Business Administration, Management, and Operations Commons^™

The 340b Program, Contract Pharmacies And Hospitals: An Examination Of The First 25 Years Of Their Increasingly Complex Relationship, David P. Paul Iii, Morgan Cathlene Ludado, Morgan Ruley, Hannah Sayre, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The 340B Drug Pricing Program, created by Congress in 1992 through the Veterans Health Care Act, has provided discounted drug prices to hospitals and other health care organizations serving a wide population of low-income patients. Some 340B programs use contract pharmacies, an arrangement whereby the hospital or health care organization signs a contract directly with a pharmacy to provide covered pharmacy services at discounted prices.

The federal 340B Drug Pricing Program has provided access to reduced price prescription drugs to over 35,000 individual healthcare facilities and sites certified by the U.S. Department of Health and Human Services (HHS), and clinics …

The Continuing Epidemic Of Hepatitis C In The United States: The Case Of West Virginia, David P. Paul Iii, Neha Botre, Maggie Phillips, Jumana Abboud, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Hepatitis C virus (HCV) is one of the most significant public health problems currently facing the U.S. If it is left untreated, the likelihood of sustaining a treatment response decreases. While early identification has been identified as a critical focus in trying to obtain better health outcomes, new drug treatments appear quite promising.

Macra And Rural Hospitals, Erica Kelley, Rhea Lipscomb, Jennifer Valdez, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The purpose of this research was to study MACRA (Medicare Access & CHIP Reauthorization Act) and to determine how its implementation would financially impact rural hospitals. Although the long-term effects of MACRA have not been able to be studied, MACRA has the prospective to negatively impact rural hospitals financially. MACRA has potential risks and benefits for physicians associated with its two reimbursement payment methods. The estimated negative reimbursements and set reductions to hospital reimbursement have supported the idea that physicians and all healthcare organizations need to be aware and prepared for MACRA.

Hospital Nurse Burnout: A Continuing Problem, David P. Paul Iii, Lama Bakhamis, Harlan M. Smith Ii, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

RNs are a critically important component of the U.S. healthcare system. RN burnout – the feeling of exhaustion from working long hours without rest – is a real concern, having been reported in many hospitals. We examine the background, causes and consequences of burnout among RNs in U.S. hospitals, in order to identify solutions to this problem. Findings indicate that Burnout Syndrome in RNs can be analyzed in terms of four clusters of characteristics: individual, management, organizational, and work. The consequences of burnout include increased RN turnover rates, poor job performance, and threats to patient safety. RN burnout in hospitals …

Price Transparency In The United States Healthcare System, Gurlivleen (Minnie) Ahuja

USF Tampa Graduate Theses and Dissertations

The study explores price transparency in the healthcare system. With the increase in healthcare spending resulting in the advent of high deductible plans, consumers have been exposed to high healthcare cost. Despite being burdened with outrageous and extravagant bills, studies have shown that the consumers are not using price transparency tools to their benefit.

The literature review reveals that the major stakeholders in the healthcare industry have never been studied together to understand the research question on ‘Why is there lack of price transparency in the healthcare system?’ moreover, there is no theory to explains this phenomenon.

This study undertakes …

Medical Tourism And Its Effect On United State Healthcare Industry In A Highly Connected Global Landscape, Katarina Haist

The Hilltop Review

For centuries people have traveled to other countries to obtain the best healthcare. Traditionally these popular destinations were highly developed countries; the trend of people traveling to less developed areas for treatment is relatively new. The average person is more connected to the world around them than ever before through globalization. Information about the best practices are more widely available than ever before. The importance of physical barriers to business such as geography and time are being eliminated. Due to this “flattening” per Friedman, the competition and expertise for areas in Science, Technology, Engineering, and Mathematics (STEM) can be shifted …

The Continuing Epidemic Of Hepatitis C In The United States: The Case Of West Virginia, David P. Paul Iii, Neha Botre, Maggie Phillips, Jumana Abboud, Alberto Coustasse

Management Faculty Research

Hepatitis C virus (HCV) is one of the most significant public health problems currently facing the U.S. If it is left untreated, the likelihood of sustaining a treatment response decreases. While early identification has been identified as a critical focus in trying to obtain better health outcomes, new drug treatments appear quite promising.

