Medicine and Health Sciences Commons^™

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 …

Examining The Relationship Between Organizational Climate And Organizational Citizenship Behaviors Within Hospitals, Michelle Christine Maus

Walden Dissertations and Doctoral Studies

Members of the healthcare industry have not fully understood organizational climate factors that enhance organizational citizenship behaviors (OCBs). This lack of understanding can result in negative patient outcomes. The purpose of this cross-sectional quantitative study was to examine the relationships between organizational climate factors and OCBs of employees at hospitals via person-organization fit theory. More, specifically, the purpose of this research was to explore (a) the relationships between organizational climate variables (i.e., welfare, autonomy, involvement, effort, training, integration, and supervisory support) and OCBs (n = 218), (b) differences in OCB scores between hospital leaders (n = 72) and followers (n …

Cyber Threats And Healthcare Organizations: A Public Health Preparedness Perspective, Lauren Elizabeth Branch

Graduate Theses, Dissertations, and Problem Reports

Healthcare in the United States, heavily reliant on digital technology in service provision, has recently seen an increase risk of cyberattacks. Coordinated electronic medical records, imaging, pharmaceutical services, lab services and even treatment devices all rely on electronic connectivity and represent critical services that must be secured from cyber threats. Hospitals have become increasingly complex systems, and this often makes the organization more vulnerable to failure. Planning for these events is often hard for hospitals because their main charge is to provide life-saving care to patients as they need it. This is a relatively new threat to healthcare organizations, and …

Nonprofit Hospital Community Benefit Requirements: An Exploration Of National Health Policy Models, Justin P. Swearingen

Dissertations and Theses

Introduction: Nonprofit hospital organizations are public charities with complete tax immunity. Such exemptions are worth $24.6 billion and impact the health of hundreds of millions of people, yet what these charities must do to meet the current “community benefit standard” to maintain their tax-exempt status remains a policy debate. To help inform policymaking, an evaluation of four national requirement models was performed: Tax Value Requirement (at least the value of the tax exemptions must be spent on community benefit), Grassley Requirement (at least 5% of revenue must be spent on community benefit), Expense Requirement (at least 3% of expenses must …

How To Effectively Improve Nurse-Physician Communication, Savannah R. Lacoste

Honors Theses

A study of the issue of Nurse-Physician communication, its causes, effects, importance, and possible improvements through research. The results suggest both physicians and nurses agree that nurse-physician communication is an important problem, and can be effectively improved in many ways including: a required nurse-physician communication class for pre-medical and pre-nursing students at an undergraduate level, improved and structured communication tools, and inter-professional education (IPE) between nurses and physicians. The research provides the outlooks of twenty-five nurses and twenty-five physicians independently, as well as demonstrating the nurse-physician disconnect through data comparison and analysis.

Improving Patient Outcomes: Early Mobilization Of Intensive Care Patients, Casey Teves

Honors College Theses

Early mobilization of intensive care patients has gained the interest of researchers within the last few years due to its safe and practical application and numerous benefits it can provide. Reviewing the literature on this topic reveals the substantial benefits of early mobilization and the detrimental effects of prolonged bed-rest. Despite recent evidence proving that this practice will increase quality of care, many intensive care units still utilize bed-rest as a standard. Understanding the barriers and facilitators of this change can help transform this research into practice and improve patient care outcomes. Nurses are the key facilitators in the initiative …

Dimensions Of Nurse-Physician Communication, Rachel Malek Hamdan

Walden Dissertations and Doctoral Studies

Hospital leaders set quality and safety as high priorities in their strategic goals. Improving the quality and safety of patient care requires improving internal processes that have direct implications for patient care. Hospital leaders need to improve health care providers' communication as part of improving quality and safety. The problem addressed in this study was the lack of strategies health care administrators use to guide nurse-physician communication patterns in a university medical center in the Middle East. The purpose of this qualitative case study was to explore communication strategies that health care administrators use to guide nurse-physician communication. Relational coordination …

Rn Perceptions Of Coworker Incivility And Collective Efficacy As Influential To Hospital Structures And Outcomes, Jessica Grace Smith

Theses and Dissertations

Background: An aging population and retiring workforce might affect United States health delivery care and could threaten the quality of care in hospitals. Nurses, as the largest profession in healthcare, can buffer these effects if supported in a safe nurse work environment. The purpose of this dissertation was to understand how peer-to-peer registered nurse workplace incivility as a mediator, and collective efficacy as a moderator, influence relationships among hospital structures (i.e. nurse manager leadership and staffing) and hospital outcomes (i.e. missed nursing care and patient safety cultures).

