<p> This quantitative study was an evaluation of the effectiveness of the online Training Home software program, designed for use with a national nonprofit business model. This study was undertaken because nonprofits have a difficult time resourcing training. If the Training Home program can deliver a comprehensive training program for minimal cost, then a nonprofit will be better able to deliver on the nonprofit&rsquo;s stated mission. For this study, six research questions centered on measuring the helpfulness of the program, the difference in job function training, improved knowledge of a national nonprofit, and perception of the Training Home program between those that had and or had not used the program. Additionally, cost per unit of training, the number of training vignettes delivered, time spent in training, ease of use by supervisors, and staff ratings of the effectiveness of the training home program. The population studied was the 450 staff at one affiliate of the national nonprofit. This staff group consisted of a mix of genders, ages, and education levels. This study used archival data gathered over the 2013, 2014, and 2015 calendar years and was analyzed using multivariate regression and descriptive analyses. The cost and number of training vignettes delivered in a 24-month period were compared to determine whether the Training Home program was a more cost-effective delivery model than the prior system for the year before the study. Analyses indicate that the Training Home program delivered more training to staff at a lower cost per unit of training when compared to the units of training delivered in the prior model. Supervisors and staff reported the program to be effective in knowledge management and tracking and the training of all staff. The study had positive results for the sample studied. It would be beneficial for any future studies to expand the sample size into other geographic regions.</p><p>

<p> <b>Rationale/Background:</b> Fall prevention is a paramount and lifesaving healthcare initiative. The investigation of interventions for the prevention of falls may lead to a decrease in injuries and promotion of superlative care for patients hospitalized in an acute healthcare environment. </p><p> <b>Purpose: </b>The purpose of this quantitative correlational direct practice improvement (DPI) project is to determine the relationship between the implementation of a fall prevention training program and changes in fall rates over a period over three months. </p><p> <b>Theoretical Framework:</b> The Neuman system model served as the theoretical foundation for this project. The model presents a holistic approach to patient at-risk for falling and guides bedside nursing care, assess stressors, safety needs, and environmental factors suggest potential indicators linked to fall-risk patients. </p><p> <b>Project Method and Design:</b> A quantitative method and correlational design was used to investigate the impact of the intervention. The intervention involved training for a total 28 nurses (N = 28) on two wards. The final data collection included fall rates for 56-patients (N = 56). </p><p> <b>Data Results:</b> The control ward had a fall rate of nearly twice as high than the ward who received the intervention. There is a statistically significant reduction in fall rates on the intervention ward (p = 0.04). </p><p> <b>Implications:</b> Based on the findings of this project, a fall education training program supported safety through a reduction of falls. The training program was adopted as a part of standard education for the site. </p><p>

<p> This study examines methods and barriers to minority leadership recruitment in healthcare organizations. Minorities are underrepresented in healthcare organizations at the executive level, even though staff and patient demographics are becoming increasingly diverse. This disparity in minority representation presents the potential for staff and patient needs, interests, and values to be overlooked by senior management and the strategies, policies, and programs they implement. This study conducted interviews with human resources personnel at healthcare organizations identified as top performers to determine whether their organizations engaged in minority recruitment methods, what methods were successful, and what barriers existed to recruitment of minorities. These results were compared to survey data compiled by the Institute for Diversity in Health Management. The results show significant room for improvement in the implementation of comprehensive methods to recruit minority senior management, with significant variation among organizations in the amount and type of methods to recruit minority executives. These findings lead to the conclusion that more pressure needs to be placed on healthcare organizations to identify best practices in minority recruitment and implement these in formal, comprehensive human resources activities related to recruitment, retention, and professional development.</p>