The 340b Program, Contract Pharmacies And Hospitals: An Examination Of The First 25 Years Of Their Increasingly Complex Relationship, David P. Paul Iii, Morgan Cathlene Ludado, Morgan Ruley, Hannah Sayre, Alberto Coustasse

Management Faculty Research

The 340B Drug Pricing Program, created by Congress in 1992 through the Veterans Health Care Act, has provided discounted drug prices to hospitals and other health care organizations serving a wide population of low-income patients. Some 340B programs use contract pharmacies, an arrangement whereby the hospital or health care organization signs a contract directly with a pharmacy to provide covered pharmacy services at discounted prices.

The federal 340B Drug Pricing Program has provided access to reduced price prescription drugs to over 35,000 individual healthcare facilities and sites certified by the U.S. Department of Health and Human Services (HHS), and clinics …

Coordination Of Inpatient And Outpatient Care For Neurology Patients Undergoing Epilepsy Monitoring, Sara Schrock, Michelle Beane, Kathryn Cope, Mark Parker, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks, Brendan Lilley

Operations Transformation

ORGANIZING A SYSTEM TO CONSOLIDATE EPILEPSY REFERRALS TO AN OUTPATIENT NEUROLOGY PRACTICE

An outpatient neurology practice was experiencing delayed or lost referrals for epilepsy monitoring. This delay was leading many patients to suffer unnecessary and unmanaged seizures and, in some cases, frequent trips to the emergency department.

As a result, a team consisting of the neurology practice and neuro-navigators used baseline metrics to demonstrate the current state of the problem and conducted a root cause analysis that outlined several causes. A number of countermeasures were initiated with the goal of decreasing referral misses.

Post the initiation of two KPIs, a …

Mmc Fall With Injury Prevention Project, M. Wiggins, Joanne Chapman, Laurie Wilson, Rhonda Babine, Jennifer Laflamme, Melissa Vanmeter, Erica Weightman, Natalie Talbot, Kristine Hykras, Marie Hodge, Angela Smith

MaineHealth Maine Medical Center

Problem/Impact Statement:

Patients falls with injury remains an elusive problem at MMC. Over the past 8 quarter, (2016 and 2017) MMC has outperformed 3 of the last 8 Quarters of data. The average rate for the past 8 quarters is .57/1000 patient days with the mean benchmark of .54/per 1000 patient days. MH has determined a focus goal for all the MH hospitals to be below .70/MH 100 patient days as a goal for falls with injury. MMC having the largest volume must be below NDNQI mean to drive this change as the .70 is the average of all MH …

Labor Planning Outcomes: Systemic Management Models, Human Interactions, And Knowledge Sharing, Richard J. Tarpey

USF Tampa Graduate Theses and Dissertations

This project takes a systemic approach to hospital labor planning and allocation rather than sub-optimizing the individual components of workload demand forecasting, scheduling, and staffing separately. The research considers all three components within their interdependent, dynamic, cyclical systemic nature to develop a better labor planning and allocation cycle (LPAC) management model across the various subsystems of the hospital. We used an Action Design Research (ADR) method to the guided emergence of innovative artifacts – Systemic LPAC Management Model and LPAC Performance Metrics – that we evaluate and improve through interventions in situ with practitioners. The Systemic LPAC Management Model leveraged …

Telepharmacy And Access To Pharmaceutical Services In Rural Areas, Raghav Sarkar, Brandon J. Metzger, Hannah M. Sayre, Chelsea M. Slater, Sruthi Katamneni, Alberto Coustasse

Management Faculty Research

Access to pharmaceutical services in rural areas has been affected by a national shortage of pharmacists. Telepharmacy, a subspecialty of telemedicine, has involved the utilization of telecommunications to deliver pharmaceutical services to consumers located at a distance. The number of telepharmacy programs in the United States and worldwide has been progressively increasing. The purpose of this research project was to examine the effect of the utilization of telepharmacy on rural hospitals’ access to pharmaceutical services. The methodology of this qualitative study was a literature review. Four electronic databases were employed to retrieve peer-reviewed journal articles, and three websites were accessed …

