Christiane Spitzmueller

Investigating individual differences among targets of workplace incivility.

The present study focused on individual differences in Big Five traits among targets of workplace incivility. The authors hypothesized a negative relation between agreeableness and incivility, a positive relation between neuroticism and incivility, and a negative relation between extraversion and incivility. The authors also hypothesized that provocative target behavior is the mediating force that drives these relations. Multisource data from a diverse sample of employees and their coworkers indicate that individuals low in agreeableness and those high in neuroticism experience more incivility than their counterparts. The mediation model was supported for agreeableness and neuroticism. Findings suggest that target traits are important components in incivility research, and should be considered in future research as well as in efforts to alleviate the consequences of incivility.

Information Overload and Missed Test Results in Electronic Health Record–Based Settings

cal one, especially because of the rapid proliferation of decision aids. However, reducing alert fatigue comes at the expense of a higher rate of false negatives (lower sensitivity). If the alert threshold were increased from 40% to 80%, this would increase its specificity even further, but such an approach would have limited clinical utility. The best way to determine the right threshold is to prospectively test the tool in real-world settings and examine how it changes physician treatment behavior and/or the outcomes and efficiency of patient care. What about the use of chest radiography as part of the computerized screening tool? The chest radiograph is considered the reference standard for the diagnosis of pneumonia, despite the fact that it is neither 100% sensitive, nor 100% specific. Pneumonia can be present in the absence of an acute radiographic infiltrate, particularly among elderly patients with dehydration at the time of presentation. In addition, substantial interobserver variation among ED physicians and even radiologists has been well documented for the interpretation of chest radiographic findings compatible with pneumonia. Notably, 59% of the false positives of the reported screening tool were due to incorrect reading of the imaging reports using natural language processing. If trained radiologists cannot agree, it comes as no surprise that the tool itself also has difficulty interpreting radiography reports. Perhaps a more basic need in the diagnosis of pneumonia is to standardize the interpretation and reporting of chest radiographic findings prior to attempting to integrate such findings into a computerized decision aid. This innovative and unique tool may foreshadow the future of medicine—a future in which vast amounts of data are synthesized by computers to improve physician diagnosis and treatment decisions. As others have discussed, the quality and accuracy of diagnosis is often overlooked in most efforts to improve quality and safety, which instead focus on the management of alreadydiagnosed problems. Although there is clearly a role for decision-support tools, prior to their wide adoption they will need to show an incremental benefit over physician judgment alone and demonstrate improvements in patient outcomes.

Primary care practitioners' views on test result management in EHR-enabled health systems: a national survey

Context Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system. Methods Between June and November 2010, we conducted a cross-sectional, web-based survey of all primary care practitioners (PCPs) within the Department of Veterans Affairs nationwide. Survey development was guided by a socio-technical model describing multiple inter-related dimensions of EHR use. Findings Of 5001 PCPs invited, 2590 (51.8%) responded. 55.5% believed that the EHRs did not have convenient features for notifying patients of test results. Over a third (37.9%) reported having staff support needed for notifying patients of test results. Many relied on the patients next visit to notify them for normal (46.1%) and abnormal results (20.1%). Only 45.7% reported receiving adequate training on using the EHR notification system and 35.1% reported having an assigned contact for technical assistance with the EHR; most received help from colleagues (60.4%). A majority (85.6%) stayed after hours or came in on weekends to address notifications; less than a third reported receiving protected time (30.1%). PCPs strongly endorsed several new features to improve test result management, including better tracking and visualization of result notifications. Conclusions Despite an advanced EHR, both social and technical challenges exist in ensuring notification of test results to practitioners and patients. Current EHR technology requires significant improvement in order to avoid similar challenges elsewhere.

Why do overqualified incumbents deviate? Examining multiple mediators.

In the modern marketplace, especially when unemployment is high, more and more Americans find themselves overqualified (i.e., possessing more competencies than the job requires). Using and extending person-environment fit theory and the stressor-emotion model of counterproductive work behaviors (CWBs), we examine whether overqualified employees are more likely to display CWBs than employees who feel their positions match their qualification levels. Further, we examine why overqualified employees may behave in counterproductive ways and compare the empirical viability of several theoretically derived competing mediators. Based on data from a sample of full-time employees (n = 215), we found that consistent with the theoretical frameworks, overqualified incumbents display nondesirable counterproductive work behaviors because they become cynical about the meaningfulness of their activities. We further show that although poor person-job fit or inadequate psychological contracts can motivate such misbehavior, cynicism dominates as a reason for why overqualified employees engage in counterproductive work behaviors.

Demand-control-person: integrating the demand-control and conservation of resources models to test an expanded stressor-strain model.

We propose an expanded stressor-strain model that explicitly incorporates person characteristics, the Demand-Control-Person model. This model integrates Karaseks traditional Demand-Control model with Hobfolls (1989) Conservation of Resources theory. With participants from two organizations, we tested the moderating role of emotional stability in conjunction with two job demands (i.e., uncertainty and time pressure) and control (i.e., decision latitude) in predicting two forms of strain (i.e., job dissatisfaction and disengagement). Our findings support the expanded Demand-Control-Person model, such that a significant three-way interaction emerged for uncertainty and time pressure. As predicted, the traditional Demand-Control model only held among individuals high in emotional stability, such that low-emotional stability individuals did either not benefit as readily from decision latitude or were more susceptible to job demands when they had decision latitude. Thus, the Demand-Control-Person model may provide a more comprehensive model and consistent prediction of the effect of stressors on strain as determined by individual characteristics.

