Digital Commons Network^™

Health Leadership And Management Practices That Support Accountability For Results, Peter Kayiira Byansi

Walden Dissertations and Doctoral Studies

Although leaders are expected to nurture and sustain a culture of accountability for results, little is known about how health leaders in developing countries perceive, interpret, demonstrate, and promote accountability in their day-to-day practices. The purpose of this generic qualitative study was to explore the management and leadership practices that leaders of public and non-profit health support organizations in Uganda utilize to embody and support accountability for key stakeholders’ results. Data from in-depths interviews with 13 participants at the governance, senior management, and middle management levels were analysed using thematic data analysis. Riggio's conceptualization of using multiple perspectives and disciplines …

Experiences And Attitudes Regarding The Availability And Usage Of Telemedicine Services Among Providers During A Pandemic, Keya Gaston Brooks

Walden Dissertations and Doctoral Studies

Telehealth became a prominent fixture in the way healthcare was delivered during COVID-19. Providers were forced to offer telehealth as an optional mode of care. Although little research was available, studies about the experiences and attitudes of providers regarding their intention and willingness to use telemedicine before the pandemic was exiguous. The purpose of this study was to understand providers perception and use behavior patterns regarding the acceptance and adoption of telemedicine during the pandemic. Data collected from the COVID-19 Healthcare Coalition Telehealth Impact Survey was used to help characterize the experiences and attitudes of providers regarding telehealth utilization during …

Health Leadership And Management Practices That Support Accountability For Results, Peter Kayiira Byansi

Walden Dissertations and Doctoral Studies

Although leaders are expected to nurture and sustain a culture of accountability for results, little is known about how health leaders in developing countries perceive, interpret, demonstrate, and promote accountability in their day-to-day practices. The purpose of this generic qualitative study was to explore the management and leadership practices that leaders of public and non-profit health support organizations in Uganda utilize to embody and support accountability for key stakeholders’ results. Data from in-depths interviews with 13 participants at the governance, senior management, and middle management levels were analysed using thematic data analysis. Riggio's conceptualization of using multiple perspectives and disciplines …

Perceptions Of Women Of Color Improving Patient Outcomes Through Hospital Leadership Advancement, Benita A. Mclarin

Walden Dissertations and Doctoral Studies

Women of color have been underrepresented in hospital leadership positions and face challenges in advancing their careers. The benefit to hospitals providing women of color with training and support to move into leadership positions may be improved patient outcomes. Grounded in the interactional model of cultural diversity framework, the purpose of this basic qualitative study was to explore the perceptions of women of color advancing in leadership roles in hospitals and their impact on patient outcomes. The study participants included 16 women of color in leadership positions from hospitals in a western U.S. state. Data were collected through semi structured …

Perceptions Of Women Of Color Improving Patient Outcomes Through Hospital Leadership Advancement, Benita A. Mclarin

Walden Dissertations and Doctoral Studies

Women of color have been underrepresented in hospital leadership positions and face challenges in advancing their careers. The benefit to hospitals providing women of color with training and support to move into leadership positions may be improved patient outcomes. Grounded in the interactional model of cultural diversity framework, the purpose of this basic qualitative study was to explore the perceptions of women of color advancing in leadership roles in hospitals and their impact on patient outcomes. The study participants included 16 women of color in leadership positions from hospitals in a western U.S. state. Data were collected through semi structured …

Strategies For Maximizing The Use Of Electronic Health Records Systems In Medical Clinics, Alexandra Nieves Rivera

Walden Dissertations and Doctoral Studies

Ineffective leadership can negatively impact the use of electronic health records (EHR) systems in medical clinics. Healthcare managers who fail to maximize the use of EHR systems are missing out on the opportunity to optimize the quality of medical care that their clinic provides. Grounded in complexity leadership theory, the purpose of this qualitative multiple-case study was to explore strategies healthcare managers use to maximize the use of EHRs systems. Participants comprised six healthcare managers who successfully implemented strategies to maximize the use of EHRs systems. Data were collected from semistructured interviews and publicly available information. Thematic analysis was used …

Strategies To Reduce Turnover Among Black Home Healthcare Aides, Diane Allen Tate

