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EP84 Organizational Cognition with Dr. Alden Lai
Alexandra Arriaga: Hello, everyone, and welcome back to another episode of I AM GPH. My name is Alexandra Arriaga, and today, we're going to be talking to Dr. Alden Lai. Dr. Alden is a management scholar who researches organizational cognition in healthcare and public health. He investigates the ways healthcare professionals and managers handle complex, ambiguous, or novel information at work, and how these processes contribute to the safety and quality performance of healthcare organizations. He also examines how people generate meaning and meaningfulness of work to understand issues on burnout, resilience, and workplace wellness. Dr. Lai has an affiliated appointment in the Department of Management and Organizations at NYU Stern. Prior to joining the NYU faculty, Dr. Lai was involved in teaching executive education, as well as graduate and undergraduate courses on healthcare leadership and management, patient safety, and quality improvement at the Johns Hopkins Bloomberg School of Public Health and Carey Business School. His professional experience includes being a management consultant, social enterprise strategist, and education research consultant. He was also the Novartis Visiting Fellow at Ho Chi Minh City Medicine and Pharmacy University in Vietnam, Visiting Fellow at Fukushima Medical University in Japan, and Chair of the European Health Psychology Society's early career researcher division, as well as executive board member in the Academy of Management's Division of Healthcare Management. If you'd like to learn more about his work and the advice he has for all NYU students, please stay tuned. Hello, Alden. How are you doing today?
Alden Lai: Hi, how's it going?
Alexandra Arriaga: It's going great. Thank you so much for coming today.
Alden Lai: Thanks for having me.
Alexandra Arriaga: Could you please tell us about your current role and your background?
Alden Lai: Sure. I am a new assistant professor in the Department of Public Health Policy and Management at the NYU School of Global Public Health. I have an affiliated appointment at the Stern School of Business in the Department of Management and Organizations. And as you can tell, my research really spans between public health and management studies.
Alexandra Arriaga: Yeah. And speaking of that, on our podcast, we've had great conversations with people doing work at the intersection of public health and another domain, such as technology, music, art, entrepreneurship, but can you tell us about your work, where it fits, and why you think interdisciplinary thinking is so important?
Alden Lai: Sure. So I see my scholarly profile really spanning between two fields, and the first is health services research, and the second is organization science. And so within HSR, I focus more on patient safety and quality improvement issues, and within organization science, I'm really interested in the cognitive theory. So in terms of how do managers and leaders think? How do these shape the way that organizations are being run? So I'm really interested in those. And digging deeper into the topics I'm doing research. And the first is really around organizational structures and processes around patient safety, quality improvement. And then the second one, which I'm increasingly having a bigger focus on, would be meaningful work among healthcare workers, and how does that impact on job-related as well as clinical outcomes? So I can talk all about why interdisciplinary thinking matters and stuff, but the thing is, I think we've heard that so much already. And I can just say that the main thing why I'm doing this is that it's just so fun. It's really fun for me, because you... Well, Kurt Lewin once mentioned there's nothing as practical as a good theory, right? So I think when you are kind of immersed in interdisciplinary thinking, like the way I'm approaching my research, there's a lot of theories and previous frameworks and perspectives I can draw from. And these are really fun for me, because I think it leads me to... They act like a North Star for me in terms of telling me, generally speaking, which direction I'm taking my research, how am I deviating, and basically giving me some kind of direction. But the other thing is that it’s also really fun because I get a lot of variation in terms of the different kinds of colleagues I'm working with, the different questions they're grappling with, and speaking a different language, so to speak. Even though we're all in academia, they care about different things, they come from different perspectives. So really kind of being in that space where I can deepen my thinking, but also have fun with different groups of people forming different communities. I think that's great. And that's why I never quite thought of doing interdisciplinary work as a very deliberate choice. It was more something that, because it's really fun and I just kind of, I got into it. So, yeah.
Alexandra Arriaga: So what's one example of interdisciplinary work for those that may not be familiar with it?
