Assistant Professor of 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
Complexifying Individualism Versus Collectivism and West Versus East: Exploring Global Diversity in Perspectives on Self and Other in the Gallup World PollLomas, T., Diego-Rosell, P., Shiba, K., Standridge, P., Lee, M. T., Case, B., Lai, A. Y., & VanderWeele, T. J. (n.d.).
Journal titleJournal of Cross-Cultural Psychology
Page(s)61-89AbstractA wealth of research has suggested the West tends toward individualism and the East toward collectivism. We explored this topic on an unprecedented scale through two new items in the 2020 Gallup World Poll, involving 121,207 participants in 116 countries. The first tapped into orientations toward self-care versus other-care (“Do you think people should focus more on taking care of themselves or on taking care of others?”). The second enquired into self-orientation versus other-orientation (“Which of the following is closest to your main purpose in life? Being good at what you do in your daily life, Caring for family and close friends, or Helping other people who need help?”). We anticipated that self-care and self-orientation would index individualism (hence be higher in the West), while other-care and other-orientation would index collectivism (hence be higher in the East). However, contrary to expectation, there was greater self-care in the East (45.82%) than in the West (41.58%). As predicted though, there was greater self-orientation in the West (30.20%) than in the East (23.08.%). Greater self-care in the East invites one of two interpretations. Either these items: (a) index individualism and collectivism as anticipated, so in some ways the East is more individualistic and the West less individualistic than assumed; or (b) do not index individualism and collectivism as anticipated, so the concepts are more complex than often realized (e.g., collectivism may involve prioritizing self-care over other-care). Either way, the findings help complexify these concepts, challenging common cross-cultural generalizations in this area.
Delivering High-Quality Primary Care Requires Work That Is Worthwhile for Medical AssistantsLai, A. Y., Fleuren, B. P., Yuan, C. T., Sullivan, E. E., & Mark McNeill, S. (n.d.).
Journal titleJournal of the American Board of Family Medicine
Page(s)193-199AbstractMedical assistants are core members of the primary care team, but health care organizations struggle to hire and retain them amid the ongoing exodus of health care workers as part of the “Great Resignation.” To sustain a stable and engaged workforce of medical assistants, we argue that efforts to hire and retain them should focus on making their work worthwhile. Work that is worthwhile includes adequate pay, benefits, and job security, but additionally enables employees to experience a sense of contribution, growth, social connectedness, and autonomy. We highlight opportunities during team huddles, the rooming of patients, and career development where the work of medical assistants can be made worthwhile. We also connect these components to the work design literature to show how clinic managers and supervising clinicians can promote worthwhile work through decision-making and organizational climate. Going beyond financial compensation, these components target the latent occupational needs of medical assistants and are likely to forge employee-employer relationships that are mutually valued and sustained over time.
A double-edged sword: The effects of social network ties on job satisfaction in primary care organizationsYuan, C. T., Lai, A. Y., Benishek, L. E., Marsteller, J. A., Mahabare, D., Kharrazi, H., & Dy, S. M. (n.d.).
Journal titleHealth Care Management Review
Page(s)180-187AbstractBACKGROUND: Social ties between health care workers may be an important driver of job satisfaction; however, research on this topic is limited.PURPOSE: We used social network methods to collect data describing two types of social ties, (a) instrumental ties (i.e., exchange of advice that enables work) and (b) expressive ties (i.e., exchange of social support), and related those ties to workers' job satisfaction.METHODOLOGY: We surveyed 456 clinicians and staff at 23 primary care practices about their social networks and workplace attitudes. We used multivariable linear regression to estimate the relationship between an individual's job satisfaction and two network properties: (a) eigenvector centrality (a measure of the importance of an individual in a network) and (b) ego network density (a measure of the cohesiveness of an individual's network). We examined this relationship for both instrumental and expressive ties.RESULTS: Individuals who were more central in the expressive network were less satisfied in their job, b = -0.40 (0.19), p < .05, whereas individuals who had denser instrumental networks were more satisfied in their job, b = 0.49 (0.21), p < .05.CONCLUSION: Workplace relationships affect worker well-being. Centrality in an expressive network may require greater emotional labor, increasing workers' risk for job dissatisfaction. On the other hand, a dense instrumental network may promote job satisfaction by strengthening workers' access to full information, supporting competence and confidence.PRACTICE IMPLICATIONS: Efforts to increase job satisfaction should consider both the positive and negative effects of social networks on workers' sense of well-being.
