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Full-Text Articles in Entire DC Network
Strategies Human Resource Leaders Use To Implement Holistic Wellness Programs To Reduce Absenteeism And Increase Profitability, Diane Hardy
Walden Dissertations and Doctoral Studies
Human resources (HR) leaders struggle to reduce employee absenteeism and increase organizational profitability due to a lack of effective strategies for implementing holistic wellness programs. Identifying effective strategies for implementing holistic wellness programs is essential for helping HR leaders address absenteeism and strengthen organizational profitability. Grounded in the Pender health promotion model, the purpose of this qualitative pragmatic inquiry was to identify and explore effective strategies for implementing holistic wellness programs to reduce employee absenteeism and increase organizational profitability. Participants were nine HR leaders from medium- to large-sized organizations across the United States who implemented holistic wellness programs to reduce …
Implementation Of An Electronic Gad-7 Screening Tool To Improve Anxiety Screening Completion And Documentation, Obiageli L. Ukatu
Implementation Of An Electronic Gad-7 Screening Tool To Improve Anxiety Screening Completion And Documentation, Obiageli L. Ukatu
Walden Dissertations and Doctoral Studies
Quality Improvement Initiative Implementation of an Electronic GAD-7 Screening Tool to Improve Anxiety Screening Completion and Documentation
Probation Officers’ Experiences Supervising Domestic And Intimate Partner Violent Probationers, Megan Davis
Probation Officers’ Experiences Supervising Domestic And Intimate Partner Violent Probationers, Megan Davis
Walden Dissertations and Doctoral Studies
This study includes insights regarding potential supervision challenges that are faced by probation officers overseeing domestic and intimate partner violence (IPV) probationers, emphasizing the importance of effective management to enhance offender accountability and victim safety. The relationship dynamic between probation officers and domestic and IPV probationers influences recidivism rates, highlighting the importance of effective and empathetic supervision. The purpose of this study was to identify gaps in training, supervision strategies, and resources, with a focus on integrating attachment-based practices to improve outcomes. Guided by the attachment theory, the research included key questions about supervision effectiveness and relational dynamics. Employing a …
Implementation Of A Fall-Prevention Clinical Practice Guideline In A Neurological Rehabilitation Center, Ron L. Adolph
Implementation Of A Fall-Prevention Clinical Practice Guideline In A Neurological Rehabilitation Center, Ron L. Adolph
Walden Dissertations and Doctoral Studies
This executive summary presents the final plan for implementation of an evidence-based fall-prevention clinical practice guideline on an open neurological rehabilitation unit. It does not propose a new device, a new electronic platform, or a separate education-only initiative. The practice change is the implementation and evaluation of a structured interdisciplinary clinical practice guideline designed to reduce inpatient falls and improve the reliability of daily prevention practices. The unit reports a baseline fall rate of 6.3 falls per 1,000 patient days. Thirty-five staff members from nursing, therapy, and support roles completed the survey, and 57% reported that patients had experienced falls …
Lived Experience Of Secondary School Teachers During The Covid-19 Pandemic, Diane R. Lovett
Lived Experience Of Secondary School Teachers During The Covid-19 Pandemic, Diane R. Lovett
Walden Dissertations and Doctoral Studies
The study emphasizes the need for a deeper understanding of secondary school teachers' experiences during the COVID-19 pandemic, particularly focusing on their challenges during the transition back to in-person instruction after teaching online. The purpose of this phenomenological study explored the experiences of U.S. secondary teachers during the onset of COVID-19, the shift to virtual teaching, and the return to in-person instruction. The study was grounded in Bandura’s (1986) social cognitive theory, specifically the concept of observational learning and self-efficacy, to understand how teachers learned from peer successes and challenges during the transition to virtual learning and when returning to …
Staff Education To Increase Knowledge Of Universal Protocol And Surgical Readiness Documentation Among Ambulatory Surgery Staff, Miranda Gould
Staff Education To Increase Knowledge Of Universal Protocol And Surgical Readiness Documentation Among Ambulatory Surgery Staff, Miranda Gould