Methods: Donabedian’s (1980) structure-process-outcomes conceptual framework was the theoretical basis for this study. …

An Investigation Of Nurse Education Service Models In Acute Care Metropolitan Hospitals Across Australia, Carolyn Keane

Theses

The provision of continuing professional development for nurses is necessary to support the delivery of safe patient care. Nurse education departments need to function as effectively and efficiently as possible, producing measurable outcomes to justify their cost in regard to the organisation’s financial bottom line. In reviewing the literature, three recognised models of nurse education services within hospitals were identified. These are described as centralised, decentralised and combination models. All of these models have advantages and disadvantages that can affect service delivery, quality of service and cost.

The purpose of this study was to investigate the different nurse education service …

An Empirical Investigation Of Privacy And Security Concerns On Doctors’ And Nurses’ Behavioral Intentions To Use Rfid In Hospitals, Thomas George Winston

CCE Theses and Dissertations

Radio frequency identification (RFID) technology is a useful technology that has myriad applications in technology, retail, manufacturing, and healthcare settings. Not dependent upon line-of-sight, RFID can scan devices in their proximity and report the information to connected (wired or other wireless) information systems. Once touted as the panacea for home healthcare, RFID devices can add benefit to patients in remote settings. RFID devices have been used to optimize systems in areas such as manufacturing and healthcare to expose inefficiencies in a system or process. Unlike manufacturing, however, RFID in healthcare settings presents security and privacy concerns to the people being …

Workplace Violence, Organizational Culture, And Registered Nurses' Incident Reporting Patterns In Acute Hospitals In California, Feodora Jacobsen

Doctoral Dissertations

The purpose of this study was to increase understanding of the reporting patterns of WPV Type II in acute hospital settings. Although some patients are abusive toward nurses, that the abuse is underreported to hospital administrators. Qualitative studies identified common themes for underreporting including fear of being blamed, abuse considered part of the job, and not having sufficient time to fill out a formal report. This study is the first quantitative study to explore the changes in mean scores of organizational-culture factors under two mutually exclusive conditions: registered nurses (RNs) who do not report hospital incidents and RNs who do …

Patient Engagement Functionalities Facilitated By Health Information Technology: An Examination Of The Adoption Rate And Financial Performance Among U.S. Hospitals, Oghale Elijah Asagbra

All ETDs from UAB

The Centers for Medicare and Medicaid (CMS) meaningful use requirement, as well as documented evidence suggest that health information technology (HIT) has the potential to promote patient engagement and consequently improve quality and reduce cost. This prompts a better understanding of hospital adoption of HIT for patient engagement. The purpose of the three papers presented in this dissertation is to examine hospital adoption of health information technology (HIT) to facilitate patient engagement. Emphasis is placed on the functionalities (i.e., functions or capabilities) offered by these technologies that have been determined to allow patients be more involved in their care because …

Differences Between For-Profit And Nonprofit Hospitals: Perceived Quality And Access, Michael Ray Eiland

Walden Dissertations and Doctoral Studies

Despite a large body of literature addressing the issue, questions remain about whether nonprofit hospitals provide more community benefit than do for-profit hospitals. This lack of information impacts governments, hospitals, and the healthcare industry, as stakeholders attempt to generate requirements to which hospitals should adhere to maintain nonprofit status, and thus tax exemption. This study addressed this lack of information by examining U.S. hospitals through the lens of stewardship theory to determine whether nonprofits are better stewards of the public good than for-profits, and thus likely to provide higher quality and access. The study applied logistic regression to Centers for …