<p> A nursing shortage has resulted in hospitals seeking ways to meet their staffing needs. One strategy is the use of travel nurses (travelers) employed by staffing agencies. Hospitals are challenged with providing travelers an adequate orientation to assure their patients receive safe care while placing the travelers where they are urgently needed&mdash;at the bedside. The goals of this project are to identify best practices to provide a quality orientation and to propose an orientation program. To address these goals, pertinent literature has been reviewed, and input from travelers has been examined. As a result, an orientation program has been developed with a module for travelers to review prior to their assignments. An onsite orientation program follows with one day of didactic training and two shifts with a preceptor at the bedside. The recommendation is that organizations use the proposed program as a template when developing their orientation programs.</p>

The aim of this thesis is to develop analytic methods to support the implementation of decentralization in primary health care. Decentralization may be defined as the delegation of decision-making power from central management to middle or local management for coordinated control. To be an effective mechanism for coordinated control it needs to be implemented by systematic methods. This doctrine generally comes from the experience of implementing decentralization in the industrial sector. This thesis develops systematic methods of resource allocation to support the implementation of decentralized primary health care in Britain. The thesis also considers the transferability of methods to support the implementation of decentralization to Pakistan. The work reported in this thesis is based on case studies carried out in health districts in both Britain and Pakistan. Based on the reported work this thesis concludes that decentralization could be beneficial for both British and Pakistani primary health care systems, provided its implementation is supported by appropriate analytic methods.

<p>Average compensation of a CEO of publicly-traded hospitals was about $4 million a year for the period 2011 to 2016. Their compensation is growing while people have a hard time to pay the medical bills. The passage of the Affordable Care Act of 2010 has a significant effect on the healthcare system specifically on hospital operations. Hospitals account for 32% of the total healthcare costs. Through the passage of the ACA, lawmakers intended to reduce costs and increase the quality of care. Publicly-traded entities because of the separation of the management (agent) and ownership (principal) have conflicts of interest that lead to agency problems and costs such as the cost of monitoring and low return to shareholders. The publicly-traded hospitals are no exception. Hospitals provide incentives to the CEOs to reduce these costs and align their and shareholders? objectives. The purpose of the quantitative study was to examine the following question. What correlation, if any, existed between CEO compensation and financial performance of the U.S. hospitals post the ACA Act of 2010 for 2011-2016? The following metrics, operating margin, return on assets, return on equity, occupancy rate, length of stay, and profit per discharge, were used to perform multiple regression analysis. Initially, seven hospitals were selected, but one hospital was excluded because of missing data. Spearman?s rho correlation was used because data violated some of the parametric assumptions. The Operating margin, occupancy rate, and profit per discharge variables were statistically significant in explaining the CEO compensation. Other variables affected the CEO compensation but were not statistically significant. Finally, including all six variables explained less than 30% of CEO compensation, which would indicate agency problems exist in the hospitals. Future studies should identify what other variables explain the change in CEO compensations

<p> With the push for national EHR adoption and the subsequent increase in meaningful use of HIT applications, the healthcare industry has sought to realize reduced cost, increased safety, and improved patient outcomes. In an effort to evaluate the goal of improved patient outcomes, this study examines the effect of HIT adoption stage on the length of stay (LOS) for children admitted with an asthma diagnosis. Asthma is a chronic disease affecting millions of children each year, and has significant health, monetary, and emotional costs. As asthma is in the top three of most common conditions requiring hospital admissions for children and that nearly 50% of inpatient pediatric patients are covered by Medicaid, improving quality outcomes for this condition has large implications across the healthcare delivery system. </p><p> Using comparisons from the KID 2009 and 2012 datasets, the differences between mean LOS for pediatric asthma patients between stages of adoption of Health IT as measured by the EMRAM scale are statistically significant at the p &lt; .05 level, demonstrating that increased use of Health IT has lowered the mean length of stay for this population. Thus, the utilization of a medical best practice, here the adoption of Health IT, resulted in shorter hospital stays and thus cost savings, in this defined pediatric patient population. While further studies examining Health IT implementation in other patient populations are necessary, these results demonstrate that the implementation of Health IT can lead to both better standards of care and lower healthcare costs, which should be of significant interest to those charting the future course of healthcare and healthcare reimbursement in this country.</p><p>