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice (DNP) project evaluated the impact of a structured staff educational intervention on ambulatory surgery center (ASC) staff knowledge of Universal Protocol and SOAP (Surgeon, Operating Room, Anesthesia, and Preprocedure Ready) documentation. A practice gap was identified in staff knowledge of perioperative safety processes that are essential for preventing surgical safety events. The purpose of this doctoral project was to improve ASC staff knowledge of Universal Protocol and SOAP readiness documentation through an evidence-based educational intervention designed to strengthen perioperative safety practices. The practice-focused question was: According to the evidence, in multi-specialty ASC staff, what is …
Executive Summary On Prolonged Emergency Department Waiting Period, Peace Adaugo Ezirim
Executive Summary On Prolonged Emergency Department Waiting Period, Peace Adaugo Ezirim
Walden Dissertations and Doctoral Studies
Emergency departments (EDs) are essential access points to healthcare for patients with urgent and emergent conditions. Yet, many EDs face persistent challenges, including overcrowding, prolonged wait times, and delays in care. These challenges can significantly affect patient safety, quality of care, and overall healthcare outcomes. Patients presenting with symptoms, such as cardiac, pulmonary, or abdominal discomfort, may initially appear clinically stable, but their conditions can deteriorate rapidly while awaiting evaluation by a provider. Without structured reassessment processes and efficient communication systems, early warning signs of clinical decline may be missed. ED crowding has become a widespread operational and patient safety …
Staff Education On Evidence-Based Weight Management Strategies For Adults With Mental Health Disorders And Type Ii Diabetes Mellitus, Abimbola Oluwafunmilayo Somoye
Staff Education On Evidence-Based Weight Management Strategies For Adults With Mental Health Disorders And Type Ii Diabetes Mellitus, Abimbola Oluwafunmilayo Somoye
Walden Dissertations and Doctoral Studies
Summary The type of project is a staff education project, specifically on evidence-based weight loss strategies that the facility can use to manage adults with type 2 diabetes mellitus (T2DM) and co-morbid mental health disorder(s). The evidence-based practice (EBP) question is: Does educating staff on weight loss strategies for T2DM with mental health disorder(s) improve staff knowledge and confidence within one month of staff education program implementation? The facility’s staff managed these patients using standardized diabetes management practices and have no formal staff education program that focuses on evidence-based weight loss strategies for this population. The staff has a vast …
The Impact Of Sexual Harassment Policy Strictness And Supervisory Support On Reporting Behavior In Local, County, And State Female Law Enforcement Officers In Northeastern Kansas, Cleora Maxine Tousey
The Impact Of Sexual Harassment Policy Strictness And Supervisory Support On Reporting Behavior In Local, County, And State Female Law Enforcement Officers In Northeastern Kansas, Cleora Maxine Tousey
Walden Dissertations and Doctoral Studies
This quantitative study examined the impact of stricter sexual harassment policies with protections against retaliation and stronger supervisory support on the likelihood that female law enforcement officers would report incidents of sexual harassment by male colleagues. The problem addressed was the underreporting of sexual harassment in policing, a critical issue given the negative impact on victims and workplace culture. Connell’s theory of masculinity served as the theoretical framework, indicating how traditional power dynamics may negatively influence the likelihood of reporting. Using a correlational design, this study surveyed municipal, county, and state female officers in Northeastern Kansas to measure their perceptions …
Staff Education To Increase Knowledge And Shape Attitudes Among Staff To Improve Control Of Hypertension In Primary Care, Doris Marie Mosby-Peterson
Staff Education To Increase Knowledge And Shape Attitudes Among Staff To Improve Control Of Hypertension In Primary Care, Doris Marie Mosby-Peterson
Walden Dissertations and Doctoral Studies
This doctoral project was an evidence-based staff education intervention designed to improve healthcare team knowledge, attitudes, and clinical practices related to the management of uncontrolled hypertension within a federally qualified health center (FQHC). The practice problem addressed was the persistent challenge of uncontrolled hypertension among patients receiving primary care services, which contributes to increased risk for cardiovascular disease, stroke, and preventable health disparities. Thus, the practice-focused question that guided the project asked whether a multidisciplinary staff education program at a rural FQHC improve healthcare staff’s knowledge, skills, attitudes, and workflow related to the management of uncontrolled hypertension? Findings demonstrated statistically …
The Relative Strength Of Justice-Related Satisfaction, Posttraumatic Maladaptive Beliefs, And Self-Compassion In Predicting Perceived Control Over Stressful Events, Katherine Mooney
Walden Dissertations and Doctoral Studies
