Remote work as a new normal? The technology-organization-environment (TOE) context.

The COVID-19 pandemic has established remote work as the new normal. However, the factors that influence the effectiveness of remote work are unexplored. Moreover, the relationships between remote work and job performance and emotional exhaustion are under-investigated. This study addresses these gaps by investigating the factors that influence the effectiveness and outcomes of remote work. The technology-organisation-environment (TOE) framework and the theory of planned behaviour (TPB) are used as a theoretical lens to examine the internal and external factors that affect remote work and work-life balance. An online cross-sectional survey of knowledge workers engaged in remote work in Hong Kong indicates that both external (technological competence, government support) and internal (work flexibility, attitude, perceived behavioural control) factors are significant predictors of successful remote work. Furthermore, remote work is positively associated with job performance but has no association with emotional exhaustion. These findings suggest that to ensure a successful transition to the new normal, governments and organisations should provide technical support to employees engaged in remote work. The theoretical and practical implications of the findings are discussed.

Preconsult interactive computer-assisted client assessment survey for common mental disorders in a community health centre: a randomized controlled trial.

BACKGROUND: Access disparities for mental health care exist for vulnerable ethnocultural and immigrant groups. Community health centres that serve these groups could be supported further by interactive, computer-based, self-assessments. METHODS: An interactive computer-assisted client assessment survey (iCCAS) tool was developed for preconsult assessment of common mental disorders (using the Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder 7-item [GAD-7] scale, Primary Care Post-traumatic Stress Disorder [PTSD-PC] screen and CAGE [concern/cut-down, anger, guilt and eye-opener] questionnaire), with point-of-care reports. The pilot randomized controlled trial recruited adult patients, fluent in English or Spanish, who were seeing a physician or nurse practitioner at the partnering community health centre in Toronto. Randomization into iCCAS or usual care was computer generated, and allocation was concealed in sequentially numbered, opaque envelopes that were opened after consent. The objectives were to examine the interventions' efficacy in improving mental health discussion (primary) and symptom detection (secondary). Data were collected by exit survey and chart review. RESULTS: Of the 1248 patients assessed, 190 were eligible for participation. Of these, 148 were randomly assigned (response rate 78%). The iCCAS (n = 75) and usual care (n = 72) groups were similar in sociodemographics; 98% were immigrants, and 68% were women. Mental health discussion occurred for 58.7% of patients in the iCCAS group and 40.3% in the usual care group (p ≤ 0.05). The effect remained significant while controlling for potential covariates (language, sex, education, employment) in generalized linear mixed model (GLMM; adjusted odds ratio [OR] 2.2; 95% confidence interval [CI] 1.1-4.5). Mental health symptom detection occurred for 38.7% of patients in the iCCAS group and 27.8% in the usual care group (p > 0.05). The effect was not significant beyond potential covariates in GLMM (adjusted OR 1.9; 95% CI 0.9-4.1). INTERPRETATION: The studied intervention holds potential for community health centres to improve mental health discussion. Further research with larger samples should examine the impact on detection and enhance generalizability. Trial registration: ClinicalTrials.gov, no: NCT02023957, registered on Dec. 12, 2013.

Knowledge of peripheral arterial disease: Results of an intervention to measure and improve PAD knowledge in Toronto.

Background Prevalence of peripheral arterial disease (PAD) has dramatically increased in both developing, as well as developed countries. However, significant knowledge and practice gaps persist. In Canada, efforts to improve this knowledge level are lacking. In this study, we examine PAD knowledge in Toronto, and evaluate a pilot intervention to address the knowledge gaps. Objectives Measure PAD awareness in Toronto, and evaluate an intervention to improve PAD knowledge among the public. Methods In the context of a community-based awareness campaign, an interview-based survey was used to assess the PAD awareness among general public. A sample of participants was split into two arms: control (survey only) and intervention (survey and education pamphlet), the choice between assigning the site as case or control was random. A follow-up telephone and email-based survey was conducted after 6 weeks to assess the attained knowledge level of PAD. Results Two hundred thirty-seven participants completed the baseline survey. One hundred eighty-eight participants (78.7%) had never heard of PAD. The remaining "PAD-aware" cohort had low overall knowledge of the disease characteristics. Participants from each arm completed the follow-up survey. The level of education, age, and gender were not predictors of knowledge scores; however, age was a predictor of PAD awareness, while gender and level of education were not. Participants in the intervention group showed significant knowledge scores improvement in five PAD domains, while those from control group showed significant improvement in their preventative measures, treatment modalities, and total scores. The impact of the study intervention on average scores was borderline not significant ( p = 0.05). Conclusion PAD knowledge gap in the Canadian public is larger than what was previously reported. Educational campaigns are necessary to address this gap and improve the outcome of PAD patients through patients' activation. Our results are encouraging and warrant a next intervention to explore an educational program impact on PAD knowledge.