<p> Patient falls present challenges in acute care settings. It was unknown if hourly patient rounding using an electronic whiteboard system (EWS) impacted fall rates on a 16-bed surgical unit in a community hospital in Philadelphia, PA. The clinical questions for this project were what impact does the EWS have on hourly patient rounding and fall rates, and what impact does patient rounding logs have on hourly patient rounding and fall rates. Roy&rsquo;s adaptation model, capacity building, and Kurt Lewin&rsquo;s change theory were the theoretical and conceptual frameworks used in this project. Descriptive analyses were used to interpret data from the EWS and patient rounding logs completed on 220 randomly selected patients, in two nursing units, totaling 7,689 patient rounds. A quantitative correlational design determined the impact of the EWS on hourly patient rounding. A chi-square (&chi;²) test of independence determined the expected and actual numbers of missed and completed patient rounds. The results indicated a statistically significant relationship between the EWS and hourly patient rounding, <i>X²</i> = (1, <i>N</i> = 7,689) = 371.3; <i>p</i> = &lt; 0.05. A statistically significant relationship was found between hourly patient rounding completed on dayshift compared to nightshift, <i>X²</i> = (1, <i>N</i> = 7,689) = 38.7, <i>p</i> = &lt; 0.05. However, using the EWS did not reduce fall rates on the control unit (<i>n</i> = 7.04). The findings of this project support the use of an EWS to enhance hourly patient rounding and is being considered as a standard of care for the future. </p><p>

<p> Mitigating ED crowding will not be solved by working harder and faster, and is not a one-solution problem. There are tactics the ED can implement, tactics the inpatient units can implement, and tactics that should be implemented to support the transitioning of patients from the ED to the inpatient units. This DNP project focuses on implementing a pilot to evaluate the use of hall beds in the inpatient units for ED patients awaiting placement. This will be a significant change for the inpatient caregivers, and time and attention must be committed to the initial phase to promote cultural readiness in order to achieve success. Crowding in the ED is a facility problem, not an ED problem. A multipronged approach when mitigating ED crowding must emphasize safe, efficient patient care that leads to the best possible outcomes without delays in treatment, while still maintaining standards of care, respect for privacy, and clear communication with the patient. This project focuses on both providing care to adult general medical-surgical patients admitted to a Midwestern level-1 trauma center through the ED and reducing the volume of patients who leave before treatment complete or without being seen. In the end, this practice change will benefit patients seeking care in addition to capturing the lost patients and reimbursement that accompanies the care. </p><p>

This thesis is concerned with current debates as to the value of patient satisfaction research. The thesis reports two surveys by means of which the scope of patient satisfaction research is considered. Conceptual and methodological problems in this field of research and alternative theories of the social process whereby patients evaluate health care are reviewed. The two surveys are presented in terms of an introduction to the particular field of medicine involved, the methods of enquiry used, survey responses and discussion of results. The first survey is of patients attending outpatient neurological clinics presenting with headache. This study was conducted with intensive interviews, one before the neurological consultation and a second at home, one month later. The problems of making sense of patients' accounts in terms of 'expectations' and 'satisfaction' are outlined. Instead different perceptions of the value of clinic visits are related to four different concerns felt by patients in relation to their headaches, concerns for reassurance, explanation, prevention and symptomatic treatment. The second survey is of patient satisfaction with outpatient care in a department of genito-urinary medicine. This survey was conducted with two questionnaires: one completed whilst patients waited in the clinic for theirconsultation, and a second which was mailed to patients one month later. Survey results are used to examine an interactionist model of patient satisfaction developed by Ben Sira. The data is examined by various methods to suggest limitations of and modifications to the original model. Finally the thesis assesses the contribution of the two surveys to an understanding of how patients evaluate medical care. Alternative models of patient satisfaction are reexamined. It is argued that some perspectives have too restricted a view of patients' abilities. The implications of the two surveys are reviewed in terms of the different interests researchers may have in surveying patients' views.