Association of Implementation and Social Network Factors With Patient Safety Culture in Medical Homes: A Coincidence AnalysisDy, S. M., Acton, R. M., Yuan, C. T., Hsu, Y. J., Lai, A. Y., Marsteller, J., Ye, F. C., McGee, N., Kharrazi, H., Mahabare, D., Kim, J., Gurses, A. P., Bittle, M., & Scholle, S. H. (n.d.).
Journal titleJournal of Patient Safety
Page(s)E249-E256AbstractObjectives: The patient-centered medical home (PCMH) may provide a key model for ambulatory patient safety. Our objective was to explore which PCMH and patient safety implementation and social network factors may be necessary or sufficient for higher patient safety culture. Methods: This was a cross-case analysis study in 25 diverse U.S. PCMHs. Data sources included interviews of a clinician and an administrator in each PCMH, surveys of clinicians and staff, and existing data on the PCMHs' characteristics. We used coincidence analysis, a novel method based on set theory and Boolean logic, to evaluate relationships between factors and the implementation outcome of patient safety culture. Results: The coincidence analysis identified 5 equally parsimonious solutions (4 factors), accounting for all practices with higher safety culture. Three solutions contained the same core minimally sufficient condition: the implementation factor leadership priority for patient safety and the social network factor reciprocity in advice-seeking network ties (advice-seeking relationships). This minimally sufficient condition had the highest coverage (5/7 practices scoring higher on the outcome) and best performance across solutions; all included leadership priority for patient safety. Other key factors included self-efficacy and job satisfaction and quality improvement climate. The most common factor whose absence was associated with the outcome was a well-functioning process for behavioral health. Conclusions: Our findings suggest that PCMH safety culture is higher when clinicians and staff perceive that leadership prioritizes patient safety and when high reciprocity among staff exists. Interventions to improve patient safety should consider measuring and addressing these key factors.
Balance and harmony in the Gallup World Poll: The development of the Global Wellbeing Initiative moduleLomas, T., Ishikawa, Y., Diego-Rosell, P., Daly, J., English, C., Harter, J., Standridge, P., Clouet, B., Diener, E., & Lai, A. Y. (n.d.).
Journal titleInternational Journal of Wellbeing
Page(s)1-19AbstractOver recent decades, scholarship on wellbeing has flourished. However, this has been critiqued as Western-centric, firstly in terms of the location of research participants and scholars, and moreover in terms of the very ideas and values through which wellbeing is understood. In response to such issues, the Global Wellbeing Initiative – a partnership between Gallup and the Wellbeing for Planet Earth foundation – was created to look at wellbeing from a more global perspective. The centrepiece of this initiative is a survey module in the Gallup World Poll. This paper charts the evolution of this module to date, from its initial incarnation in the 2020 poll (featuring items on various aspects of wellbeing) to a finalized 2022 iteration (which focuses specifically on balance and harmony). With the 2022 version now intended to stay consistent longitudinally, this paper establishes a valuable baseline for this important project which will contribute to a more inclusive and comprehensive understanding of wellbeing.
Being “low on the totem pole”: What makes work worthwhile for medical assistants in an era of primary care transformationLai, A. Y., Fleuren, B. P., Larkin, J., Gruenewald-Schmitz, L., & Yuan, C. T. (n.d.).