Alden Lai: Yeah, sure. Absolutely. So I was just actually thinking about this, and I'm sure that many students have different passions in different areas. So for example, you could be really into data science and reproductive health. You could be really into, say, substance abuse issues but also film studies. Right? And I think, generally speaking, people try to find the fit between "What am I good at?" and "What am I trying to do?" And the thing is sometimes you have one, you have two or more areas that you are really, really into. And I think it's really fun to then try to be a bit creative in terms of "How can I combine my passion for film studies and substance abuse issues? Or how can I combine my passion for reproductive health and data science? Can I be doing some kind of algorithm, machine learning, to predict certain things?" So I think it forces you to be a little bit more creative in terms of "I'm really interested in these, and I'm using this very unique combination of my interests to pursue something that perhaps hasn't been thought of before."
Alexandra Arriaga: Right. Absolutely. So speaking of these projects, one of them studies medical assistants and their ability to be empowered and motivated to perform their best work. And I think that's the dream we all have. We definitely want to find a workplace in which we can truly thrive and be our best. So can you tell us more about that study?
Alden Lai: Sure. So this is motivated by the fact... or an observation from a previous project that in primary care, medical assistants play a very important role. So just to refresh you quickly in terms of the role of the medical assistant, they are the ones checking you in and checking you out. So when you go in, they will be taking your vitals, they'll be maybe updating your electronic medical records, updating a medication list, et cetera, and also seeing what you need to maintain your health. And so they are the ones really setting up the whole process before the doctor or the clinician basically comes in. But at the same time, they also do a lot of coordination work and background work to make sure that your information is up to date, et cetera. So they have a very important role to play in primary care. But the thing is, they are also facing a lot of challenges in terms of... The salaries are kind of limited, and it's quote-unquote "an elastic labor market" in terms of... Basically, in the field that we were out, we were collecting data, and someone coined this term called a Target phenomenon. So if a new Target store were to open in a neighborhood, some healthcare systems are seeing an exodus of medical assistants from the system because they get a higher pay at Target, and you do things that are less... How to say, less perhaps emotionally or cognitively straining. You're packing things in a supermarket versus really being part of the health system, right? So there's this whole phenomenon that we are just trying to grapple with. So we're funding from a foundation. We were trying to find out more about the working conditions of medical assistants. What keeps them there? What keeps them motivated? What are the things that the managers and leaders can basically be considering to make sure that we better retain and better recruit medical assistants to make sure that primary care can be of top quality? Yeah.
Alexandra Arriaga: And so based on what you observed from this study, what type of solutions or conclusions did you come to?
Alden Lai: Yeah, so we're still in the middle of data analysis. I can't say too much right now, but I think generally speaking, it's really fascinating to just look at the different ways in which medical assistants are motivating themselves. So there's a limit to what the system can do in terms of increasing the salaries. Yes, salary is a really important component to everyone, but then people also have called other sets of work values, say, the ability to develop new skills and knowledge, the ability to use these new skills and knowledge, the ability to maintain meaningful relationships at work. So these are the different things that people value. And I think it's kind of aligned with what we're finding, at least from now in the data. And I think one important thing I can say from the study is that medical assistants can be pretty creative in terms of getting their recognition or kind of finding their own path to meaningful work, even though they are facing certain challenges. And one of them could be, they found that they're really good at facilitating the processes of a particular class of medications. So because of that, they've really seized the opportunity to be known for being the person to go to if a patient wants to be on that particular class of medications. Or they really take pride in being really good at drawing blood. So I remember this one particular medical assistant, she was telling me how she was really good at drawing blood, and at some point, patients knew about it. So patients would then be asking, "Oh, is this particular MA working on Tuesday? Then I want my blood drawn on a Tuesday only, because she only pokes me once, never twice." So things like that really create some kind of recognition for the medical assistants. And then they say, "Wow, I'm really happy that I'm being recognized on my blood drawing skills. Patients are giving me the validation, and they really congratulated me for that. So I feel that I have a role to play in the primary care clinic." So I feel that these mechanisms allow the medical assistants to generate more meaning in their work, and so we're basically trying to systematically identify these ways and to see how managers and leaders can be replicating them to make sure that we help workers feel more meaning in their work.
Alexandra Arriaga: Okay. So I can see how this is very important, because basically what you're saying is, salary or an increment in what you're getting paid is not going to be the only variable affecting how happy you are at your job or how likely you are to stay. Right?
Alden Lai: Absolutely. So salary is definitely a huge component, right?
Alexandra Arriaga: I mean, of course.
