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An Exploratory Study Of User Resistance In Healthcare It, Madison Ngafeeson, Vishal Midha

Journal Articles

The US healthcare system is clearly experiencing a major transition. By 2015, the healthcare sector is expected to have migrated from a paper record system to a completely electronic health record (EHR) system. The adoption and use of these systems are expected to increase legibility, reduce costs, limit medical errors and improve the overall quality of healthcare. Hence, the US government is investing $70 billion over a 10-year period to facilitate the transition to an electronic system. However, early reports show that physicians and nurses among other health professionals continue to resist the full use of the system. This paper …

Patient Safety Culture And High Reliability Organizations, Jared D. Padgett

Walden Dissertations and Doctoral Studies

A 1999 evaluation of case studies performed by staff from the Institute of Medicine found that between 40,000 and 98,000 patients died from preventable errors, while 43,598 individuals died in car accidents that year. A 2011 report increased that estimate nearly 10 times. Widespread preventable patient harm still occurs despite an increase in healthcare regulations. High-reliability organization theory has contributed to improved safety and may potentially reverse this trend. This explorative single case study explored how the perceptions and experiences of nursing and respiratory staff affected the successful transition of a healthcare organization into a reliability-seeking organization. Fourteen participants from …

Psycap And The Impact On The Development Of Intercultural Sensitivity Of Healthcare Educators: A Mixed Methods Study, Helen A. S. Fagan

Department of Agricultural Leadership, Education, and Communication: Dissertations, Theses, and Student Research

This purpose of this explanatory sequential mixed methods study was to examine the intercultural sensitivity development process of faculty and staff at a health sciences college in the Midwest. In the quantitative phase, this study investigated changes in intercultural sensitivity over a three year period, along with the relationship between developmental level of intercultural sensitivity (as measured by Intercultural Development Inventory [IDI] [Hammer, Bennett, & Wiseman, 2003]) of participants and Psychological Capital (PsyCap, a multidimensional construct consisting of hope, efficacy, resiliency, and optimism [Luthans, Youssef, & Avolio, 2007]). In the qualitative phase (Case Study) data collection and analysis further explored …

Factors That Influence Student Selection Of Educational Leadership Master’S Programs At Regional Universities, Pam Winn, Lesley F. Leach, Susan Erwin, Liza Benedict

Administrative Issues Journal

Graduate enrollment numbers in Educational Leadership programs have dwindled at many public higher education institutions. At the same time, for-profit institutions and institutions with private marketing partnerships have experienced increasingly greater enrollments. Many public institutions are reevaluating their marketing and recruiting strategies as they struggle to compete for students. Central to any marketing strategy is knowledge of the needs and wants of consumers; in the case of higher education, the consumers are students. This study sought to determine the needs and wants of Master’s-level Educational Leadership students by investigating the factors that influenced students’ selections of programs as well as …

Why Hospital Improvement Efforts Fail: A View From The Front Line., Paul D. Longenecker, Clinton O. Longenecker

Health and Sport Sciences Faculty Scholarship

In the 21st century, healthcare executives are facing changes of unprecedented magnitude in virtually every area, affecting their ability to compete. That hindrance brings with it a greater need for rapid and effective organizational change and improvement. Yet changes in the U.S. healthcare delivery system have historically been criticized as slow and less than effective in responding to the changes necessary for rapid performance improvement. To that end, the purpose of this applied research study was to help healthcare executives better understand the barriers to effective organizational change and improvement from the perspective of frontline leaders. Focus groups were conducted …

State Uses Financial Incentives To Fund Nursing Home–Initiated Quality Improvement Projects Through Competitive Bidding Process, Leading To Better Care, Valerie Cooke, Greg Arling, T. Lewis, Kathleen Abrahamson, Priscilla Arling, H. Davila, C. Mueller

