Uncertainty as a critical determinant of antibiotic prescribing in patients with an asthma exacerbation: a qualitative study.

OBJECTIVE: To identify factors that influence providers' decisions to prescribe antibiotics in patients presenting to the hospital with an asthma exacerbation. METHODS: We performed semi-structured interviews with a purposive sample of providers including sixteen hospitalists, emergency room providers, or pulmonologists, and one focus group with internal medicine residents recruited from one large, urban, teaching hospital and one small, rural, community hospital. Questions were informed by the Theoretical Domains Framework to determine factors that may influence behaviors. Directed content analysis was used to code and analyze transcripts of the interviews. RESULTS: Uncertainty regarding the diagnostic (asthma vs. COPD) and the cause of exacerbation (bacterial vs. viral infection) emerged as the main driver for prescribing behavior. Provider response to uncertainty included: "watchful waiting" or immediate antibiotic prescribing. The following factors played important roles in providers' prescribing decision: 1) awareness/agreement with existing guidelines 2) confidence in their ability to apply the guidelines in challenging cases; 3) perceived risk of patient deterioration without antibiotics; 4) fear of litigation; 5) habit and clinical inertia 6) prescribing within the group 7) lack of information of antibiotic prescribing rates and 8) lack of time and/or resources. CONCLUSIONS: We identified diagnostic uncertainty as the primary determinant of antibiotic prescribing in asthma exacerbations and developed a conceptual model to explain provider responses and factors that influenced their responses. These results enhance our understanding of the factors that can contribute to low-value and wasteful practices like superfluous antibiotic prescribing and will support the development of interventions to de-implement such practices.

Leadership styles and employee knowledge sharing: Exploring the mediating role of introjected motivation.

Drawing on Social Exchange Theory and Self-Determination Theory, this study examines the impact of three leadership styles (ethical, transformational, and passive avoidant) on employee knowledge sharing. Further, this study explores the mediating effect of introjected motivation in the relationship between three leadership styles and employee knowledge sharing. Using time lag data this study employed a sample of 254 faculty members of public sector universities in Pakistan. Results supported the positive relationship between three styles of leadership and employee knowledge sharing. Moreover, our findings confirmed the mediating role of introjected motivation in the relationship between three leadership styles and employee knowledge sharing. Our study is unique, as it simultaneously examines how various styles of leadership predict introjected motivation and employee knowledge sharing. Implications along with limitations and future research directions are discussed.

Does Organizational Cronyism Lead to Lower Employee Performance? Examining the Mediating Role of Employee Engagement and Moderating Role of Islamic Work Ethics.

In this research, using a time-lagged approach, we investigated the relationship between organizational cronyism and employee performance. Drawing on the conservation of resources theory, we tested the mediating role of employee engagement in the relationship between organizational cronyism and employee performance. We also examined how Islamic work ethics moderated the relationship between organizational cronyism and work engagement. The study, with a total of 267 participants, was conducted in the healthcare sector of Pakistan. The results revealed that organizational cronyism was negatively related to employee performance. The analyses confirmed the mediating role of work engagement in the relationship between organizational cronyism and employee performance. Similarly, Islamic work ethics moderated the relationship between organizational cronyism and work engagement. Implications for future research as well as managerial implications of our findings along with the limitations and future research directions are also discussed.