Journal titleHealth Care Management Review
Page(s)340-349AbstractBackground Primary care is undergoing a transformation to become increasingly team-based and multidisciplinary. The medical assistant (MA) is considered a core occupation in the primary care workforce, yet existing studies suggest problematic rates and costs of MA turnover. Purpose We investigated what MAs perceive their occupation to be like and what they value in it to understand how to promote sustainable employability, a concept that is concerned with an employee's ability to function and remain in their job in the long term. Approach We used a case of a large, integrated health system in the United States that practices team-based care and has an MA career development program. We conducted semistructured interviews with 16 MAs in this system and performed an inductive analysis of themes. Results Our analysis revealed four themes on what MAs value at work: (a) using clinical competence, (b) being a multiskilled resource for clinic operations, (c) building meaningful relationships with patients and coworkers, and (d) being recognized for occupational contributions. MAs perceived scope-of-practice regulations as limiting their use of clinical competence. They also perceived task similarity with nurses in the primary care setting and expressed a relative lack of performance recognition. Conclusion Some of the practice changes that enable primary care transformation may hinder MAs' ability to attain their work values. Extant views on sustainable employability assume a high bar for intrinsic values but are limited when applied to low-wage health care workers in team-based environments. Practice Implications Efforts to effectively employ and retain MAs should consider proactive communications on scope-of-practice regulations, work redesign to emphasize clinical competence, and the establishment of greater recognition and respect among MAs and nurses.
Challenges and Strategies for Patient Safety in Primary Care: A Qualitative StudyYuan, C. T., Dy, S. M., Yuanhong Lai, A., Oberlander, T., Hannum, S. M., Lasser, E. C., Heughan, J. A., Dukhanin, V., Kharrazi, H., Kim, J. M., Gurses, A. P., Bittle, M., Scholle, S. H., & Marsteller, J. A. (n.d.).
Journal titleAmerican Journal of Medical Quality
Page(s)379-387AbstractAlthough most health care occurs in the ambulatory setting, limited research examines how providers and patients think about and enact ambulatory patient safety. This multimethod qualitative study seeks to identify perceived challenges and strategies to improve ambulatory safety from the perspectives of clinicians, staff, and patients. Data included interviews (N = 101), focus groups (N = 65), and observations of safety processes (N = 79) collected from 10 patient-centered medical homes. Key safety issues included the lack of interoperability among health information systems, clinician-patient communication failures, and challenges with medication reconciliation. Commonly cited safety strategies leveraged health information systems or involved dedicated resources (eg, providing access to social workers). Patients also identified strategies not mentioned by clinicians, emphasizing the need for their involvement in developing safety solutions. This work provides insight into safety issues of greatest concern to clinicians, staff, and patients and strategies to improve safety in the ambulatory setting.
Global Trends of Mean and Inequality in Multidimensional Wellbeing: Analysis of 1.2 Million Individuals From 162 Countries, 2009–2019Shiba, K., Cowden, R. G., Gonzalez, N., Lee, M. T., Lomas, T., Lai, A. Y., & VanderWeele, T. J. (n.d.).
Journal titleFrontiers in Public Health
Volume10AbstractIntroduction: Human flourishing is a multidimensional concept characterized by a state of complete wellbeing. However, much of the prior research on wellbeing has principally focused on population averages assessed using a single item of wellbeing. This study examined trends in population averages and inequalities for a multidimensional index of wellbeing and compared emergent patterns with those found for Cantril's ladder, a measure of life satisfaction commonly used as a unidimensional index of wellbeing. Methods: Data were from the Gallup World Poll from the years 2009 to 2019, a repeated cross-sectional survey of nationally representative samples comprising ~1.2 million individuals from 162 countries. We assessed five domains of flourishing: (1) happiness, (2) health, (3) purpose, (4) character, and (5) social relationships. We used the Gini Index to estimate inequalities in wellbeing within populations. We examined and compared country ranking, global and region-specific trajectories of mean and inequality, and relationships with age for flourishing and Cantril's ladder. Results: Although all trends were highly correlated across the two metrics of wellbeing, we identified distinct patterns in flourishing concerning geography, time, and age relationships that were not observed for Cantril's ladder. Temporal trends and age relationships were different across domains of flourishing. Evidence of changing inequalities in wellbeing was also found, even when population averages were high or stable over time. Conclusion: Comprehensive measures of wellbeing are needed to capture the complex and changing patterns of wellbeing both within and across populations.
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. (n.d.).
Journal titleJournal of Substance Abuse Treatment
Volume138AbstractIntroduction: 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.
State-level unemployment and negative emotions throughout the Covid-19 pandemic in the United StatesHagen, D., Lai, A. Y., & Goldmann, E. (n.d.).
