<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>

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Previous studies have shown that Parkinson’s disease (PD) patients are at an increased risk for a variety of complications impacting health related quality of life (HRQoL). Additionally, these various complications often lead to increased healthcare utilization. Wellness intervention in PD has shown to be effective in improving HRQoL and objective measures of disease burden such as motor functioning. What has not been demonstrated to date is whether patients who are given the opportunity to participate in regularly administered classes in these modalities will continue to attend and whether benefits will continue to be realized outside the strict confines of a controlled trial. This study examined whether intervening early in PD with a comprehensive Wellness Program is feasible and promotes lasting habits that will continue to provide sustained benefit. It was hypothesized that intervening early in PD with an intensive program involving structured exercise, socialization and PD specific education would serve to maintain or improve subject’s quality of life while decreasing healthcare utilization. Twenty‐one consenting ambulatory adult subjects diagnosed with PD within the last five years completed various screenings at baseline and following a required 6‐month Wellness Program intervention. Subjects were assessed at 12 and 18 months if they continued to participate. Patient demographics, disease specific quality of life, objective mobility, healthcare utilization and falls were assessed. Data were collected at Banner Sun Health Research Institute, located in Sun City, Arizona. All p‐values were 2‐tailed and P<0.05 was considered statistically significant. All data analyses were conducted using STATA‐14. Twenty of twenty‐one subjects completed the required 6‐month intervention. Continued participation was 70% at 12 months and 60% at 18 months. Overall HRQoL was stable at 18 months. Significant improvement was seen in patient reported mobility and emotion sub‐areas at 12 months. Communication specific HRQoL was significantly worsened at 12 months. Subjects demonstrated a stable level of physical activity while fatigue was significantly decreased. All objective measures were significantly improved from baseline. Healthcare utilization was decreased by 18 months. A total of 5 falls were reported by 3 subjects during the 6‐month interventional period. This pilot study demonstrates that comprehensive wellness intervention in early PD is feasible, effective, safe and valuable in establishing long‐term beneficial habits while potentially reducing healthcare utilization. The significant long‐term subject participation observed in this study establishes that wellness intervention may be practical for large scale implementation. The results also highlight the importance of addressing communication specific symptoms early in the course of the disease. Ultimately, this study will aid the design and implementation of future PD wellness interventions.

<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>

<p> This study examined the relationship between health care leadership competencies as measured by the American College of Healthcare Executives Healthcare Executives Competencies Assessment Tool 2014 and leadership behaviors measured by the Path-Goal Theory Leadership Questionnaire among health care administrators and executives. The purpose of the study was to identify relationships between the 4 leadership behaviors (Directive, Supportive, Achievement-Oriented, and Participative) of the path-goal leadership theory with the 4 leadership competencies (Leadership Skills and Behavior, Organizational Climate and Culture, Communicating Vision, and Managing Change) from the health care sector as identified by the Leadership Domain of the American College of Healthcare Executives Healthcare Executive Competencies Assessment Tool 2014. Leadership competencies have been linked to increased performance and building professional development in individuals. For this study, quantitative methodology using survey administration was distributed to health care administrators and executives across the United States. Multiple linear regression design addressed the relationship among the Path-Goal Theory Leadership Questionnaire leadership behaviors variables and the health care leadership competencies identified by the Leadership Domain of the American College of Healthcare Executives Healthcare Executives Healthcare Executive Competencies Assessment Tool 2014. One hundred and fifty-three health care administrators and executives from across the United States were surveyed. The Path-Goal Theory Leadership Questionnaire was used to examine the impact of leadership behaviors on leadership competencies. The results of this study verified Directive and Supportive leadership behaviors were statistically significant predictors of health care leadership competencies in male subjects. Achievement-Oriented and Participative leadership behaviors were positive predictors of health care leadership competencies in female subjects. However, there was no statistical significance found between the organizational climate and culture health care leadership competencies in women.</p>

