<p> Shared leadership paradigms are becoming more popular in organizations because of the increased responsibilities placed on leaders within health care organizations. Researchers have conducted little research on how individuals on leadership teams perceive their role in engaging with others in their team. The qualitative phenomenological hermeneutic study involved examining how radiology administrators in Northern California describe their lived experiences on shared leadership teams, with an emphasis on their perceptions of team productivity and trust. The conceptual framework for the study included shared leadership theory, which scholars have noted is still a new field of study. Seven research participants representing from three to 18 years of experience as radiology managers with experience serving on shared leadership teams. From the five initial questions and sub questions, the analysis involved breaking down the responses into 175 separate areas of exploration. In addition to the demographics of the groups and types of teams served on, four themes emerged from this data: lived experience on shared leadership teams, knowledge and skills learned from shared leadership teams, key factors affecting team performance on shared leadership teams, and the effect of diversity on shared leadership teams. The implications of the research to leadership are that radiology managers may gain a better understanding of when to use shared leadership and how to best staff the teams to support organizational work, and how to improve shared leadership team dynamics.</p>

<p>Oceanside Durable Medical Equipment (DME) is an accredited start-up company that will offer a comprehensive line of the latest medical supplies and equipment to patients in Long Beach, California. This company will focus on the distribution of leading medical equipment brands to patients who are in need of support for short-term and chronic health conditions. Durable medical equipment can offer help outside of the hospital environment and aid in a better quality of life. </p><p> With more than 2.4 million individuals over 60 years old in Southern California, there appears to be a large market and opportunity for this company. Oceanside DME will contract with leading medical equipment manufacturers and healthcare providers to deliver patients with quality products. A rapidly growing market for medical equipment will allow Oceanside DME to create a presence in this healthcare industry. </p>

<p> Traditional nursing homes are based on a model that can limit a resident&rsquo;s ability to make basic choices, minimize opportunities to direct their own lives, and ultimately destroy the human spirit. As an alternative to the traditional model, the household model is an arrangement in which small groups of residents direct their daily lives in a shared home setting (a household), supported by a decentralized self-led service team of frontline professionals empowered to be responsive to the residents&rsquo; needs. While many frontline nursing staff members are advocates of the need for change, it is also common for them to react negatively toward the process of household model implementation. The purpose of this qualitative study was to examine nurse aides&rsquo; and licensed nurses&rsquo; reactions to household model implementation. Sixteen semi-structured interviews were transcribed verbatim, divided into 524 units of meaning, and coded using concepts of Oreg, Vakola, and Armenakis&rsquo; (2011) theoretical model, derived from 60 years of qualitative studies on change recipients&rsquo; reactions to organizational change. In this model, employee reactions are a function of antecedents, categorized as pre-change (individual characteristics and internal context) and change antecedents (change process, perceived benefit/harm, and change content). Antecedents influence affective, cognitive, and behavioral reactions to change and, subsequently, lead to change consequences, including work-related and personal consequences. Two trained independent coders reviewed transcripts and achieved 70% agreement. Explicit reactions accounted for 48% of comments, followed by antecedents (27%) and change consequences (25%). Most common antecedents were related to change process (71%), perceived benefit/harm (24%), and change recipient characteristics (4%). Study participants reported difficulties with cross training, initial experiences of hardship and fear, confusion over the new model, and perceptions that it would be harmful to staff members and residents. Although experiences improved over time, some staff members, who self-identified as positive individuals, still reported perceived harm and engaged in resistant behaviors. Explicit reactions to change were behavioral (41%), cognitive (33%), and affective (26%). Most staff members supported household model implementation through their actions. They communicated with each other to learn and to cope with change. While three staff members actively resisted changes, they still supported at least some aspects of the household model. Cognitive and affective reactions were mixed, ranging from excitement and happiness to fear, nervousness, and frustration. Core household model components were received as positive, especially for residents. Concerns regarding work accounted for 94% of all reported organizational change consequences and included insufficient household staffing, harder working conditions, insufficient time to get everything done (or to do it well), and widespread feelings of isolation. The theoretical model for analyzing organizational change proved to be useful in understanding nursing staff members&rsquo; reactions to household model implementation and for identifying proactive steps to manage this change. Ongoing education is recommended to ensure staff members follow through with changes over time and to reduce confusion and perceptions of harm. The household model may need to be staffed at a higher level, at least initially, to maintain the same quality of care as in the traditional care delivery model. Ongoing team training within each household can serve to improve operations and balance responsibilities of blended roles. Due to the decentralized environments, potential feelings of isolation among residents and staff members are anticipated, which can be alleviated through regular multi-household gatherings.</p>

