<p> Medical errors have been detrimental in the field of medicine. They have impacted both patients and doctors. While physicians recognized that error disclosure was an ethical and professional obligation, most remained silent when mistakes happened for different reasons. Guided by the theory of planned behavior and Kant's deontological theory, the purpose of this quantitative study was to investigate the perceived barriers affecting physicians' willingness to report major medical errors. An association was tested between the independent variables physician fear of disclosure of errors, organizational culture toward patient safety, physician apology, professional ethics and transparency, physician education, and the dependent variable physician willingness to disclose major medical errors. Using a cross-sectional method, 122 doctors out of 483 surveyed, completed the online and paper-based survey. Multiple linear regression and descriptive statistics models were used to analyze and summarize the data. The results showed there was a statistically significant relationship between the independent variables organizational culture toward patient safety, physician apology, professional ethics and transparency, and physician education and the dependent variable physician willingness to disclose major medical errors. There was no relationship between the independent variable fear of disclosure of errors and the dependent variable. The findings added to the knowledge base regarding barriers to physicians' medical errors disclosure. The results and recommendations could provide positive social change by helping hospitals raising doctors' awareness regarding major medical errors disclosure. </p><p>

<p> The Healthcare System in the United States is in dire need of improvement and reform for preventive healthcare. Diseases that can be prevented compose a significant problem due to the high costs they impose on our system. Beyond the Stroke is an organization which caters to past stroke victims who seek prevention form a future stroke by making lifestyle changes. Beyond the Stroke offers their health services with the main goal of educating and raising awareness to facilitate better decision making to its patients. Patients with recurrent stroke have a markedly higher mortality than patients with a first-ever stroke, but those who survive recover as well and as fast as patients with a first-ever stroke. The business plan for this organization is divided into 4 main parts. Chapter 1 will provide a complete market analysis with an overview of a full company and market analysis. It will also summarize the target population, services provided and main purpose. Chapter 2 provides a full feasibility analysis by the SWOT analysis, shedding light on potential success and problems this organization may face as it develops. Chapter 3 will focus on legal and regulatory issue enforcement along with litigation and medical compliance laws that Beyond the Stroke will to abide to. Chapter 4 explains a clear financial analysis to ensure business probability.</p><p>

<p>The Juvenile Diabetes Empowerment Center is a business located in the city of Los Angeles, Ca that focuses on educating children diagnosed with diabetes mellitus about their condition. The company offers a place where children can spend an entire day learning and connecting with other children who share the same condition. Education is offered by means of formal lecture, small group discussion involving therapeutic communication, and educational video games developed using BrainPoP software. The goal of the company is to empower children living with diabetes through teaching them how to independently manage their condition effectively. The business plan gives an in-depth description of how the Juvenile Diabetes Empowerment Center operates and discusses the company?s strengths, weaknesses, opportunities, threats, and regulatory issues. Furthermore, financial assumptions are explained in detail and an excel spreadsheet is attached displaying the company?s increasing cash valuation trend during the first three years of operation. The financial development of the Juvenile Diabetes Empowerment Center will allow the company to help empower children with diabetes both physically and emotionally while continuing to grow and offer a valuable service to the community.

