Health and Medical Administration Commons^™

Relationship Between Nurse-To-Patient Ratios, Patient Satisfaction Scores, And Hospital Profitability, Patrick Ross Bumstead

Walden Dissertations and Doctoral Studies

In 2019, hospital profitability margins were at their lowest levels since the great recession due to a declining volume of patients. Hospital executives who fail to improve profitability are at risk of sustainability. Grounded in the service-profit chain theory, the purpose of this quantitative correlational study was to examine whether nurse-to-patient ratios and patient satisfaction scores significantly predict hospital profitability. Data were collected from 74 hospitals in Southern California from the Centers for Medicare & Medicaid Services government database and publicly available financial statements. Results from multiple regression analysis were not statistically significant. A key recommendation is for hospital executives …

Experiences Of Spanish-Speaking Patients Using Interpreter Services With Their Physicians, Rafael Raul Caycho

Walden Dissertations and Doctoral Studies

In the United States, many patients cannot speak English well enough to communicate with their medical providers. Many of these patients use professional interpreter services offered by their medical organizations to help with communication, which can lead to miscommunication due to the translation process between patients, interpreters, and physicians, and to incorrect diagnosis and poor health outcomes for the patient. The purpose of this study was to explore the experiences of Spanish-speaking patients who used interpreter services with their physicians. The transmission model was the theoretical framework used to explore the experiences and outcomes for the participants. In this study, …

Developing Nurse Managers Through An Evidence-Based Education Program, Theresa Ann Hannu

Walden Dissertations and Doctoral Studies

AbstractThis study explored the lack of formalized managerial education and training for nurses new to leadership. This quantitative study specifically explored the knowledge gap of beginner nurse managers based on a lack of formalized education, a universal approach is supported by the research. Currently, there is no standard or formal nurse manager education program through the Department of Nursing or the Department of Learning and Development. The focus of the evidence-based project was to evaluate pre- and post-data assessing the impact of instituting a formal education program for beginner level nurse managers in collaboration with the human resources department of …

Association Of Surgical Site Infections With Hospital Size And Urban And Rural Locations In California, Jim Edjerore Omaraye

Walden Dissertations and Doctoral Studies

Approximately 20% of health care-associated infections (HAIs) result from surgical site infections (SSIs), increasing health costs, morbidity, and mortality. The mandates of public reporting of HAIs through the Centers of Medicare and Medicaid Services can have consequential effects on hospitals’ reimbursement, a significant concern to health care administrators. The primary purpose of this quantitative study was to determine if urban and rural locations and the size of hospitals affect the rate of SSIs in California. The two research questions addressed whether there is an association between the rate of SSIs in urban and rural locations and the size of hospitals …

Employee Retention Strategies In The Fast Food Industry, Patrick C. Umezurike

Walden Dissertations and Doctoral Studies

AbstractThe annual employee turnover rate in the fast-food industry is 73%, resulting in significant financial losses to the fast-food industry across the United States. The fast-food managers who lack strategies to improve employee retention; risk reduced organizational performance and effectiveness. Grounded in the eight motivational forces of voluntary employee turnover, the purpose of this qualitative multiple case study was to identify strategies managers in the fast-food industry used to improve employee retention. The participants were five senior fast-food managers in Baltimore, Maryland, who successfully improved restaurant employee retention. Data were collected through semistructured interviews; and documents (e.g., employee handbook, training …

Physician Retention Strategies In Small Military Treatment Facilities, Stacey Sherrice Amos

Walden Dissertations and Doctoral Studies

During a time of increasing physician shortages, health care leaders must identify successful physician retention strategies. Health care leaders are concerned with physician retention, as a lack of physicians minimizes patient access to care. Grounded in the stakeholder theory, the purpose of this qualitative multiple case study was to explore strategies health care leaders in small military treatment facilities in rural areas use to improve physician retention. The participants were five health care leaders from different Army military treatment facilities located in rural areas throughout the continental United States who had more than four months of experience in physician shortages …

