Alden Lai

Alden Lai
Alden Lai
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Assistant Professor of Public Health Policy and Management

Professional overview

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.

Education

BA, Psychology, National University of Singapore, Singapore
MPH, Social & Behavioral Sciences, The University of Tokyo, Japan
PhD, Health Policy & Management (Organizational Behavior), Johns Hopkins University, Baltimore, MD

Honors and awards

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)

Areas of research and study

Health Care Workforce
Managerial Cognition
Patient Safety
Population Health
Primary Care
Proactivity at Work
Qualitative and Mixed Methods
Qualitative Research
Well-Being at Work

Consulting and Community Engagement

Asian Venture Philanthropy Network
Carnegie UK Trust
Clinical Directors Network Inc.
Earth Company
G1 Institute Japan
Gallup Inc.
Harvard University Human Flourishing Program
John Templeton Foundation
Unson 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
Nikkei Inc.
OECD Statistics and Data Directorate
OECD Center for Well-Being, Inclusion, Sustainability and Equal Opportunity
Otsuka Pharmaceutical
Oxford University Wellbeing Research Centre
PERSOL Holdings
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

Publications

Publications

Managing Surges in Demand: A Grounded Conceptual Framework of Surge Management Capability

Larson, J. D., Lai, A. Y., DePuccio, M. J., & Hilligoss, B. (n.d.).

Publication year

2024

Journal title

Medical Care Research and Review

Volume

81

Issue

3

Page(s)

245-258
Abstract
Abstract
Surge management is important to hospital operations, yet surge literature has mostly focused on the addition of resources (e.g., 25% more beds) during events like pandemics. Such views are limiting, as meeting surge demands requires hospitals to engage in practices tailored to a surge’s unique contingencies. We argue that a dynamic view of surge management should include surge management capability, which refers to how resources are deployed to respond to surge contingencies. To understand this capability, we qualitatively studied five hospital systems experiencing multiple surges due to COVID-19 between April 2020 and March 2022. We develop a framework showing that managing surges involves preserving capacity, expanding capacity, smoothing capacity demand, and enabling surge management. We contribute to surge literature by identifying practices hospitals can adopt to address surges and offering a better understanding of surge conditions (e.g., degree of novelty) that make some surge management practices more appropriate than others.

Proactive behaviors and health care workers: A systematic review

Lai, A. Y., Wee, K. Z., & Frimpong, J. A. (n.d.).

Publication year

2024

Journal title

Health Care Management Review

Volume

49

Issue

3

Page(s)

239-251
Abstract
Abstract
Background Proactive behaviors at work refer to discretionary actions among workers that are self-starting, change oriented, and future focused. Proactive behaviors reflect the idiosyncratic actions by individual workers that shape the delivery and experience of professional services, highlight a bottom-up perspective on workers' agency and motivation that can influence organizational practices, and are associated with a variety of employee and organizational outcomes. Purpose This systematic review aims to understand the various forms of proactive behaviors in health care workers that have been studied, and how these proactive behaviors are associated with employee-level outcomes and quality of care. Methods Systematic review of articles published to date on proactive behaviors in health care workers. Results Based on the identification of 40 articles, we find that job crafting, active problem solving, voice, extra-role behaviors, and idiosyncratic deals have been investigated as proactive behaviors among health care workers. Among these, job crafting is the most commonly studied (35% of articles), and it has been conceptualized and measured in the most consistent way, including as individual- and group-level phenomena, and as organizational interventions. Studies on active problem solving, which refers to workers accepting responsibility, exercising control, and taking action around anticipated or experienced problems at work, have not been consistently investigated as a form of proactive behavior but represent 25% of the articles identified in this review. Overall, this review finds that proactive behaviors in health care is a burgeoning area of research, with the majority of studies being cross-sectional in design and published after 2010, and focused on workers' job satisfaction as the outcome. Practice Implications Health care workers and managers should consider the distinct influences and contributions of proactive behaviors as ways to improve employee-level outcomes and quality of care.