How To Build A Robust Provider Improvement Partnership Program To Enhance Patient Experience – A Case Study, Venkat Iyer, Pamela Prissel, Karee Munson, Jennifer Eide, Rebecca Brustad, Nickie Kranz, Lukas P. Madson, Beverly Frase

Patient Experience Journal

Patient experience is emerging as a key differentiating factor in patients’ choice of healthcare system. Many healthcare organizations are attempting to improve their patient experience by data-driven, patient-centered initiatives. This involves engaging all staff along all the contact points of a patient’s journey in healthcare. Perhaps, the physicians or care providers are most important link in this chain but also the most challenging to engage in improvement efforts. Most healthcare organizations have some training or workshops to educate providers on communication skills and other tools to enhance patient experience. However, there seems to a paucity of a standardized approach or …

Hospital Nurse Burnout: A Continuing Problem, David P. Paul Iii, Lama Bakhamis, Harlan M. Smith Ii, Alberto Coustasse

Management Faculty Research

RNs are a critically important component of the U.S. healthcare system. RN burnout – the feeling of exhaustion from working long hours without rest – is a real concern, having been reported in many hospitals. We examine the background, causes and consequences of burnout among RNs in U.S. hospitals, in order to identify solutions to this problem. Findings indicate that Burnout Syndrome in RNs can be analyzed in terms of four clusters of characteristics: individual, management, organizational, and work. The consequences of burnout include increased RN turnover rates, poor job performance, and threats to patient safety. RN burnout in hospitals …

Macra And Rural Hospitals, Erica Kelley, Rhea Lipscomb, Jennifer Valdez, Alberto Coustasse

Management Faculty Research

The purpose of this research was to study MACRA (Medicare Access & CHIP Reauthorization Act) and to determine how its implementation would financially impact rural hospitals. Although the long-term effects of MACRA have not been able to be studied, MACRA has the prospective to negatively impact rural hospitals financially. MACRA has potential risks and benefits for physicians associated with its two reimbursement payment methods. The estimated negative reimbursements and set reductions to hospital reimbursement have supported the idea that physicians and all healthcare organizations need to be aware and prepared for MACRA.

The Opioid Epidemic In West Virginia, Nicholas Bowden, Rachel Merino, Sruthi Katamneni, Alberto Coustasse

Management Faculty Research

The rate of overdose-related to the use of licit and illicit opioids has drastically increased over the last decade in the U.S. The epicenter being West Virginia the highest rates of overdoses accounting for 41.5 deaths for 100,000 people among the 33,091 deaths in 2015. The number of people injecting drugs has increased from 36% in 2005 to 54% in 2015. The total U.S cost of prescription opioid abuse in 2011 has been estimated at $25 billion, and criminal-justice-system costs to $5.1 billion. The reasons for this opioid epidemic incidence in WV have been a combination of sociocultural factors, a …

Personal Health Records: Beneficial Or Burdensome For Patients And Healthcare Providers?, Melissa Lester, Samuel Boateng, Jane Stanley, Alberto Coustasse

Melissa Lester, DO

Personal health records (PHRs) have been mandated to be made available to patients to provide increased access to medical care information, encourage participation in healthcare decision making, and enable correction of errors within medical records. The purpose of this study was to analyze the usefulness of PHRs from the perspectives of patients and providers. The methodology of this qualitative study was a literature review using 34 articles. PHRs are powerful tools for patients and healthcare providers. Better healthcare results and correction of medical records have been shown to be positive outcomes of the use of PHRs. PHRs have also been …