Walden Dissertations and Doctoral Studies

AbstractMany individuals prefer to remain in their homes as they age instead of entering a long-term care facility. As the proportion of older Americans rapidly grows, the demand for delivery of nonmedical services by home healthcare aides (HHAs) is expected to increase. However, the national and local supply of HHAs is insufficient and must be rectified to meet a projected increase of older Americans by 2050. This research study involved exploring this problem for one small home healthcare organization in the Maryland suburbs outside of Washington, DC with an HHA workforce that was comprised predominantly of Black/African American and African …

Exploring The Benefits Of A Collaboration Between Behavioral Health Coaches And Clinicians, Devan White

Walden Dissertations and Doctoral Studies

This case study addressed how to best use health coaches in the field of behavioral health to improve the accessibility and outreach of a new program launched by the target organization that emphasizes coaching as an intervention for improving well-being and mental fitness. The purpose of this qualitative case study was to investigate the potential influence of coaching within the behavioral health field and explore how health coaches could partner with clinicians or behavioral health leaders to allow for more collaboration and accessibility to services. The RQs centered on how health coaches might support the treatment of those who have …

Strategies To Reduce Turnover Among Black Home Healthcare Aides, Diane Allen Tate

Walden Dissertations and Doctoral Studies

Many individuals prefer to remain in their homes as they age instead of entering a long-term care facility. As the proportion of older Americans rapidly grows, the demand for delivery of nonmedical services by home healthcare aides (HHAs) is expected to increase. However, the national and local supply of HHAs is insufficient and must be rectified to meet a projected increase of older Americans by 2050. This research study involved exploring this problem for one small home healthcare organization in the Maryland suburbs outside of Washington, DC with an HHA workforce that was comprised predominantly of Black/African American and African …

Improving Access For Medicare Inpatient Psychiatric Patients: A Health Policy Analysis, Malinda B. Whitfield

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The Medicare Inpatient Psychiatric Services (IPS) policy, originally developed in the 1960s and without any significant or meaningful updates since the 1980’s, is physician specific, does not reflect the current model of care for psychiatric inpatients, and is restrictive for psychiatric mental health nurse practitioner (PMHNP) practice. The policy is complex, consists of outdated regulations, and results in millions of dollars in compliance costs for Inpatient Psychiatric Facilities (IPFs) annually (NABH, 2019). Although clearly an important part of the inpatient psychiatric services team, PMHNPs are not identified or defined in the policy (Center for Medicare and Medicaid Services [CMS], 2019). …

Reducing The Risk Of Central Line Associated Blood Stream Infection With Chlorhexidine Gluconate Education, Scarlett Ocon

Master's Projects and Capstones

Problem: A nosocomial central line-associated bloodstream infection is a preventable infection that is costly and potentially fatal. In order to combat bloodstream infections chlorhexidine gluconate wipes have been used as antiseptic. Medical surgical units do not have accessible CHG for bathing purposes. In addition, the staff lacks knowledge of how to use CHG wipes. The current standard bathing practice on this unit consists of using soap and water or disposable washcloths spontaneously without a predetermined time. The aim of this quality improvement project is to educate the registered nurses (RNs) and certified nurse assistants (CNAs) on the benefits of daily …

Increasing Equitable Access To Care: Implementation Of Universal Palliative Care Screening In The Intensive Care Unit, Sarah Weaver

Student Scholarly Projects

Practice Problem: At a small community hospital in Virginia, there is an absence of standardized screening processes for identifying intensive care unit (ICU) patients with unmet palliative care needs, contributing to delayed and unequitable access to palliative care consultations.

PICOT: The PICOT question that guided this project was “In adult ICU patients, how does implementing a palliative care screening tool upon ICU admission, as compared to standard ICU admission protocol, affect palliative care consultations within an 8-week time frame?"