Scholarship and Professional Work - Business

Authorized in 2006 by the State legislature, Minnesota’s Performance-Based Incentive Program funds nursing home–initiated quality improvement projects for 1 to 3 years through increases of up to 5 percent in the operating per diem rate charged to Medicaid and private-pay residents. Funding decisions are made through a competitive bidding process administered annually by the Department of Human Services, with recommendations from a review committee. Program staff provide support to nursing homes during and after the application process. Nursing homes that do not achieve project-specific performance targets can lose up to 20 percent of the incentive payments. The program has engaged …

A Correlational Analysis Of Empowerment And Experience With Resistance To Change, Rita Elizabeth Burgess

Walden Dissertations and Doctoral Studies

Despite more than 60 years of research about the nature of change, resistance to change remains a problem across industries. Health care leaders have limited knowledge of how health care managers' perceptions of empowerment, years of experience, and resistance to change (RTC) relate. The purpose for this nonexperimental correlational study was to examine the relationship between empowerment, years of experience, and RTC among managers via an online survey. The theoretical framework incorporated Kanter's structural empowerment theory and Kotter's change theory. The sample included 245 out of 1,181 health care managers from Veterans Administration (VA) hospitals in the New York metropolitan …

The Impacts Of Change In Governance On Faculty And Staff At Higher Education Institutions: A Case Study Of Ohsu, Dana L. Director

Dissertations and Theses

In the early 1990s, Oregon Health and Science University leadership examined the political and economic landscape and determined it needed a new operational model to survive and thrive. In 1995 OHSU separated from the state higher education system and became a public corporation, with goals of increased efficiency, customer-focus, ability to attract world-class researchers and physicians, and salaries commensurate with an urban academic health center.

This research examines the internal impacts when universities undergo significant change, using OHSU's governance change as a case study. Central is the question: what effect(s) did OHSU's decision to become a unique public corporation have …

The Influence Of Organizational Culture On Affinity For Knowledge Management Practices Of Registered Nurses, Gregory Allen

Faculty Publications - George Fox Digital

This study addressed the problems of hospitals’ duplicated effort and ad hoc knowledge management (KM) practices. The purpose of this quantitative study was to examine the focus and type of organizational culture in order to describe and predict the relationship between organizational culture and the affinity for KM of nurses working in health care organizations in Portland, Oregon. Guided by the competing values framework and social capital theory, this research study was undertaken to illuminate the possible relationship between the affinity for and probable use of KM and organizational culture in Oregon hospitals. Data were collected from 93 registered nurses …

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

Administrative Issues Journal

Change is a commonplace occurrence in today’s organizations. In order to survive in an extremely competitive marketplace, organizations and their employees undergo change frequently. The ability to manage change and to learn from this experience is now viewed as a key competency for sustainable competitiveness in most business markets. However, while change management processes are employed and followed, a high percentage of change efforts are judged to be unsuccessful by upper management. Moreover, 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 …

Perceptions Of Hospital Patient Safety Culture In Department Of Veterans Affairs Station 593 Southern Nevada, Kimberly Falco

UNLV Theses, Dissertations, Professional Papers, and Capstones

Opportunities for error exist, adverse events occur, and challenges endure. However, patients will continue to experience preventable adverse events unless steps are taken. Efforts to improve patient safety are critical to today's healthcare environment. The Department of Veterans Affairs (VA) believes that the identification of adverse events allows for creation of system improvements to increase patient safety.

Implementing safety culture requires a proper assessment of existing barriers and potential challenges. Patient safety culture assessments start by evaluating the current patient care environment. This assists the organization in identifying barriers to patient safety and in working toward creating a culture of …

Comparison Of Study/Article Characteristics And Methodological Quality Of International Nurse Workplace Violence Research Published Before And After The Joint Commission Sentinel Event Alert On Disruptive Behaviors, Terressa Margarette Stowell Love

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: The majority of new nurses experience workplace violence from other nurses. The purpose of this study was to compare study/research characteristics and methodological quality of international nurse workplace violence research published before and after the 2008 release of the U.S. The Joint Commission (TJC) sentinel event alert on disruptive behaviors.

