Health and Medical Administration Commons^™

Effective Strategies Employed By Retail Store Leaders To Reduce Employee Turnover, Alexandro Beato

Walden Dissertations and Doctoral Studies

Employee turnover affects retail organizations in the form of lower productivity, decreased profitability, and reduced sustainability. In 2014, organizations lost over $11 billion in tangible and intangible assets as the result of employee turnover. High employee turnover rates have an adverse effect on productivity, which lead to unsustainable business practices. The number of retail employees who quit their jobs each month increased from 432,000 in December 2016 to 464,000 in January 2017, which indicates that some managers lack strategies to reduce employee turnover. Using the transformational leadership theory, the purpose of this single case study was to explore effective strategies …

Work-Family Conflict: Does Romance Matter?, Christie Marie Charles

Walden Dissertations and Doctoral Studies

Research has shown that being in a romantic relationship has related negatively with work-family conflict. Using social exchange theory, the investment model, and role theory, this study examined the relationships among the dimensions of perceived partner support, romantic relationship interdependence, and work-family conflict. A sample of 192 adults in paid employment, currently involved in a romantic relationship, were recruited from SurveyMonkey Contribute. Study participants completed online a demographic survey, the revised Support in Intimate Relationships Rating Scale (SIRRS), the Investment Model Scale, and work-family conflict scales. Correlation analyses showed that work-to-family conflict and family-to-work conflict correlated negatively with commitment and …

A Phenomenological Inquiry Of Nurses' Lived Experiences Of Implementing Evidence In Practice, Monnie Abraham

Walden Dissertations and Doctoral Studies

Research-informed practice is crucial to ensure best possible decisions are made during care delivery. In reality, research-based evidence often does not reach patient care due to many elements that impede the implementation process. The purpose of this phenomenological study was to discover the lived experiences of nurses involved in implementing evidence-based practice (EBP) in clinical settings within hospitals in United Arab Emirates. The theoretical and conceptual basis for the study was derived from Promoting Action on Research Implementation in Health Services framework for knowledge translation and Benner's Novice to Expert theory. Twelve nurses who had experience implementing evidence to practice …

Use Of Physician Credentialing Standards By U.S. Medical Services Professionals, James Allen Reeder

Walden Dissertations and Doctoral Studies

Credentialing in hospitals is the first line of defense for improving patient safety and reducing medical errors by verifying a physician's medical knowledge and skills. There is no single set of standards for physician credentialing followed by all hospitals in the United States. Using May's normalization process theory, the purpose of this quantitative study was to survey medical services professionals (MSPs) to determine which physician credentialing standards were being used, the sources being used, and the frequency of standards used. The dependent variables in this study were the 13 ideal credentialing standards developed by the National Association of Medical Staff …

Primary Care Nurse Practitioners And Organizational Culture, Leanne Christine Rowand

Walden Dissertations and Doctoral Studies

Nurse practitioners (NPs) were introduced to the British Columbia healthcare system 12 years ago. Integration challenges related to infrastructure and relationships between administrators and physicians continue. The purpose of this project was to understand how nurse practitioners, working in primary care roles, experience the organizational climate within their healthcare agency. Kanter's empowerment theory guided this project. Data were collected using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. A total of 64 NPs relayed their degree of perceived organizational support. NPs scored highest on Autonomy and Independent Practice (Mean [M] = 3.54, Standard Deviation [SD] = 0.59). Organizational Support and …

Length Of Stay And Reimbursement Rates For Medicare Patients, Wandella Ezell

Walden Dissertations and Doctoral Studies

Medicare reimbursement rates across the United States have varied by as much as 49-130% across healthcare facilities. Geographic adjustments and severity of medical diagnoses attribute to some dissimilarity; however, the source of longer hospitalization and higher re-admission rates among Medicare patients requires financial consistency. The research encompassed (N = 3000) patients with hypertension as the focus for the study because this is a critical group of Medicare patients with a chronic disease that has been identified as a silent killer. The principal goal that drove this research study was to explain the variations in length of stay for Medicare patients …

Focus Groups As A Method To Build Library Services And Partnerships Across The Institution, Courtney R. Butler, Megan Molinaro

Posters

BACKGROUND: Children's Mercy is an independent, non-profit, 367-bed pediatric health system with multiple clinic locations and a strong focus on research. It offers a pediatric residency program and over 37 subspecialty fellowship programs.