<p>Hospital leaders who fail to respond to poor patient satisfaction reports may experience lower organizational performance. The purpose of this qualitative case study was to explore strategies of leaders in private health care settings to improve patient satisfaction. This study may provide strategies that health care leaders in the public setting can apply to improve patient satisfaction and organizational performance. One private health care provider operating in Vancouver, British Columbia, Calgary and Edmonton, Alberta, was selected as both private and public healthcare centers are located in these areas. Data were gathered from 12 participant interviews and from an examination of available physical artifacts such as organizational documents provided by the participants and the company website. Transformational leadership was the underlying conceptual framework for this research. Triangulation was used to ensure the rigorousness of the study. In the study, themes were identified after member checking the transcribed open-ended interview questions. The 5 themes identified were cohesive culture of employee engagement, patient-focused model of care, timely access and follow-up of results and coordination of care, continuous system quality improvement, and employee accountability. These themes underscore the importance of a culture of employee engagement; they also illuminate care that focuses on the patient-care that ensures timely access, follow-up and coordination of care, quality improvement based on patient feedback, and employee accountability. Current publicly-funded hospitals and health care centers may apply these findings to improve patient satisfaction and organizational performance. </p>

<p> Falls are a serious issue for the elderly living in long-term care facilities, as falls contribute to significant health problems such as increased dependence, loss of autonomy, confusion, immobilization, depression, restriction in daily activities, and, in some cases, death. An estimated 424,000 fatal falls in elderly patients residing in long-term facilities occur annually in the United States costing $34 billion in direct medical costs. One way to reduce falls among elderly patients in long-term care is to assess for fall risk frequently and implement evidence-based strategies to prevent falls. Patients in this project site facility had been assessed for fall risk via the Briggs Fall Risk Assessment Tool with implementation of fall risk iinterventions only upon admission or when there was a fall. The purpose of this project was to assess whether changing to weekly use of the Briggs Fall Risk Assessment Tool with implementation of fall risk interventions by nursing staff could decrease fall rates in the elderly in long-term care in Harris County, Texas. The model of prevention served as the conceptual framework for this project. Thirty participants (20 females and 10 males) between the ages of 65-115 participated in the program. Pre-implementation data were collected for 1 month and post-implementation data were collected for 1 month. The total number of falls reported weekly was counted before and after the weekly implementation of the Briggs Fall Risk Assessment Tool. The number of falls decreased from 12(70.6%) before the implementation of the assessment tool to 5(29.4%) falls afterwards. A fall prevention program in long-term care may affect social change positively by reducing fall risk in long term care by reinforcing the importance of increased awareness of risk of falls to implement fall prevention strategies</p>

<p> The purpose of this study was to identify and measure trends in genetic counselor (GC) workforce supply in the United States from 2002 to 2016. Using data collected biennially from the National Society of Genetic Counselors&rsquo; Professional Status Survey (PSS), I calculated overall percent change in GC employment across specific work settings over the past 14 years. I also measured change in the relative percentage of GCs who provide direct patient counseling (i.e. clinical GCs) to determine if the percentage of clinical GCs decreased over time. Analyses were performed to determine if associations existed between GC work settings and 1) percentage of clinical GCs employed by those work settings, and 2) average number of new patient visits per week. </p><p> For several years, investigators have suggested that shortages of clinical GCs exist and that GC shortages could worsen, given increasing demand for genetic counseling and testing services. However, studies quantifying GC supply and demand are limited, and both must be measured and compared to confirm GC shortages. The goal of this study was to focus on measuring change in GC supply across work settings over time, and its impact on direct patient counseling. </p><p> From this study&rsquo;s results, I confirmed that there was a decrease in the percentage of GCs employed by University Medical Centers (UMCs), and an increase in GCs employed by Diagnostic Laboratories (DLs) from 2002 to 2016. I also showed that a greater percentage of GCs employed at UMCs counsel patients than GCs employed by DLs. An increase in DL GCs and a decrease in UMC GCs was temporally associated with a decrease in the percentage of clinical GCs. Although a significantly smaller percentage of DL GCs counseled patients than UMC GCs, clinical DL GCs, on average, counseled significantly more new patients per week than clinical UMC GCs. Evidence drawn from this study can help inform strategies to redistribute GC employment across specific work settings in order to increase the percentage of clinical GCs and increase the number of patients receiving genetic counseling services.</p>

