An Organizational Psychology Approach to Understanding Overuse in Pediatric Hospital Medicine

Medical overuse in pediatrics is estimated to cost $27 million yearly and carries physical and emotional harms. Despite guidelines promoting high-value care, practice has changed minimally, and studies have focused on individual behaviors. We aimed to learn the perspectives of pediatric hospitalists on overuse and apply an organizational psychology framework as a novel way of understanding this issue.

This was a qualitative study interviewing pediatric hospitalists at 2 sites. Interviews were conducted until thematic saturation was reached. Transcripts were coded using grounded-theory methodology and themes were identified. An organizational psychologist reviewed emerging themes and recommended applying the levels of analysis framework, a method for diagnosing institutional issues by examining group and system factors.

There were 16 study participants (69% female, 31% male). The following themes influenced physicians toward overuse: (1) at the individual level, fear and risk-aversion, particularly among early-career faculty; (2) at the interpersonal level, the emphasis on maintaining positive interactions and relationships with other clinicians; (3) at the group level, the desire to align with peers; (4) at the intergroup level, using previous interactions with members of a group (such as parents and consultants) to inform the contemporary dynamic; and (5) at the system level, institutional factors and competing priorities, such as patient throughput demands and a focus on errors of omission.

Overuse is driven by influence of the individual's membership within a group or system and their interactions with other groups. Interventions should target complex group dynamics and systems pressures contributing to overuse.