Alden Lai: Yeah. So there are studies that are showing how... I believe it's based on the US data. Your happiness or your perceived life satisfaction increases in a linear fashion with salary, but then it reaches this particular point at $70,000 or $75,000, and after that, it plateaus off. So more money doesn't add to your happiness or well being from that point. So I think in the case of medical assistants, their median salary is definitely way lower than that. But at the same time, I think they are finding other ways to motivate themselves to stay in their job. And those are not specifically money-related because there's a limit to what the health system can do to increase their salaries. They are considering that, and I think that's great news, but at the same time, there are other variables. For example, they want to create a family-like dynamic at work so they feel that it's a work family, right? They are feeling that they could develop certain skills and to be known for something like blood drawing, they can be really good at facilitating a particular class of medication, or they're really good at getting things done, or things like that. So I think there are multiple ways to really sustain a workforce that is really engaged, and they're here to stay because they want to be their best self at work, really. So, yeah.
Alexandra Arriaga: Nice. So it sounds like much of your work examines work behavior, and managerial styles, and organizational structures in healthcare. So how would you design the perfect workplace where everyone is happy and productivity is high? What would be the Alden Lai perfect corporation?
Alden Lai: I really enjoy that. I really enjoy thinking about this question. It's a fun exercise. It's also really hard. And I can give you the whole scientific way, but I'm not going to do that, because if you were to just base it on science, there are a million ways you can basically be thinking about and be experimenting to make the workplace a fun one, really. But I think to give my own perspective, I think I would basically start off by really questioning what is the organization type and what is the organizational mission. So am I a startup company, or am I in an established company, right? Or is this a nonprofit, or is this a for-profit? Because I think these are really the fundamental things you've got to really think about. And then after that, from there, you can basically figure out, based on that context, the sources of meaning that I could give to the workers and the processes of doing so. So if this were a nonprofit organization, then the mission... then we know that one of the major pathways to meaningfulness is that people want to feel that they are making a difference to the lives of others, right? So as a nonprofit organization, I have to make sure that that is a very strong theme in my organization and that workers are really feeling that. So make sure of that. So chances are, I'll be attracting a lot of people that really want to make a difference. But as a leader or as a manager, I need to really make sure that the day-to-day processes, the day-to-day communication, is really sustaining that notion that everyone is really making a difference to other people's lives. Whereas if I were basically leading a for-profit organization that has maybe less of that kind of mission, then chances are I might be attracting people that really want to develop themselves. They want to have a good... They want to have new skills and knowledge. They want to be competent in something. In that case, the way I would go about it is to make sure that I've got really robust professional development programs. Right? So I think... and that's why I think it's really fundamental to be first thinking about the organization mission and the type. But then, if you think about what the processes are doing... So in terms of hiring as well. I think we should be more creative in the ways that we are hiring, because I think right now, most organizations do it via interviews, but we all know how limiting that is. So perhaps thinking about different ways of immersing potential candidates in your organization. So make them work. Make them shadow or be part of a team for a week, something like that, to make sure that this is a really, really good fit. But chances are, you've got to probably provide something else to signal that this is the job that you want to go for. Right? Because it's a lot to ask for, right? So things like that. And also, another pathway to meaningfulness is really maintaining meaningful relationships at work. So I think in that case... And that applies to all kinds of organizations, for-profit, nonprofit, startup, established. And I think then I would really think hard about the way I'm structuring my teams, the way that the teams get to choose their projects. How do they want to do that? And I think thinking about the ways that people are generating meaning and then making sure as a manager or leader really enhancing those so that people can feel that they are a part of the organization. So that's a short answer.
Alexandra Arriaga: Okay. And from your experience in terms of generating meaning for people, have you ever had to implement any of these strategies? Can you give me an example of something specific that you did?