Multiple Regression Analysis Of Factors Concerning Cardiovascular Profitability Under Health Care Reform, Gordon Brian Wesley

Walden Dissertations and Doctoral Studies

Cardiovascular (CV) patients receive one-third of the care and account for $444 billion of the health care costs in the United States. The cardiovascular service line (CVSL) in hospitals contributes to the profitability influenced by elements of resource dependence theory (RDT). The purpose of this study was to understand whether the regression model of hospital characteristics and outcomes would predict profitability in a CVSL through the cost-to-charge ratio (CCR). The use of a general linear model and multiple regression analysis to examine the 2012 National Inpatient Sample from the Healthcare Cost and Utilization Project allowed estimates from a weighted sample …

The Relationship Between Hospital Safety Culture And Variation In Adverse Events : What Is The Evidence From Nys Hospitals?, Kathleen Ciccone

Legacy Theses & Dissertations (2009 - 2024)

Background: There is widespread acknowledgement that patients often suffer from adverse events that occur in the provision of medical care (Leape et al., 1991; Kohn et al., 2000). A notable percentage of these events stem from poor practices and unreliable hospital safety systems (Leape et al., 1991; Kohn et al., 2000; Chassin, 2013). Although the literature has been mixed regarding the association between perception of safety culture in hospitals and rates of adverse events, policy makers and healthcare thought-leaders have called on hospital leadership to improve safety culture as one strategy for decreasing harm to patients.

Breastfeeding Initiation, Duration And Exclusivity In New York State : Impact Of Hospital Maternity Care Practices, Hospital Characteristics And Individual/Socio-Demographic Factors, Eileen Mary Fitzpatrick

Legacy Theses & Dissertations (2009 - 2024)

Prevalence of breastfeeding initiation in New York State (NYS) nearly meets Healthy People 2020 goals. Improvements in breastfeeding duration and exclusive breastfeeding (EBF) have lagged behind those achieved for initiation. Implementation of Ten Steps to Successful Breastfeeding in hospital maternity care has improved breastfeeding initiation, duration and exclusivity; but data on the independent association with specific Steps have been equivocal. Utilizing NYS-linked data from the Maternity Practices in Infant Nutrition and Care (mPINC) and the Pregnancy Risk Assessment Monitoring System (PRAMS), the associations of individual maternity care practices/Steps with breastfeeding behaviors were evaluated. Analyses included mothers who participated in PRAMS …

Physician Density And Location Of Physician Training : The Impact On Avoidable Hospitalizations, Robert Martiniano

Legacy Theses & Dissertations (2009 - 2024)

Avoidable hospitalizations are those hospitalizations that could have been avoided had there been appropriate levels of primary care, and higher levels of avoidable hospitalizations have been linked to higher rates of poverty and of race/ethnicity and to individuals who are on Medicaid or who are uninsured. The association with physician density has, however, been inconsistent, with research linking both better and worse physician density to higher rates of avoidable hospitalizations. Very little research, however, has been conducted on other physician characteristics and the rate of avoidable hospitalizations.

Hospital Community Orientation: Predictors And Performance Outcomes, J'Aime Jennings

All ETDs from UAB

The three publishable manuscripts contained within this dissertation examine the predictors and performance outcomes of hospital community orientation. Community orientation is the customization of hospital services to meet identified community health needs. Together, these papers fill gaps in the literature regarding the factors that assist or hinder hospitals from being community-oriented, as well as the effects of community orientation. The first paper uses longitudinal data to examine the organizational and environmental factors that may influence how engaged hospitals are in a community orientation strategy based on the number of activities performed. The remaining papers consider the performance outcomes of community …