Evidence: This project was guided by consensus reports from the World Health Organization and the Centers to Advance …

The Correlation Between Transformational Leadership And Mental Health Clinician Burnout, Rebekah E. Shutter

Electronic Theses and Dissertations

Mental health clinicians working in a hospital setting are at a high risk of experiencing burnout due to the stressful demands of their caseloads, compassion fatigue, limited resources, and unsupportive leadership. While there is ample research regarding the cause and effect of burnout on clinicians there is a gap in the literature when it comes to the impact leadership has on mental heath clinician burnout. The purpose of this quantitative, correlational study is to determine if and to what extent there is a correlation between Transformational Leadership and mental health clinician burnout. Participants for this study consisted of 200 mental …

Key Healthcare Providers’ Perspectives On The Implementation Of Senior-Friendly Emergency Department Care In Quebec, Deniz Cetin-Sahin, Francine Ducharme, Jane Mccusker, Mona Magalhaes, Nathalie Veillette, Paul-André Lachance, Sylvie Cossette, Alain Vadeboncoeur, Rick Mah, T.T. Minh Vu, Simon Berthelot

Journal of Geriatric Emergency Medicine

Background: Senior-friendly emergency department (ED) care is emerging to address large numbers of older adults in healthcare and implementation is variable.

Objectives: We aimed to explore key healthcare providers’ perspectives on factors affecting implementation of senior-friendly ED care during the first five years of the Senior-Friendly Hospital Initiative in the Province of Quebec, Canada.

Methods: We conducted a descriptive qualitative study of four urban EDs. Key healthcare providers involved in care within the ED or after discharge to the community were purposefully selected. Semi-structured telephone interviews were conducted in participants’ preferred language, English or French. Recorded interviews were transcribed. A …

Strategies Ambulatory Practice Leaders Use In Optimizing Electronic Medical Record Systems, Jeffrey L. Brown

All Theses And Dissertations

Electronic medical record systems (EMRs) were quickly adopted by ambulatory care practices due to federal government programs encouraging their rapid adoption and implementation. The accelerated implementation and adoption of these digital care systems introduced new forms of administrative burdens that have become negatively associated with the practice of medicine. Research regarding the challenges related to implementing and adopting EMR systems has been abundant. However, there is little research on EMR optimization strategies within ambulatory practice settings. This qualitative phenomenological study explored the lived experiences of ambulatory practice leaders and the strategies they used to optimize EMR systems. The data collected …

Improving The Delivery Of Discharge Instructions On The Postpartum Unit By Increasing The Nurses' Knowledge, Judy Anne Settles

Master's Projects and Capstones

Abstract

The field of nursing prides itself on two critical functions: safety and patient education. One of the mechanisms for both education and safety is the discharge process. Improvements in the discharge process have been shown to increase patient comprehension and safety. This study is grounded in the (Barach & Johnson, 2006) healthcare organizational framework called the 5 Ps microsystems assessment to explore the impacts and improvements in the discharge instruction process on a postpartum unit in a large organization. It was found that HCAHPS scores regarding discharge instructions were 55-60%, which is below what is considered satisfactory. Utilizing the …

Understanding Modern Drivers Of The Employee Experience In Healthcare, Antonio Pangallo, Tim Atwell, Kristi Roe, Adrienne Boissy

Patient Experience Journal

Employee engagement has been considered the guiding metric to convey the health, loyalty, and performance of the healthcare workforce. However, the pandemic created new challenges and stimulated deeper conversations around remote work, systemic racism, inclusivity, trust, well-being, and mental illness, which calls into question whether engagement alone is enough. Using an employee experience model deployed in other industries, we identified key drivers of six employee experience (EX) outcomes. We conducted a panel study with close to 5,000 nurses and physicians to identify and prioritize current key drivers specific to the healthcare employee experience. Relative weights analyses suggest that being treated …

Integrating Culturally Tailored Interventions To Increase Cervical Cancer Screening: A Quality Improvement Initiative In A Primary Care Clinic, Marife Centeno Solomon

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: While the incidence of cervical cancer in the US has significantly decreased due to the utilization of vaccination and screening tests, Asian, Native Hawaiian, and other Pacific Islander women consistently have the lowest rate of cervical cancer screening, making them at risk for undetected cervical cancer disease.

