<p>ABSTRACT Electronic medical record (EMR) use has improved significantly in health care organizations. However, many barriers and factors influence the success of EMR implementation and adoption. The purpose of the descriptive qualitative single-case study was to explore health care professionals? perceptions of the use of EMRs at a hospital division of a major medical center. The study findings highlighted the challenges in transitioning from paper records to EMR despite the many benefits and potential improvement in health care. A description of the 16 health care professionals? perceptions of EMR use emerged by adopting the unified theory of acceptance and use of technology (UTAUT) model and NVivo 10 computer software to aid with the analysis of semi-structured, recorded, and transcribed interviews. Themes emerging from the analysis were in five categories: (a) Experience of health care professionals with a subtheme of workflow, (b) Challenges in transition from paper to EMR, (c) Barriers to EMR acceptance, with a subtheme of privacy, confidentiality, and security, (d) Leadership support, and (d) Success of EMR. The findings of the case study may inform health care industry decision makers of additional social and behavioral factors needed for successful EMR strategic planning, implementation, and maintenance.

<p> Managed care through a series of comprehensive health care services is a trend in today&rsquo;s healthcare; and it includes specialized services that can provide plenty of opportunities to many healthcare organizations. Private Medical Service of San Diego currently does not have the necessary medical equipment to provide a comprehensive pain management and the ability to retain availability and flexibility to grow at its own pace and convenience. The new business plan is to acquire fluoroscopic equipment that will be staged in-house to equip its interdisciplinary pain management program. This will help increase the efficacy and safety of the pain management procedures as well as a potential for good profit.</p>

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<p> User acceptance and usage of technology is an established field of academic inquiry with distinct applications to health information technology adoption. Healthcare systems lag behind in technological advancements related to information systems. The recent push toward health information exchange (HIE) systems to enable the sharing of electronic medical records (EMR) between healthcare organizations has many working to upgrade to the latest EMR system technology. Healthcare organizations strive to lower costs, improve patient care, streamline processes, and meet regulatory requirements. Leading EMR systems promise the realization of attaining these goals. User acceptance and usage of technology is a challenge when implementing new technology. In more recent years, a growing need appeared to study user acceptance and usage behavior in healthcare organizations. The central question of this study is: What deeper understanding can be developed when evaluating the similarities and differences of healthcare and business users&rsquo; experiences and behaviors through the lens of the unified theory of acceptance and usage of technology (UTAUT)? A subset of related research questions focuses on factors influencing users&rsquo; acceptance and usage, similarities and differences among healthcare users, and similarities and differences between healthcare and non-healthcare users. This study explores participants&rsquo; experiences using a comparative cross-case approach applying the theoretical framework of the UTUAT by Venkatesh, Morris, Davis, and Davis (2003). Twenty-one participants were interviewed to ascertain their lived experiences of learning and using computer systems. Areas of inquiry included new system implementations; the importance of factors in the UTAUT model such as effort expectancy, facilitating conditions, performance expectancy, and social influence; and the impact of these on users&rsquo; experiences. The majority indicated sub-elements of facilitating conditions and effort expectancy as critical factors. Training is dominant among the majority of cases, while ease to learn and use, process alignment, and time are interwoven with training and usage experiences. Social influence and voluntariness of use were seldom observed, with shared experiences being circumstantial and situational. The success of EMR systems hinges on how the foundational system is built, which involves understanding detailed clinical and business processes, and ensuring the new system is built on forward-thinking practices. </p>

<p> Alternative healthcare programs have been steadily flooding the health care market, with the most notable being mobile health. Mobile health, more popularly known as mHealth, is expected to generate upward of $59 billion dollars. This is astonishing, considering the mHealth market is still in its infancy as an alternative healthcare model. Still, there are over 100,000 mHealth smartphone applications and platforms on the market. The concept of offering affordable medical services that are accessible to anyone, at any time and in any place appeals to the mission and purpose of healthcare organizations. However, a large number of the studies and publications on mHealth are associated with the technologies behind mHealth and provide very little information on the practices and challenges associated with implementing mHealth, especially within a medical facility. For this reason, it was important to learn from executive health IT professionals who have successfully implemented mHealth services within the US healthcare system. Accordingly, the purpose of this study was to identify the practices used and challenges faced by CIOs in implementing mHealth technologies. The study also obtained recommendations CIOs believe are associated with successful mHealth services.</p><p> This was a qualitative study that used a phenomenology lens focused on the viewpoint of CIOs and the growing phenomenon of mHealth as a part of the U.S. healthcare system. This approach allowed the research to obtain data on the lived experiences of seven CIOs through semi-structured interviews who were identified as top experts by <i>Becker Hospital Review</i> publications. The analysis of their experiences revealed 13 best practices for mobile health implementation. The findings in this study aimed to identify how mHealth services could expand access to medical services by outlining key considerations and resources required for successful implementation.</p>