Alden Lai: Yeah, so my research to date has been seeking to really explain or to really identify what are the current mechanisms. So I have not reached a stage where I got to do an intervention or an implementation yet. But that is to say it won't happen in the future. But the thing is, working as a meaningful work scholar, it is challenging, because meaning is very subjective, and it includes multiple streams and pathways to it. There are many factors to meaningful work. There are many pathways to meaningful work, and some people will think that, well, because it is so subjective, how would you actually be thinking about an intervention? But I do think that fundamentally, leaders and managers have a very crucial role to play in terms of communicating or setting up communication processes in a way to really highlight or to make certain meanings more robust among the workers. And thinking along those lines, and there's a separate topic called job crafting that is really looking at the ways that workers could be changing their ways of working or relating with others to make their work more meaningful for them. So we can also be potentially thinking about, how are people actually doing that in their day-to-day work life to capture that? And then probably we can think about replicating those for their colleagues that are interested. So I think right now, we have not reached a stage where we can be confident in doing certain interventions, because we know the different pathways and the factors, but it's such a huge field right now. There are many things to consider, but certainly, hopefully, something like that will happen in the future.
Alexandra Arriaga: Yeah. So now I want to talk a little bit more about your roles, the roles you've had throughout your career. So you've held a wide variety of them. You've worked for a management consulting company, you've worked for a social enterprise and even for health systems. So for current students or maybe recent graduates, even prospective students that might be listening to this, we're all trying to find where we fit in the world to make an impact. Right? So from your perspective, what is one major skill you learned from each role and what attributes make a person a good fit for those different roles?
Alden Lai: Sure. So I think from my experiences in a management consulting company, I think the major skill I took away was communication and visualization, because it's fascinating to see how good these consultants are, because they do a lot of analysis work in the background. But to communicate and to visualize them in a way that's persuasive for the client, for them to then take it to the next level, I think that's one incredible skillset to have. In terms of working in a social enterprise, it's really about establishing relationships. So I remember thinking a lot about public-private partnerships, reaching out to people in universities, to governments, industry partners, et cetera, to really convince them of a particular social cause. And being in a health system, I think the major thing is that I really got good perspectives in terms of what's happening on the ground, and I think it gives you a more grounded perspective in terms of, well, these are the things that are really important, these are the issues that healthcare workers are facing on an everyday basis, because I think that's just a great perspective to have. But if I were to boil everything down into one scale, I think these have taught me to be good at writing emails. I'm very good. I'm very good. Because in trying to establish relationships with other people whom you have not met in person, typically the first way to contact is just email. Right? So I think I've really honed the skill of reaching out to people whom I have not met, but really convincing them of, "This is what we are doing. We are genuine. We really value your expertise or your input because of these." And I think over the years, I've really honed my skill in doing that for particular organizations that I've not been in touch with. And so it's no surprise that many of my colleagues and my friends, when they are writing important emails, it's like, "Hey, can you take a look at this?" One of my colleagues was negotiating a salary as part of his job offer, and then we were talking about it. So I was helping him to look at that. And so yeah, I think it's a really fun thing. So it's really like communicating and establishing relationships, but then the nitty gritty is that yes, usually the first step is writing an email. And as I was reflecting on this, I think I've really honed the skill of structuring a nice, genuine, and persuasive email.
Alexandra Arriaga: Like a nice-
Alden Lai: You have, you have one shot. So, yeah.
Alexandra Arriaga: That is so true. Do you have like a little coined phrase that is just your particular email phrase that is super effective, or no?
Alden Lai: No, I don't, but I typically try to anticipate the questions or the hesitations these potential partners would have. So it's really a lot of background work involved. And I can give an example. So, as a particular foundation that I know that is newly established, and they're trying to build a whole community of scholars. They're trying to get people to join their scientific advisory board. And the thing is, the foundation is new. No one really knows what they're up to, but the homework they have done is that the foundation convinced a very senior person in the field to be their scientific advisor. Right? And I think that automatically gives credentials to their foundation, that they are very serious about this. So there are multiple strengths. I think you can first think about what you have got to offer, and I think the rest is really then crafting that story in terms of, "We have been doing all of these, we're doing A, we're doing B, we have C, et cetera, and this is how we can really contribute." So I don't think there's a particular template to that, but really I think the key skill was to really anticipate what the questions, these potential... And the needs, really. The questions they have and the needs that they might have and really meeting their extrinsic and intrinsic motivation to get them to say yes. So really putting ourselves in their shoes. Yeah.
Alexandra Arriaga: Yeah. And I think this ties back to what you mentioned about also developing your persuasiveness skills. In terms of being persuasive, how do you navigate that area between being persuasive and being pushy, coming across as genuine without coming across as too eager, too pushy, too desperate?