Methods: Thirty-nine quantitative nurse workplace violence research articles published between 2001 and 2012 were assessed and divided into two groups: articles published (a) before the 2008 TJC sentinel event alert or the same year, i.e., 2001-2008 (BTJC) and (b) after the 2008 TJC sentinel event alert, i.e., 2009-2012 (ATJC). …

Factors Contributing To Successful Transitions Into The Role Of A New Superintendency In Texas: A Mixed Methods Triangulation Convergence Inquiry, Nancy B. Jones

Administrative Issues Journal

The purpose of this study was to examine the factors contributing to a successful transition into the role of a new superintendency in Texas. A triangular designed mixed methodology with a convergence model was employed. The setting was urban, suburban, and rural school districts in Texas. The participants were superintendents of public school districts in Texas. Quantitative data were collected through the use of an electronic survey, while a focus group was conducted to collect the qualitative data. Participating superintendents indicated that the training and education they received had adequately prepared them for the role of a new superintendent and …

The Patient Protection And Affordable Care Act And Medicaid Expansion: Leadership Strategies For Effective Change Management In Managed Care Organizations, Emily Aurand

Theses and Graduate Projects

As a result of tlie 2010 Patient Protection and Affordable Care Act (ACA), eligibility requirements for the Medicaid program were revised resulting in a greater number of people eligible to enroll in tlie government healthcare program. These circumstances require numerous organizational changes for Medicaid managed care organizations (MCOs) that administer the Medicaid program in order to accommodate the healthcare needs of the growing Medicaid population and comply with applicable regulatory requirements. This case study sought to identify effective leadership strategies employed by Minnesota Medicaid MCO change leaders guiding organizational change processes and seeking quality change outcomes, resulting from the externally …

Facilitating Emergence: Complex, Adaptive Systems Theory And The Shape Of Change, Peter Martin Dickens

Antioch University Dissertations & Theses

This study used Principal Component Analysis to examine factors that facilitate emergent change in an organization. As organizational life becomes more complex, today’s dominant management paradigms no longer suffice. This is particularly true in a health care setting where multiple sources of disease interacting with each other meet with often-competing organizational priorities and accountabilities in a highly complex world. This study identifies new ways of approaching complexity by embracing the capacity of complex systems to find their own form of order and coherence. Based on a review of the literature, interviews with hospital CEOs, and my organization development practice experience …

Anomalies In The System: Is A New Educational Paradigm Upon Us?, Ed Cunliff, John Barthell

Administrative Issues Journal

In this article, we describe the palpable changes of a paradigm shift in higher education. Although this shift has been described and/or predicted elsewhere, we affirm the transition from over 30 years of collective teaching and administrative experience at a predominantly undergraduate institution (PUI) with historical roots as a state normal school. In many respects, the anomalies that Thomas Kuhn predicted in such a transition are all the more evident given our institution’s history. These anomalies include (but are not limited to) 1) the state of knowledge “ownership” (as mediated by the internet), 2) student-centered (vs. faculty-centered) educational practices, 3) …

Complexity, Knowledge And Structure: A Systemic Understanding Of Organizational Learning, Justin D. Walton

Administrative Issues Journal

Organizations are among the most socially complex institutions within modern culture. As corporations face the challenges of technological change and globalization, it becomes essential that they find new ways and forms of fostering knowledge sharing and creativity. Challenging the age-old belief that employees should “dominated and directed,” complexity theory challenges the classic machine metaphor of organizational structure with a view that conceptualizes them as nonlinear systems that fluctuate between conditions of stability and chaos. This model offers new and exciting opportunities for exploring the dynamics of organizational learning. Toward this end, this paper examines the systemic features of organizations with …

Childhood Loss And Ad/Hd: Program Implications For Education Administrators, Helen Wilson Harris, Marlene Zipperlen

Administrative Issues Journal

Evidence-based practice and evidence-informed practice are not just buzzwords in education. It is essential that administrators encourage both the development and the application of new knowledge in the field. This study of 1755 elementary age children in Central Texas indicates a positive association between the experience of childhood loss and grief and a diagnosis of AD/HD. Implications of this information for administrators in education are explored, including the training of counselors and classroom teachers in grief interventions and accommodations for grief related attention problems in children.