This dissertation investigates how patient-perceived integrated care and manager commitment influence the improvement and integration of health care delivery. Using survey instruments, across three studies I examine potential mechanisms for improving health care delivery: patient perceptions of integrated care, a physician organization care management program, and manager commitment to a quality improvement program. In Chapter Two, I examine how patient-perceived integrated care relates to utilization of health services. I assess relationships between provider performance on 11 domains of patient-reported integrated care and rates of emergency department (ED) visits, hospital admissions, and outpatient visits. I find better performance on two of the surveyed dimensions of integrated care are significantly associated with lower ED visit rates: information flow to other providers in doctor’s office and responsiveness independent of visits. Better performance on three dimensions of integrated care is associated with lower outpatient visit rates: information flow to specialist, post-visit information flow to the patient, and continuous familiarity with patient over time. No dimension of integration is associated with hospital admission rates. In Chapter Three, I use the same patient sample to evaluate the achievement of integrated care by a care management program (CMP) from the perspective of older patients with multiple chronic conditions. Survey results suggest that patient perceptions of integrated care vary substantially among survey items and domains. CMP enrollment is significantly associated with greater patient perceptions of care integration in two domains: connecting patients to home services and being responsive independent of visits, domains that were targeted for improvement by the CMP. Enrollment in the CMP is not significantly associated with other domains of integration. In Chapter Four, I assess whether and how senior and middle manager commitment to a falls reduction quality improvement (QI) program is associated with the successful implementation of the program. Survey results suggest managers’ affective commitment to the program is positively associated with program implementation success across all manager levels surveyed (senior managers, middle managers, and assistant middle managers). Stronger frontline worker support for the falls QI program partially mediates the relationship between manager affective commitment and falls program implementation success for middle managers and assistant middle managers, but not for senior managers. Manager affective commitment to the falls program mediates the relationship between organizational support for the falls program and program implementation success across all manager levels. Together, these studies advance our understanding of how patient-perceived integrated care, care management programs, and manager commitment to a quality improvement program influence the integration and improvement of health care delivery. Findings demonstrate how patient reports of integration can be useful guides to improving health systems. Dissertation results also provide empirical evidence of a relationship between manager commitment—at both the middle and senior manager levels—and successful QI program implementation. In addition, these studies provide practical implications for physicians and hospital managers seeking ways to improve the quality and integration of health care delivery. / Health Policy

<p> Objective. To systematically evaluate and compare healthcare innovations in three geographically small nations, Ireland, Israel, and Switzerland, and to explore the factors that contribute to both innovations and diffusions of innovations. </p><p> Design. Systematic review of published articles. </p><p> Data Survey. CINAHL, ProQuest, PubMed Central, Google Scholar and Citation Lists. All articles published 2017 and earlier will be included in the search. </p><p> Review Method. Articles describing innovation in healthcare, diffusion in innovation, and/or innovation indicators in Israel, Switzerland, and Ireland were selected for review. Only scholarly journals were accepted. </p><p> Results. The data analysis for this systematic review followed the PRISMA guidelines that encapsulated the basic eight steps for systematic review process. Academic search engines were used to identify studies relevant to the topic under study. The CASP checklist was used to evaluate the quality of the study, along with determining whether the study met the eligibility criteria for this systematic review. Eighty-nine full text sources were included in the final assessment, and 57 of these were excluded from the final review because, while some appeared in scholarly journals, these were either webpages, conference papers, commentaries, interviews, or news related. The 32 remaining full text articles were included in the review. </p><p> In addition to the systematic literature review, six Subject Matter Experts were interviewed. Participants&rsquo; responses showed clear perspectives on the critical success factors v necessary for healthcare innovation to thrive within a country and an organization. Their responses overlapped in answering each of the research questions. The principal areas of concern included committed leadership, collaborative cultures, cost effectiveness, planning, and futureoriented thinking. These areas were the top critical success factors for healthcare innovation. However, these also represented concerns about and barriers to it. The absence of these factors potentially stalled innovation in a country. This stall occurred if that country lacked openness to new ideas or was extremely risk adverse. These various factors required further study to understand the overall effect on healthcare innovation in different contexts. </p><p> Conclusion. Small nations that innovate in healthcare benefit the most from government subsidies of research and development. Additionally, benefits accrue exponentially with strong global partnerships. The development of national and international partnerships occurred when existing internal information was shared at the beginning of the innovation process. Connecting healthcare stakeholders is necessary for improving innovation experts. Developing new methods of measuring innovation will significantly aid in understanding the influence of adaption and diffusion of innovations in healthcare systems. The implications of this study suggest that our understanding of innovation and innovation diffusions have the potential to lead to adaptations. However, we don&rsquo;t yet fully understand the most efficacious way to measure innovation and its impact on society.</p><p>