Journal titlePreventive Medicine
Volume164AbstractAlthough prior research has assessed public mental health in the U.S. throughout the COVID-19 pandemic, it is unclear how area-level unemployment impacted psychological well-being; moreover, studies that examine potential effect heterogeneity of the impact of area-level unemployment on well-being by employment status are lacking. To address these shortcomings, this study utilized data from Gallup's repeated cross-sectional, nationally representative COVID-19 web survey collected between April 2020 and July 2021 (n = 132,971). Survey modified Poisson regression models were estimated to determine the association between current unemployment rate in respondents' state of residence and experience of each of the following negative emotions during a lot of the prior day: sadness, worry, stress, anger, loneliness, depression, and anxiety. These models were stratified by employment status and sequentially adjusted for individual-level covariates, state fixed effects, and current state-level COVID-19 mortality. State-level unemployment was most strongly associated with sadness, followed by worry, anger, loneliness, stress, and anxiety; no associations were observed for depression. For sadness, worry, and stress, associations were strongest among full-time employed and retired individuals, and weakest among unemployed respondents and homemakers. Moreover, there was some evidence that state-level unemployment was negatively associated with the experience of anger in the early stages of the pandemic, and positively in its later stages. In sum, these findings suggest that Americans' emotional experience during the COVID-19 pandemic was considerably impacted by the state of the economy, highlighting the need for risk-buffering social policies.
Trends in negative emotions throughout the COVID-19 pandemic in the United StatesHagen, D., Lai, A. Y., & Goldmann, E. (n.d.).
Journal titlePublic Health
Page(s)4-6AbstractObjectives: This study aimed to identify trends in the prevalence of negative emotions in the United States throughout the COVID-19 pandemic between March 2020 and November 2021. Study design: This was a descriptive, repeated cross-sectional analysis of nationally representative survey data. Methods: Data originated from Gallup's COVID-19 web survey, encompassing 156,684 observations. Prevalence estimates for self-reported prior-day experience of sadness, worry, stress, anger, loneliness, depression, and anxiety were computed, plotted using descriptive trend graphs, and compared with 2019 estimates from the Gallup World Poll. Differences between estimates were evaluated by inspecting confidence intervals. Results: Stress and worry were the most commonly experienced negative emotions between March 2020 and November 2021; worry and anger were significantly more prevalent than prepandemic. The prevalence of sadness, worry, stress, and anger fluctuated considerably over time and declined steadily to prepandemic levels by mid-2021. Distinctive spikes in the prevalence of several negative emotions, especially sadness and anger, were observed following the murder of George Floyd. Conclusions: Several negative emotions exhibited excess prevalence during the pandemic, especially in spring/summer 2020. Despite recent reductions to prepandemic levels, continued monitoring is necessary to inform policies and interventions to promote population well-being.
Work Engagement and Patient Quality of Care: A Meta-Analysis and Systematic ReviewWee, K. Z., & Lai, A. Y. (n.d.).
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.
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. (n.d.).
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.
Even superheroes need restFleuren, B. P., Stephenson, A. L., Sullivan, E. E., Raj, M., Tietschert, M. V., Sriharan, A., Lai, A. Y., Depuccio, M. J., Thomas, S. C., & McAlearney, A. S. (n.d.). In Advances in Health Care Management: A guide to facilitating recovery from work for health-care workers during covid-19 and beyond.
Page(s)273-282AbstractThe COVID-19 pandemic burdens health-care workers (HCWs) worldwide. Amid high-stress conditions and unprecedented needs for crisis management, organizations face the grand challenge of supporting the mental health and well-being of their HCWs. The current literature on mental health and well-being primarily focuses on improving personal resilience among HCWs. However, this puts the responsibility for coping with COVID-19-related stress almost fully on the individual. This chapter discusses an important alternative framing of this issue – how health-care organizations (HCOs) can facilitate recovery from work processes (i.e., returning to a baseline level by engaging in nonwork activities after work) for their workers. Based on a narrative review of the occupational health psychology literature, we provide practical strategies for supporting the four key recovery experiences of detachment, control, mastery, and relaxation, as well as present general recommendations about how to promote recovery. These strategies can help HCOs facing the grand challenge of sustaining worker well-being and functioning during the COVID-19 pandemic, as well as during future pandemics and for workers facing high work pressure in general.