Coercive control and domestic violence perpetrated by men against women are global social problems sustained by patriarchal norms that normalize gender-based violence. These norms often contribute to victims' maladaptive self-beliefs, leading women to believe they provoked the abuse. When survivors seek legal protection, they may experience revictimization through legal processes that minimize their claims and enable perpetrators to continue exerting power and control through the justice system. As a result, dissatisfaction with the legal system may reinforce self-blame, while low self-compassion may further undermine women's perceived control over stressful events in both the short and long term. While previous research …
Experiences With Microaggression Of African American Female Faculty Who Work In Predominantly White Institutions, Teffany Jonte Malone
Experiences With Microaggression Of African American Female Faculty Who Work In Predominantly White Institutions, Teffany Jonte Malone
Walden Dissertations and Doctoral Studies
The problem addressed through this study is the gap in the literature on the experiences of African American female faculty in higher education institutions with racial microaggressions while working in predominantly White institutions (PWIs). Grounded in Delgado and Stefancic’s critical race theory, the purpose of this basic qualitative study was to explore African American female faculty’s experiences with racial microaggressions and recommended support their institutions can put in place at PWIs in California. For this basic qualitative design, data were collected through semistructured interviews with 15 African American female faculty members employed at PWIs in California. Through qualitative content analysis, …
Effective Leadership Strategies For Sustaining Radiology Departments During And After The Covid-19 Pandemic, Tameron Shanay Reed
Effective Leadership Strategies For Sustaining Radiology Departments During And After The Covid-19 Pandemic, Tameron Shanay Reed
Walden Dissertations and Doctoral Studies
Pandemic-driven workforce challenges highlighted the urgent need for radiology leaders to retain skilled staff and sustain service delivery. The COVID-19 pandemic raised considerable concerns for radiology leaders regarding future preparedness for patient safety, care outcomes, hospital expenses, and hospital profitability. Grounded in the Vroom expectancy theory, the purpose of this qualitative pragmatic inquiry was to explore successful strategies radiology department leaders used to retain employees, improve supply inventory management, and develop ambulatory and virtual services during and after the COVID-19 pandemic. Data were gathered through semistructured interviews with six successful radiology leaders and publicly accessible documents in northern Louisiana. The …
A Proposal For An Evidence-Based Program For Communication Continuity, Yavonne G. Evans
A Proposal For An Evidence-Based Program For Communication Continuity, Yavonne G. Evans
Walden Dissertations and Doctoral Studies
This doctor of nursing practice (DNP) executive leadership project is a practice-focused quality improvement initiative to reduce avoidable 30-day hospital readmissions in a skilled nursing facility by implementing the INTERACT communication tools, SBAR and STOP & WATCH. The practice problem is the lack of a standardized communication process for recognizing changes in resident conditions, contributing to preventable hospitalizations. The project's purpose was to develop an evidence-based communication process that promotes early recognition and timely provider intervention. The practice-focused question asked whether implementing INTERACT communication tools would improve communication and reduce avoidable acute care transfers. A focused literature search was conducted. …
Improving Chronic Disease Monitoring In Patients With Diabetes And Hypertension Through Guideline-Adherent Care, Olukemi Ogunmakinwa
Improving Chronic Disease Monitoring In Patients With Diabetes And Hypertension Through Guideline-Adherent Care, Olukemi Ogunmakinwa
Walden Dissertations and Doctoral Studies
Evidence-based chronic disease monitoring is essential for improving outcomes among adults with diabetes and hypertension; however, inconsistent application of clinical practice guidelines may result from gaps in healthcare providers' knowledge, confidence, and competency. Staff education is an effective strategy for strengthening evidence-based practice and promoting consistent guideline implementation. Purpose: The purpose of this Doctor of Nursing Practice (DNP) staff education project was to develop, implement, and evaluate a structured educational program to improve healthcare providers' understanding, knowledge, confidence, self-efficacy, and competency in applying evidence-based chronic disease monitoring guidelines in a primary care clinic. Methods: The educational intervention was developed using …
Evaluating Mentorship, Professional Networking Participation, And Leadership Classifications For Women In Health Service Organizations, Marina Nagy Hanna