Complexifying Individualism Versus Collectivism and West Versus East: Exploring Global Diversity in Perspectives on Self and Other in the Gallup World Poll

Lomas, T., Diego-Rosell, P., Shiba, K., Standridge, P., Lee, M. T., Case, B., Lai, A. Y., & VanderWeele, T. J. (n.d.).

Publication year

2023

Journal title

Journal of Cross-Cultural Psychology

Volume

54

Issue

1

Page(s)

61-89
Abstract
Abstract
A 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 Assistants

Lai, A. Y., Fleuren, B. P., Yuan, C. T., Sullivan, E. E., & Mark McNeill, S. (n.d.).

Publication year

2023

Journal title

Journal of the American Board of Family Medicine

Volume

36

Issue

1

Page(s)

193-199
Abstract
Abstract
Medical 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.

Starting from scratch: New work design to enact entrance screening during the COVID-19 pandemic

Lai, A. Y., Larson, J. D., Depuccio, M. J., & Hilligoss, B. (n.d.).

Publication year

2023

Journal title

Health Care Management Review

Volume

48

Issue

3

Page(s)

260-273
Abstract
Abstract
Background Health care organizations are constantly creating new work to achieve evolving goals such as digitalization, equity, value, or well-being. However, scholars have paid less attention to how such work becomes "work"in the first place, despite implications for the design, quality, and experience of work and, consequently, employee and organizational outcomes. Purpose The aim of this study was to investigate how new work becomes enacted in health care organizations. Methodology A longitudinal, qualitative case study on the enactment of entrance screening - a new operation in response to COVID-19 - in a multihospital academic medical center was performed. Results Entrance screening comprised four tasks, whose design was initially influenced by institutional guidelines (e.g., Centers for Disease Control and Prevention recommendations) and clinical experts. Organizational-level influences (e.g., resource availability) then became more prominent, necessitating multiple feedback-response loops to calibrate the performance of entrance screening. Finally, entrance screening was integrated into existing operations of the organization to ensure operational sustainability. The treatment of entrance screening as an operation changed over time - initially seen as infection control work, it eventually bifurcated into patient care and clerical work. Conclusion The enactment of new work is constrained by the fit between resources and its intended output. Furthermore, the schema of work influences how and when organizational actors calibrate this fit. Practice Implications Health care leaders and managers should continuously update their schemas of work so that they can develop more sufficient and accurate representations of the employee capabilities that are required for the performance of new work.

The world prefers a calm life, but not everyone gets to have one: global trends in valuing and experiencing calmness in the Gallup World Poll

Lomas, T., Diego-Rosell, P., Shiba, K., Standridge, P., Lee, M. T., & Lai, A. Y. (n.d.).

Publication year

2023

Journal title

Journal of Positive Psychology
Abstract
Abstract
Psychology has paid relatively little attention to low arousal positive states like calmness. To remedy this lacuna, this study draws on the most globally comprehensive study to date on calmness (121,207 participants in 116 countries in the 2020 Gallup World Poll), featuring two items asking whether people: (a) prefer a calm life or an exciting life; and (b) experienced calmness yesterday. By intersecting these, we could categorise people in four categories of calmness: satisfied (both prefer and experience it); unwanted (experience calmness but prefer excitement); longed-for (prefer calmness but don’t experience it); and unmissed (neither prefer nor experience it). The results reveal a nuanced picture that challenges certain stereotypes (e.g. calmness had no particular association here with Eastern cultures), and shed new light on this overlooked topic (e.g. poorer people and countries are more likely to prefer calmness yet are less likely to actually experience it).

A double-edged sword: The effects of social network ties on job satisfaction in primary care organizations

Yuan, C. T., Lai, A. Y., Benishek, L. E., Marsteller, J. A., Mahabare, D., Kharrazi, H., & Dy, S. M. (n.d.).

Publication year

2022

Journal title

Health Care Management Review

Volume

47

Issue

3

Page(s)

180-187
Abstract
Abstract
BACKGROUND: 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 Analysis

Dy, 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.).

Publication year

2022

Journal title

Journal of Patient Safety

Volume

18

Issue

1

Page(s)

E249-E256
Abstract
Abstract
Objectives: 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 module

Lomas, T., Ishikawa, Y., Diego-Rosell, P., Daly, J., English, C., Harter, J., Standridge, P., Clouet, B., Diener, E., & Lai, A. Y. (n.d.).