The Emerging International Taxation Problems, James G. Yang, Victor N.A. Metallo

Department of Accounting and Finance Faculty Scholarship and Creative Works

The problems of tax evasion and tax avoidance are as old as taxes themselves. Between 2015 and 2016 alone, many U.S. multinational corporations were involved in tax disputes with the European Commission. From a historical perspective, these disputes are unprecedented as they have resulted in tremendous amount of tax penalties. The most notable case was Apple for €13 billion of unpaid tax. This article discusses what tax strategies these corporations used that caused such disputes. It specifically investigates seven corporations: Apple Inc., McDonald’s, Starbucks, Fiat, Amazon, Google, and Ikea, and elaborates on the following tax strategies: high royalties, intercompany transfer …

Proactive Coordination In Healthcare Service Systems Through Near Real-Time Analytics, Seung Yup Lee

Wayne State University Dissertations

The United States (U.S.) healthcare system is the most expensive in the world. To improve the quality and safety of care, health information technology (HIT) is broadly adopted in hospitals. While EHR systems form a critical data backbone for the facility, we need improved 'work-flow' coordination tools and platforms that can enhance real-time situational awareness and facilitate effective management of resources for enhanced and efficient care. Especially, these IT systems are mostly applied for reactive management of care services and are lacking when they come to improving the real-time "operational intelligence" of service networks that promote efficiency and quality of …

A Multi-Method Scheduling Framework For Medical Staff, Wael Rashwan, John Fowler, Amr Arisha

Conference Papers

Hospital planning teams are always concerned with optimizing staffing and scheduling decisions in order to improve hospital performance, patient experience, and staff satisfaction. A multi-method approach including data analytics, modeling and simulation, machine learning, and optimization is proposed to provide a framework for smart and applicable solutions for staffing and shift scheduling. Factors regarding patients, staff, and hospitals are considered in the decision. This framework is piloted using the Emergency Department(ED) of a leading university hospital in Dublin. The optimized base staffing patterns and shift schedules actively contributed to solving ED overcrowding problem and reduced the average waiting time for …

Informing Quality In Emergency Care: Understanding Patient Experiences, Esmat Swallmeh, Vivienne Byers, Amr Arisha

Articles

Purpose: Assessing performance and quality in healthcare organisations is moving from focussing solely on clinical care measurement to considering the patient experience as critical. Much patient experience research is quantitative and survey based. The purpose of this paper is to report a qualitative study gathering in-depth data in an emergency department (ED).

Design/methodology/approach: The authors used empirical data from seven focus groups to understand patient experience as participants progressed through a major teaching hospital in an Ireland ED. A convenience sampling technique was used, and 42 participants were invited to share their perceptions and outline key factors affecting their journey. …

Prenatal Opioid Maintenance In The U.S. And Its Effect On Neonatal Abstinence Sysndrome: The Case Of West Virginia's Opioid Epidemic, Morgan Ruley

Theses, Dissertations and Capstones

Introduction: West Virginia’s opioid epidemic has been the cause of about 1,000 deaths each year. Opioid abuse has become an issue among pregnant mothers and has increased the effects of NAS in infants. The purpose of this research study was to evaluate the participation of prenatal opioid maintenance to determine if it has decreased the amount of treatment needed for NAS in infants in WV.

Methodology: The methodology for this study utilized a literature review and a semi-structured interview. It consisted of academic sources, five electronic databases, academic journals, and government websites. Thirty-seven sources were referenced for this literature …

Harm Reduction Programs: West Virginia Vs. United States, Morgan L. Belcher, Hannah Sayre

Theses, Dissertations and Capstones

Introduction: Harm reduction has been a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. It has been defined as a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. The U.S. has been experiencing an opioid/heroin epidemic, with significant increases in overdose death among drug users with more than 72,000 Americans having died from drug overdoses in 2017.