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. (n.d.).
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. (n.d.).
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.
THE INCOMPLETE, OUTDATED, INCORRECT, AND UNKNOWN: MITIGATING THREATS OF KNOWLEDGE ERRORS IN HIGH-PERFORMANCE PRIMARY CARELai, A. Y. (n.d.).
Journal titleACADEMY OF MANAGEMENT DISCOVERIES
Page(s)581-602AbstractProfessional service work is knowledge intensive and client dependent for the quantity and quality of available information. Knowledge errors occur when a professional service worker does not know certain facts about a client or lacks an adequate cognitive representation of a client’s profile. Using the case of “patient-centered medical homes” (PCMHs)—high-performance primary care clinics where workers are constantly acquir-ing information about patients to ensure their health and safety—I explore how PCMH workers handle knowledge errors at work. Through qualitative analysis, I find that PCMH workers encounter the threat of knowledge error from information that is incom-plete, outdated, incorrect, or unknown. To address these threats, they acquire information via four modes—gathering, verifying, expanding, and sensitizing—that generate two different forms of knowledge for the organization: (1) “maximized knowledge,” whose use is intentional to achieve organizational aims (e.g., to perform diagnoses); (2) “elaborated knowledge,” which represents new understanding, but whose use is com-paratively less scripted (e.g., a patient’s living situation). These discoveries suggest how different modes of information acquisition afford distinct opportunities for error prevention at the knowledge level, and that greater precision is needed when theorizing the ways in which organizational actors acquire information.
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. (n.d.).
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. (n.d.).
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. (n.d.).
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 AccidentGoto, A., Lai, A. Y., Kumagai, A., Koizumi, S., Yoshida, K., Yamawaki, K., & Rudd, R. E. (n.d.).
Journal titleJournal of Health Communication
Page(s)200-206AbstractFollowing the Fukushima nuclear accident in 2011, the central government provided health and radiation-related information that was incomplete, difficult to understand and contradictory, leading to widespread distrust in the community. Thus, from 2013 to 2014, we developed and implemented a series of health literacy training workshops for local public health nurses, often the first health care professionals with whom members of the community interact. The results from our program evaluation revealed that the task of paraphrasing professional terms and skills related to relaying numeric information to the community were difficult for the nurses to acquire. In 2016, to further support the communication efforts of public health nurses, we developed a pocket-size “health literacy toolkit” that contained a glossary explaining radiation-related terms in plain language and an index to measure the accessibility of both text and numerical information, so that nurses could calibrate and appreciate the literacy demand of information. This case study documents an interprofessional collaborative effort for the development of the toolkit, and highlights the iterative process of building health literacy skills in health care professionals.
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. (n.d.).
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 educatorsKrishnasamy, C., Lai, A. Y., Lim, L., & Lee, R. (n.d.).
Journal titleMedical education
Leveraging Public Health Nurses for Disaster Risk Communication in Fukushima CityGoto, A., Rudd, R. E., Lai, A. Y., Yoshida, K., Suzuki, Y., Halstead, D. D., Yoshida-Komiya, H., & Reich, M. R. (n.d.). In Effective Communication During Disasters: A Qualitative Analysis of Nurses’ Written Records of Parenting Counseling and Peer Discussions.
Page(s)225-246AbstractExperience from past nuclear accidents shows that poor risk communication increases uncertainty and panic among the public , which has also been observed after the Fukushima nuclear disaster that occurred on March 11, 2011 following the Great East Japan Earthquake. The central government of Japan failed to inform the municipal governments of the occurrence and severity of the incident in a timely manner, leading to chaotic migrations among residents, and eventually causing excess mortality among vulnerable populations such as the institutionalized elderly [2,3]. Mothers of young children are among the most-affected in the Fukushima nuclear incident, as inconsistent information about radiation levels in breast milk posted by two different professional organizations (the Japanese Society of Obstetrics and Gynecology and the Japan Radiological Society) had further created high levels of confusion in terms of maintaining safety for their children .
Health literacy training for public health nurses in fukushima: A multi-site program evaluationGoto, A., Lai, A. Y., & Rudd, R. E. (n.d.).
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.