Physical Therapy Non-Treatment Of The Acute Hospital Inpatient, Daniel Lee Young

UNLV Theses, Dissertations, Professional Papers, and Capstones

The detrimental effects of inactivity and mobility extend to the most ill and injured patients in the acute hospital setting. Facilitating the activity and exercise of these most critical patients often requires the skill and expertise of a physical therapist. When physical therapists are involved in the care of hospital inpatients they experience significant benefits; patients experience fewer secondary complications related to their primary illness or injury, they spend less time in critical care units and less time in the hospital overall, and when they leave they go to less restrictive environments and more comfortable care settings. These known benefits …

Predictors Of Emergency Room And Hospital Utilization Among Adults With Intellectual And Developmental Disabilities (Idd) In New York City, Meghan G. Blaskowitz

Legacy Theses & Dissertations (2009 - 2024)

Background. Avoidable emergency room (ER) visits and hospital admissions among people with intellectual and developmental disabilities (IDD) contribute significantly to rising Medicaid costs. The Affordable Care Act (ACA) and New York State (NYS) Medicaid Redesign Team have identified a critical need to reduce ER and hospital utilization in an effort to contain healthcare costs and improve quality of care. Study Objective. This study identifies independent predictors of medical and behavioral/psychiatric ER and hospital utilization for a cohort of individuals with IDD (n=597) residing in supported living arrangements in New York City, the most Medicaid-dense region of NYS. Methods. A retrospective …

30-Day Readmission And Emergency Department Visits : Experience Of Diabetes And Abdominal Surgery Patients, Andrea Jane Mathis

Legacy Theses & Dissertations (2009 - 2024)

Nearly one-fifth of Medicare beneficiaries are readmitted within 30 days of a hospital stay. Readmissions contribute to the rising health care costs and they serve as a proxy for overall inpatient quality of care. Policy makers and payers interested in the efficacy of strategies to improve care coordination have scrutinized readmission rates for some time, yet this analysis attends to several remaining gaps in the literature. First, the rising prevalence of diabetes may be an underappreciated driver for readmissions. Second, many abdominal surgery patients require post-operative care, yet the point of care delivery and level of care needed has not …

End Of Life Decisions In The Nicu: The Value Of New Life And The Degree To Which Religion Plays A Role In These Ethical Decisions, Maria Battaglia

Honors Theses

This thesis explored the role of religion as a social variable affecting end of life decisions in the NICU. The existing literature has studied many factors that are a part of the tough ethical decisions made in the NICU with some reference to religion. However, there is not adequate attention given to religion specifically. In order to further expand upon religion, various members composing the medical teams of two hospitals were interviewed. The interviewees included neonatologists, nurses, chaplains, and a social worker. This thesis found that religion is a variable that matters more than the existing literature has claimed. Often, …

Variables Associated With Critical Illness Among Clark County Residence Hospitalized With H1n1 Influenza A Virus During The 2009 Influenza Season., Jonathan P. Hyatt

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background:In 2009, a novel H1N1 Influenza A virus was detected in the population. Because it can potentially affect a different population than the influenza strains circulating for the past 35 years, it is critical for physicians, practitioners and public health organizations to understand who is susceptible to this disease, and which sub-populations are most likely to suffer critical illness. The objective of this study was to examine the factors unique to 2009 H1N1 infection, with the goal of finding the variables associated with ICU admission (Critical Illness) in the Clark County 2009 H1N1 patient.

Methods:Factors that were assessed in this …

Hospitals With Physican Ceos: An Institutional Theory Perspective, Jeremy Zoch

Theses and Dissertations

ABSTRACT HOSPITALS WITH PHYSICIAN CEOS: AN INSTITUTIONAL THEORY PERSPECTIVE By: Jeremy S. Zoch, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Health Related Sciences at Virginia Commonwealth University. Virginia Commonwealth University, 2011 Major Director: Kenneth R. White, Ph.D. Professor Department of Health Administration The complexities of the healthcare industry at the beginning of the 21st century continue to challenge hospitals to optimize their operations. A key leadership position in the overall success of a hospital is the role of the Chief Executive Officer. The purpose of this study was to …

Factors Associated With Hospital Entry Into Joint Venture Arrangements With Ambulatory Surgery Centers, Reethi Iyengar