The study investigated the accessibility and use of health information within the lower echelons of Primary Health Care service delivery. Hence, it focused on women and health workers' experiences with information in rural Uganda. Face-to-face interviews were conducted using an interview schedule that consisted of open questions and one relating to health information critical incidents. The qualitative interviews added depth, detail and meaning at a very personal level of experience. A holistic inductive paradigm was used in the study with a grounded theory analysis. This approach was adopted because of its ability to generate findings inductively from empirical data. An 'Interaction-value model' emerged from the study. The model was driven by the value and impact of information unlike previous information models which have been driven by information needs. This study has demonstrated that although an information need could trigger off an information activity, the subsequent information process could only be sustained by the value of information. Hence, access and use of information depends on the value and impact of information to overcome or reduce constraints. The value of information is therefore the core category, while the moderation of constraints and interaction with sources for latent or apparent needs are the two main categories that make up the model. The study has also shown that not all information users are active seekers. The main difference between the two groups of interviewees was that health workers' needs were generally apparent and led to active information seeking, whereas the women's needs were generally latent. Women mainly accessed information passively. Passivity, however, was generally limited to the act of accessing information. After passive information access, the subsequent user behaviour was active. Hence, women passively accessed information, but actively used it. Women's information behaviour was therefore dynamic. This was confirmed throughout the study when, for example, their information needs changed from latent to active and vice versa. The difference in the findings appears to stem from the fact that for women, the process of information access and use was dependant on the relationship and interaction between their social and information environment in everyday life; while for the health workers, professional matters added a further dimension to their information activities. The ways in which women and health workers accessed and used information as elaborated in this study have a number of implications for improving information provision, policies, training of health workers, and further research.

<p>The following non-experimental quantitative study was conducted in the context of an acute care hospital, surveying almost 4,000 registered nurses across 14 hospitals. The study had two primary objectives: the first utilized a two-sample t-test to determine if there was a statistically significant difference in job satisfaction and years of professional experience for those identified as informal leaders and those not identified as informal leaders. In both cases the study found a statistically significant relationship. Second, the study performed regression analysis to assess the relationship between registered nurses that were as informal leaders and patient satisfaction. Additionally, the study further assessed the impact of leadership style of the informal leader, specifically studying the impact of transactional, transformational, and passive-avoidant leadership tendencies on patient satisfaction. In this case, the study was unable to identify a statistically significant relationship between informal leadership and patient satisfaction. Similarly, the study was unable to identify a statistically significant relationship between transactional, transformational, and passive-avoidant leadership tendencies of the informal leaders and patient satisfaction. The study found that informal leaders tend to have more experience and a higher job satisfaction than their peers who were not identified as informal leaders. While failing to demonstrate a relationship between informal leadership and patient satisfaction, the study opens the door for future studies that can further assess the impact of the informal leader as a means of accomplishing important organizational outcomes. </p><p> <i>Key words</i>: informal, emergent, leadership, transformational, transactional, passive-avoidant, nursing, patient satisfaction, outcome </p>

<p>Turnaround time is a metric most often used to determine a laboratory?s performance. This business project discusses the proposal of a mobile laboratory company called the Mobile Laboratory Unit. The focus of this project is the implementation of a mobile laboratory company that can reduce turnaround time on laboratory results and deliver services at a competitive rate while keeping the integrity and reliability of laboratory results that health care providers are accustomed to receiving. North Orange County businesses are the demographic target and currently does not have an organization such as this, therefore, a company that offers a service such as the Mobile Laboratory Unit would fill a void that is present within this market. Organizations outside of health care companies would be able to use the services of the Mobile Laboratory as well to conduct onsite health screenings and drug tests for students and employees.

<p> This business plan proposes a health promotion center to help educate low-income families in Compton suffering from obesity on how to begin and maintain weight loss. Obesity is one of the leading causes of preventable deaths in adults and children. By creating a family and community-based center that provides individualized and group nutrition and fitness services, the rate of obesity can be significantly reduced. </p><p> The center which will be located in east Compton will operate as a non-profit organization. It will offer nutrition and fitness services through certified nutritionist and fitness specialist with emphasis placed on gradual weight loss. Meal planning, label reading and training, and grocery store tours are some of the nutrition services that will be offered, while aerobic training and weight training will be part of the fitness service. There will be a life coach and an on-site daycare at the center. The life coach will help potential families establish their weight loss needs, while the on-site day care will provide care for children while families exercise. Services will be offered at reduced prices, and payment will only be made out-of pocket.</p>