Burden of common mental disorders in a community health centre sample.

OBJECTIVE: To examine the rates of common mental disorders (CMDs) such as depression, anxiety, posttraumatic stress disorder (PTSD), and alcohol use in an urban community health care centre (CHC) serving vulnerable immigrant and ethnoracial communities in order to improve knowledge on the rates of CMDs specific to these groups accessing primary care settings. DESIGN: English or Spanish, self-administered, tablet-based survey known as the Interactive Computer-Assisted Client Assessment Survey (iCCAS). SETTING: Access Alliance Multicultural Health and Community Services CHC in Toronto, Ont. PARTICIPANTS: Adult patients waiting to see a clinician. MAIN OUTCOME MEASURES: The iCCAS screened for depression (using the PHQ-9 [Patient Health Questionnaire]), anxiety (using the GAD-7 [Generalized Anxiety Disorder 7-item scale]), PTSD (using the PC-PTSD [Primary Care PTSD Screen]), and alcohol dependency (using the CAGE questionnaire); those with an existing diagnosis and active treatment for one of these conditions were not asked to complete that condition-specific screening scale. An exit survey measured demographic characteristics and relevant indicators. RESULTS: A response rate of 78.6% was achieved. The iCCAS survey was completed by 75 patients (26 men and 49 women) with a mean age of 36.5 years. Almost all were first-generation immigrants: 32.0% originated from Latin America, 28.0% from South Asia, and 17.3% from Africa or the Middle East. Major depression was found among 44.0% of participants (11 with diagnosis and treatment, 22 with a score of 10 or greater on the PHQ-9). Generalized anxiety disorder was present in 26.7% of participants (7 with diagnosis and treatment, 13 with a score of 10 or greater on the GAD-7 scale). Posttraumatic stress disorder was detected in 37.3% of participants (7 with diagnosis and treatment, 21 with a score of 3 or greater on the PC-PTSD tool). Alcohol dependency was found among 10.7% of participants (1 with diagnosis and treatment, 7 with a score of 2 or greater on the CAGE questionnaire). CONCLUSION: The high rates of probable depression, generalized anxiety, and PTSD that were found in the studied population suggest a need for systematic assessment of CMDs in CHCs, as well as training and resources to increase readiness to handle identified cases.

The relationship between organizational leadership for safety and learning from patient safety events.

OBJECTIVE: To examine the relationship between organizational leadership for patient safety and five types of learning from patient safety events (PSEs). STUDY SETTING: Forty-nine general acute care hospitals in Ontario, Canada. STUDY DESIGN: A nonexperimental design using cross-sectional surveys of hospital patient safety officers (PSOs) and patient care managers (PCMs). PSOs provided data on organization-level learning from (a) minor events, (b) moderate events, (c) major near misses, (d) major event analysis, and (e) major event dissemination/communication. PCMs provided data on organizational leadership (formal and informal) for patient safety. EXTRACTION METHODS: Hospitals were the unit of analysis. Seemingly unrelated regression was used to examine the influence of formal and informal leadership for safety on the five types of learning from PSEs. The interaction between leadership and hospital size was also examined. PRINCIPAL FINDINGS: Formal organizational leadership for patient safety is an important predictor of learning from minor, moderate, and major near-miss events, and major event dissemination. This relationship is significantly stronger for small hospitals (<100 beds). CONCLUSIONS: We find support for the relationship between patient safety leadership and patient safety behaviors such as learning from safety events. Formal leadership support for safety is of particular importance in small organizations where the economic burden of safety programs is disproportionately large and formal leadership is closer to the front lines.

Development of a measure of patient safety event learning responses.