Problem: The low cervical cancer screening uptake can be attributed to a knowledge deficit about cervical cancer and its screening and the importance of early detection. Being an immigrant and with limited English proficiency can hinder women of Asian, Native Hawaiian, and other Pacific Islander from getting screened for cervical …

Nurses Leading In Bridging The Culture Gap: Communicating With The Deaf Community, Veronica C. Leftridge

Electronic Theses and Dissertations

Nurses provide patient care in clinics, hospitals, homes, churches, schools, communities, and military, as well as on emergency medical helicopters. When a nurse is assigned to care for a patient, the patient expects the nurse to be culturally competent, communicate effectively, and provide safe quality care. However, cultural incompetence is observed when nurses provide care for Deaf patients, but they are unfamiliar with Deaf culture. In addition, communication is a fundamental skill nurses learn in nursing school, but course content in nursing programs rarely touches on how to communicate effectively with Deaf patients. Of the approximately 325 million people in …

From Liability To Asset: A Large Health System’S Approach To Transforming Hospital Food, Sven Gierlinger, Bruno Tison, Nicole Giammarinaro

Patient Experience Journal

Historically, hospitals are infamous for poor food quality. Valuing food as a tenant of health and well-being, Northwell Health, New York’s largest healthcare system, is transforming its hospital food program to become an asset and market competition differentiator. By focusing on structure, workforce, procurement and process, Northwell has improved patient experience performance “Quality of Food” by 61 percentile rank points within three years with minimal impact on budgetary cost.

Experience Framework

This article is associated with the Environment & Hospitality lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework).

• Access other PXJ articles related to this lens.
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Evaluating Healthcare Leaders: A Competency Assessment Of Rural Healthcare Management Within The Midwest, Heather Winkler

Dissertations, Theses, and Projects

Rural healthcare facilities, which include critical access hospitals, are vulnerable to closure due to workforce shortages, low patient volumes, challenging payer and patient populations, and geographic isolation. Additionally, many rural communities entered the COVID-19 pandemic understaffed, under-serviced, facing inadequate healthcare infrastructures, and with limited clinical resources and equipment. This exploratory research aimed to measure the leadership competencies identified by the American College of Healthcare Executives (ACHE) of healthcare leaders working in rural hospitals and clinics within the Midwest. Having expert leadership skills and competencies can significantly impact how an organization succeeds, both for the patients, staff, and community. In contrast, …

Implementation Of Daily Nhppd Calculator In The Acute Care Setting, Spencer Y. Cho

Student Scholarly Projects

Practice Problem: In the United States, it is estimated that hospitalized patients experience an adverse event that require a rapid response and/or code blue event in 3% to 18% of hospitalizations.

PICOT: In the adult medical-surgical inpatient (P), does the implementation of a daily NHPPD calculator (DNC) (I) compared to an annual staffing methodology for calculating NHPPD (C) reduce rapid response calls, code blue episodes, and unplanned admission to critical care (O) over 8 weeks (T).

Evidence: Seven studies provided evidence that implementation of staffing methodology, nursing surveillance, and nurse staffing that supports meeting targeted nursing hours per patient …

Behavioral Code Team, Daniel Mcgrath

Student Scholarly Projects

Practice Problem: The organization lacked an evidence-based intervention for behavioral emergencies within the inpatient acute care setting, leading to increased mechanical restraints. A security-driven paradigm was the organization's primary tool for addressing behavioral crises and lacked a more patient-centered treatment and support paradigm.

PICOT: The PICOT question that guided this project was In the Veteran patient population admitted to acute inpatient services (P), how does having a behavioral code team respond to behavioral emergencies (I) compared to the current practice (C) affect the prevalence of mechanical restraint usage (O) within an eight week period (T).

Evidence: Seven …

Nurse-Driven Protocols For Abdominal Pain In The Emergency Department, Chris Schmidt

Student Scholarly Projects

Practice Problem: Emergency department (ED) crowding hinders the opportunity to deliver safe, quality care to abdominal pain patients and detrimentally affects clinical outcomes. Leadership of a rural community ED recognized a comparable issue by introducing a nurse-driven protocol (NDP) to reduce patient length of stay (LOS) and the rate of patients who leave the department prior to physician evaluation.

