<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> The 2010 Affordable Care Act has affected access and availability to medical services because states have increased the number of individuals on Medicaid and health exchanges have offered coverage to those who previously lacked it. The purpose of this qualitative exploratory case study was to identify whether the Affordable Care Act affects access to and availability of medical services, and to identify alternatives to how medical practices are formed and operated to accommodate an increase in patients. The study was based on Geyman&rsquo;s theory of economics and Glasser&rsquo;s consumer choice theory. Research questions addressed the effects the Affordable Care Act has had on providers&rsquo; schedules and patients&rsquo; appointments. Data collection involved interviews with six health care providers (four from Michigan and two from Maryland), three administrators (one each from Michigan, Maryland, and Kentucky), and six patients (three from Michigan, two from Maryland, and one from Kentucky). Results showed that under the Affordable Care Act newly insured Medicaid individuals are seeking care more often, whereas those with private insurance are seeking medical treatment less often. Increased out-of-pocket costs were the reason given by privately insured individuals for the decrease in obtaining medical care. The study did not find evidence of patients waiting longer to book an appointment with a medical practice or shortened visits. The study will inform the efforts of providers to address changes in access and availability of medical care due to implementation of the Affordable Care Act.</p>

<p> Hospitals, like many industries, are under great competition and cost control. Hospital leaders are responding to these environmental factors by becoming more efficient in their operations coupled with improving quality and patient satisfaction. According to Ozcan (2008), the health care industry lacks in adequate decision making strategies and performance to maintain competitive market position and understand which hospital is the best practice. Additionally, many companies and hospitals embark on process improvement initiatives, but lack evidence that these programs result in high efficiency. The inspiration for this research project was galvanized from this 21^st century challenging dynamic and supported by Sherman and Zhu&rsquo;s (2012) article, which analyses the performance of service organizations. These factors along with the Sherman and Zhu article <i>Analyzing Performance in Service Organizations</i> was the inspiration for this research. The research investigates the impact of quality improvement programs on the overall efficiency of hospitals. The study uses Data Envelopment Analysis (DEA) to understand hospital efficiency and employ a survey to understand the hospital&rsquo;s process improvement implementation. The research also collects hospital characteristics such as (a) hospital size, (b) location, and (c) ownership type. The analysis uses 2-Way ANOVA to test the association between process improvement implementation and efficiency of 32 hospitals in the Mid Atlantic region of the United States. The process improvement implementation is assessed from the top management prospective of each of the hospitals. The efficiency of each hospital is evaluated using DEA BCC input oriented model. The findings of this research indicate that (1) process improvement programs are widespread in the hospitals in the Mid Atlantic region, (2) hospitals with highest implementation of process improvement showed increases in the hospital&rsquo;s efficiency regardless of size, location, or ownership type, (3) Data Envelopment Analysis is a practical tool to monitor process improvement practices and identify best practices in a hospital setting.</p>

<p> The purpose of this qualitative instrumental single case study was to explore how patients living with Type 2 diabetes (T2D) in Barbados manage the disease and what role health literacy might play. Purposeful sampling aided in selecting the sample for the study. The sample was 23 participants who were 40 years and older, diagnosed with T2D, living in Barbados, and attending the Endocrine Center for treatment. Participants responded to 13 open ended questions used to answer the research questions. Information was coded using NVivo 10 software and the software provided the themes based on the participants&rsquo; responses to the interview questions. The themes provided were managing T2D, diet, exercise, and understanding T2D and related information. The interpretation of the findings were that patients in Barbados had a moderate understanding on how to manage T2D and managed the disease with moderate effectiveness. The findings also revealed that health literacy might have a meaningful impact on how to manage T2D but other factors might be involved. Recommended strategies are to improve communication between patient and providers and to provide initiatives to improve patients&rsquo; self-efficacy. The findings might provide health care leaders, and policy makers with insight on how patients living in Barbados with T2D manage the disease and the role that health literacy might play.</p>

<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>

CF is an autosomal recessive disorder caused by mutations in the CFTR gene. The life expectancy for patients with CF remains severely shortened, with the median predicted survival for patients currently estimated at 36.5 years. For patients with a life-limiting disease such as CF, the decision to participate in a clinical trial is often based on the desire to improve quality of life and/or increase the likelihood of long-term survival. Recent advances in CF care have increased the number of therapies available for CF patients which in turn has increased life expectancy and diminished disease progression. The CFF has developed a patient registry and has worked with individual CFF-accredited care centers in the US to approach all patients followed at these CF centers to participate in an observational prospective cohort study. Using data from 504 patients followed at Boston Children's Hospital and submitted to the data registry maintained by the CFF, we examined disease progression, as measured by the decline in pulmonary function tests between 2007 and 2012 and compared multiple subsets of CF patients: those who participated in interventional studies, those who participated in observational studies only, and those who did not participate in any research studies. Results suggest a lower amount of lung function decline for adults who participate in interventional trials; however, the opposite pattern is true for children, with a higher amount of lung function decline seen for children who participate in interventional trials.

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