Supporting the gathering of critical information has the potential to improve the diagnosis and management of difficult problems in family medicine.

A case study of the impact of improved precipitation forecasts on the snow-fighting operations of the New York State Thruway is reported. The goal was to use currently available data and literature on forecast process, communication, and use in conjunction with observations and interviews with key decision makers to derive a model that yields estimates of value to users based on a model of their decision processes rather than an optimal decision-making model. That goal proved too ambitious due to limitations in available data. A major lesson learned from this research is the importance of improved, ongoing data collection to support studies of use and value of weather information. A more holistic approach to understanding and realizing forecast value is needed, that is, one in which information (both of forecast skill and usage) centered on the decision process is collected in a much more intensive manner than is presently the case.

KeywordsElectronic health records and systems, safety culture, organizational change management, workflows and human interactions, sociotechnical aspects of information technology SummaryBackground: The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. Objective: This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. Methods: We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Results: Data from 209 primary care practices responding between 2006-2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Conclusions: Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings.

A considerable and growing body of crisis management literature seeks to help business managers address disasters. Notwithstanding, the business literature on crisis management fails fully to understand the policy and political aspects of business disasters, and concentrates on prescriptive, managerial issues that show disregard and sometimes disdain for plural democracy. We illustrate our argument with a review of the existing crisis management literature, and three case studies: the Exxon Valdez oil spill, the Jack in the Box E. Coli outbreak, and the crash of ValuJet flight 592. We find that the primary gap in the crisis management literature is its failure to understand the motivations of countervailing interest groups and the facts that mobilize them to take action. We argue that the lessons derived from these cases are equally applicable to North American, European and Asian business crises.