PICOT: The PICOT question that guided this project was: For adult patients in an emergency department, how does a nurse-driven protocol for abdominal pain compared to no protocol use affect the LOS and left without being seen (LWBS) rate over 10 …

The Transformational Leader In Nursing Practice – An Approach To Retain Nursing Staff, Anita C. Reinhardt, Teresa G. Leon, Linda Ochart Summers

Administrative Issues Journal

Transformational leaders have been shown to influence positive work environments and support the retention of nursing staff. While exemplars have been found in upper-level management, the implementation of these characteristics in unit-based leaders is less explained. The elements of the transformational leader on followers and the organization—individual consideration, individual stimulation, inspirational motivation, and idealized influence—can engage nursing staff to remain in an organization which will promote positive patient outcomes. This article will review the elements of the transformational leader and share two exemplars of the transformational metanarrative as demonstrated in nursing care units. Both exemplars demonstrate how the transformational leader …

Policies That Support Emergency Department Staff In Providing Behavioral Health Care, Lizabeth Lepp Hennig

Walden Dissertations and Doctoral Studies

A significant portion of individuals with a behavioral health (BH) condition return to emergency departments (ED) seeking care, resulting in reduced quality of care, and contributing to disproportionate healthcare costs. Care can be improved and return visits to the ED reduced where behavioral health care and follow-up care planning are provided as part of their treatment. However, policies expected to create declines in ED use for behavioral conditions are typically in short duration or are difficult to use given other funding and policy constraints. With little known about how policy is supporting the engagement of ED staff who are critical …

Age And Experience As Factors For Predicting Emotional Intelligence In Nurse Managers, Patricia Gursky

Walden Dissertations and Doctoral Studies

Emotional intelligence (EI) is defined as the capacity to recognize and manage emotions and feelings to guide behaviors which is an ability that is crucial for nurse mangers to possess. Understanding the key factors for predicting emotional intelligence in nurse managers may influence hiring practices and the appointment of managers who will influence job satisfaction, employee engagement, retention, and turnover. The purpose of this quantitative predictive correlational study, guided by King’s theory of goal attainment and Mayer and Salovey’s four-branch ability model of EI, was to determine whether age, years of experience as a nurse, and years of experience as …

Relationship Between Incentive Program Costs, Incentive Payments, And Profitability, Claire Claire Turner

Walden Dissertations and Doctoral Studies

The lack of profitability among primary care businesses can have harmful impacts on business operations. Primary care businesses owners must remain profitable to remain in business and provide quality health care to patients. Grounded in Freeman’s stakeholder theory, the purpose of this quantitative correlational study was to examine the relationship between incentive program costs, incentive payments, and profitability. Data were collected from 73 primary care physician business owners in the Inland Empire region of southern California. The multiple linear regression analysis results indicated the model was able to significantly predict profitability, F(2,70) = 1343.6, p <.001, R2 = .975. Incentive payments (t = 51.837, p < .001,  = .928) was the only statistically significant predictor. Key recommendations include educating primary care physicians on the potential financial benefits of full participation in the commercial line of business pay-for-performance incentive programs and creating a campaign to bring in patients for wellness visits. The implications for positive social change include the potential for an additional revenue stream for primary care physician business owners, which could support more clinics, increasing patient access. Patients having better access to healthcare could positively affect the health and wellness of individuals in local communities.

Evaluation Of Action Plan Management Strategy To Improve Survey Readiness And Decrease Negative Accreditation Findings, Carla Pierson

Walden Dissertations and Doctoral Studies

This project was an evaluation of a quality improvement (QI) initiative conducted in a large medical enterprise to address the problem of poor performance of their hospitals in accreditation surveys. The desired outcome was to evaluate whether an innovative plan of correction process was impactful in reducing the negative outcomes of regulatory and accreditation surveys. The practice-focused question guiding this project addressed the effect of the pre-accreditation evaluation and a plan of correction process in this QI initiative on reducing requirements for improvement (RFI) and condition-level deficiencies (CLD) cited in a recent The Joint Commission survey review. This project was …

Implementation Of A Standardized Medication Reconciliation Protocol In A Psychiatric Stabilization Setting, Sara Robinson

DNP Scholarly Projects

BACKGROUND: Medication errors are a prevalent patient safety concern across healthcare settings. High-quality medication reconciliation is an intervention and expected standard of care that can help to prevent adverse drug events. This quality improvement project focused on implementing a standardized medication reconciliation protocol on a short-stay psychiatric unit.

INTERVENTION: An evidence-based toolkit supported by the Agency for Healthcare Research and Quality (AHRQ), Medications at Transitions and Clinical Handoffs (MATCH) was selected as the framework for developing and implementing this protocol.

Congruent with the evidence-based toolkit recommendations, baseline data collection and needs assessment provided context for tailoring the intervention to the …