Digital Commons Network^™

Proposal Defense: Improving Patient Portal Adoption In Primary Care, Melissa Wagner

Doctoral Projects

Introduction: Stage three of Meaningful Use (MU) is currently underway and is focused on promoting patient portal use. If the electronic medical record patient portal use is less than 25%, primary care providers face reductions in value-based reimbursements. National adoption rates from portal use remain under 27% with some providers averaging well below the needed 25%. The following practice question is proposed, “In a low-income urban adult clinic, how does an interactive electronic education intervention compared to no education intervention affect patient portal adoption rates?”

Objectives: The purpose of this project is to identify whether an electronic patient educational video …

Use Of Quality Improvement Strategies Among Small To Medium-Size Us Primary Care Practices, Bijal A. Balasubramanian, Miguel Marino, Deborah J. Cohen, Rikki L. Ward, Alex Preston, Rachel Springer, Stephan R. Lindner, Samuel Edwards, John Mcconnell, Benjamin F. Crabtree, William L. Miller, Kurt C. Stange, Leif I. Solberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Improving primary care quality is a national priority, but little is known about the extent to which small to medium-size practices use quality improvement (QI) strategies to improve care. We examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US states to improve quality of care for heart health and assessed factors associated with those variations.

Strategies For Healthcare Payer Information Technology Integration After Mergers And Acquisitions, Kishore Maranganti

Walden Dissertations and Doctoral Studies

Despite the high rate of failure in merger and acquisition (M&A) transactions, many organizations continue to rely on M&As as their primary growth strategy and to address market competition. The purpose of this qualitative single case study was to explore strategies managers from a large healthcare payer in the midwestern United States used to achieve operational and strategic synergies during the postacquisition information technology (IT) integration phase. Haspeslagh and Jemison's acquisition integration approaches model was the conceptual framework for the study. Methodological triangulation was established by analyzing the data from the semistructured interviews of 6 senior executives and 6 IT …

Strategies For Increasing Volunteer Engagement In Nonprofit Healthcare Organizations, Sanja Katina Hudson

Walden Dissertations and Doctoral Studies

Implementing effective strategies to address the challenges of volunteer engagement is critical for helping ensure the sustainability of nonprofit healthcare organizations. Nonprofit healthcare leaders seek strategies to increase the volunteer workforce and enhance volunteer engagement. Through the conceptual lens of Deci and Ryan's self-determination theory, the strategies nonprofit healthcare leaders used to reduce volunteer turnover were explored in this single-case study. Data were collected using semistructured interviews with 5 nonprofit healthcare leaders from a single organization in the southwestern United States. Analysis of internal and external organizational documents and publicly available data were manually coded and thematically organized. The use …

Leadership Strategies For Implementing Quality Improvement Initiatives In Primary Care Facilities, Jose A. Poncevega

Walden Dissertations and Doctoral Studies

Health care spending accounts for 17.7% of the gross domestic product in the United States, and it is expected to continue rising at an annual rate of 5.3%. Despite high costs, health care quality lags behind other high-income countries; yet, over 70% of change initiatives fail. The purpose of this multiple case study was to explore strategies primary care leaders use for implementing quality improvement initiatives to improve patient outcomes and reduce waste in primary care facilities. The target population consisted of 3 health care leaders of 3 primary care facilities in southern California who successfully implemented quality improvement initiatives. …

Strategies Rural Hospital Leaders Use To Implement Electronic Health Record, Susan Mejia

Walden Dissertations and Doctoral Studies

The Centers for Medicare and Medicaid Services issued over 144,000 payments totaling $7.1 billion to medical facilities that have adopted and successfully demonstrated meaningful use of certified electronic health record (EHR). Hospital organizations can increase cost savings by using the electronic components of EHRs to improve medical coding and reduce medical errors and transcription costs. Despite the incentives, some rural health care facilities are failing to progress. The purpose of this multiple case study was to explore the strategies rural hospital leaders used to implement an EHR. The target population consisted of rural hospital leaders who were involved in the …

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 …

Technology Acceptance And Compliance In Obstructive Sleep Apnea Patients, Asif Kidwai

Walden Dissertations and Doctoral Studies

The focus of this study is the problem of declining trend in obstructive sleep apnea (OSA) patient compliance. Studies reported improved compliance in patients with chronic diseases due to technology-based interventions. However, researchers have not investigated the advantages of technology to improve the compliance of OSA patients in detail. The specific problem was the lack of engagement between patients and healthcare managers, resulting in low compliance within OSA patients. The purpose of this qualitative study was to evaluate how technology-based interventions can improve OSA patient engagement with the healthcare managers resulting in improved compliance with treatment procedures. In this study, …