This thesis presents an attempt to assess how prediction about patients' expected stay in the operating room, intensive care and postoperative surgical units could be used in the process of scheduling of patients for cardiac surgery. The study was carried out in the setting of the University of Ottawa Heart Institute (OHI) where current scheduling practices and the process of flow of patients through surgery were studied. Data were collected from all patients who underwent cardiac surgery at the University of Ottawa Heart Institute during the 1994 and 1995 calendar years. Information of interest is the relation of demographic, clinical and procedural factors for each patient to the time of operation, length of stay in the intensive care unit after surgery, length of postoperative stay until discharge from the hospital and in-hospital mortality after surgery. As a result of the analysis of the University of Ottawa Heart Institute surgical scheduling system and patient data we (i) understood how the current system is operating, (ii) developed and assessed models for predicting length of stay in ICU after cardiac surgery. (Abstract shortened by UMI.)

Abstract Not Available.

Day surgery is a rapidly growing alternative mode of treating patients. Instead of a two to three day stay in the hospital, the patient arrives the morning of surgery, is operated on and returns home the same evening. There are restrictions on the type of patient and type of procedure that can be done in day surgery. It also has been shown that day surgery is a much less costly method of treating patients, provided the patients and the procedure meet the day surgery requirements. This study was conducted at the University of Alberta Hospital in Edmonton, Alberta. It looked at six procedures that meet the day surgery requirements (Dilatation and Curettage, Laparoscopy, Non-Recurrent Inguinal Hernia, Breast Biopsy, Cataracts and Haemorrhoids) and the cost associated with each procedure both on an inpatient and day surgery basis. A sample of medical records for each procedure was examined and information concerning Nursing, Supply, Drug and Test costs, as well as, length of stay was extracted. Hotel service costs were obtained from various departments and the remaining costs, including Administration and Plant, were obtained from the Hospital's annual return to the government. The costs were added up to give a procedure cost for each procedure on an inpatient and day surgery basis. Then using data derived from the medical records, including age and complications, an eligibility rate (the percentage of patients eligible for day surgery) was derived. This was multiplied by the total number of that particular procedure performed in 1980 and was then multiplied by the procedure cost. The final result was the savings that would have possible if a greater percentage of procedures had on a day surgery basis. The results show that significant savings can be expected by substituting day for inpatient surgery, providing a number of inpatient beds are closed to correspond with the increase in day surgery.

The method whereby fees are set for medical services is of significant relevance to the operation and overall total cost of a health care delivery system. Until the advent of medical insurance, the setting of fees was traditionally a matter for the profession. Although many of the early medical insurance organisations were physician sponsored, the profession began to lose its autonomy as these insurance bodies became involved in the process. With the introduction of medicare the setting of fees became a joint government and profession matter with fees, for medical benefit purposes, being set by negotiation. It may be argued that by 1978 the Government had assumed responsibility for medical fee setting in many Provinces. The purpose of this paper is to review the conduct of fee negotiations in five provinces---Alberta (in depth), British Columbia, Saskatchewan, Ontario and Quebec---up until 1978. In the first chapter the purpose is further defined and explained, while in the second the method to be followed is developed. The third chapter is devoted to a review of literature relevant to physician behaviour in relation to fees and income. As an introduction to the chapters dealing with the individual Provinces the fourth chapter develops a set of possible objectives for the profession and the government in the fee negotiation process; this reference set is provided to allow the reader to access the conduct of negotiations in each Province. The individual provinces are dealt with one by one in Chapters V to IX. In the final chapter the conduct of fee negotiations is discussed.

As part of a multiple-case study, the objective of this single-case study is to examine the impact of the accreditation process offered by the Canadian Council on Health Services Accreditation (CCHSA) on one health care organization. The main hospital of the organisation selected has been accredited for a little over 50 years. Quantitative and qualitative data was collected for methodological triangulation. Two questionnaires were distributed; interviews and focus groups were conducted on site. A previously developed conceptual framework on the dimensions of change was used for the analysis. Some changes within the organization were traced back to the accreditation process and they were mainly at the organizational level, affecting processes and organizational structures. In addition, the accreditation self-assessment phase offers an opportunity to increase social capital, but the quantity and type acquired depends on the composition of the self-assessment team and the follow-up done after the accreditation survey.