Evaluating Mentorship, Professional Networking Participation, And Leadership Classifications For Women In Health Service Organizations, Marina Nagy Hanna
Walden Dissertations and Doctoral Studies
Despite women comprising a substantial portion of the U.S. health care workforce, they continue to be underrepresented in leadership across health service organizations. Mentorship and professional networking opportunities are commonly used to support women’s professional growth; however, inequities in leadership attainment remain prevalent, particularly among women from racial and ethnic minority backgrounds. The purpose of this quantitative archival comparative study was to examine associations across mentorship participation indicators, professional networking participation indicators, leadership classifications, and racial and ethnic classifications. The study was underpinned by intersectionality theory and social capital theory, which supported examination of how demographic identities and access to …
Organization Change Process Initiative Suicide Risk Assessment Screening Implementation, Dawn Marie Zaccardo
Organization Change Process Initiative Suicide Risk Assessment Screening Implementation, Dawn Marie Zaccardo
Walden Dissertations and Doctoral Studies
Suicide remains a leading cause of preventable death among individuals receiving psychiatric care, emphasizing the need for consistent suicide risk assessment practices in outpatient behavioral health settings. This Doctor of Nursing Practice (DNP) quality improvement project addressed inconsistent suicide risk screening and documentation by implementing a standardized evidence-based suicide risk assessment protocol in an outpatient psychiatric clinic. Guided by the Johns Hopkins Evidence-Based Practice Model, the project incorporated staff education, workflow standardization, leadership support, and stakeholder engagement to improve provider adherence to organizational policy requiring suicide risk screening during every patient encounter. Deidentified retrospective chart audits conducted before and after …
How Texas Early Childhood Teachers Collaborate To Support Students With Disabilities, Anna Weathers
How Texas Early Childhood Teachers Collaborate To Support Students With Disabilities, Anna Weathers
Walden Dissertations and Doctoral Studies
The problem addressed in this study was it was not known how Texas early childhood special education (EGSE) teachers and early childhood general education (ECGE) teachers use collaboration to identify, place, and support students with disabilities (SWDs). Framed by Colby’s collaboration theory, the purpose of this basic qualitative study was to explore the experiences of Texas ECSE and ECGE teachers when collaborating regarding identification, placement, and support for SWDs. Data were collected in semstructured interviews with 11 ECSE and 11 ECGE teachers who taught in Texas early childhood settings. Data were analyzed using thematic analysis with open coding, leading to …
Higher Education Instructors’ Perspectives On The Challenges Of Implementing Competency-Based Learning In Coursework, Sammie Leo Davis Jr
Higher Education Instructors’ Perspectives On The Challenges Of Implementing Competency-Based Learning In Coursework, Sammie Leo Davis Jr
Walden Dissertations and Doctoral Studies
Higher education instructors face challenges in implementing competency-based learning (CBL) in their coursework. Grounded in Vygotsky’s social constructivist theory, the purpose of this basic qualitative study was to explore the perspectives of higher education instructors on the challenges and their needs to implement CBL in coursework. For this basic qualitative design, semistructured interviews were conducted with 12 higher education instructors who had at least 2 years of experience teaching CBL courses. Data were analyzed using qualitative content analysis and inductive coding to identify codes and categories, with the following five themes emerging: CBL implementation depends on (a) aligned assessment, curriculum …
Staff Education To Improve Mindfulness Knowledge Among Rns, Nps, And Mas In A Behavioral Health Setting, Barbara Buxton
Staff Education To Improve Mindfulness Knowledge Among Rns, Nps, And Mas In A Behavioral Health Setting, Barbara Buxton
Walden Dissertations and Doctoral Studies
Burnout is a recurrent problem for healthcare workers and is associated with staff turnover, a decline in the quality of care, emotional fatigue, and risks to patient safety. This Doctor of Nursing Practice (DNP) staff education initiative created a mindfulness-based training program to expand the knowledge of registered nurses, nurse practitioners, and medical assistants on mindfulness practices in a behavioral health setting. Baseline assessment data identified a need for support to address emotional fatigue, absenteeism, and staff disengagement, with a mean pre‑education knowledge score of 66%. A structured, in‑person educational program addressing burnout awareness, stress reactivity, and helpful mindfulness methods …
A Proposal For A Program To Deliver Equitable Nursing Assignments, Laporsha Glover