Alden Lai: In what context were you thinking about? Was that like a job negotiation, or...
Alexandra Arriaga: I mean, I guess we could go with a job negotiation. I guess I was just thinking in broad terms, but maybe you're right. Maybe it depends on the specific scenario. But sure. Let's say you're negotiating a job. How do you become a persuasive job negotiator?
Alden Lai: Yeah. And this is something I spend some time thinking about because the class that I teach has a negotiation component to that as well. And I think ultimately, when you are negotiating for a job offer, the key thing is to really signal the fact that you want to be part of the organization, and you really want to contribute, and you want to be a member. And the certain things that you are asking for will be beneficial for you as well as the organization. So I think the key is... So that you don't really come across as someone that's necessarily greedy or you just want certain things, but framing it in a way that "I want these particular types of resources because they can enable me to be a better, more productive person, and that ultimately will become benefits, or it will reap particular productivity benefits, for you and my potential colleagues." So I think that's the very important mindset to go into. And of course, you know in terms of specific negotiation techniques, there's a whole science behind it in terms of thinking about your highest threshold, your lowest threshold, where do you come in with a particular figure so that we can then reach a particular agreement? So I think there's a whole science behind it. But I think just A, coming in with the mindset that you really want to contribute to the organization, and B, being authentic enough in terms of being honest. So you can be honest and also be tactful at the same time. So I think there are different ways of framing that. So I think probably those are the two main things that I would really stress as you are thinking about going into a particular negotiation process.
Alexandra Arriaga: Amazing. Thank you. And what advice would you give to students thinking about the next steps in their career? And in general, just to be successful professionally and personally?
Alden Lai: Yeah, I think it's important to first have an internal stock take. And I got reminded of this Japanese concept called ikigai, and it's really imagining four circles and the Venn diagram that these circles are basically forming. So I think you should be asking yourself, what do you love to do? What are you good at? What can you be paid for? And what the world needs, right? So if you manage to find the sweet spot between all of these circles, and I think that is the spot that you want to basically gear towards. And I think I've got two caveats to this, and the first is I'm speaking with the assumption that you were not in any particular challenging situation. I mean, you're in a privileged position to be choosing the kind of jobs that you want to do. I wasn't necessarily in that kind of position all the time. And I think there's a certain percentage of people that basically, they don't really have a choice. They're in a particular financial situation. They need to get the first job that they get. Right? So this the first caveat. And the second caveat is that you're seeking some kind of balance in your life. So that is a very balanced philosophy in terms of, yes, looking at these four circles, you want to find a sweet spot, but for some people, they just want to be really, really good at something. And for some people, they just really want to do what they love. Like, who cares about the other things? Right? So I'm assuming that you want a sense of balance and you have a choice to make. But then thinking about doing some kind of internal stock take in terms of, "What am I really good at, what do I really love?" I think that's a very important first step in terms of then seeking or gearing yourself towards particular potential job opportunities. There's another thing I think it's really important for us to... At least a lesson I've taken to heart is that sometimes closing doors creates better opportunities. I think that the traditional mantra is that you want to keep as many doors open as possible, because then you have the choice. But we rarely think about the energy and the time and the resources that you need to be keeping these doors open. And to me, I think if you were to choose to close certain doors down, then the remaining doors become wider, because then you have more time to really focus on the fit between your profile and what those particular doors are looking for. And I think they become wider/better doors. They become better opportunities, because you really get the time to think about them as opposed to trying to stretch yourself too thin. So I'm a big proponent of this particular concept called Essentialism. There's a book called Essentialism, and I really loved it. I have reread that a couple of times now. But really thinking about focusing, curating, finding a good fit, and not trying to chase after numbers. So I think after a couple of years, it really had occurred to me that closing particular doors would really make sure that you have a better opportunity. So it's a bit paradoxical, but I think my personal experiences have really illuminated that.
Alexandra Arriaga: Yeah. But it's actually very refreshing to hear you don't have to keep all the doors open. I mean, I think it might be one thing to leave maybe like bridges, where you don't burn down bridges with people, because that's obviously unnecessary, I think, most of the time. But yeah, just really being specific, very specific on how you channel your energy and what type of projects you dedicate your time and your mental power to.