<p> A significant amount of evidence existed in support of the positive effect on the quality of healthcare that resulted from transitioning to electronic health information systems, equally compelling evidence suggests that the development process for electronic health information systems falls short of achieving its potential. The objective of this research was to assess the existing HIT standards and health information management (HIM) principles to determine if they are robust enough to inform the development of national and international interoperability standards. The research question asked; How do HIT standards and HIM principles and practices influence the quality of EHR performance? This study&rsquo;s goal was to maintain focus on the collaborative challenges revealed by the lack of understanding and shared vision that commonly exists between HIM professionals, HIT developers, and HIT vendors that obstruct synergy and enfolding of health information standards-based capabilities and HIM practice (business) standards. The complex electronic health record (EHR) universe proved well suited for testing by a combination of complexity science and the unified theory of acceptance and use of technology (UTAUT) information management theories. Through analysis of research literature and qualitative interviews, the research identified nine factors defined into drivers and barriers that influenced the actions of healthcare organizations; leadership, patient focus, planning, communication, alignment with lifecycle models people, processes, dynamics, training and user input, change management standard adoption, and recognition of the power of technology. Analysis of the data obtained from exploratory qualitative interviews of health information technology professionals selected from a professional healthcare management organization supported conclusions that leadership, collaboration, planning, and training limiters, have a direct impact on EHR system success or failure.</p><p>

<p> The purpose of this quantitative correlational study using archived data was to determine if there is a relationship between patient satisfaction and indicators of medical harm in the state of Florida. The study reviewed the archived data for patient satisfaction for the 328 hospitals located in Florida along with archived data of six hospital-acquired infections for the hospitals in the study. The metric used for patient-centered care is patient satisfaction. Although the literature supports a patient-centered model supplanting non patient-centered models, patients continue to suffer medical harm and even die while no one has evaluated the difference between the models. A linear regression and Spearman&rsquo;s rho analysis was performed for each of the six research questions in the study. The results demonstrated a rejection of the null hypothesis for two of the research questions. This outcome indicates a relationship between patient satisfaction and two indicators of medical harm; SSI Colon, and MRSA. Although the results did not support all six of the research questions, leadership of hospitals supportive of a patient-centered environment should continue to investigate the positive relationships demonstrated in this study to duplicate efforts in increasing the quality of care. Additionally, leaders of hospitals who have low patient satisfaction scores may consider implementing a patient-centered model of care to reduce indicators of medical harm.</p>

<p>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 used by retail store managers from El Paso, Texas to decrease employee turnover. Participants were purposefully selected because of their experience implementing effective employee turnover reduction strategies; they reduced employee turnover from 24% in 2012 to 15% in 2016. Data were collected via face-to-face semistructured interviews with 10 managers and the review of organizational documents on employee turnover. Data were analyzed using inductive coding of phrases, word frequency searches, and theme interpretation. Three themes emerged: supportive leadership reduced employee turnover, managing personnel scheduling decreased employee turnover, and competitive compensation reduced employee turnover. Reducing employee turnover contributes to social change by providing retail store managers with valuable insight that can lead to enhanced sustainability, improved organizational growth, and increased profitability, which might promote prosperity for local families and the community.

<p> Staff turnover is high in the hospital industry, influencing health care administration leaders to implement successful strategies to decrease staff turnover. The purpose of this case study was to explore successful strategies to reduce hospital employee turnover. Five health care leaders from Raleigh, North Carolina hospitals were in the sample drawn from the population of medical professionals with successful employee retention in their hospital settings. The conceptual framework for this study was the Herzberg dual-factor theory with the supporting theory, Maslow&rsquo;s hierarchy of needs theory, and the opposing theory, Vroom&rsquo;s expectancy theory. Semistructured interviews occurred with 5 leaders. The review of hospital human resource documents, website pages, and training program information combined with interview data for methodological triangulation using the Yin 5-step process, leading to 5 themes. Participants emphasized selective recruitment and hiring with a focus on hiring employees for a good organizational fit. Participants discussed different ways of engaging, supporting, and motivating hospital employees. Strategies included valuing employees, effective communication, recognition, and respect. Participants identified a fair, flexible, collaborative, and safe organizational culture as ideal for the retention of hospital employees who fit with the hospital environment. Reducing employee turnover may improve customer relations and quality of care in hospitals, leading to lower health care costs, representing positive social change for hospital employees and the patients served.</p>

<p> Medication administration is an important task performed daily by nurses and is one of the key aspects of safe patient care. The multiple and varied roles of nurses, complexity of workplace, chaotic and technical nature of the work environment may result in cognitive overload that may overwhelm nurses, which may possibly lead to medication errors. All medication errors committed are considered serious events but some may consequently be harmful to patients. Research indicates that when medication errors occur the concern is usually for the patients involved in the incident. However, making a medication administration error has a lasting effect on the nurse as well as the patient (Schelbred &amp; Nord, 2007; Treiber &amp; Jones, 2010).</p><p> This study examined what it was like to make a medication error for eight registered nurses through in-depth and focused face to face interview using the descriptive phenomenological approach rooted in the philosophical tradition of Husserl. Two interviews were carried out with each participant and the research data were generated from a total of sixteen interviews and field notes. The transcripts were analyzed using the seven-step methodological guidelines developed by Colaizzi for data interpretation to understand the meaning of the nurses lived experiences of making medication errors.</p><p> Five theme categories emerged: Immediate <i>Impact: Psychological and Physical Reactions; Multiple Causes within Chaos: Cognitive Dimensions; Embedded Challenges: Healthcare Setting; Organizational Culture: Within the Place/Within the Person; Dynamics of Reflection: Looking Forward</i>. The essential structure of the phenomenon of making a medication administration error included the realization that a profound experience had happened to them. This resulted in physical and emotional upheavals, a threatened professional status, with low self-esteem and confidence. An overwhelming workload, a stressful work environment and ill-treatment by peers were descriptions of the cause of the errors. Nurses did offer ways to improve the system but felt their concerns were often not valued. Implications for nursing practice to improve patient outcomes, and for nursing education, to radically change the teaching of medication administration were formulated.</p>