OBJECTIVE: To define patient safety event (PSE) learning response and to provide preliminary validation of a measure of PSE learning response. DATA SOURCES: Ten focus groups with front-line staff and managers, an expert panel, and cross-sectional survey data from patient safety officers in 54 general acute hospitals. STUDY DESIGN: A mixed methods study to define a measure of learning responses to patient safety failures that is rooted in theory, expert knowledge, and organizational practice realities. EXTRACTION METHODS: Learning response items developed from the literature were modified and validated in front-line staff and manager focus groups and by an expert panel and second group of external experts. Actual learning responses gleaned from survey data were examined using exploratory factor analyses and reliability analysis. PRINCIPAL FINDINGS: Unique learning response items were identified for minor, moderate, major events, and major near misses by an expert panel. A two-factor model of major event learning response was identified (factor 1=event analysis, factor 2=dissemination/communication of learnings). Organizations engage in greater learning responses following major events than less severe events and, for major events, organizations engage in more factor 1 responses than factor 2 learning responses. CONCLUSIONS: Eleven to 13 items can measure learning responses to PSEs of differing severity. The items are feasible, grounded in theory, and reflect expert opinion as well as practice setting realities. The items have the potential for use to assess current practice in organizations and set future improvement goals.

Categorizing errors and adverse events for learning: a provider perspective.

There is little agreement in the literature as to what types of patient safety events (PSEs) should be the focus for learning, change and improvement, and we lack clear and universally accepted definitions of error. In particular, the way front-line providers or managers understand and categorize different types of errors, adverse events and near misses and the kinds of events this audience believes to be valuable for learning are not well understood. Focus groups of front-line providers, managers and patient safety officers were used to explore how people in healthcare organizations understand and categorize different types of PSEs in the context of bringing about learning from such events. A typology of PSEs was developed from the focus group data and then mailed, along with a short questionnaire, to focus group participants for member checking and validation. Four themes emerged from our data: (1) incidence study categories are problematic for those working in organizations; (2) preventable events should be the focus for learning; (3) near misses are an important but complex category, differentiated based on harm potential and proximity to patients; (4) staff disagree on whether events causing severe harm or events with harm potential are most valuable for learning. A typology of PSEs based on these themes and checked by focus group participants indicates that staff and their managers divide events into simple categories of minor and major events, which are differentiated based on harm or harm potential. Confusion surrounding patient safety terminology detracts from the abilities of providers to talk about and reflect on a range of PSEs, and from opportunities to enhance learning, reduce event reoccurrence and improve patient safety at the point of care.

Computerized management of oral anticoagulant therapy: experience in major joint arthroplasty.

OBJECTIVE: Evaluation of the safety and potential cost savings of a computerized, laboratory-based program to manage inpatient warfarin thromboprophylaxis after major joint arthroplasty. DESIGN: A consecutive-case study of adults. SETTING: A tertiary care orthopedic institution. PATIENTS: Patients requiring joint arthroplasty who had no recent episodes of thromboembolic disease, no mechanical heart valve, atrial fibrillation, severe liver disease or baseline international normalized ratio [INR] greater than 1.3 admitted over a 54-month period (July 1994-December 1998). All patients received a standard regimen of warfarin beginning on the evening after the operation. Four hundred and thirty randomly selected patients managed by the program were followed up by telephone survey 3 months after discharge. Patients exhibiting erratic responses to warfarin were withdrawn from the program and managed individually thereafter. INTERVENTION: Major joint arthroplasty with warfarin therapy administered through the computerized program. MAIN OUTCOME MEASURES: Test results maintained within the desired therapeutic range (INR 2.0-3.0), clinically severe bleeding episodes, readmission rates, clinically symptomatic and venographically proven episodes of venous thrombosis or pulmonary embolism. RESULTS: Over the study period 5629 patients underwent joint arthroplasty; 5,372 patients were considered for the program; 332 patients were ineligible and were managed individually; 311 entered patients did not complete the program. This left 4,729 patients who completed the program. In 2932 (62%) patients test results were maintained in the desired therapeutic range. The major bleeding rate was less than 0.5%, the readmission rate was 3.8%, the deep venous thrombosis rate was 3.7% and the pulmonary embolism rate was 0.2% with no thromboembolic related deaths in the small sample cohort. CONCLUSIONS: The majority of patients requiring warfarin thromboprophylaxis can be safely and effectively managed by this laboratory-based computerized program while in hospital. Significant potential cost savings in nursing time could be achieved.