New initiatives go through many steps from conception to implementation. The focus of this case study is to describe how gathering feedback from stakeholders during proposal development provided valuable insight, secured stakeholder collateral to support requests for administrative approval and funding, and marked the beginning of new productive institution-wide partnerships.

PROJECT STAGES:
Identify Needs
Identify Stakeholders
Evaluate Software
Conduct Focus Groups
Develop Fair Market Analysis/Executive Summary
Convene …

Racial And Ethnic Differences In Receipt Of Immediate Breast Reconstruction Surgery: Do Hospital Characteristics Matter?, Jaya Shankar Khushalani

Theses and Dissertations

Immediate Breast Reconstruction Surgery (IBRS) is associated with better quality of life among women who undergo a mastectomy. Despite insurance coverage for IBRS, utilization of IBRS remains low. Data from publicly available sources for 2010-2012 are used to examine the association between hospital characteristics receipt of IBRS by patients. Minority-serving status, low bed size, for-profit ownership, non-teaching status, high competition, low density of plastic surgeons in the market and non-metropolitan location are associated with lower likelihood of receipt of IBRS.

Racial and ethnic minorities are less likely to receive IBRS. A mixed effects logistic regression model with interactions between Black/Hispanic …

Nonprofit Pay In A Competitive Market: Wage Penalty Or Premium?, Christian King, Gregory B. Lewis

Department of Nutrition and Health Sciences: Faculty Publications

Two competing theories argue that the nonprofit sector pays differently: Nonprofit employees may accept lower pay to be able to do meaningful work for a good cause, or they may earn higher pay due to nonprofit organizations’ tax exemptions and weaker incentives to hold down wages. To test these opposing expectations, we use the 2005-2013 American Community Surveys to examine pay differences among registered nurses working for nonprofit, for-profit, and public hospitals. We also test hypotheses that public and nonprofit hospitals have smaller pay disparities by gender, race, and relationship status. We find that pay is highest in nonprofit hospitals, …

Barriers And Perceptions Of Black American Men About Prostate Cancer In Georgia, Martins M. Nnoko

Walden Dissertations and Doctoral Studies

In 2016, prostate cancer was the second leading cause of fatality in the United States. However, the population in this study 'Black American men, ages 40 and older, in selected counties in Fulton, DeKalb, Gwinnett, Clayton and Atlanta metropolitan areas' tended to underutilize prostate cancer care. The purpose of this quantitative, nonexperimental descriptive study was to determine whether socio-economic barriers and perceptions of Black American men about prostate cancer reduce their ability to access quality care in this county in Georgia. The Health Belief Model (HBM) was used to inform the predictive validity of perceptions, attitudes, and belief on individual …

Policing The Mentally Ill In Coronado, Ca, Jennifer Susan Ayres

Walden Dissertations and Doctoral Studies

The growing number of individuals suffering from mental illnesses and their inability to access intervention methods has adverse effects on the criminal justice system. These impairments increase the likelihood that police officers will have negative attitudes about persons with mental illnesses. This study sought to understand whether police officers' empathy, education, experience outside of work as well as on the job, and officers' training in the field of mental health all related to police officers' attitudes relating to persons with mental illness. The purpose of this study was to expand the body of knowledge and determine how factors such as …

Barriers To Preventive Healthcare For Immigrants In Michigan, Sondos Ghazi Al-Hachim

Walden Dissertations and Doctoral Studies

The Affordable Care Act expanded insurance coverage to the general population; however, expanding insurance coverage to immigrants might not be sufficient to improve utilization of annual physical preventive exams. This study evaluated adult Michigan immigrants' individual demographics, perceptions, and behaviors, as well as the collective cultural and system characteristics that might act as barriers to the utilization of annual physical preventive exams. Ken Wilber's integral operating system model for medicine conceptual framework was used to create a comprehensive map of factors and bring more clarity and understanding to the barriers to annual physical preventive exam. The quantitative survey was the …

Exploring The Strategies To Implement A Sustainable Energy Program In Hong Kong Public Hospitals, Terry Ting

