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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. [ABSTRACT FROM AUTHOR]

Background: Proactive behaviors at work refer to behaviors that are self-starting, future focused, and change oriented. Proactive behaviors are generally thought of as positive and desired and can benefit both the employee (e.g., job promotion) and organization (e.g., innovation). These behaviors can, however, backfire (e.g., due to unintended consequences), reflecting the "initiative paradox.", Purpose: The aim of this study was to investigate, through the perspectives of health care executives, how employees can be more effective when engaging in proactive behaviors., Methodology: We used the episodic narrative interview method. Health care executives narrated instances of perceived effective and ineffective proactive behaviors among employees. We then performed an inductive qualitative analysis of these episodes to identify emerging themes and dimensions., Results: The effectiveness of proactive behaviors among health care employees is shaped by three dimensions: managerial expectation (in)congruence (e.g., knowledge of expectations, engagement with chain of command), organizational priority (in)congruence (e.g., degree of alignment between individual and organizational benefits), and boundaries of action and change (e.g., nonadherence to regulatory or financial conditions). Among the dimensions, managerial expectations may be the most challenging for employees to navigate., Conclusion: Engaging in proactive behaviors is not a straightforward process. Navigating multiple dimensions is necessary for health care employees to be effective., Practice Implications: Employees should be equipped with knowledge on relevant expectations, priorities, and boundaries when engaging in proactive behaviors at work. Health care leaders and managers should aim to clarify and periodically reassess these dimensions to facilitate effective proactive behaviors and to generate benefits for employees and the organization., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Electronic health record (EHR) systems have been shown to be associated with improvements in care processes, quality of care, and patient outcomes. EHR also has a crucial role in the delivery of substance use disorder (SUD) treatment and is considered important for addressing SUD crises, including the opioid epidemic. However, little is known about the adoption of EHR in SUD treatment programs or the organizational-level factors associated with the adoption of EHR in SUD treatment., Objective: We examined the adoption of EHR in SUD programs, with a focus on changes in adoption from 2014 to 2017, and identified organizational-level factors associated with EHR adoption., Methods: We used data from the 2014 and 2017 National Drug Abuse Treatment System Surveys. Our analysis included 1027 SUD programs (531 in 2014 and 496 in 2017). We used chi-square and Mann-Whitney U tests for categorical and continuous variables, respectively, to assess changes in EHR adoption, technology use, program, and client characteristics. We also investigated differences in characteristics and barriers to adoption by EHR adoption status (adopted EHR vs had not adopted or were planning to adopt EHR). We then conducted multivariate logistic regressions to examine internal and external factors associated with EHR adoption., Results: The adoption of EHR increased significantly from 57.6% (306/531) in 2014 to 69.2% (343/496) in 2017 (P<.001), showing that nearly one-third (153/496, 30.8%) of SUD programs had not yet adopted an EHR system by 2017. We identified a significant increase in technology use and ownership by a parent company (P=.01 and P<.001) and a decrease in the percentage of uninsured patients in 2017 (P<.001), compared to 2014. Our analysis further showed significant differences by adoption status for three major barriers to adoption: (1) start-up costs, (2) ongoing financial costs, and (3) privacy or security concerns (P<.001). Programs that used computerized scheduling (adjusted odds ratio [AOR] 3.02, 95% CI 2.23-4.09) and billing systems (AOR 2.29, 95% CI 1.62-3.25) were more likely to adopt EHR. Similarly, ownership type, such as private nonprofit (AOR 1.86, 95% CI 1.31-2.65) and public (AOR 2.14, 95% CI 1.27-3.67), or interest in participating in a patient-centered medical home (AOR 1.93, 95% CI 1.29-2.92), were associated with an increased likelihood to adopt EHR. Overall, SUD programs were more likely to adopt an EHR system in 2017 compared to 2014 (AOR 1.44, 95% CI 1.07-1.94)., Conclusions: Our findings highlighted that SUD programs may be on track to achieve widespread EHR adoption. However, there is a need for focused strategies, resources, and policies explicitly designed to systematically address barriers and tackle obstacles to expanding the adoption of EHR systems. These efforts must be holistic and address factors at multiple organizational levels., (©Jemima A Frimpong, Xun Liu, Lingrui Liu, Ruoqiuyan Zhang. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 14.12.2023.)