-adherence in patients on peritoneal dialysis: A systematic reviewGriva, K., Lai, A. Y., Lim, H. A., Yu, Z., Foo, M. W. Y., & Newman, S. P.
Journal titlePloS one
Issue2AbstractBackground: It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). Methods: A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. Results: The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of nonadherence varied across studies: 2.6-53% for dialysis exchanges, 3.9-85% for medication, and 14.4-67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. Conclusion: Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population.
Communicative and critical health literacy, and self-management behaviors in end-stage renal disease patients with diabetes on hemodialysisLai, A. Y., Ishikawa, H., Kiuchi, T., Mooppil, N., & Griva, K.
Journal titlePatient Education and Counseling
Page(s)221-227AbstractObjective: Health Literacy (HL) has been linked to disease self-management and various health outcomes, and can be separated into components of functional, communicative and critical skills. The high comorbidity between diabetes and end-stage renal disease (ESRD) poses concerns for compromised disease self-management. This study aimed to identify the relationships between HL and self-management behaviors in end-stage renal disease patients with diabetes. Methods: Self-report questionnaires measuring HL and self-management with the Functional, Communicative and Critical HL scale and Summary of Diabetes Self-Care Activities, respectively, were implemented with a sample of 63 patients. Socio-demographic and clinical characteristics were obtained from medical records. Results: Self-management in diabetes was associated with communicative and critical HL, but not functional HL. Educational attainment was associated only with functional HL. No relationship between HL and glycated hemoglobin (HbA1c) was identified. Conclusion: Communicative and critical HL skills are associated with self-management in ESRD patients with diabetes. Education levels are not related to self-management. Practice implications: Healthcare professionals and health information aiming to improve self-management in ESRD patients with diabetes should consider their capacities of communicative and critical HL instead of solely assessing functional HL.
Perspectives of patients, families, and health care professionals on decision-making about dialysis modality-the good, the bad, and the misunderstandings!Griva, K., Li, Z. H., Lai, A. Y., Choong, M. C., & Foo, M. W. Y.
Journal titlePeritoneal Dialysis International
Page(s)280-289AbstractObjectives: This study explored the factors influencing decision-making about dialysis modality, integrating the perspectives of patients, their families, and health care professionals within an Asian population. The study further sought to understand the low penetration rate of peritoneal dialysis (PD) in Singapore. Methods: A sample of 59 participants comprising pre-dialysis patients, dialysis patients, caregivers, and health care professionals (HCPs) participated in semi-structured interviews to explore the decision-making process and their views about various dialysis modalities. Data were thematically analyzed using NVivo9 (QSR International, Doncaster, Australia) to explore barriers to and facilitators of various dialysis modalities and decisional support needs. Results: Fear of infection, daily commitment to PD, and misperceptions of PD emerged as barriers to PD. Side effects, distance to dialysis centers, and fear of needling and pain were barriers to hemodialysis (HD). The experiences of other patients, communicated informally or opportunistically, influenced the preferences and choices of patients and family members for a dialysis modality. Patients and families value input from HCPs and yet express strong needs to discuss subjective experiences of life on dialysis (PD or HD) with other patients before making a decision about dialysis modality. Conclusions: Pre-dialysis education should expand its focus on the family as the unit of care and should provide opportunities for interaction with dialysis patients and for peer-led learning. Barriers to PD, especially misperceptions and misunderstandings, can be targeted to improve PD uptake.
Starting on haemodialysis: A qualitative study to explore the experience and needs of incident patientsLai, A. Y., Loh, A. P. P., Mooppil, N., Krishnan, D. S. P., & Griva, K.
Journal titlePsychology, Health and Medicine
Page(s)674-684AbstractDialysis can be very stressful with the initial months onto treatment being highly critical in terms of both adaptation and mortality. This qualitative study aimed to explore the lived experiences of incident haemodialysis patients in Singapore. Topics related to the end-stage renal disease diagnosis and haemodialysis treatment were raised with 13 incident haemodialysis patients in the form of semi-structured interviews, and interpretative phenomenological analysis was undertaken as the framework for data analysis. Emotional distress, treatment-related concerns and social support emerged as main issues following a critical review of themes. Our study revealed that incident haemodialysis patients have emotional and informational needs, highlighting the importance of intervention programmes in particular to this patient group to promote better psychosocial adjustment to the disease and its treatment.