Publication year

2022

Journal title

International Journal of Wellbeing

Volume

12

Issue

4

Page(s)

1-19
Abstract
Abstract
Over 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 transformation

Lai, A. Y., Fleuren, B. P., Larkin, J., Gruenewald-Schmitz, L., & Yuan, C. T. (n.d.).

Publication year

2022

Journal title

Health Care Management Review

Volume

47

Issue

4

Page(s)

340-349
Abstract
Abstract
Background 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 Study

Yuan, 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.).

Publication year

2022

Journal title

American Journal of Medical Quality

Volume

37

Issue

5

Page(s)

379-387
Abstract
Abstract
Although 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.

Final Thoughts

Kwasnicka, D., & Lai, A. Y. (n.d.). In Survival Guide for Early Career Researchers: A Fulfilling Scholarly Career (1–).

Publication year

2022

Page(s)

253-257
Abstract
Abstract
As Early Career Researchers (ECRs), we face many competing demands in our work that require distinct skillsets to effectively be involved in research, acquiring funding, teaching, mentoring, service, professional development or any of the other numerous demands placed on us. We may encounter imposter syndrome. We may want to work towards better work-life balance. We may find ourselves suddenly thrusted into the limelight to talk about our research with the media. This book is foremost an acknowledgement of the challenges that ECRs face, and we have therefore sought to put together a compendium of hacks that you can use to deal with those challenges. In this chapter, we share main themes that have emerged throughout this book: self-discovery, building your support team, having a career strategy and having an impact. These key issues were highlighted by our contributing authors as some of the key drivers to their career success.

Global Trends of Mean and Inequality in Multidimensional Wellbeing: Analysis of 1.2 Million Individuals From 162 Countries, 2009–2019

Shiba, K., Cowden, R. G., Gonzalez, N., Lee, M. T., Lomas, T., Lai, A. Y., & VanderWeele, T. J. (n.d.).

Publication year

2022

Journal title

Frontiers in Public Health

Volume

10
Abstract
Abstract
Introduction: 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 treatment

Chang, J. E., Franz, B., Cronin, C. E., Lindenfeld, Z., Lai, A. Y., & Pagán, J. A. (n.d.).

Publication year

2022

Journal title

Journal of Substance Abuse Treatment

Volume

138
Abstract
Abstract
Introduction: 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.

Setting Up for a Thriving Career

Lai, A. Y. (n.d.). In Survival Guide for Early Career Researchers: Assessing Your Scholarly Identity and Institutional Environment (1–).

Publication year

2022

Page(s)

13-25
Abstract
Abstract
What does it mean to be thriving in our early careers as researchers? In this chapter, I discuss the need to assess our scholarly identity and our institutional environment so that we can maximize the fit between them to craft a thriving career for ourselves. I also discuss how assessing our scholarly identities requires continuous reflection on what we do at work, as well as the communities and places that we belong to, and the ways we most want to spend our time. I consider the fundamental elements of scholarly institutional environments - research, funding, teaching, mentoring, service, and professional development activities - and look at how they shape the norms of an institution and define the extent to which we can assert our scholarly identity. This chapter aims to clarify how we can better align what our institutions expect with what we individually value as early career researchers so that we can sustainably enjoy our work and be good at it, and thus thrive.

State-level unemployment and negative emotions throughout the Covid-19 pandemic in the United States

Hagen, D., Lai, A. Y., & Goldmann, E. (n.d.).

Publication year

2022

Journal title

Preventive Medicine

Volume

164
Abstract
Abstract
Although 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.

Survival Guide for Early Career Researchers

Kwasnicka, D., & Lai, A. Y. (n.d.). (1–).

