<p> Death from medical error at time of writing is the third leading cause of the death in the United States. Creating a world where patients and those who care for them are free from harm is the priority in the patient safety movement. A strong culture of prioritizing safe practices is the foundation for safe patient care; this culture can be developed and maintained by the implementation of daily safety huddles. By engaging the team in safety behaviors to achieve the goal of reducing preventable patient harm, daily safety huddles have the potential to impact the safety culture at both the unit and organizational level. Daily safety huddles are deliberate, intentional, purposed conversations in a non-punitive environment from the leader with their team about safety events, concerns, and needs so that situational awareness is created, the team has a shared mental model, and resources can be assigned to reduce the risk of potential events of harm to patients, families, and the health care team. This change project evaluated the impact of daily safety huddles on unit-level safety culture as measured by the Safety Organizing Scale (SOS) survey which is based on the principles of high reliability utilizing a pre-posttest quantitative design. Descriptive statistics were used to describe the characteristics of the inclusive of gender, race, age, experience level, and educational level. Results indicated an overall increase in mean scores from the pre-test to the post-test for all behavioral indices of safety culture with the exception of one question describing handoff communication. A statistically significant positive difference was noted between groups with p = .03 for the SOS question on discussion of mistakes and how to learn from them as a result of huddle implementation. Thus, the implementation of huddles demonstrated a clinically significant improvement in unit level safety culture and a statistically significant improvement in one domain.</p>

<p> The purpose of this study was to explore the relationship between green environments and resilience in older adults. It had two aims: 1) to explore the effect of a reflective garden walking program on resilience and three of its related concepts&mdash; perceived stress, personal growth initiative, and quality of life&mdash;in older adults, and 2) to explore the resilience patterns of older adults engaging in the reflective garden walking intervention. A parallel mixed method design using a quasi-experimental quantitative and a descriptive exploratory qualitative approach was used. Participants engaged in a six week reflective garden walking program. By the end of the program, resilience levels exhibited a slight increase and perceived stress levels a decrease. The qualitative data supported some beneficial effects of the reflective garden walking program, but also indicated that much of the participants&rsquo; experience of resilience may have been related to the rich social and nature-filled environment in which already they lived. Patterns of resilience that appeared in the data were <i>maintaining a positive attitude, belief in one&rsquo;s self in the face of one&rsquo;s vulnerabilities, woven into the social fabric, purpose and meaning, personal strength, and communities for growing older</i></p>

<p> The purpose of this qualitative multiple case study was to explore women&rsquo;s perceptions of provider influence in shaping their beliefs about protection against sexually transmitted diseases during provider-patient consultations. Women indicate they prefer to discuss sexual health issues with providers, yet research was not available to fully understand provider influence on women&rsquo;s beliefs regarding sexually transmitted diseases. Telephone interviews were conducted with a purposive sample of 12 adult women in Baton Rouge, Louisiana. Data collected from these interviews and analyzed for emerging themes using NVivo 10 software revealed how women perceived providers&rsquo; discussions and the dissemination of STD related information. Findings also revealed how women believed healthcare providers might present sexual health information to motivate changes in risky sexual behaviors. The three major themes emerging from the analyses of the data collected were providers did not initiate discussions about preventing STDs, no information was received about preventing STDs during consultations, and visuals could motivate changes in risky sexual behaviors. Recommendations based on the study&rsquo;s findings involved identifying opportunities to leverage staff members in healthcare providers&rsquo; settings, illuminate cues to action, develop STD awareness programs specifically for women, and to conduct future research.</p>

<p> The capstone project reports the risk factors causing unplanned hospital readmission of vascular patients as well as the effects on healthcare cost. The methods for determining the risk factors include clinical indicators for risk prediction process, and the STAAR (State Action on Avoidable Rehospitalization) initiatives, which can be used as healthcare improvement projects to facilitate the cross-continuum team. The findings indicate a relationship between the patient&rsquo;s engagement in the lower extremity vascular procedure, and effectiveness of follow-up after surgery in the reduction of hospital readmission and healthcare cost. Potential strategies to prevent the risk factors for readmission of vascular patients and to reduce the healthcare cost are discussed. Presenting unplanned readmission for vascular patients and reducing the cost associated with readmission is important for senior leaders and policy makers to improve health care outcome.</p>