A Proposal For A Program To Deliver Equitable Nursing Assignments, Laporsha Glover
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice (DNP) project was conducted at an inpatient rehabilitation hospital that provides comprehensive interdisciplinary rehabilitation services for adults. Due to the diverse clinical needs of the rehabilitation patient population, nursing workload varies considerably based on patient acuity, functional status, cognitive impairment, medical complexity, and the intensity of nursing interventions required. This creates a practice gap that contributes to inequitable nursing assignments. A comprehensive literature search was conducted using PubMed, CINAHL, Cochrane Library, and Google Scholar. Nine studies were critically appraised using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Evidence Appraisal Tools (Bissett et al., 2025). The …
A Multifaceted Surgical Suite Quality Improvement Initiative, George Tazvitya Mhosira
A Multifaceted Surgical Suite Quality Improvement Initiative, George Tazvitya Mhosira
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice project focuses on modernizing an acute care hospital’s surgical suite, enhancing environmental safety, and supporting the growing complexity of surgical care. As surgical procedures become more advanced, the physical environment must evolve to maintain sterile technique and reduce microbial presence. Current operating room configuration, characterized by overcrowding and outdated ventilation systems, introduces environmental risks that compromise patient safety and limit perioperative efficiency. Modernization is essential to align the surgical environment with contemporary safety expectations and organizational performance goals. The proposed initiative includes a comprehensive renovation and expansion of surgical spaces, integrating advanced air decontamination technologies, …
The Relationship Between Employees’ Involvement, Process Improvement, And Customer Satisfaction In Manufacturing Industries, Nawres Fouad
The Relationship Between Employees’ Involvement, Process Improvement, And Customer Satisfaction In Manufacturing Industries, Nawres Fouad
Walden Dissertations and Doctoral Studies
Customer satisfaction remains a challenge for some manufacturing organizations despite the widespread implementation of TQM practices. Manufacturing leaders must improve customer satisfaction because it enhances customer retention, organizational competitiveness, and long-term business performance. The purpose of this quantitative correlational study was to examine the relationships between employees' involvement, process improvement, and customer satisfaction. The expectancy-disconfirmation theory grounded the research project. Participants were 68 middle managers employed in manufacturing organizations in Ontario, Canada. Data were collected through an anonymous online survey using the Utrecht Work Engagement Scale (UWES-9) and the TQM Practices Scale. The data were analyzed using descriptive statistics, Cronbach’s …
Improving Adolescent Antidepressant Medication Adherence In An Outpatient Psychiatric Clinic Through Teach-Back And Motivational Interviewing, Sandra Ajao
Walden Dissertations and Doctoral Studies
Antidepressant medication adherence among adolescents is a significant concern in outpatient psychiatric care. Adolescents may miss doses because of stigma, forgetfulness, side effects, limited understanding of medication instructions, or inconsistent caregiver support. The purpose of this Doctor of Nursing Practice project was to improve antidepressant medication adherence and adherence-focused communication among adolescents in an outpatient psychiatric clinic through staff education on teach-back and motivational interviewing. The practice-focused question examined how teach-back combined with motivational interviewing, compared with usual care, affected medication adherence and depressive symptoms during the implementation period. Staff education included use of a previsit questionnaire, structured visit script, …
Standardized Metabolic Monitoring Protocol For Adult Outpatients Who Are Prescribed Antipsychotic Medications, Abel Bueno Gonzalez
Standardized Metabolic Monitoring Protocol For Adult Outpatients Who Are Prescribed Antipsychotic Medications, Abel Bueno Gonzalez
Walden Dissertations and Doctoral Studies
This doctoral project was an organization change process evaluation of a quality improvement initiative in a masked outpatient mental health clinic. The practice challenge was poor metabolic monitoring and documentation among adult outpatients taking antipsychotics that were not in line with guidelines. This problem is relevant to nursing practice because use of antipsychotic medications raises risk for weight gain, dyslipidemia, hypertension, and glucose abnormalities, and not monitoring risks may delay referral or management. The practice-focused question was: According to evidence, among adult patients who are prescribed antipsychotic medications in an outpatient mental health clinic, what is the impact of implementing …