Walden Dissertations and Doctoral Studies

Healthcare is one of the most energy-intensive industries because of its 24 hour-a-day and 7-days-a-week operation model. Climate change, due to environmental pollution, has increased the incidence of respiratory disease, cardiovascular disease, and cancer, which further overload the financial burden of our healthcare system. The National Health Service Sustainable Development Unit suggested that a sustainable healthcare sector also requires using their resources in an efficient and responsible way. Hong Kong public hospitals are facing this problem along with high energy expenditure. The purpose of this qualitative, multiple site case study was to explore strategies for Hong Kong's public hospital leaders …

Performance Improvement Data And Staff Responsibility, Tabitha Anne Bentley

Walden Dissertations and Doctoral Studies

Improving the role the nurse plays in health care delivery should be embodied in the performance improvement initiatives to successfully improve the quality of care that is delivered. The purpose of this evidence-based practice project was to collect performance improvement data and present it to staff who, in turn, used the information to improve practice and influence patient safety outcomes. The practice-focused question addressed what would occur if a tool that allowed frequent data trending was used to measure effectiveness of care and thereby influence key outcome measures. Duffy's quality caring model provided a framework for the study to support …

Human Resource Strategies For Improving Organizational Performance To Reduce Medical Errors, Dr. Mary Ellen Taylor-Hyde

Walden Dissertations and Doctoral Studies

Preventable medical errors are the third leading cause of death in the United States. Healthcare leaders must consistently promote the delivery of quality and safe care of patients to reduce unnecessary errors and prevent harm. The purpose of this case study was to explore human resource strategies for improving organizational performance to reduce medical errors. The study included face-to-face interviews with 5 healthcare clinical managers who work within a multifaceted health system in the Midwestern region of the United States. Complex adaptive systems theory was used to frame this study. Interview notes, publicly available documents, and audio recordings were transcribed …

Impact Of Emergency Department Patient Flow Model And Triage Level On Patient Wait Times, Joann Lynn Featherstone

Walden Dissertations and Doctoral Studies

Some hospital emergency departments (EDs) are negatively affected by extended patient wait times, resulting in reduced hospital profitability. Therefore, it is critical hospital leaders understand factors impacting ED average patient wait times. Grounded in the business process improvement theoretical framework, the purpose of this causal comparative study was to examine the impact of an ED rapid evaluation unit (REU) patient flow model and emergency severity index (ESI) on average weekly patient wait times. Data collection comprised a census of 26 archival data records pre and postimplementation of an ED REU patient flow model from a hospital ED in Upstate New …

Strategies Hospital Leaders Use In Implementing Electronic Medical Record Systems, Shaunette Miller

Walden Dissertations and Doctoral Studies

Some hospital leaders lacked strategies for implementing electronic medical record (EMR) systems. The purpose of this case study was to explore successful strategies that hospital leaders used in implementing EMR systems. The target population consisted of hospital leaders who succeeded in implementing EMR systems in a single healthcare organization located in the Los Angeles, California region. The conceptual framework used was Kotter's (1996) eight-step process for leading change, and data were collected from face-to-face recorded interviews with 5 participants and from company documents related to EMR design and development. Data were analyzed through methodological triangulation of data types, and exploring …

Deep Sequencing Transcriptome Analysis Of Murine Wound Healing: Effects Of A Multicomponent, Multitarget Natural Product Therapy-Tr14, Georges St. Laurent Iii, Bernd Seilheimer, Michael Tackett, Jianhua Zhou, Dmitry Shtokalo, Ian Toma, +Several Additional Authors

Clinical Research and Leadership Faculty Publications

Wound healing involves an orchestrated response that engages multiple processes, such as hemostasis, cellular migration, extracellular matrix synthesis, and in particular, inflammation. Using a murine model of cutaneous wound repair, the transcriptome was mapped from 12 h to 8 days post-injury, and in response to a multicomponent, multi-target natural product, Tr14. Using single-molecule RNA sequencing (RNA-seq), there were clear temporal changes in known transcripts related to wound healing pathways, and additional novel transcripts of both coding and non-coding genes. Tr14 treatment modulated >100 transcripts related to key wound repair pathways, such as response to wounding, wound contraction, and cytokine response. …

Doodle Health: A Crowdsourcing Game For The Co-Design And Testing Of Pictographs To Reduce Disparities In Healthcare Communication, Carrie Christensen, Doug Redd, Erica Lake, Jean P. Shipman, Heather Aiono, Roger Altizer Jr., Bruce Bray, Qing Zeng

Clinical Research and Leadership Faculty Publications

Supplementing patient education content with pictographs can improve the comprehension and recall of information, especially patients with low health literacy. Pictograph design and testing, however, are costly and time consuming.