Waste Management Minimization Strategies In Hospitals, Andrea L. Clark

Walden Dissertations and Doctoral Studies

During the delivery of healthcare services, hospital employees use enormous amounts of water, energy, and nonbiodegradable carcinogenic plastics. In the U.S., hospital staff generate an average of over 7,000 tons of waste per day at an average cost of $0.28 per pound for the disposal of regulated medical trash, which if efficiently managed or reduced, could result in substantial cost savings. Using the organizational learning and the transaction cost economics theories as the conceptual frameworks, the purpose of this qualitative case study was to explore strategies healthcare leaders used to minimize their waste management operational costs. Data were collected using …

Toward Excellence: Exploring Leader Strategies In Chronic Wound Care Centers, Geraldine Rosol

Walden Dissertations and Doctoral Studies

The number of chronic wounds is rising in the United States, and health leaders face the economic and health burdens these wounds pose to the U.S. health care system. Many investigators have documented the importance of leadership in promoting excellence and reducing health care costs in chronic disease. Yet, the literature lacks information regarding leader strategies used to promote wound treatment cultures of excellence directed toward improved quality and reduced health costs. This study examined leader strategies used to promote excellence in chronic wound treatment to address the problem of the economic and health burdens associated with chronic wounds. The …

Predictive Relationships Between Electronic Health Records Attributes And Meaningful Use Objectives, Solomon Nii Koppoe

Walden Dissertations and Doctoral Studies

The use of electronic health records (EHR) has the potential to improve relationships between physicians and patients and significantly improve care delivery. The purpose of this study was to analyze the relationships between hospital attributes and EHR implementation. The research design for this study was the cross-sectional approach. Secondary data from the Health Information and Management Systems Society (HIMSS) Analytics Database was utilized (n = 169) in a correlational crosssectional research design. Normalization Process Theory (NPT) and implementation theory were the theoretical underpinnings used in this study. Multiple linear regressions results showed statistically significant relationships between the 4 independent variables …

Educational Training Of Staff Nurses For Evidence-Based Practice, Tina June Theriaque

Walden Dissertations and Doctoral Studies

Translating research into practice takes 10 to 20 years or more. Evidence-based practice (EBP) integration remains at 10% to 20%, despite recommendations requiring EBP-guided decisions. Up to 30% decreases in health care system spending, improved quality outcomes, and increased staff satisfaction result from EBP integration. Nurse leaders, who rate quality and safety as the highest priority but EBP as the lowest, are accountable for EBP enculturation; a desire to support bedside registered nurses in EBP exists, yet this EBP use knowledge gap supersedes this goal. The purpose of this project was to provide an EBP education program introducing the use …

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 …

Perspectives Of Primary Care Physicians On Adopting Electronic Medical Records In The Atlanta, Georgia Area, Chris U. Okoro

Walden Dissertations and Doctoral Studies

Slow adoption of electronic medical records (EMR) by primary care physicians in medical office practices has not facilitated the EMR adoption process. The problem is the slow pace of EMR adoption by primary care physicians in the Atlanta, Georgia area has become a public health concern. Research regarding the lived experiences of these physicians with EMR implementation and utilization may identify reasons for the slow adoption. The purpose of this phenomenological study was to explore the lived experiences of primary care physicians, who practice in the Atlanta area, regarding their perception, successes, barriers, and urgency of adoption of EMR in …

Strategies For Shipping Temperature-Sensitive Medical Devices Using Cognitive Mapping, Eric C. Guynes

Walden Dissertations and Doctoral Studies

Supply chain management (SCM) practitioners who ship temperature-sensitive diagnostic medical devices (DMDs) to clinicians must use effective cold chain management (CCM) strategies to avoid temperature excursions that contribute to medical device errors. Such errors have caused patient harm and death, which costs the U.S. health care system billions of dollars per year. The purpose of this qualitative multiple case study was to explore strategies for selecting and managing cold chain shipping solutions (CCSSs) requiring SCM executives to trade cost for regulatory compliance and predictability when mitigating temperature variations that occur during shipping. The conceptual framework for the study was the …

