Hospitals face significant pressure to improve patient safety. This dissertation examines how organizational learning influences three processes critical to hospital efforts to identify, prioritize, and promote safety improvements. The first study, a systematic scoping review, investigates if and how safety toolkits identify learning mechanisms that are important for hospitals to achieve safety improvements. Fewer than half of the peer-reviewed toolkit articles (n=36) identified all of the organizational learning mechanisms required to optimize improvement from safety interventions. Further, articles rarely included all relevant measure types (staff perception, process, outcome) that assess and facilitate learning from the toolkit-based interventions in order to improve safety. The second study draws on in-depth qualitative interviews (sixteen informants at four hospitals) to describe how hospitals’ organizational learning capabilities relate to the identification of safety practices and information sources used to prioritize hospital safety improvements. Hospitals varied in the safety practices and information sources used to determine priorities. Hospitals with learning-oriented leadership or a supportive learning environment appear more likely to learn from multiple safety practices and various information sources. Barriers in organizational learning capabilities may hinder hospitals’ potential for improvement and thereby their safety performance. The third study explores whether a relationship exists between hospital staff perceptions of their organizational culture and staff involvement in large-scale adverse events (LSAEs) using survey data (209 respondents from six hospitals). Hospitals are often advised to modify their organizational cultures in order to promote safety. Respondent perceptions differed between respondents involved in an LSAE relative to those that were not involved in an LSAE on all ten cultural factors considered. Results from an adjusted logistic regression model indicated that one culture factor was key: less favorable respondent perceptions of employee engagement were associated with an increased likelihood of the respondent’s involvement with an LSAE. Hospitals with an organizational culture supportive of learning for safety improvement, and in particular more favorable employee engagement, appear to be better protected against the risks of LSAEs. Collectively, these studies highlight opportunities for hospitals to improve patient safety by managing their organizational learning capabilities. Future research should examine how hospitals develop their organizational learning capabilities. / 2020-10-23T00:00:00Z

<p> How Medicare beneficiaries utilize CMS star ratings data as part of their Medicare Advantage (MA) health insurance selection criterion was the focus of this qualitative exploratory case. Limited published research exists on how Medicare beneficiaries utilize the CMS star ratings data. Without published research, ascertaining the impact of the CMS star ratings program on the intended end users is difficult. Twenty senior adults from Hillsborough County Florida comprised the sample. Three primary themes emerged from data analysis: change aversion, generalized distress, and hassle-free experiences. Study participants were change averse, preferring to retain their existing MA coverage. Participants experienced generalized distress pertaining to their MA coverage and the process of insurance procurement. Participants desired hassle-free experiences related to MA health coverage. Study participants had very limited awareness of the CMS star ratings program. Of the few participants with program awareness, none utilized the data when selecting MA health coverage. The current study involved theory triangulation to interpret and support the findings. One conceptual framework with three components was triangulated as part of the analysis of these research outcomes. Stakeholders, leaders, policy makers, and the like should consider modifying how CMS star ratings data are shared with seniors. If seniors had a better understanding of the value of these data, they may be more likely to utilize the data as part of their MA plan selection criterion. </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.

The management and control process in an Accident and Emergency (A/E) department of a District General Hospital is investigated and the functional relationship between the A/E department and the inpatient hospital service is discussed. Attention is focused on resource allocation and methods are proposed towards reconciling levels of service and resource utilisation. Within the framework of control problems inside the A/E department, a computerised patient record system has been designed and implemented, on an experimental basis, to allow easy access to patient-related information for performance evaluation. Established statistical techniques are employed to demonstrate how such information can be utilised in medium-term management activities in the A/E department and to provide a sound basis for defining areas where specific problems arise. A method is developed, which uses patient data to the extent that they are routinely available through the patient record system, for allocating physicians to weekly shifts in a way which takes account of the fixed number of physician hours per week; of physician preferences with regard to shifts; and of the patient assessment of the service provided. With regard to the role of the A/E department as an essential link between the community at large and the hospital service, a simulation model is developed for determining the number of beds in hospital inpatient departments on the basis of expected demand and according to a pre-specified set of measures of hospital efficiency. The measures used are the rapid admission of emergency patients; high occupancy rates; and short lengths of waiting lists. A further study on bed capacity planning concerns the contemplated development of an observation ward in the A/E department. Owing to the increased uncertainty in planning for prospective units, approximation is accepted for the sake of procedural simplicity and an analytic infinite server queueing model is employed to evaluate various numbers of beds for the unit interms of the average occupancy rates and of hourly and daily service levels.

<p> Access to primary health care services is a significant issue for many communities seeking to improve the health of their populations. This single case study describes the 12-year journey of 2 adjoining rural counties in 2 states towards meeting the primary and specialty care needs of the uninsured and underinsured population. Data were triangulated using historical documents, first-person interviews, and health utilization data. The community leadership moved through various models including a free clinic and a university-sponsored health center before finally establishing a federally qualified health center, which now serves 40,000 citizens in these counties. The site is now hosting new programs funded by research grants in alliance with area universities. Success is contributed to an unwavering desire to provide a medical home for the underinsured and underinsured, a shared vision, recognition that continued success was dependent on a funding source, recognition that practices and processes must be in place to assist with navigation for those in need of services to seek care at the appropriate venue, and a belief that the infrastructure built to provide care was sustainable. All participants recognized the importance of funding for sustainability. Positive social change has occurred from the emergence of a multidisciplinary center to serve the community&rsquo;s uninsured and underinsured, thus improving access to care, management of chronic conditions, and access to behavioral health professionals. Findings from this study may inform other communities faced with similar problems and can inform legislators of the importance of federally qualified health centers in the provision of health care to vulnerable populations.</p><p>