Nurse Turnover A Crisis In Healthcare, Billie Robinson

Walden Dissertations and Doctoral Studies

AbstractNurse turnover is a global, national, and local problem that impacts the ability of healthcare leaders to deliver high quality healthcare to the populations in need of healthcare services. The purpose of this study is to identify reasons nurses leave organizations. The Leader-Member Exchange Theory undergirds the quantitative research which was conducted using the Supervisor Leader Communication Inventory. Nurse leaders communicate with acute care nurses using principles of the Leader- Member Exchange Theory. The survey was distributed to members of the Georgia Nurse Association. Positive correlations were revealed between the independent and dependent variables. SPSS was used to establish the …

Benefits Of Using An Electronic-Medical-Record In The Emergency Department: A Systematic Review, Eduardo Paguntalan Monroy

Walden Dissertations and Doctoral Studies

AbstractLow quality of care is a problem for many United States (U.S.) emergency departments (E.D.). The use of electronic medical records (EMR) with quick embedded tools, treatment plans, and protocols decrease E.D. overcrowding, reduce boarding time, to approximate the 4- hour recommendation by the Joint Commission on Accreditation of Healthcare Organizations, and improve quality of care. The project question asked whether a systematic review of EMRs with quick embedded tools, treatment plans, and protocols decreased overcrowding and boarding time, and improved E.D. quality care. This systematic review used the Johns Hopkins Model to answer the project question by guiding selection, …

Associations Between Nurse Manager Engagement And Nursing Quality Indicators, Justin Travis Morris

Walden Dissertations and Doctoral Studies

Individuals serving in the nurse manager role are critical stakeholders supporting frontline nurses delivering quality care within acute care settings. Despite evidence supporting nurse managers’ contributions to improved quality outcomes for patients by proxy, there is scant evidence supporting direct relationships between the role and outcomes. This study intended to provide quantitative evidence of relationships between nurse managers’ engagement, nurse managers’ tenure, and patient outcomes. The leadership complexity theory classified the nurse manager as a meso-level leader, requiring support from the macro- and microlevels of the organization. Acting as a liaison, meso-level leaders’ function in the space between executive leadership …

Strategies To Recruit Age-Diverse Volunteers For A Nonprofit Behavioral Health Organization, Karen A. Peters

Walden Dissertations and Doctoral Studies

Volunteers are a crucial resource for behavioral health organizations, especially those that rely predominantly on a volunteer workforce for delivery of services. In such instances, the inability to maintain an adequate and age-diverse volunteer workforce threatens organizational sustainability and interrupts valued services to the community. A case study was completed to identify volunteer recruitment and retention challenges for a behavioral health nonprofit organization in the southwestern United States. The Baldrige Excellence Framework was used to guide the study, with emphasis placed on the assessment of the organization’s leadership, strategy, and workforce. Data sources included interviews with organizational leaders, organizational records, …

The Relationship Between Quality Score, Generated Savings/Losses And Assigned Beneficiaries Among 2018 Mssp Acos, Crystal Crider

Walden Dissertations and Doctoral Studies

In 2018, Medicare spending in the United States accounted for 15% of the comprehensive federal budget forecasted to exceed $1.5 trillion by the year 2028. To help manage the spending in this sector, the Centers for Medicare and Medicaid Services implemented Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs). There is a need to understand current data as it relates to the correlation between MSSP ACO participants’ costs, quality, and assigned beneficiaries. The purpose of this quantitative study was to examine the relationship between Quality Score, Generated Total Savings/Losses and Total Assigned Beneficiaries for 2018 MSSP ACO participants. General …

Hpv Vaccination And Cervical Cancer Prevention In Women, Ateela Duffy

Walden Dissertations and Doctoral Studies

Cervical cancer is the second most common cancer in women worldwide and is mainly caused by the human papillomavirus (HPV). The purpose of this study was to determine whether there was a statistically significant difference in the diagnosis of cervical cancer in women who received the HPV vaccine compared to women who did not receive the vaccine, while considering demographic factors (race, ethnicity, level of education, household income), personal risk factors (sexual orientation, cigarette use, diet, and type of contraception use), and factors affecting access to healthcare (type of healthcare coverage, delay in receiving medical care). This research study, guided …

Strategies For Implementing Self-Service Technologies In Supermarket Retail Operations, Ryan Christopher Gurley