Predictive Analytics For Nurse Staffing Optimization And Patient Outcomes, Rhonda Lynn Fisher
Predictive Analytics For Nurse Staffing Optimization And Patient Outcomes, Rhonda Lynn Fisher
Walden Dissertations and Doctoral Studies
This evidence-based quality improvement project assessed the use of a Predictive Analytics Staffing Decision-Support Tool (PASDST) to enhance nurse staffing alignment, workforce planning, and patient outcomes in an acute care setting. Traditional staffing relied mainly on historical census data and fixed nurse-to-patient ratios, with limited real-time information on admissions, discharges, census, and patient acuity. Guided by the Johns Hopkins Evidence-Based Practice Model, a 12-week pilot of PASDST was conducted on one acute care unit. Baseline data from 30 stakeholders—five nurse managers and 25 bedside nurses—were collected. Quantitative responses were analyzed via frequencies and percentages, while open-ended responses underwent thematic analysis. …
Staff Education To Improve Depression Screening And Management Using Phq-9, Elizabeth Aja
Staff Education To Improve Depression Screening And Management Using Phq-9, Elizabeth Aja
Walden Dissertations and Doctoral Studies
This doctoral project was a staff education initiative. It was motivated by the realization that depression is often under-recognized when standardized screening practices are not consistently implemented. The identified practice gap was inconsistent administration, interpretation, and documentation of the PHQ-9 by the nursing staff. The practice-focused question examined whether a staff education intervention would improve nurses’ knowledge and confidence in using the PHQ-9 for depression screening. The purpose of the project was to implement and evaluate an evidence-based educational program on PHQ-9 administration, scoring, interpretation, and documentation. Data analysis included descriptive statistics on pretest and posttest scores from 14 participating …
Staff Education To Improve Whiteboard Utilization To Focus On Nurse Communication And Patient Experience On A Medical-Surgical Unit, Charline J. Bethea
Staff Education To Improve Whiteboard Utilization To Focus On Nurse Communication And Patient Experience On A Medical-Surgical Unit, Charline J. Bethea
Walden Dissertations and Doctoral Studies
Inconsistent use of standardized whiteboards in patient rooms may contribute to ineffective nurse communication and lower patient experience scores. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether an evidence-based staff education program improved nursing knowledge, intent to use standardized whiteboards, and whiteboard utilization on a medical-surgical unit. Guided by the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) instructional design model, the intervention included a standardized educational presentation, pre- and post-education knowledge assessments, a workflow integration guide, competency validation, and weekly compliance audits. Thirty-five staff members, including registered nurses and patient care technicians, participated in the project. Following …
Implementation Of Standardized Suicide Risk Screening With Staff Education In An Outpatient Psychiatric Clinic, Gwendoline Nfotiog
Implementation Of Standardized Suicide Risk Screening With Staff Education In An Outpatient Psychiatric Clinic, Gwendoline Nfotiog
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice project was a quality improvement staff education initiative focused on improving suicide risk screening and documentation in an outpatient psychiatric clinic. Inconsistent use of validated screening tools and documentation practices created risks for missed identification of patients at risk for suicide. Addressing this gap was essential to improve patient safety and support evidence-based behavioral healthcare. In the project, I examined whether implementing standardized suicide risk screening with staff education would improve screening and documentation consistency over 12 weeks. The purpose was to increase staff knowledge, screening compliance, and documentation accuracy. Pre- and postimplementation chart audits, …
An Exploration Of Successful Cloud Database Migration Strategies Used By Small And Medium-Sized Enterprises Leaders In The United States, Ashli Jarrett
Walden Dissertations and Doctoral Studies
Cloud database migration can improve organizational performance in small and medium-sized enterprises (SMEs), but SME leaders are concerned about ineffective migration strategies, which can increase risks to data security, regulatory compliance, and operational continuity. Grounded in diffusion of innovation theory, the purpose of this qualitative pragmatic inquiry project was to explore the effective strategies SME leaders use to manage secure cloud database migrations, mitigate risks, enhance data security, ensure regulatory compliance, and improve organizational effectiveness. The participants were 10 SME leaders in the United States who had successfully adopted cloud-based database systems. Data were collected through semistructured interviews and publicly …