We created a Web-based game, Doodle Health, for crowdsourcing the drawing and validation of pictographs. The objective of this pilot study was to test the usability of the game and its appeal to healthcare consumers. The chief purpose of the game is to involve a diverse population in the co-design and evaluation of pictographs.

We conducted a community-based focus group to inform the game design. Game designers, health sciences librarians, …

The Patient-Centered Medical Home And Diabetes Mellitus Outcomes: A Systematic Review, Lisa Sullivan Mcmanus

Walden Dissertations and Doctoral Studies

Ineffectively managed chronic diseases such as diabetes mellitus (DM) increase overall health care expenditures and negatively affects health outcomes such as exacerbations, functional decline, disability, and death. The purpose of this systematic review (SR) was to review the DM outcomes reported by patient-centered medical homes (PCMHs). The goal was to determine how care coordination and evidence-based clinical management impacted financial and health outcomes. The SR followed the Cochrane protocol and complied with the PRISMA evidence-based minimum set for reporting. Overall, DM management in the PCMH demonstrated statistically significant completion rates for essential screenings and preventive care, including HgA1c (p = …

Geospatial Analysis Of Spatial Patterns Of U.S. Hospital Readmission Rates, Yamei Wang

Walden Dissertations and Doctoral Studies

Unplanned hospital readmission after a recent hospitalization is an indication of poor healthcare quality and a waste of healthcare resources. The Centers for Medicare and Medicaid Services (CMS) initiated the Hospital Readmission Reduction Program (HRRP) to improve healthcare quality and reduce costs; however, studies found the risk adjustment method used in calculating the standardized readmission rate was less accurate without hospital region or community factors. Accordingly, this cross-sectional quantitative study was designed to examine spatial patterns in hospital readmission rates following Andersen's behavioral model of health service utilization. This study was the first geospatial analysis on risk standardized hospital readmissions …

Comparing Outcomes Of Laparoscopic Adjustable Banding And Laparoscopic Sleeve Gastrectomy Bariatric Surgery, Seth Kojo Ananse Baffoe

Walden Dissertations and Doctoral Studies

Bariatric surgery is an effective procedure type for morbidly obese patients when all else fails. Because obesity is a chronic disease, prolonged assessment and understanding of the credibility of procedure types and their effects on bariatric surgery outcomes are essential, yet current evidence shows decreasing utilization of one of the dominant procedure types. To better compare outcomes of procedure type, this research was designed to control for volume, hospital size, age, gender, season, month, year, and ethnicity. The goal of the study was to compare the outcomes of laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) bariatric surgery …

Losing New Graduate Bedside Nurses, A Practice Improvement Initiative, Beverly Elaine Miller

Walden Dissertations and Doctoral Studies

New graduate nurses (NGNs) at bedside are faced with numerous challenges, which prompt them to leave jobs in their first year. The transition from being a student to competent nurse requires a NGN to have the necessary skills and experience. Subsequently, hospitals continue to face shortages of staff because of high turnover and low retention levels. Nonetheless, evidence from reviewed literature has indicated that the use of residency programs can increase NGNs' stay at bedside, improve retention, reduce costs of operations, and return employees' turnover. The purpose of this quality improvement project was to identify the likelihood of NGNs remaining …

Leadership Styles And Leadership Effectiveness Of Outpatient Physical Therapy Clinic Managers, Adedolapo Ibiyemi Oyefeso

Walden Dissertations and Doctoral Studies

Outpatient physical therapy clinics (OPTC), like many other healthcare organizations, face an array of challenges in meeting the needs of the growing elderly population. The leadership behavior of OPTC managers is a key component to secure employee loyalty, accommodate increased patient demand, and implement positive organizational change. The purpose of this nonexperimental quantitative survey designed study was to investigate the relationship between the leadership styles perceived by OPTC healthcare managers and nonmanagerial employees, as measured by the Multifactor Leadership Questionnaire Short. The primary research question examined the difference between the OPTC managers' self-perceived leadership style and the nonmanagerial subordinates' perceptions …