Alden Lai: Absolutely. So one major pathway to kind of like finding meaning at work is the authentic self. So I feel that it's important to be authentic to yourself, to want to be authentic. And one key way of doing that is to have a brutally honest evaluation or conversation with yourself. What do you really like to do, et cetera. So having a really honest conversation first with yourself. And then I think you can then basically move on to the next step in terms of, "Well, these are the particular opportunities that are manageable, and I really want to devote myself to them." So I think you're right, it's really taking care of yourself first and not feeling that you have to stretch yourself so thin. And I think there's a level of confidence, too. So being confident that you can do it, right? So, "I am closing these doors." It takes courage to be closing doors. You're right, you're not burning the bridge, but you're closing the door, and it takes a particular kind of courage. But then having that courage to close these doors and then being authentic enough and confident enough to say that, "Hey, these are the particular few doors that I really, really want to pursue," And then channeling your energy and focus onto them.
Alexandra Arriaga: Absolutely. And so what would you recommend to those people that are thinking, "Okay, I definitely just want to sit down and have that brutally honest conversation with myself. I want to figure out what my authentic self needs." How do you start that conversation?
Alden Lai: Right. So there are a couple of books that you can be reading. I remember when I was starting in my master's program, I took the StrengthFinder test. I've read this book called What Color is Your Parachute?, I think, and a couple of others. Finding Your Element, for example. So I think there are a couple of them, and there are so many of these kinds of books out there, and I'm pretty sure you can just do a quick search and figure out which are the ones that really speak to you. So I think you can be using those resources. I think talking to your close friends and your acquaintances will help. Your close friends probably know your strengths and really know you for who you are, and then acquaintances will probably know you for the general profile or the general type of person you can be without going into the details. So there's a very famous paper called The Strength of Weak Ties. And one nugget of knowledge we get from that paper is that usually, job opportunities come from your acquaintances, not your close friends.
Alexandra Arriaga: I actually read this paper, which is... I think it also goes into saying that an acquaintance is more likely to do a favor for you than a close friend.
Alden Lai: I mean, in a job hunting context, absolutely. Yeah. Because your acquaintances are people that you're not regularly in touch with. Right? But once in a while, you get to talk to them, they kind of figure out, "Oh, you're really good at doing this. I think I might have an opportunity for you." Whereas your close friends, you're in touch with them all the time. So if they had an opportunity, you would have known about that in the first place. But your close friends and your family, of course, they really know you for who you are. So I think they can give you valuable feedback. You can be hiring a life coach, for example. I think coaches can be really helpful in terms of helping you think about things in a very different way. And of course, last but not least, just taking time to yourself, feeling comfortable, being comfortable with yourself. It can be taking a walk. Find a really comfortable spot and start writing. You don't have to... And I should emphasize that an internal stock-take, it's not something you would do in a day. It really takes time. It can be pretty intense. So you should totally be kind to yourself. Make sure that this is a pace you're comfortable with. Make sure that these are the methods that you're comfortable with. Either you're reading, you're talking to people, you're getting a coach, et cetera. But it is a lifelong journey. And even today, I still do regular check-ins with myself. Is this the way I want to be spending my time? Am I in a good spot, or do I want to make certain changes in the way that my professional and personal lives are heading? So I think it's really a lifelong journey, but the earlier you start, the better it is, because... We are not going with the flow, and we're doing whatever life or certain circumstances tell us to. And I think it's really important to be aware how you're spending your time. Who is the real you, really? And then moving on from that. So it's a lifelong process, and there are multiple ways of doing that. But I think the key is being willing to be open with yourself. And sometimes the truth can hurt, and that's why I mentioned being brutally honest, but I think fundamentally, don't forget that you should be kind to yourself. So, yeah.
Alexandra Arriaga: Absolutely. That's great advice. Well, thank you so much for joining us today.
Alden Lai: No problem, it's my pleasure.
Alexandra Arriaga: Yeah, this was wonderful. And for everyone listening, if they want to learn more about your work and what you're doing, where could they read some of that?
Alden Lai: Some of my work, they are basically on the faculty website. People can reach out to me via email, and I'm happy to initiate conversations.
Alexandra Arriaga: Amazing. Thank you so much.
Alden Lai: Thank you.