Walden Dissertations and Doctoral Studies

AbstractOrganization leaders who do not adopt self-service technology (SST) are at risk of failure. The adaptation of SST can aid leaders in the supermarket industry improve checkout operations, increase efficiency, and minimize customers’ waiting experiences, reducing the customers’ shopping satisfaction. Grounded in the disruptive innovation theory, the purpose of this multiple case study was to explore strategies supermarket managers use to adapt SST practices. The participants included six supermarket managers in Jackson County of Southern Illinois. Data were collected from face-to-face interviews with managers, company documentation, and observations. Thematic analysis was used to analyze the data. Four themes emerged: cultural …

The Relationship Between Advanced Payment Model Providers And Patient Behavior, Harry Petaway

Walden Dissertations and Doctoral Studies

Public health initiatives include vaccination and screening efforts to reduce the burden of disease. This study addressed colorectal cancer (CRC) screening behaviors of accountable care organization (ACO) patients with different social determinants of health and providers’ ability to comply with the Medicare Shared Savings Plan (MSSP) quality measure ACO #19. This study followed the socioecological model and a cross-sectional quantitative design to assess data from the MSSP public use file 2019 across three manuscripts to expand on current literature. The purpose was to determine whether patient behavior was the primary driver to improve healthcare quality. Study results showed that performance …

Electronic Health Record Adoption, Interoperability, And Consumer Access, Edet Udofia

Walden Dissertations and Doctoral Studies

AbstractElectronic health record (EHR) adoption is necessary across many healthcare settings. The problem identified in the current study is that EHR systems and consumer access to their health records tend to be inconsistently applied across various health care settings which could have adverse effects on health outcomes in the policies, and procedure of healthcare delivery. EHR systems can improve the perceptions of patients on healthcare systems and the operation of health care facilities. More specifically, the issue of interoperability in the context of EHR system implementation was reviewed in the current project. The purpose of this study was to understand …

Demographics And 30-Day Readmissions For End-Stage Renal Disease Patients, Shelia Concepcion Perez

Walden Dissertations and Doctoral Studies

End-stage renal disease (ESRD) is increasingly a problem in the United States, and factors such as race/ethnicity and gender may not only worsen the risk of the disease but also correspond to worse treatment access. This is significant because ESRD is a heavy economic burden not only on patients, but on caregivers and the health care system, especially as disparities remain between different demographic groups. The purpose of this quantitative nonexperimental, historical, correlational design was to determine the extent to which gender and race/ethnicity predict 30-day readmission rates after hospitalization for ESRD patients. The theoretical framework for the current study …

Job-Related Stress And Burnout On Turnover Intention Of Nurses In Dallas, Texas, During Covid-19, George Ochieng

Walden Dissertations and Doctoral Studies

AbstractIn a country with a large aging population such as the United States, nursing is a crucial profession that is also a high-stress and high-turnover occupation, leading to a shortage of nurses and increased healthcare costs. The year 2017 saw a 10-year high in nurse turnover. The general management problem is that current efforts to decrease the turnover of nurses remain ineffective. The specific problem studied was the high turnover of nurses in Dallas, Texas, linked to work-related stress and burnout. This quantitative nonexperimental regression and moderation research study aimed to study factors that predict or reduce turnover intention. This …

The Relationship Between Organizational Culture And Hospital Performance In The Veterans Health Administration, Darline Jasmin Nabbie

Walden Dissertations and Doctoral Studies

High quality care consists of a culture that involves staff who are engaged and keepthemselves accountable when providing care. In 2014, employees described their organizational culture at the Veteran Affairs (VA) as entrenched and intimidating. An audit also revealed that in 2014, patients were receiving substandard care. The present study was an analysis of the relationship between organizational culture and hospital performance in the Veterans Health Administration (VHA). This study provided key stakeholders such as the VA administration an understanding of work climate as an indicator of organizational culture and how it affected hospital performance with the VHA. The VHA …