<p>The purpose of this directed project was to develop a four-hour workshop for Gerontologists and associated health professionals to assist older adults in understanding the Medicare products available to them. The workshop was specifically developed for delivery through a non-profit called ?In Transition Planning,? which is an educational platform to assist aging individuals with the aging process through education, community involvement and training. The four-hour workshop was based on the ?Medicare and You? booklet developed by the Centers for Medicare and Medicaid Services (CMS) sent to older adults prior to turning 65 years old and annually. This workshop covers the basics of Medicare planning, which includes elections on basic Medicare, Medicare Advantage, and Medicare Supplemental Plans that a senior receiving Medicare needs to consider. Workshop materials were sent to three expert reviewers, who gave suggestions for revision. General suggestions included adding material about Medicaid and rules for dual eligibles, discussing identity theft as it relates to one?s Social Security card, including breaks in the presentation, and condensing some of the material for the time allotted. The workshop will educate Gerontologists and associated health professionals about the different components of Medicare and insurance coverage available to older adults.

<p> The goal of the project was to implement best-practice guidelines for adults with heart failure (HF) receiving home care. Heart failure is incurable, but can be managed when healthcare providers use evidence-based treatment guidelines and patients comply with routine follow-up and practice a healthy lifestyle. Providing access to care for the elderly in the form of a structured telephone call program to monitor self-care efficacy related to adherence to medication and other treatments and therapies is associated with reduced HF symptoms and improved quality of life. This project implemented a phone call follow-up program to evaluate and improve self-care efficacy in adults with heart failure by monitoring compliance, providing education, and focusing on key indicators of HF symptom exacerbation. The Self-Care of Heart Failure Index (SCHFI) was used in weekly phone calls for a total of 10 weeks. Using the SCHFI tool provided structure and included key best practice content areas with scripting to enhance consistency. The project participants were adults age > 65 year old patients receiving care through a home health care team in central Louisiana who had an established diagnosis of heart failure. </p>

<p> Sightseers Ophthalmology Services is a mobile medical business that provides concierge vision and ophthalmic services to individuals in Newport Beach and Huntington Beach. The implementation of the Affordable Care Act (ACA) has provided millions of previously uninsured patients with medical coverage, which is causing increased demand for primary and specialty care services, in addition to higher premiums for those who have historically maintained an insured status. A result of the ACA is overcrowding; patients are having more difficulty getting access to care, and are experiencing long wait times in clinic when they actually <i>do</i> get an appointment. Concierge medicine is becoming more popular as many patients are finding that increased costs and inconvenient access to care are not worth their time and money. Newport Beach and Huntington Beach are home to a population who may prefer concierge eye services, and be able to meet the expense of them, if needed. Sightseers is an affordable way to have access to same-day or next-day appointments; and, moreover, we come directly to the patient. Whether the patient has difficulty with transportation, a conflicting work schedule, or if he or she simply does not want to travel to and wait in a busy ophthalmology clinic, Sightseers&rsquo; business plan proves that convenient and high quality services can benefit both the patient and the provider.</p>

<p>Abstract The aim of this quality improvement (QI) project was to explore whether the implementation of an enhanced telephone reminder system improved the rate of attendance at initial follow-up appointment and medication adherence. A total of 86 patients, discharged from inpatient psychiatric units with a follow-up within 7 days of discharge, were eligible to receive the enhanced telephone contact reminder and follow-up text. A preliminary retrospective chart review was conducted to collect historical data on medication and attendance adherence. A prospective interventional design was used to implement the QI project. Patients received telephone contact within 24-72 hours of discharge and text message reminder strategies. A medication adherence assessment was completed at telephone contact and at initial follow-up appointment. An analysis of the data examined the impact of the TCM strategy on patient?s rate of adherence to medication and initial follow-up appointments. Descriptive analysis assessed the frequency of medication adherence in retrospective and implementation data. Inferential statistics analyzed factors of association such as prior clinic services and rate of attendance at follow-up appointment. In the retrospective chart review (n=57), data revealed a 28% attendance rate and an 81% medication adherence at the follow-up appointment, with no statistical difference in a 145 history of prior series on attendance. Implementation data on medication adherence at telephone contact and at first follow-up appointment revealed a 61.5% medication adherence rate at telephone contact and 80% adherence rate at first follow-up appointment. The predictor value of a prior history of service on attendance at first follow-up appointment revealed no statistically significant difference. The project, however, resulted in clinically significant benefits that promoted individual patients? medication-taking behaviors and decisions to attend follow-up appointments, and improved clinical practices at the BHC.