<p><b>Background</b>: Throughout the twentieth century, Brazil developed a Social Health Insurance, providing coverage to formal workers and their dependents. In 1988, the country implemented a health reform adopting a National Health Service model, based on three core principles, universal coverage, open-ended benefit package and striving for health equity. During this transition, formal workers recomposed their privileged access to healthcare through private health insurance, resulting in a two-tier system represented by those with dual coverage&mdash;public and private&mdash;and those who must rely exclusively on the public insurance. Private health insurance coverage has a positive correlation with income, however, between 1998 and 2008 private coverage expanded vigorously among the poor, while remained stable among the rich. The health equity literature in Brazil consistently reports the presence of relevant inequalities in utilization of health services favoring privately insured individuals. A gap in this literature, however, is to determine whether inequalities in utilization of health services remain among insured individuals, i.e., does private insurance improve access regardless of individuals&rsquo; income? </p><p> <b>Methods</b>: The study relies on Andersen&rsquo;s behavioral model as a theoretical framework to analyze data from two rounds (1998 &amp; 2008) of a national household survey, assessing levels of utilization of fourteen dependent variables across income quintiles and calculating concentration indexes as summary measures of inequality. Dependent variable distributions across income are standardized by need using the indirect method. Concentration curves compare the evolution of inequality during that time. Curve dominance is formally tested between survey years. Decomposition analysis identifies the most relevant contributors to inequality. Physician services are analyzed as the probability of having a physician visit and the number of physician visits. Hospital services are analyzed as the number of hospital admissions, the probability of having a hospitalization, and the number of hospital days during the last hospitalization. The latter two variables are broken down according to their financing source, either public (SUS) or private insurance. </p><p> <b>Results</b>: Physician services present very low inequalities, although a statistically significant positive gradient persists in both survey rounds. Poor PHI beneficiaries have an advantage compared to national levels. SUS financed hospitalizations are a rare phenomenon among privately insured individual but strongly concentrated on the poor. Poor PHI beneficiaries utilize private hospital at lower levels than the rich. Compared at a national level, they are at a disadvantage. In 1998, this was not the case, suggesting that insurers may be developing mechanisms to deter hospital utilization among the poor. Premium value and income are the most relevant contributors to inequality in physician and hospital services. </p><p> <b>Conclusions</b>: The Brazilian government (ANS) needs to monitor utilization levels across income and develop policies to increase accountability of PHI products particularly preventing insurers from purposefully pushing their beneficiaries to use SUS hospitals. Greater availability on insurance policies segmented as ambulatory care only and inpatient services only would increase the range of options for consumers that could sort more adequate coverage according to their capacity to pay and healthcare needs. </p>

<p> There is a near-universal assumption in both practice and literature that greater accuracy and management to the budget improves profitability (Libby &amp; Lindsay, 2010; Umapathy, 1987). Prior to this study, this assumption has gone untested and we know little about the wisdom of such an assumption. </p><p> The results of this study indicate greater accuracy in forecasting and/or tighter management to the budget, or favorably exceeding it, leads to improved profitability. More specifically, smaller unfavorable budget variances are associated with greater operating margins while greater favorable budget variances are associated with greater operating margins. A single standard deviation reduction in unfavorable revenue and expense increases operating margin by 5.2% and 6.3%, respectively. An equivalent favorable deviation in revenue and expense increases operating margin by 3.2% and 2.7%, respectively. Managers can improve hospitals&rsquo; operating margins by first prioritizing the reduction and/or eliminating unfavorable variances, and second increasing favorable variances.</p>

<p> Strategic sourcing has long been utilized by organizations to maximize budget and supply chain efficiency, usually through leveraged buying, but also through the formation of strategic partnerships with suppliers. When considering leveraged buys, the strategic sourcing process begins with a spend analysis, and the data obtained during the analysis is used by stakeholders to begin defining requirements. Traditional spend analysis restricts the data used in the spend analysis process to basic transactional information, and does not considered corporate social responsibility objectives as part of the strategic sourcing process. This research modifies an existing spend analysis process framework, and applies the framework in a case study that uses additional data points to identify opportunities to allow an organization to simultaneously achieve both strategic purchasing and social responsibility objectives. The study also examines strategic healthcare purchasing in a single source environment, and combines best practices developed using decentralized purchasing strategies by healthcare facilities and successful buyer-supplier relationships from multiple industries to create a process map for hospital systems transitioning to strategic centralized purchasing models. Systems engineering frameworks, process modeling, regression analysis, and cross functional process maps are used in this study&rsquo;s analysis. (Abstract shortened by ProQuest.) </p>

<p> The level of encouragement provided to female African American breast cancer survivors post-diagnosis by their medical providers to engage in physical activity and the amount of their current physical activity levels was investigated. Six female San Francisco Bay Area breast cancer survivors were interviewed to determine their levels of physical activity pre and post diagnosis and the level of encouragement they received from their medical providers to engage in physical activity.</p>

<p>The Health Managerial Appraisal (HMA) is a competency-based assessment that measures a test-taker?s ability to evaluate interpersonal effectiveness and decision-making capabilities in others. The instrument was developed for assessing managers in Health, Human, and Community Service (HHCS) organizations for skills that are essential to managing staff as they provide person-centered care. This study evaluated the construct validity of the HMA through a correlational method. HMA scores were correlated with the Watson-Glaser Critical Thinking Appraisal, California Psychological Inventory, and Behavioral Observations. The sample included 77 managerial job applicants in the HHCS industry. The results yielded convergent and discriminant evidence that the HMA as a valid measure of these necessary constructs for managing in the HHCS industry. The HMA has potential to be used to inform selection of HHCS managerial applicants as well as help current HHCS managers identify areas for professional development.

<p>The initial development and content validation of the Health Managerial Appraisal (HMA) is outlined in this study. The content of the HMA was developed based on a Health, Human, and Community Service (HHCS) Managerial Competency Model that was created by subject matter experts. In today?s HHCS organizations, managerial roles now include empowering direct support professionals. Empowerment requires that managers accurately evaluate staff?s interpersonal effectiveness and decision-making capability. The HMA measures a test-taker?s ability to evaluate these two skill sets. The HMA was first administered to initial job applicants across all job levels (N = 2,072). Based on these test-taker responses, the HMA was revised from six scenarios to four. The revised form was then administered to final candidates for managerial and executive level jobs (N = 77). These executive and managerial candidates performed better on the HMA than initial stage job applicants, suggesting that more qualified managerial candidates were more likely to perform well on the HMA. Additionally, internal consistency reliability of the HMA test scores was .735, suggesting that the HMA produced reliable test scores. The HMA has the potential to inform selection of HHCS managerial candidates as well as help current HHCS managers identify areas for professional development.