<p>Federal healthcare reform has been a major driver for the widespread shift towards high-quality, value-based care at healthcare organizations in the United States. With increased emphasis on quality and value in healthcare, process and performance improvement have been identified and capitalized upon as methods by which to achieve higher quality clinical outcomes, increase patient safety and satisfaction and improve care coordination. For past several decades, lean management and related doctrines and principles have been widely adopted among healthcare organizations in the United States for process and performance improvement purposes. This business plan proposes a lean management consulting firm for healthcare organizations of all sizes and delivery models in the Greater Los Angeles area with a mission to deliver state-of-the-art lean education and training to management and staff of all backgrounds and roles. The aim of the proposed firm is to train, develop and empower its clients to ensure continuous quality improvement and eventually become one of the biggest lean consulting players in the market. </p>

<p> Over the past ten years, community-based palliative care (CBPC) has rapidly expanded as older adults are living in the community longer with advanced illness and high symptom burden. Yet there are no models of standardized care for this population. It has been suggested that primary and secondary palliative care be delivered in the primary care setting to address palliative care needs in the community. However, a description of older adults in primary care with advanced illness and symptom burden who would benefit from primary and secondary palliative care, and a description of the process to deliver care are lacking. The aim of this dissertation was to explore the facilitators and barriers to providing palliative care in primary care, and to describe the prevalence of advanced illness and symptoms of older adults in primary care to identify who would benefit from palliative care in primary care. </p><p> Using a grounded theory methodology, twenty semi-structured interviews were conducted with primary care and palliative care providers in academic and community settings. Four major themes emerged from the data that are facilitators and barriers in care coordination: (i) role clarity; (ii) feedback and communication; (iii) time constraint and workforce; (iv) education. </p><p> A secondary analysis was conducted using the National Ambulatory and Hospital Medical Care Surveys 2009-2011 to examine primary care visits. There were more visits by older adults to primary care for advanced illness and symptoms than to non-primary care. More visits were due to advanced COPD, CHF, dementia, pain, depression, anxiety, fatigue, and insomnia compared to non-primary care. This research contributes to our knowledge of the delivery of palliative care in the community and the patient population that could benefit from primary and specialty palliative care. I offer a conceptual model of the process of primary care and specialty palliative care in order to coordinate care for older adults with advanced illness and progressive symptomatology. </p>

This dissertation is an empirical work dealing with child health issues in developing . countries and specifically in Pakistan where the emphasis is put on the analysis of the relationship between socioeconomic determinants and health impacts. The first chapter includes a general discussion of child health and its importance for economic development in Pakistan and other developing countries. Undoubtedly, the health of children and young people are among the most important health issues. In this regard, the under-five mortality rate is widely used as credible measure of child health in this study. Children tend to be most vulnerable in their first year of life when their health is influenced not only by their own physical condition but also by the social and environmental conditions of the household (Elder & Shanahan, 2006; Lerner et al., 2011). This strong relationship between child mortality and socioeconomic conditions has ensured its continued and widespread use in monitoring social inequalities in health. This is combined· with the fact that preventing early deaths is an effective approach to increasing life expectancy and the monitoring of child mortality rates remains a key component of effective public health action. This dissertation has three objectives. The first objective is to examine the socioeconomic determinants of child health as well as the environmental degradation and child malnutrition variables on child health across the panel countries. The second objective is to develop regression based decomposition analysis to measure the child health inequalities among different socioeconomic groups in Pakistan. The third objective of the study is to investigate the impact of women empowerment and relative bargaining power on child health in Pakistan. In order to reach the first objective, this study used panel data methods to estimate the determinants of child mortality employing World Bank data for 96 low and middle income countries. This study empirically examined the socioeconomic and environmental determinants of child mortality outcomes by applying various panel data estimation methods i.e, Pooled, Fixed Effect, R~dom Effect, 2SLS, 2SLS FE and system GMM. Moreover, the analysis also examined if fertility is causal to child mortality and the effect of fertility on child mortality using 2SLS. The analysis revealed that the System GMM estimate is the best model which suggests a positive and significant coefficient of lagged child mortality, implying that child mortality is persistent over time. The results provide strong evidence that women's education, women's labour participation, immunization coverage and real GDP per capita are important detelminants of child mortality for developing countries. Other important findings are that immunization coverage and environmental degradation have significant effects on child mor,tality. Overall the results suggest that more attention should be given to the economic costs of poor health associated with environmental damage such as air pollution. Immunization coverage and improved sanitation seyms to be much more effective in reducing child mortality in developing countries. Therefore, it is argued that investments in these specific activities will yield significant social benefits within the sample of countries examined. . The second objective is achieved through the application of a decomposition approach to explain socioeconomic inequalities in child health in Pakistan. Inequalities in child health are measured using the concentration index, which is then decomposed into its contributions to socioeconomic inequality in the observed determinants of child health. Data for the analysis came from the 1998/99, 2001102, 2005/06 and 2007/08 Pakistan Social and Living Standard Measurement Survey (PSLM). The analysis reveals that child under five mOliality inequalities are concentrated among socio-economic groups that are poor in Pakistan in all four years of the survey. Furthermore, the results from decomposition analysis shows that household income, urban residency, mother's education, no breastfeeding and having no sanitation facility each made a sizeable contribution to child health inequality. This study recommends that scaling up social and economic policies that are in alignment with child health policies could bridge the current avoidable and unjust gap between the child health of advantaged and disadvantaged groups in Pakistan. .'~ The third objective of this study is to evaluate the hypothesis that women empowerment and relative bargaining power is related to lower child mortality. This hypothesis is again tested using PSLM data from Pakistan. The study attempts to focus light on the status of women and the effect on early childhood mortality controlling for the effect of other associated determinants. To allow for unobservable heterogeneity across birth cohorts and geographical districts, this study constructs a pseudo panel for a sample of children under the age of five from three repeated cross sections observed in 2001/02, 2005/06, and 2007/08. It is evident by the results that women empowerment and women bargaining power seemed to have the strongest effect on child m011ality in Pakistan. This study concludes that empowerment of women bestows further benefit to society indicating that there is the need for increasing the incentives for good care of children. The health status of children clearly increases with lower mortality, and this probability is higher when women are more empowered to make decisions within the household, suggesting the need for interventions that increase women's financial and physical autonomy.