Hospital Executive Succession Planning Strategies, Janet Tingling

Walden Dissertations and Doctoral Studies

Approximately 50% of New York City hospitals lack succession planning as baby boomers transition out of the workforce into retirement. The potential loss of knowledge capital could affect leadership development and corporate stability. Guided by the transformational leadership theory, the purpose of this single site case study was to explore successful strategies executive-level leaders used to facilitate succession planning within their hospital. Three hospital executive-level leaders from a single site location participated in a semistructured face-to-face interview and provided data that assisted the analysis. Four themes emerged from the data analysis through a word cloud format that showed the most …

The Survival Of Healthcare In Rural Texas, Destin Cook

Walden Dissertations and Doctoral Studies

Over 80 rural hospitals have closed in the United States since 2010, representing about half of all hospital closures during this period, and another 600-700 rural hospitals are at risk of closing shortly. The purpose of this qualitative exploratory multiple case study, which was based on transformational leadership and diffusion of innovation theories, was to gain a common understanding of financial problems and operational inefficiencies that may be impacting rural hospital leaders in the state of Texas. Data collection involved semi-structured interviews with 4 senior healthcare leaders from 3 separate regions in Texas. Data analysis included compiling, sorting, fragmenting, and …

Strategies For Developing And Implementing Information Technology Systems For Ehrs, Priscilla Riddley

Walden Dissertations and Doctoral Studies

Some hospital leaders lack the technical expertise to implement electronic health records (EHRs) even though the healthcare industry has a government mandate. The purpose of this single case study was to explore strategies healthcare executives use to develop and implement information technology systems for processing EHRs. The target population consisted of healthcare leaders and managers successful in implementing EHR systems in a healthcare organization. Lewin's 3-step change theory was used as the conceptual framework for this study with data collected from observations (5), semistructured interviews (5), and organizational documents. Descriptive coding was used to identify 3 themes that emerged from …

Addressing Uncertainty During Workplace Change: Communication And Sense-Making, Rich Parsells

Administrative Issues Journal

Change is a commonplace occurrence in today’s organizations. A number of scholars suggest that communication strategies during organizational change are an important element to the success of a change initiative, yet such strategies are not given primacy in the research literature. The purpose of this paper is to add to the discourse on communication and workplace change initiatives by reporting on a research project that explored communication actions which were employed and viewed as useful by those experiencing a change in the workplace. This paper presents the findings that emanated from the study and explore their meaning in relation to …

How Managers Use The Stockdale Paradox To Balance “The Now And The Next”, C. W. Von Bergen, Martin S. Bressler

Administrative Issues Journal

Recent discussions of leadership paradoxes have suggested that managers who can hold seemingly opposed, yet interrelated perspectives, are more adaptive and effective. One such paradox that has received relatively little attention is the “Stockdale Paradox,” named after Admiral James Stockdale, an American naval officer who was held captive for seven and one-half years during the Vietnam War and survived imprisonment in large part because he held beliefs of optimism about the future, while simultaneously acknowledging the current reality of the desperate situation in which he found himself. This contradictory tension enabled him and his followers to emerge from their situation …

Overcoming Barriers To Implementing Electronic Health Records In Rural Primary Care Clinics, Patricia Mason, Roger Mayer, Wen-Wen Chien, Judith P. Monestime

The Qualitative Report

Medicare-eligible physicians at primary care practices (PCP) that did not implement an electronic health record (EHR) system by the end of 2015 face stiff penalties. One year prior to the 2015 deadline, approximately half of all primary clinics have not implemented a basic EHR system. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants’ experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the …

Operationalizing Person-Centered Care Practices In Long-Term Care: Recommendations From A “Resident For A Day” Experience, Jennifer L. Johs-Artisensi

Patient Experience Journal

As the senior population continues to age, long-term care is positioned for growth and care recipients are demanding more person-centered care. While long-term care leaders may understand and believe in the value of person-centered care, sometimes operationalizing practices to ensure its delivery can be challenging. Using an ethnographic approach, over three years, 159 long-term care administrator-in-training practicum students each lived as a resident for 24 hours in a nursing home. Following the experience, using the Picker Institute’s framework, each participant identified and justified an Always Experience® – an optimal experience they believed should routinely occur for every long-term care resident. …

Driving Organizational Change From The Bedside: The Aacn Clinical Scene Investigator Academy., Susan R. Lacey, Caryl Goodyear-Bruch, Adrienne Olney, Dave Hanson, Marian S. Altman, Natasha S. Varn-Davis, Debbie Brinker, Ramón Lavandero, Karen S. Cox

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes.