<p> At any given time, approximately 4% of women in the United States are pregnant. Planned or unplanned, pregnancy changes the lives, mentalities, and bodies of women. Health and care are not only limited to the mother, but now extends out to the child as well. Pregnant women and their children require specialized care before and after the birth but sometimes these services can be difficult to locate, attend, and maintain. Mobile Mother aims to provide expecting mothers with top prenatal and postnatal services conveniently by bringing the clinic to them. The mission is to provide accessible, valuable, and quality care to pregnant women who have limited transportation, access to care, scheduling and time, or simply choose to not attend traditional maternity clinics in hospitals. Mobile Mother's goal is to deliver the best, convenient maternity care to expecting mothers in the Greater Los Angeles area. This proposal will provide detailed insight on how Mobile Mother aims to achieve these goals.</p><p>

<p> The continuously growing readmission rates within 30-days of discharge point toward compromising quality outcomes such as fragmented health care. The purpose of this project was to compare the effectiveness of pre-intervention traditional interdisciplinary rounds (IR)/ progression of care rounds (POCR) members, in comparison to the intervention of modified IR/POCR members, by adding a disease-specific educator (DSE) member to the team, as measured by the 30-day unplanned readmissions rate in patients discharged from a single cardiology unit in Galveston, Texas. A comparison of 30-day unplanned readmissions during two different timeframes was performed using the planned readmission tool. The Iowa model of evidence-based practice and the model of collaborative care supported the project. A comparative quantitative methodology was used to analyze the data. The final sample consisted of 50 (<i>N</i> = 50) patients discharged during the pre-intervention and 53 (<i>N</i> = 53) during post-intervention. The data was analyzed using descriptive statistics and an unpaired t-test. The pre-intervention IR/POCR team members period 30-day readmissions were 7 compared to 3 during the post-intervention IR/POCR team members. The standard deviation of pre-intervention IR/POCR and post-intervention was 3.95980 and 2.12132 respectively. The results show a significant value of 0.106 (95% CI, -1.04243 to 5.04243). The implementation of the DSE to the IR/POCR team assisted in identifying and closing the gap associated with quality patient outcomes and reduced 30-day unplanned readmission rates. Further research is needed due to a limited practice site. </p><p>

<p> <b>Background:</b> Stroke is the leading cause of disability in the US, affecting approximately 795,000 persons annually. Stroke care is delivered across multiple settings from hyperacute care in a hospital through chronic stroke management in the community. Considerable advancements have been made in the delivery of hyperacute and acute stroke care. Science and practice gaps exist in providing stroke transitional care across multiple providers and settings once an individual is discharged from an in-patient care facility to home. </p><p> <b>Purpose:</b> Using a qualitative descriptive design, this study engaged and elicited descriptions from stroke survivors and caregivers affected by stroke to inform the refinement and tailoring of a stroke-specific model of transitional care. </p><p> <b>Sample:</b> A purposeful sample of 19 individuals affected by stroke and their caregivers was required to attain data saturation. Participants provided rich descriptions regarding the postacute stroke transition from an inpatient care facility to home. </p><p> <b>Methods:</b> The investigator conducted five focus group discussions using a semi-structured interview format to elicit participant descriptions of their stroke transitional care experience. Interviews were audio-recorded, transcribed, organized using Atlas.ti 8.1 software, and analyzed using the content analysis method. </p><p> <b>Findings:</b> Stroke transitional care is generally not provided, and a host of unmet survivor and caregiver needs persist. The findings of this study inform stroke-specific exemplars for essential transitional care components. Stroke-specific findings emerged from the data that could not be explained in the context of the transitional care model, such as self-determination and self-efficacy, transportation challenges, and neuropsychiatric management. There is considerable healthcare system passivity in delivering postacute and transitional stroke care, leaving stroke survivors and their caregivers feeling abandoned and marginalized. The findings from this dissertation study and the literature inform refined, stroke-specific components and a stroke transitional care model. </p><p> <b>Conclusion:</b> This dissertation study is the first of its kind to engage primary stakeholders in developing stroke-specific refinements to and exemplars of stroke transitional care components. Study findings describe an urgent need for <i>active</i> stroke transitional care delivery, discusses stroke-specific exemplars of core transitional care components, and identifies refinements for a stroke transitional care model. The findings of this study are innovative in describing a community stroke nurse-led transitional care model that &ldquo;reaches back&rdquo; to the hospital. The unique findings from this study can inform a community-centric, stroke-specific transitional care model that aligns with the American Heart Association/American Stroke Association&rsquo;s guidelines for adult stroke rehabilitation and recovery, from which community stroke nurse-led interventions can be developed and examined. </p><p>

<p> Trade fairs have long been considered great platforms emerging and established businesses use as an effective way to help drum up business as well as learn and study the activities of competitors. A lot is usually going on at these events. Anywhere from (1) meeting with industry partners and prospective customers, (2) testing and studying new products, as well as (3) examining recent market trends and opportunities among other functions. The common factor in majority of trade fairs has been that they are looked at as organized little convenient stores that specific companies, within a specific industry, utilize to showcase and demonstrate their latest products and services for the purpose of boosting their market share and sales of their products and services. Through some research on trade fairs and the health industry, I found that most of the available platforms under the health care trade fair moniker are only done as single industry fairs with the purpose of just competing for sales and market share. </p><p> The goal of this paper is to showcase a new business venture under the name Health Guardians Exhibition Incorporation as a uniquely designed platform comparable to what common fairs are known for, a platform through which two different industries (technology industry and health care industry) will be tasked to work alongside each other for the purpose of developing ideas in the products and services through which accessibility to health services for the consumers of care will be made affordable and efficient for the purpose of improving community health.</p><p>