Perceptions Of Nurse's Personal Smartphone Use At Work, Esperanza Criscuolo

Walden Dissertations and Doctoral Studies

Distracted nurses who use their personal smartphone at work has resulted in the diversion of attention from patient care. The specific problem is the personal smartphone use by nurses in the hospital settings has resulted in distracted patient care, leading to wrongful release of patient’s information, medical errors, injury or preventable patient death. The purpose of this qualitative study was to describe the perceptions of nurses regarding distracted patient care in their clinical workplace due to personal smartphone use by nurses. The study was grounded in the distraction-conflict theory conceptual framework. The key research question examined the perceptions of nurses …

Associations Between Provider Type And Medicaid Overpayments, Kezia Hercules

Walden Dissertations and Doctoral Studies

Healthcare costs have been rapidly increasing in the United States and consume a significant percentage of the Gross Domestic Product (GDP). A percentage of these costs are attributed to increased incidences of healthcare overpayments to providers. This study examined the impact of these overpayments by provider type, and the underlying reasons which resulted in overpayments from the Medicaid perspective. The theoretical framework used in this study was Ostrom’s institutional analysis and development (IAD) framework. The study used all available data (N = 682) from New York State Medicaid Inspector General final audits of providers for Medicaid overpayments. A chi-square test …

Predictors Of Obesity Among Young Adults In The State Of Maryland, Kala Shahi

Walden Dissertations and Doctoral Studies

AbstractObesity has become a global wellness concern for young adults. In the past, there were very few studies conducted on predictors of obesity among young adults, even though there have been several studies on the potential predictors of obesity on the general population. The social ecological model was used to guide this quantitative cross-sectional study to identify the possible predictors of obesity among young adults. The Behavioral Risk Factor Surveillance System was used to analyze the potential predictors of obesity among young adults between the ages 18 – 34 years old in Montgomery County, Frederick County, and Princess Georges County, …

A Lebanese Health Care Organization’S Strategies To Secure Sustainable Funding, Dania Mahmoud Al Assadi

Walden Dissertations and Doctoral Studies

Fundraising and donations are the main sources of revenue for behavioral health care nonprofit organizations (NPOs) worldwide. Economic, political, social, or health crises impact fundraising and donation sources for behavioral health care NPOs. This qualitative case study addressed strategies that senior leaders of a Lebanese behavioral health care NPO could use in times of crisis. The study also addressed the behavioral health leaders’ experience managing a funding crisis. The Baldrige conceptual framework was used to assess the organization’s effectiveness in seven key areas. Interviews with the senior leaders and analysis of the organization’s archival data were used to inform the …

Nursing Home Nurse Turnover And The Association To Workload, Absenteeism, And Number Of Beds, Justin Ryan Gracieux

Walden Dissertations and Doctoral Studies

The aging population in the United States has resulted in an increased need for quality nursing home care, which includes a stable nursing staff and reduced workforce instability. The purpose of this quantitative correlational study was to examine the relationship between direct care nursing staff turnover rates for RNs, licensed vocational nurses (LVNs), and certified nursing assistants (CNAs) concerning workload, absenteeism, and number of beds in Texas nursing homes. The relational coordination theory provided the theoretical framework for understanding the underlying issues and communication needs that may relate to staff turnover. Secondary data from 11,336 direct resident care nursing staff …

Using Health Navigators To Reduce Readmission Rates Among Medicaid Or Uninsured Female Patients In The Emergency Department, Susan Renee Ibanez

Walden Dissertations and Doctoral Studies

AbstractThere has not been a significant decrease in hospital readmission rates since the 1980s, which has impacted staffing, operational, and financial resources. Unnecessary 30-day readmissions result in penalties in reimbursement, additional costs, and adverse reactions resulting from the admission for the patient. This quantitative study explored the impact of using health navigators for an emergency department (ED) patient population. The theoretical framework was based on the Donabedian model. The study focused on female patients,some of whom were covered by Medicaid, and some were uninsured. This study posed research questions targeting reducing readmission for female ED patients with no insurance or …

The Combined Impact Of Race And Education On Obesity Among U.S. Adults By Fidelis Okoye, Fidelis Chidi Okoye

Walden Dissertations and Doctoral Studies

Walden University

College of Health Professions

This is to certify that the doctoral dissertation by

Fidelis Okoye

has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made.