OBJECTIVES: To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes.

METHODS: The curriculum of the Academy included leadership topics, communication, change concepts, quality …

Color-Blind Racial Attitudes: Microaggressions In The Context Of Racism And White Privilege, Jared F. Edwards

Administrative Issues Journal

Interest in institutional racism, White privilege, and microaggressions appears to be growing. We are living in times when the impact of race and racism are debated—when even the existence of racism is debated along with the appropriateness of examining the worst parts of U.S. history. This special-issue invited article includes a brief examination of historical information and current context in which racism and microaggressions exist, leading to their connections to Color-Blind Racial Attitudes (CoBRAs). Reviewed research on CoBRAs addresses teacher training, educational practices, experiences on college campuses, and organizational management.

Combating Workplace Violence: An Evidence Based Initiative, Diana L. Giordano

Evidence-Based Practice Project Reports

Patient/visitor violence against healthcare (HC) employees is a type of workplace violence (WPV) and considered a dangerous hazard within HC occupations (Bureau of Labor Statistics, 2015). Lack of recognition of the true incidence and underreporting of WPV may contribute to a false sense of security within a HC facility (HCF). Therefore, fully addressing the problem may be met with administrative resistance, resulting in poor employee perceptions of support and commitment for a zero-violence environment. A retrospective analysis was conducted on the HCF’s online incident reports, security request calls, and data from a previously deployed WPV employee survey. The emergency department …

Organizational Factors Associated With Quality Perinatal Care, Lisa H. Akers

Dissertations, 2014-2019

Provisions for perinatal care are an integral part of quality healthcare and are increasingly moving to the forefront of quality care measures in the healthcare setting (Agency for Healthcare Research and Quality, 2012; National Quality Forum, 2012; & The Joint Commission, 2010). Previous literature specifically focused attention to general quality of care, but recently there has been a call for a more comprehensive approach to measuring quality in the perinatal care setting, which necessitates the need for a better understanding of what is currently being offered (Collins & Draycott, 2015). Until now the literature has remained limited on the association …

How Healthcare Accounting Adapts To Lean Practices, Caitlin R. Duke

Undergraduate Honors Theses

Healthcare has recently begun a push towards more lean practices and management. Healthcare accounting, in an effort to reflect business practices, must change to accurately reflect reality. This research seeks to explore how healthcare providers improve their accounting systems to keep up with an ever-changing lean environment. By examining both healthcare and accounting literature, this comprehensive literature review seeks to answer the question, “How does healthcare accounting adapt to lean philosophies?”.

Clinical Performance Measures And Quality Improvement System Considerations For Dental Education, Joseph W. Parkinson, Gregory G. Zeller

Oral Health Practice Faculty Publications

Quality improvement and quality assurance programs are an integral part of providing excellence in health care delivery. The Dental Quality Alliance and the Commission on Dental Accreditation recognize this and have created standards and recommendations to advise health care providers and health care delivery systems, including dental schools, on measuring the quality of the care delivered to patients. Overall health care expenditures have increased, and the Affordable Care Act has made health care, including dentistry, available to more people in the United States. These increases in cost and in the number of patients accessing care contribute to a heightened interest …

How Nurse-Led Practices Perceive Implementation Of The Patient-Centered Medical Home, Rosemary Frasso, A. Golinkoff, Heather Klusaritz, Katherine Kellom, Helen Kollar-Mcarthur, Michelle Miller-Day, Robert Gabbay, Peter F. Cronholm

Communication Faculty Articles and Research

Purpose

The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model.

Methods

Data were collected through in-depth interviews with providers and staff in nurse-led practices.

Results

These data suggest two categories of processes that facilitate the integration of PCMH in …

The Use Of A Patient Mobility Sensor To Decrease Hospital-Acquired Pressure Ulcers, Monica Vassallo Shallow

Walden Dissertations and Doctoral Studies

Pressure ulcers are a serious health condition that have negative consequences for patients and organizations. The primary cause of pressure ulcers is intense and/or prolonged pressure or pressure in combination with shear that results in damage to the skin and underlying soft tissue. Early identification of patients at risk for pressure ulcers and 2-hour repositioning to off-load pressure are key components in reducing pressure ulcer development. Despite ongoing efforts to prevent pressure ulcers, the incidence and prevalence of hospital-acquired pressure ulcers (HAPUs) at the practicum site exceeded the benchmark for Magnet hospitals and the health system's goal of 1%. Patient …