Methodology: The methodology for this study was a literature review with a semi structured interview with Tina Rameriz of the Kanawha-Charleston Health Department …

The Process Of Adoption Of Disruptive Innovations In Local Health Care Agencies Delivering Primary Care, Aurora Aguirre Polanco

Open Access Theses & Dissertations

The current state of the U.S. health care system is complex and limit access to care to many consumers, thus compromising their health outcomes. The problems of limited access and questionable quality can be addressed by focusing on enhancing the primary health care field. Improvements in both the access and performance of primary health care agencies, derive in better health outcomes and cost savings to the system in the long-term. Disruptive innovations, that make products and services simpler and more affordable, are adopted in agencies and potentially improve access and performance measures. However, the adoption of disruptive innovations in local …

Strategies For Compliance With Government Regulations In A Pharmaceutical Company, Charles Jagun

Walden Dissertations and Doctoral Studies

Pharmaceutical companies accrued fines of over $30 billion within 25 years because of noncompliance with regulations. Noncompliance with regulations results in fines and an adverse impact on company profitability. Some pharmaceutical company managers lack effective strategies to ensure overall company compliance with regulation. Based on complexity leadership theory, the purpose of this single case study was to explore strategies pharmaceutical company managers used to ensure compliance with regulatory requirements in Nigeria. The target population was functional managers purposely selected because they had successfully implemented strategies for compliance with the regulatory requirements in Nigeria. Data were collected through face-to-face and telephone …

Community Public-Private Partnership Leadership Synergy In Tanzania, Hawa Yatera Mshana

Walden Dissertations and Doctoral Studies

Although the public-private partnership (PPP) concept in health and social health has been politically accepted as the best pathway to improving health outcomes in many developing nations, implementation lacks leadership synergy. Lack of awareness and engagement of community leaders about PPP interventions and their benefits affect accountability and ownership of health and social care interventions. The purpose of this study was to better understand factors that could promote partnership leadership synergy to enhance ownership and accountability for community health and social welfare initiatives in Tanzania. A qualitative empirical case study design was used; diffusion of innovation and the public-private integrated …

Exploring Management Practices Of The Health Care System For Contractors, Gary L. Williams

Walden Dissertations and Doctoral Studies

Researchers have found that military members serving in war experienced changes in physical and mental health. Military members' healthcare is managed by the Department of Defense. The problem was that management practices of the system for providing long-term healthcare for employees of a contracting company working in foreign combat zones is either minimal or nonexistent. The purpose of this case study was to explore ways that contractor managers and government managers can work together to provide healthcare for those contract employees who will be deployed with the U.S. military. The primary research question was to determine what managers of contractors …

Management Of Inappropriate Behaviors By Healthcare Risk Managers, Sahar Ebrahim Zadeh

Walden Dissertations and Doctoral Studies

Medical errors are the 3rd leading cause of death in the U.S.. The problem is timely recognition and management of inappropriate healthcare worker behaviors that lead to intimidation and loss of staff focus, eventually leading to errors. The purpose of this qualitative modified Delphi study was to seek consensus among a panel of experts in hospital risk management practices on the practical methods for early detection of inappropriate behaviors among hospital staff, which may be used by hospital managers to considerably mitigate the risk of medical mishaps. High reliability theory guided the research process, utilizing the conceptual framework of fair …

Strategies To Implement Innovations In Hospitals, Schola Mutumene Kabeya

Walden Dissertations and Doctoral Studies

The Patient Protection and Affordable Care Act, which promoted quality of care, started the transformation of healthcare systems in the United States. The purpose of this qualitative multiple case study was to explore clinical practice innovation strategies used by hospital middle managers to improve quality of care and profitability. Pettigrew's theory was the conceptual framework for this study. Participants were 8 middle managers from 2 high-performing hospitals in the southwestern region of the United States. Data were collected from semistructured interviews, personal notes, and review of the hospital's publicly reported documents and literature. Member checking and methodological triangulation increased the …

Succession Planning And Development Of Nurse Leaders, Christina Martin

Walden Dissertations and Doctoral Studies

Health care organizations can provide comprehensive, formal learning opportunities to develop nurse leaders for advanced leadership roles. The purpose of this doctoral project was to create an evidence-based nursing leadership academy focused on development of advanced leadership skills and competencies to cultivate frontline and midlevel nurse leaders for executive nursing and health care leadership positions. The practice-focused question addressed how an advanced nursing leadership education program would affect the knowledge level and competencies of nurse leader participants. The American Organization of Nurse Executives' (AONE) 5 nurse executive competency domains served as the framework for this project. Data were collected from …