<p> Over the past several years, mental healthcare system in United States has evolved tremendously, however majority of people are still struggling with various forms of mental illness and find it difficult to get appropriate treatment at the right time due to barriers like lack of providers, poor access, high cost and, social stigma. This business plan proposes an online mental health service company PsychWeb, offering telemental health services, with the aim of improving access to mental healthcare in the comfort of one&rsquo;s own living environment.</p><p> Chapter 1 of this business plan is about complete market analysis for the online mental health industry along with the business overview for PsychWeb and its services. It also sheds light on business target population, competitors, growth strategies and proposed future milestones. Chapter 2 shows an in depth feasibility analysis using SWOT that ensures business viability and success. In chapter 3, we have discussed the legal and regulatory issues, along with company formation, and laws around provider and patient use of PsychWeb services laying stress on HIPAA and provider licensure requirements at the state and federal level. Lastly, chapter 4 explains the financial analysis conducted to ensure the business profitability. It gives a detailed breakdown of monthly and yearly expenditures, revenues generated and profit margin projections. All financial statements generated in the process are provided in the appendix of this business plan.</p>

<p> This qualitative study provides a snapshot into what corporations say and what they do with regard to stakeholder engagement in the context of Corporate Social Responsibility (CSR) and considers the difference in the promises made and the actions taken by corporations in the minds of stakeholders. As the research of CSR questions what a corporation is responsible for and Stakeholder Theory (ST) questions whom the corporation is responsible to, CSR and ST provide conceptual frameworks for the study. A genuine commitment to CSR and stakeholder engagement contributes to sustainability, impacting the Triple Bottom Line (TBL) of an organization. According to the National Research Council, there is an urgent need for corporations within the U.S. Healthcare sector to make such a commitment. As large corporations are established organizations with greater resources to engage stakeholders in support of CSR, many believe they should take the lead. Consequently, this study identified six large-capitalization (large-cap) corporations within the U.S. Healthcare sector, representing six different industries within the sector that complied with Global Reporting Initiative (GRI) guidelines, the study&rsquo;s sampling criteria. Content analysis of Annual Reports to Shareholders, CSR Reports, and RepRisk Reports of the corporations selected for study allowed the researcher to formulate several conclusions. A corporation&rsquo;s commitment to ESG issues evolves over time, while their level of engagement with stakeholders fluctuates. Further, the communication style of a corporation can influence perceived commitment to ESG issues and stakeholder engagement. Finally, corporations committed to ESG issues and stakeholder engagement are not immune to incidents of ESG risk, which in turn, negatively impacts a corporation&rsquo;s reputation and impairs sustainability. A critical management approach to improve our nation&rsquo;s healthcare system is the adoption of a stakeholder orientation in support of CSR efforts. This study reveals a path that corporations within the sector can take to adopt such approaches. The importance of this study lies in the observations shared to further understand if corporations walk the talk with regard to stakeholder engagement in support of CSR and the recommendations offered that hopefully inspire more healthcare corporations to contribute to the transformation required.</p>

<p> Transportation is a problem that is constantly evolving but there are few places in the world that have the transportation problems of Southern California. Although there is a lot of competition for transportation the market for disabled accessible private transportation has a lot of room for growth in Southern California. This business plan purposes the creation of a private transportation service, Beach Transportation, in Southern Orange County which assists the elderly and handicap. The goal of our business will be to provide the highest quality transportation to those who require disability services or assistance at an affordable rate. This plan of starting small and in a focused market gives of room for future growth and expansion. The financial and technical feasibility help demonstrate the companies requirements for startup and revenue estimates. While Beach Transportation will have to work hard to create a customer base it should succeed due to establishing the business within a large target market and starting on low cost operations to allow the company to grow.</p>