Challenges of making a diagnosis in the outpatient setting: a multi-site survey of primary care physicians

Background Although misdiagnosis in the outpatient setting leads to significant patient harm and wasted resources, it is not well studied. The authors surveyed primary care physicians (PCPs) about barriers to timely diagnosis in the outpatient setting and assessed their perceptions of diagnostic difficulty. Methods Surveys of PCPs practicing in an integrated health system across 10 geographically dispersed states in 2005. The survey elicited information on key cognitive failures (including in clinical knowledge or judgement) for a specific case, and solicited strategies for reducing diagnostic delays. Content analysis was used to categorise cognitive failures and strategies for improvement. The authors examined the extent and predictors of diagnostic difficulty, defined as reporting >5% patients difficult to diagnose. Results Of 1817 physicians surveyed, 1054 (58%) responded; 848 (80%) respondents primarily practiced in outpatient settings and had an assigned patient panel (inclusion sample). Inadequate knowledge (19.9%) was the most commonly reported cognitive factor. Half reported >5% of their patients were difficult to diagnose; more experienced physicians reported less diagnostic difficulty. In adjusted analyses, problems with information processing (information availability and time to review it) and the referral process were associated with greater diagnostic difficulty. Strategies for improvement most commonly involved workload issues (panel size, non-visit tasks). Conclusions PCPs report a variety of reasons for diagnostic difficulties in primary care practice. In this study, knowledge gaps appear to be a prominent concern. Interventions that address these gaps as well as practice level issues such as time to process diagnostic information and better subspecialty input may reduce diagnostic difficulties in primary care.

Individualism-Collectivism and the Role of Goal Orientation in Organizational Training.

This research examines how individualism–collectivism and goal orientation impact training effectiveness through study of an internationally diverse sample of engineers who were undergoing technical training. In light of contemporary views of individualism–collectivism, we argue that collectivism will moderate the influence of learning and performance goal orientations on training by shaping the impact of ones perceived social context on existing performance concerns and goals. Using a sample from a large multinational corporation, we examined the effects of individualism–collectivism and goal orientation on training transfer intentions, motivation to learn, and test performance. Mixed support for our hypotheses was found. Collectivists were found to exhibit higher levels of training transfer intentions and motivation to learn. However, when collectivism was combined with a performance goal orientation, its effects on training outcomes were diminished. Applications for organizations and future extensions of the present research are discussed.

Behavioral Science Approaches to Studying Underemployment

As with economic approaches (see Wilkins & Wooden, this volume), there is a lack of agreement as to what constitutes underemployment (i.e., a broad term referring to inadequate employment relative to some standard; Feldman, 1996) among behavioral scientists. In this chapter, we attempt to shed some light into this issue. In structuring our chapter, we use Feldman’s (1996) Journal of Management review of underemployment as a springboard to examine how measurement of underemployment has progressed since its publication. Specifically, Feldman detailed the conceptual and methodological state of the underemployment construct and outlined specific recommendations to improve its measurement. Feldman sketched several methodological avenues for future scholars striving to better understand the underemployment phenomenon.

On the Association between Perceived Overqualification and Adaptive Behavior

Purpose – The purpose of this research was to offer an autonomous motivation perspective to explore the relationship between perceived overqualification and adaptive work behavior and examine job autonomy as a factor that may moderate the association.Design/methodology/approach – The hypotheses were tested in two culturally, demographically, and functionally diverse samples: Sample 1 was based on North American community college employees (N = 215); sample 2 was based on full-time workers, employed in a Chinese state-owned enterprise specializing in shipping (N = 148).Findings – In Study 1, perceived overqualification was negatively related to self-rated adaptive behavior. A follow-up Study 2 extended these findings by demonstrating that perceived overqualification was negatively related to supervisor-rated adaptive work behavior when job autonomy was low, rather than high.Implications – The results of this research offer an autonomous motivation perspective to explain why perceived overqualification relates to adaptive behavior and suggests a job design approach to encourage adaptive behaviors of people who feel overqualified – a sizable segment of the current workforce.Originality/value – This is one of the first studies to explore adaptive behavior of workers who feel overqualified – an outcome that has not been examined in this domain. Our findings further point out what can be done to encourage adaptive behaviors among overqualified employees.

Factors relating to wellbeing of foreign-born Hispanic workers

Purpose – The purpose of this paper is to examine stressor-strain relationships that play a role in foreign-born Hispanic workers’ well-being and family-to-work facilitation (FWF) as a moderator in this relationship. Design/methodology/approach – The authors used a unique sample of foreign-born Hispanic workers employed in blue-labor jobs in Texas (n=163). Findings – Consistent with the theoretical assertions, the authors found support for the negative relationship between legal status concern and Hispanic workers’ psychological and perceived physical health. Further, FWF attenuated the negative consequences of lack of English language proficiency on psychological well-being. Research limitations/implications – Both organizations and Hispanic workers can benefit from the results of the study. Hispanic immigrants can enhance their well-being by relying more on their families and seeking more support from their friends and families when dealing with immigration-related stressors. Organizations and policymak...