Anticipatory Thinking and Informative Searching: Proactive Management of Threats to Patient Safety
The study of errors can be expanded to include a prospective, temporal view, where anomalies that are further upstream and less defined undergo an incubation process to eventually become what we know as error events. Proactively considering and managing the antecedents of errors during this process can therefore avert errors or reduce their adverse impact in organizations. Through a qualitative investigation of 10 primary care clinics, whose central role is to safeguard patients’ health and well-being in the long-term, I examine how health care workers proactively manage threats to patient safety that they foresee leading to medical errors. First, they perform anticipatory thinking through projecting the plausible impact of omitted information and actions onto unwanted safety events. Second, because information is key to their anticipatory activities, health care workers proactively search for information in specified domains that reflect a taxonomy. Not all informational types are treated equally amid this proactive search – primary care clinics engage in a strategy mix to increase the amount of, and sensitivity to, information in two particular domains that they are dependent on patients for access while managing safety threats. Collectively, the findings suggest a two-by-two comparative model that characterizes primary care organizations in relation to their proactive threat management strategies. This paper provides an emerging view of how organizations manage their safety performances by addressing the unwanted errors that they can anticipate happening in the future.
Thriving at Work: Understanding the Work Environment of Medical Assistants to Enhance Job Satisfaction and Delivery of Team-Based Care
Work Values Fit
The role of medical assistants is integral and expanding in primary care. The advent of the patient-centered medical home model and emphasis on team-based care has necessitated changes to their work environments, and concerns about job dissatisfaction and retention are emerging. This proposed study seeks to identify ways to enhance the training, career advancement, and retention of medical assistants in light of a primary care delivery model that is team-focused. Our guiding framework is the sustainable employability model, which refers to the shaping of a work environment that is valued by the employee (e.g., adequate income, opportunities for advancement) as well as the organization (e.g., team-based care, high quality care) over sustained periods of time. In the proposed research project, we will use a mixed methods design to: (AIM 1) qualitatively examine medical assistants’ scope of practice, work values, and salient experiences related to working in teams; and (AIM 2) quantitatively assess medical assistants’ work wellness, employee-employer work value fit, and team communication patterns using validated questionnaires. Taken together, our qualitative and quantitative analyses serve as complementary approaches for developing a more complete picture of the roles and work values of medical assistants, and ultimately, how to better support the delivery of team-based care through the perspectives of a traditionally overlooked, yet integral, group of health care workers.