Publication year

2022
Abstract
Abstract
Navigating research careers is often highly challenging for early career researchers (ECRs) in the social sciences. The ability to thrive in research careers is complex and requires "soft" people and management skills and resilience that often cannot be formally taught through university coursework. Written from a peer perspective, this book provides guidance and establishes emotional rapport on topical issues relevant for ECRs in academia and industry. The authors are ECRs who have been successful in navigating their careers, and they seek to connect with readers in a supportive and collegial manner. Each chapter includes elements of story-telling and scientific thinking and is organized into three parts: (1) a personal story that is relevant to the topic; (2) key content on professional and personal effectiveness based on evidence in the psychological, sociological, and/or management sciences; and (3) action points and practical recommendations. The topics covered are specifically curated for people considering undertaking research careers or already working in research, including: • Work Hard, Snore Hard: Recovery from Work for Early Career Researchers • Networking and Collaborating in Academia: Increasing Your Scientific Impact and Having Fun in the Process • Accelerating Your Research Career with Open Science • Engaging with the Press and Media • Make Your Science Go Viral: How to Maximize the Impact of Your Research • Exploring the Horizon: Navigating Research Careers Outside of Academia • Thinking like an Implementation Scientist and Applying Your Research in Practice Survival Guide for Early Career Researchers summarizes relevant evidence-based research to offer advice in strategic but also supportive ways to ECRs. It is an essential go-to practical resource for PhD students, postdoctoral fellows, and junior faculty. This book will also benefit senior researchers who are serving as mentors or delivering professional development programs, administrators and educators in institutions of higher learning, and anyone with an interest in building a successful research career.

Trends in negative emotions throughout the COVID-19 pandemic in the United States

Hagen, D., Lai, A. Y., & Goldmann, E. (n.d.).

Publication year

2022

Journal title

Public Health

Volume

212

Page(s)

4-6
Abstract
Abstract
Objectives: 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 Review

Wee, K. Z., & Lai, A. Y. (n.d.).

Publication year

2022

Journal title

Medical Care Research and Review

Volume

79

Issue

3

Page(s)

345-358
Abstract
Abstract
Past 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.

Work Hard, Snore Hard

Gatari, E., Fleuren, B., & Lai, A. Y. (n.d.). In Survival Guide for Early Career Researchers: Recovery from Work for Early Career Researchers (1–).

Publication year

2022

Page(s)

41-51
Abstract
Abstract
Being an early career researcher often means having to work intensely on projects and articles. Periods with heavy workloads are common, and proper recovery during breaks or after work can sometimes not take place because of limited time. As prolonged periods of intense work with little rest may lead to long-term negative effects, this chapter discusses the importance of recovery and several actionable tips to consider for early career researchers. We begin with a brief personal example that illustrates why sufficient rest is needed. Next, we introduce recovery from work concepts. We explain that optimal recovery from work on a daily basis is necessary to offset negative long-term effects such as fatigue and burnout. Based on research in occupational health psychology, we provide several practical tips on how to recover well and overcome challenges related to recovery from work. The aim is to help early career researchers in preventing exhaustion or eventually burnout, so they can keep doing their work in a sustainable way.

Community Health Needs Predict Population Health Partnerships Among U.S. Children’s Hospitals

Franz, B., Cronin, C. E., Wainwright, A., Lai, A. Y., & Pagán, J. A. (n.d.).

Publication year

2021

Journal title

Medical Care Research and Review

Volume

78

Issue

6

Page(s)

771-779
Abstract
Abstract
Cross-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 rest

Fleuren, 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 (1–).

Publication year

2021

Volume

20

Page(s)

273-282
Abstract
Abstract
The 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 care

Lasser, 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.).

Publication year

2021

Journal title

Current Medical Research and Opinion

Volume

37

Issue

11

Page(s)

1991-1999
Abstract
Abstract
Patients’ 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 Era

Chang, J. E., Lai, A. Y., Gupta, A., Nguyen, A. M., Berry, C. A., & Shelley, D. R. (n.d.).

Publication year

2021

Journal title

Milbank Quarterly

Volume

99

Issue

2

Page(s)

340-368
Abstract
Abstract
Policy 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 CARE

Lai, A. Y. (n.d.).

Publication year

2021

Journal title

Academy of Management Discoveries

Volume

7

Issue

4

Page(s)

581-602
Abstract
Abstract
Professional 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.

Contact

aldenlai@nyu.edu 708 Broadway New York, NY, 10003