University In Transition: Faculty Sense-Making And Responses, Leslie D. Gonzales, Rodolfo Rincones

Administrative Issues Journal

Across the institutional spectrum, universities are attempting to reposition themselves as more research dominant institutions, a pattern referred to as “mission creep.” Such changes in university missions have several critical implications for faculty members and their work. In this qualitative study, we interviewed ten tenure-track faculty members to explore how they make sense of and respond to Sun University’s creeping university mission. Through qualitative data analysis, we found that faculty use organizational scripts to construct and make sense of their role, yet they do so towards different ends. Some faculty members own the transition and attempt to contribute to its …

The District-Wide Sustainability Of A Professionallearning Community During Leadership Changesat The Superintendency Level, Chuey Abrego, Anita Pankake

Administrative Issues Journal

The purpose of this mixed methods follow-up single case study was two-fold: to determine if a school district was able to sustain a professional learning community (PLC) and to identify factors that enhanced, inhibited, or promoted the sustainability of a PLC from a district-wide perspective, with particular focus on how a change in leadership, i.e. a new superintendent, affected the sustainability of PLC attributes. In addition, the role of trust in influencing the sustainability of a professional learning community will be discussed in this paper.

The Relationship Of Financial Performance, Quality Indicators, And The Role Of Nurse Executives In Virginia Nursing Homes, Jeany V. Murphy

Health Services Research Dissertations

Problem statement. The dynamic nature of the healthcare industry has triggered changes in nurse executive functions. The job has expanded into entrepreneurial roles to be able to provide the most cost effective services while maintaining good quality outcomes for the residents. The new responsibility requires a different set of knowledge and competencies that is usually achieved through advanced education. It is not known whether nurse executives in long term care in Virginia possess the skills to influence both the financial and quality outcomes of the facility.

Methods. This descriptive research study examined the relationship of the nurse executives' technical, human, …

Managing Health Care In A Libyan Public Hospital: A Case Study, Alexandria K. Osborne

Walden Dissertations and Doctoral Studies

Libyan citizens who can afford private health care are opting out of the public health care system. They have a perception that the quality of public health care has deteriorated. The negative perceptions have resulted in a lack of trust by many of Libyan's citizens in the Libyan public health care system and consequently to unequal access to quality health care. The purpose of this study was to identify the factors that have led to the negative perceptions and mistrust. The conceptual support for the study was based on a construct of trust that defines trust as the state of …

Quantitative And Qualitative Findings And Implications Of An Intercultural Sensitivity Assessment Among Employees At A Large Health System, Jarret R. Patton Md, Jay Baglia Phd, Lynn M. Deitrick Rn, Phd, Anthony Nerino Ma, Eric J. Gertner Md, Mph, Judith Sabino Mph, Mary Kay Grim Bs, Debbie Salas-Lopez Md, Mph

Department of Pediatrics

Tuesday, November 10, 2009: 2:45 PM Jarret R. Patton, MD , Department of Pediatrics, Lehigh Valley Health Network, Allentown, PA Jay Baglia, PhD , Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA Lynn M. Deitrick, RN, PhD , Department of Community Health, Health Studies and Education, Lehigh Valley Health Network, Allentown, PA Anthony Nerino, MA , Department of Community Health, Health Studies and Education, Lehigh Valley Health Network, Allentown, PA Eric J. Gertner, MD, MPH , Department of Medicine, Lehigh Valley Health Network, Allentown, PA Judith N. Sabino, MPH , Cultural Awareness, Lehigh Valley Health Network, Allentown, PA …