<p> Mint Green is a limited liability company who provides preventative health care services to the Greater Long Beach area. Mint Green is entering the Weight Loss Services Industry which is experiencing rapid growth due to the enactment of the Patient Protection and Affordable Care Act. Mint Green has the opportunity to reach approximately 65% of firms who offer health benefits to their employees. Mint Green&rsquo;s Healthy Eating and Lifestyle Plan (HELP) is the core instruction to the weight loss programs. Mint Green has four types of weight loss programs; each developed to satisfy a wide array of budgets. Mint Green is projected to yield a profitable margin.</p>

<p> Low back syndrome affects 20% of people, and it is estimated that 30% of patients are unable to return to work after surgery. The monitoring of health care outcomes could improve the delivery of health services. The health performance conceptual framework, derived from the Donabedian model, was used to evaluate the functional outcome, clinical recovery, response to surgery, and physician performance of the surgical management of lumbar spine degeneration. A quantitative study (n=685) was undertaken using an administrative database in a repeated-measures design. The clinical and functional outcome improvements were analyzed using t tests. Surgical complexity on health outcome was examined with ANOVA. Predictors of patient satisfaction was explored using Pearson's correlation and regression analyses. The results demonstrated highly significant improvements in functional (mean change 30%; ODI=16.79 &plusmn; <i> SD</i> 19.92) and clinical recovery (mean change 50%; modified-JOA=6.983 &plusmn; <i>SD</i> 2.613) with surgery at 3 months; a >50% positive response to surgery; and a > 90% patient satisfaction, sustained over a 2 year period. Complexity of surgery did not impact health performance. Strong correlations between the health performance metrics were detected up to 6-months from surgery. Poor clinical recovery and persistent functional disability were predictive of patient dissatisfaction. The social change implications for health policy are that a constellation of health performance metrics could predict the potential for functional and clinical recovery based on presurgery disability while avoiding medical expenditures for procedures with no health benefit; aid in health quality monitoring, peer comparisons, revision of practice guidelines, and cost benefit analysis by payers.</p>

<p> This research used a Delphi methodology to solicit challenges that significantly impact the operational success of pediatric long-term care facilities. Further, this study sought to understand the ability of pediatrics administrators to impact, affect, overcome, or resolve these challenges. Round 1 accomplished the desired goal of eliciting a substantial amount of new qualitative information regarding administrative challenges in pediatric long-term care, which previously had been extant in the literature. In Round 2, data were distilled into categories and unique exemplars which in turn were validated by participants. In Round 3, administrators ranked and rated categories and individual challenges in terms of significance and impact. </p><p> Findings revealed that the most important challenges for administrators are those of working with an inadequate model that is designed for a geriatric population, inadequate Medicaid funding, and the lack of clinical and administrative indicators in pediatric long-term care. The most important challenges that could be affected by the administrators are related to inadequate model, clinical practice, and the need for diversification. Administrators believe they can strongly impact the rules, regulations, and protocols that are currently geriatric focused, develop pediatric long-term care indicators and evidence-based research, and impact their financial security by diversification. </p><p> The Delphi research accomplishes the desired goal of eliciting a substantial amount of new information regarding administrative challenges in pediatric long- term care and contributes to the broader body of knowledge in health services administration. The significant research findings suggest the need for changes in the regulatory and financial models in pediatric long-term care and the need for enhanced clinical practice though evidence-based practice and outcomes.</p>

<p> The health care industry is moving from a volume-based, fee-for-service financial reimbursement system to a value-based purchasing model. These changes have caused substantial challenges in the delivery of care. Hospital leaders must conduct business differently to lower cost, improve safety outcomes, and be more efficient and effective. </p><p> Numerous studies show engaged employees improve operational performance. Past studies point to leaders with high emotional intelligence who are effective at engaging employees. The purpose of this study was to determine if there is a statistically significant correlation between frontline managers and supervisors&rsquo; emotional intelligence and the degree of engagement of their direct reports. </p><p> The research questions were: (a) what is the level of employee engagement among those who participated in the study, (b) what is the level of emotional intelligence of the frontline managers and supervisors who participated in the study, and (c) using inferential statistics, is there a statistically significant correlation between emotional intelligence of frontline managers and supervisors and the employee engagement of their direct reports. </p><p> The study used non-experimental, quantitative analytics to test the hypothesis. A bivariate correlation procedure called Pearson&rsquo;s Product-Moment Correlation was used to determine the potential relationship between the emotional intelligence of 24 frontline managers and supervisors and employee engagement of their direct reports, totaling 585 employees. Though a favorable, moderate correlation was found with a Pearson r of 0.39267 at a p value of 0.0577, the hypothesis was denied. The favorable correlated relationship found supports the growing scholarly work. </p><p> Future studies may provide greater understanding and value of the relationship between emotional intelligence and employee engagement. Additional recommendations were made to improve organizational performance through leadership development, recruitment, culture engineering, and ongoing assessment of managerial effectiveness. </p>