Factors Associated With Provider Utilization Of The Heath Information Exchange In The State Of Hawaii, Kris K. Wilson

Walden Dissertations and Doctoral Studies

In a context where technology is increasingly being incorporated into health care practice, many U.S. health care providers and organizations are finding it challenging to connect disparate electronic documentation systems to retrieve patient information when coordinating care across providers and heath care entities. Local and regional health information exchange (HIE) systems were created to facilitate collecting information into one integrated patient record to address information transfer between heath care providers. Yet, adoption and use of HIEs have been low. The purpose of this study was to review the predictive factors accounting for physicians' use of a HIE in the U.S. …

An Environmental Scan Of Diagnostic Practices For Children With Disabilities In El Paso, Alezandra Martinez

Open Access Theses & Dissertations

With the prevalence of developmental disabilities in the rise in the United States, it is important that these children are identified and diagnosed as soon as possible so that they may receive appropriate medical treatment and intervention. However, research suggests that there are several factors that influence screening, referral, and diagnostic practices. This study aimed to analyze key themes that arose when parents of children with disabilities and pediatric healthcare providers discussed screening, referral, and diagnostic practices for children in El Paso, a medically underserved community. Researchers conducted a 2- phase study that employed both quantitative and qualitative methodology. Results …

Healthcare Utilization Awareness And Labor Monitoring Methodology: A Theoretical I.M.S.E. Approach To Risk Minimization And Human Metrics Capturing In The Nursing Workforce, Luis Reyes

Open Access Theses & Dissertations

The healthcare industry is so complex and dynamic that the development of any tool designed to promote positive patient outcomes nearly requires the developer to be an actual healthcare practitioner. Many healthcare tools exists that initially give the perception that there will be no future requirements that may hinder the tools' integrity, but more often than not, the unexpected occurs. The future is one unpredictable element of life that most engineers wish they could capture with optimal precision. I.M.S.E. (Industrial, Manufacturing and Systems Engineering) applications do not assist with fortune telling, but they do assist with creating robust tools designed …

A Systems Approach To Moral Distress In Long Term Care, Margaret Lemley

Electronic Theses and Dissertations

Abstract: The question that this dissertation seeks to answer is whether or not a Systems Approach to Moral Distress can serve to positively address issues of moral distress within the Long-Term Care setting. Because moral distress has largely been understood as a phenomenon of the individual, efforts to address and reduce incidents of moral distress have focused almost entirely on the individual and his or her reaction to specific triggers. Building upon the existing literature this dissertation argues that previous efforts to understand moral distress within the healthcare setting have been limiting in two very important aspects. The first …

Practicing Sacred Encounters: A Narrative Analysis Of Relational, Spiritual, And Nursing Leadership, Margaret Woodrow Mark

Antioch University Dissertations & Theses

This research examined one large health system that has, through a stated mission outcome that every encounter is a sacred encounter, sought to enhance relationships occurring within the health care environment. Seeking to understand the lived experience of sacred encounters through the lens of nurse leaders in one acute care hospital settings this study examined how nurse leaders experienced their leadership role in realizing sacred encounters. Participants were defined as nurse leaders from one hospital setting and included nurse managers, directors and one vice president. A narrative thematic analysis framed by situational analysis was the method of inquiry. Data was …

Attitudes And Perceptions Of Mental Health Treatment For Native American Clients, Beverly Elaine Johnson

Walden Dissertations and Doctoral Studies

The need for mental health service is increasing in American Indian/Alaska Native (AI/AN) communities. While research has examined the availability, access, and effectiveness of provided services to the AI/AN, very little is known about the influence of the attitude and perceptions of both clinicians and clients in their therapeutic relationship in the treatment process. Using the frameworks of liberation, oppression, and trauma theory, this qualitative phenomenological study explored mental health service delivery and utilization issues within an AI/AN community. Data were collected through semistructured interviews with 14 clinician and client participants. The data were sorted into themes and subthemes and …