Contextual Leadership: The Social Construction Of Leadership In A Comprehensive Healthcare System, Mark J. Moir

Antioch University Dissertations & Theses

Healthcare is a complex and dynamic environment containing a plurality of social forces and perspectives that shape the organizational culture and the nature of the leadership. As leadership is a social phenomenon, it is important to understand the complex social processes that mediate our perceptions and that in turn influence processes of leader attribution. The central purpose of this study has been to illuminate the nature of culturally specific processes that emerge within a specific organizational setting and that fuel leader attribution and the social construction of leadership. Accordingly, this qualitative study has developed a Grounded Theory utilizing Situational Analysis …

Organizational Culture In A Terminally Ill Hospital, Alberto Coustasse, Douglas A. Mains, Kristine Lykens, Sue G. Lurie, Fernando Trevino

Management Faculty Research

This study analyzed an organizational culture in a community hospital in Texas to measure organizational culture change and its impact on Patient Satisfaction (PS). The study employed primary and secondary data, combining quantitative and qualitative methods for a case study. Participant observation was used and archival data were collected to provide a better understanding of the organizational culture and the context in which change was taking place. This study also applied a “Shared Vision” of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. …

Hospital Administrators' Perceptions Regarding Their Role In Quality Improvement, Benjamin F. Brown

MUSC Theses and Dissertations

As the formal leaders of their organizations, hospital administrators play a major role in ensuring that their hospitals meet the challenge of continually improving the care that is provided within their organizations. While the literature identifies some of the things that these leaders should be doing to lead their organizations toward providing exemplary care, the literature is lacking with regard to the specifics of how those who are successful are actually able to do so. This study sought to fill this gap in the literature through a qualitative examination of hospital administrators' perceptions of their roles in Q I. The …

Knowledge Integration: The Iaims Experience At Lvh., Donald L. Levick Md, Linda M. Schwartz Mde, Ahip, Cm, Bryan G. Kane Md

Administration & Leadership

No abstract provided.

Factors Associated With Integrating Self-Management Support Into Primary Care, Richard Crespo, Molly Shrewsberry

Family and Community Health

Purpose

The purpose of this article is to expand the understanding of self-management support by describing factors that contribute to implementing a comprehensive self-management program in primary care.

Methods

Four rural health centers in medically underserved areas participated in a study to document the implementation of a self-management program. This program consisted of a social marketing plan and decision-making tools to guide patients in making self-management behavior changes. The stages of change constructs of the transtheoretical model were used to design the social marketing plan. Key informant interviews were conducted at 6-month and 9-month intervals to document the implementation process. …

Adaptation Of Lean Methodologies For Healthcare Applications, Heather (Woodward) Hagg, Deanna Suskovich, Jamie Workman-Germann, Susan Scachitti, Brian Hudson, Joseph Swartz, Chris Vanni

RCHE Publications

Lean and Six Sigma quality concepts and terminology have been applied in the manufacturing arena since the late 1980’s and early 1990’s. It has only been in recent years that healthcare administrators have identified these methods as being adaptable to their organizations so that they may realize organizational improvements for continuing success and delighting customers. Unfortunately, this is not an application that is widely taught in typical Industrial Engineering curriculum and therefore there are few educated professionals coming right out of college that are able to apply these principles to healthcare. There are however, many experienced professionals knowledgeable in the …

The Impact Of The User Board Majority Requirement On The Governance Of Community Health Centers, Nancy J. Bracken

MUSC Theses and Dissertations

The federal requirement that 51 percent of the governing boards of federally funded community health centers must be users of the health center was originally intended to insure that the community served had a voice in the services provided. This qualitative study attempted to determine the perceptions of key stakeholders of the impact of the requirement on the effectiveness of governing boards, as well as how boards develop and measure effectiveness. Open-ended, semi-structured interviews with five CEOs and five Board Chairs revealed few concerns about the challenges of complying with the requirement. Board training in South Carolina appears to be …