Review Committee Dr. Vasileios Margaritis, Committee Chairperson, Public Health Faculty Dr. Srikanta Banerjee, Committee Member, Public Health Faculty Dr. James Rohrer, University Reviewer, Public Health Faculty

Chief Academic Officer and ProvostSue Subocz, Ph.D.

Walden University2021

AbstractThe Combined Impact of Race and Education on Obesity Among U.S. Adults by Fidelis Okoye

MA, Walden University, 2009BS, Marygrove College, 2001

Dissertation …

Managers’ Challenges Complying With Environmental Regulations In Ghana’S Mining Sector, Augustin Tandoh

Walden Dissertations and Doctoral Studies

Even though Ghana’s mining industry has been and continues to be of remarkable benefit to the national economy, environmental pollution continues to plague the industry. The purpose of the qualitative case study was to obtain the perceptions of 9 nongovernmental organization (NGO) stakeholders of the challenges faced by managers in the Ghanaian mining industry tasked with complying with Ghana Environmental Protection Agency (GEPA) regulations. Freeman’s stakeholder theory was the theoretical framework of the study. Data were collected from semistructured interviews with a purposive sample of Ghanaian and international NGO representatives who sought to work with, or even shame and pressure, …

Strategies For Catalyzing Clinicians’ Support Of Telemedicine Programs In Rural Communities, Jonathan Liwag

Walden Dissertations and Doctoral Studies

Clinicians’ failure to accept contemporary technology has been a critical barrier to telemedicine program adoption. Staff technical challenges and resistance to change can affect technology return on investment, which concerns telemedicine program leaders. Grounded in Davis’s technology acceptance model, the purpose of this qualitative, descriptive single case study was to explore strategies used by program leaders in the Marianas Islands who successfully gained clinicians’ acceptance of contemporary technology. The participants were 5 program leaders recommended by their institution because of their leadership role and telemedicine technologies experience. Data were collected from 4 face-to-face and 1 audio teleconference interview with the …

The Relationship Between Leadership Style, Job Satisfaction, Nurse Retention, And Patient Care Outcomes: A Systematic Review, Richard Lazarus Nwaorgu

Walden Dissertations and Doctoral Studies

Poor nurse retention, job dissatisfaction, and reduced patient health outcomes are pervasive issues at the healthcare institution of this project. Institutional data reflects a continual decline in retention and job satisfaction rates, which in 2018 showed a 20% drop in retention and a 25% drop in job satisfaction. The institution’s annual survey identified perceptions about leadership styles that gave rise to negative nursing behaviors and the negative impact on patient care outcomes. The purpose of this systematic review project (SRP) was to identify the relationship between nursing leadership styles, job satisfaction, nurse retention, and patient care outcomes within a hospital …

Factors That Determine The Place Of Childbirth In Lagos State, Nigeria, Ohiemi Emmanuel Adegbe

Walden Dissertations and Doctoral Studies

AbstractNigeria is among the 10 countries in the world with the worst maternal mortality. Though most of these deaths can be prevented using antenatal care (ANC) and having institutional deliveries, in Nigeria, ANC attendance and institutional delivery are suboptimal. Research is lacking on the reasons for the disparity between the use of antenatal services compared to deliveries at health centers. The aim of this study was to determine the associations between sociodemographic, obstetric, and health service factors and the place of delivery used by pregnant women in predominantly urban, cosmopolitan Lagos, Nigeria. Because both service delivery and demand factor categories …

Role Of Case Management In Access To Mental Health Care Among African Americans With Medicaid, Kira-Jai Jayne Taylor

Walden Dissertations and Doctoral Studies

Disparity in access to appropriate mental health care among African Americans compared to non-Hispanic Whites is growing. The purpose of this quantitative retrospective study was to examine the relationship between access to an outpatient mental health facility with case management and access to outpatient mental health services among African Americans with Medicaid compared to non-Hispanic Whites with Medicaid. The theoretical framework was based on the conceptual framework for integration created by PATH. The study addressed whether there is a difference in the number of African Americans compared to non-Hispanic White patients with Medicaid in access to an outpatient mental health …