Theses and Dissertations

This study presented an empirical analysis of the key market, regulatory, organizational, operational and financial factors associated with hospital entry into joint venture (JV) arrangements with Ambulatory Surgery Centers (ASCs) as examined through the framework of resource dependency theory complimented with neo-institutional theory. This study used a cross sectional design to examine hospitals that entered into a joint venture arrangement with ASCs in 2006 and 2007. The data for this study were drawn from five main sources: the American Hospital Association Annual Survey (AHA), the Area Resource File (ARF), the CMS (Center for Medicare and Medicaid Services) minimum dataset, the …

Triage In The Emergency Department: Role Challenges, Satisfaction, And Perceptions Of Staff, Jaclyn Gardner

Undergraduate Theses and Capstone Projects

The goal of this study is to describe staff satisfaction and role challenges among Registered Nurses (RN’s) and Emergency Department technicians in a 43 bed Emergency Department (ED) at a community hospital. This is an exploratory study to determine the factors that create an efficient ED, from staffs perspective, to facilitate improvement for other Emergency Departments. Four RN’s were interviewed, including at least one manager, and ED staff completed a survey to determine role challenges involved in the triage process, perceptions of qualifications needed for triage, and overall satisfaction with the comprehensive triage method used in this setting. Surveys were …

Adoption Of Electronic Health Records By Admitting Physicians: A Heuristic Model, John Sharon Hudson

Health Services Research Dissertations

Background: Although hospital electronic health records (EHRs) are generally perceived to improve care, physician resistance may hinder EHR adoption.

Purpose: This study uses constructs from diffusion of innovations and resource dependence theories to predict adoption and rate of adoption of an EHR by admitting physicians from three of ten hospitals in a highly integrated health system in Virginia. Functions evaluated: computerized physician order entry (CPOE), electronic history and physical (EH&P) and electronic discharge summary (EDS). The study tested hypotheses that adoption would be associated with: working at larger, academic hospitals; financial alignment; larger physician groups; office EHR; youth; males; medical …

Characteristics Of Fundraising For Nonprofit Hospital Organizations, Cathleen Owens Erwin

All ETDs from UAB

This study addresses a gap that has been noted in the charitable fundraising literature, which is a scarcity of theoretically-based studies of fundraising by nonprofit organizations and the need to study fundraising within sub-sectors of organizations rather than the full nonprofit sector. The study uses institutional theory and strategic management constructs to examine the characteristics of the fundraising operations of nonprofit organizations. A categorization scheme is created based on nonprofit organizational effectiveness and performance characteristics to analyze fundraising by nonprofit hospital organizations as an organizational field. The categorization scheme identifies distinct clusters of organizations that are then investigated to determine …

A Replication Study For Comparative Purposes Of Evidence-Based Practice Activities In Magnet And Non-Magnet Hospitals, Joann F. Bunke

Theses and Graduate Projects

Nursing literature is rich with articles and studies in support of evidence-based practice. Health-care consumers today expect quality and excellence. As McSherry (1997) states, "'Patients', 'consumers'or'clients'are being encouraged to expect no less than a quality service and high standards of patient care from health professionals" (p. 985). The Magnet Recognition Program is one way to publicly recognize excellent nursing service. Using the 2003-2004 Magnet Recognition criteria within Standard Xlll is a way to evaluate the research environment of health-care facilities. The purpose of this study was to examine characteristics of the research environment of nursing departments within hospitals that are …

Application Of Queuing Theory And Procedure Time Estimation In A Local Healthcare System, Galina Tsoy

Engineering Management & Systems Engineering Theses & Dissertations

People in the United States pay more for their basic healthcare needs than do people in any other nation in the world. When we consider that the United States is the wealthiest nation in the world, controlling the majority of the world's resources, it seems only reasonable to ask: Why should it be this way?

In an effort to address this problem, this thesis examines two possible methods of improving health care efficiency in hospitals. The thesis is thus in two parts: the first part examines resource allocation in medical units using Queuing Theory, and the second part examines a …