Objective. To demonstrate that participation in the CCHSA accreditation process helps HCOs to be more reactive to change, improving quality and safety, and that accreditation also helps health care organizations to develop their organizational learning processes. The hospital's culture is of a hierarchical nature (x¯ = 36.92), but with the help of organizational initiatives, strong leadership, and accreditation, it is evolving towards a group culture. The hospital has a high commitment towards information and analysis, however, employees do not always perceive themselves as receiving adequate training and education for quality improvement. Accreditation has helped the hospital through its merger. It has affected the hospital at an individual, group, organizational, and external partnerships level. The self-assessment phase was highly effective in encouraging cohesion and collaboration, the emergence of a multidisciplinary approach to care, community involvement, and the development of organizational learning. The first post-merger accreditation's report encouraged the development of an organization wide quality framework which focuses on quality of care, efficiency, and patient safety. Most key values and initiatives are in place for the hospital to be a Learning Organization. A shift in organizational culture towards a group and developmental culture, as well as a stronger commitment towards QI education and training, are still necessary. (Abstract shortened by UMI.)

A geographic information system was used to measure geographical access to general surgical services in the Champlain Local Health Integration Network. An origin-destination matrix approach was used with discharge data for Champlain residents using the Ontario Road Network file and OC Transpo trip planner for public transportation trips with in the city of Ottawa. GIS showed that adding surgical services to the Renfrew Victoria Hospital would be the best location to achieve the goal of reduced drive times for Champlain LHIN residents. However, this hospital was ill suited to take on additional surgeries due to high occupancy rates, a lack of space and surgeons. Differences in neighbourhoods' geographical access (drive and transit time) to the General Campus of the Ottawa Hospital were found. However, it was the more affluent neighbourhoods and neighbourhoods with lower percent of recent immigrants that had longer drive times and transit times.

Background: Systematic reviews (SRs) are increasingly viewed as useful decision-making tools yet the extent of SR publication bias is under-explored. Through my thesis, I aimed to investigate the extent of SR publication bias. Methods: A conceptual model was derived from literature searches and one-on-one interviews and three studies were conducted: a cross-sectional study of 296 SRs indexed in MEDLINE and published in November 2004, an international survey of 625 corresponding or first authors of a published SR in 2005, and a retrospective cohort study of 411 Cochrane protocols from Issues 2-4, 2000 and Issue 1,2001 that were followed until Issue 1,2008 in The Cochrane Library. Main findings: The interviewees reported 40 unpublished SRs and the conceptual model showed that publication bias can permeate all steps of the publication process, from conceptualization to ultimate effect on health outcomes. The cross-sectional study identified favourable results in 57.7% of Cochrane reviews and 64.3% of non-Cochrane reviews with a meta-analysis of the primary outcome and non-Cochrane reviews were twice as likely to have positive conclusions as Cochrane reviews (p-value≤0.05). In the international survey, participants reported 1405 published (median: 2.0, range: 1-150) and 199 unpublished (median: 2.0, range: 1-53) SRs. In the retrospective cohort study, 19.1% (71/372) of eligible Cochrane protocols remained unpublished and the median time to publication was 2.4 years (range: 0.15-8.96). A shorter time to publication was associated with the Cochrane review being subsequently updated versus not updated (n=100/372 Cochrane reviews that were updated, hazard ratio: 1.80 [95% confidence interval: 1.39-2.33 years]) and a longer time to publication was associated with the Cochrane review having two published versus one protocol (n=10/372 Cochrane reviews with two published protocols, 0.33 [0.12-0.90 years]). General conclusions: Over 300 unpublished SRs were identified through the interviews conducted for the conceptual model and the three studies that comprised my thesis. Possible solutions for minimizing or avoiding SR publication bias include registration of SRs at inception, educating the research community about the importance of publishing SRs, and having a general online open-access journal with rapid peer review that is dedicated to only publishing the results of SRs (including their updates).

No description available.

<p> Mint Green is a limited liability company who provides preventative health care services to the Greater Long Beach area. Mint Green is entering the Weight Loss Services Industry which is experiencing rapid growth due to the enactment of the Patient Protection and Affordable Care Act. Mint Green has the opportunity to reach approximately 65% of firms who offer health benefits to their employees. Mint Green&rsquo;s Healthy Eating and Lifestyle Plan (HELP) is the core instruction to the weight loss programs. Mint Green has four types of weight loss programs; each developed to satisfy a wide array of budgets. Mint Green is projected to yield a profitable margin.</p>

<p> Low back syndrome affects 20% of people, and it is estimated that 30% of patients are unable to return to work after surgery. The monitoring of health care outcomes could improve the delivery of health services. The health performance conceptual framework, derived from the Donabedian model, was used to evaluate the functional outcome, clinical recovery, response to surgery, and physician performance of the surgical management of lumbar spine degeneration. A quantitative study (n=685) was undertaken using an administrative database in a repeated-measures design. The clinical and functional outcome improvements were analyzed using t tests. Surgical complexity on health outcome was examined with ANOVA. Predictors of patient satisfaction was explored using Pearson's correlation and regression analyses. The results demonstrated highly significant improvements in functional (mean change 30%; ODI=16.79 &plusmn; <i> SD</i> 19.92) and clinical recovery (mean change 50%; modified-JOA=6.983 &plusmn; <i>SD</i> 2.613) with surgery at 3 months; a >50% positive response to surgery; and a > 90% patient satisfaction, sustained over a 2 year period. Complexity of surgery did not impact health performance. Strong correlations between the health performance metrics were detected up to 6-months from surgery. Poor clinical recovery and persistent functional disability were predictive of patient dissatisfaction. The social change implications for health policy are that a constellation of health performance metrics could predict the potential for functional and clinical recovery based on presurgery disability while avoiding medical expenditures for procedures with no health benefit; aid in health quality monitoring, peer comparisons, revision of practice guidelines, and cost benefit analysis by payers.</p>

Saudi Arabia has witnessed rapid development in economic, cultural and social aspects since the discovery of oil a few decades ago. This development involves all the governmental sectors including national parks. The need for national parks has become inevitable. Asir National Park was established to provide recreational sites and to preserve the unique natural and cultural features of the park. Research evaluated the impact of human activities of logging, grazing, hunting, land development and elimination and negligence of traditional architecture on Asir National Park features. A questionnaire, interviews and field observations were conducted to investigate the impact of these activities on Asir National Park. Asir National Park suffers a great deal of pressures from human activities. The local population depends on the park as their source of livelihood and as a traditional habit. The study illustrates the most affected zones where action should be taken to preserve park features.

<p> Hospital performance metrics are an indicator of leadership performance. However, there is inadequate research on whether physician or nonphysician chief executive officers (CEOs) perform better in the U.S. hospitals. The purpose of this study was to examine which type of leaders is better. Leadership trait, situational leadership, and leadership behavior theories constituted the theoretical foundation. The key research question examined the relationship between a hospital&rsquo;s outcomes, which in this study, included hospital net income, patient experience ratings, and mortality rates, and the type of CEO in that hospital: physician or non-physician. A quantitative, causal comparative design was used to answer this question. Three hypotheses were tested using multivariate analysis of variance. The dependent variable was hospital outcomes: hospital net income, patient experience ratings, and mortality rates. The independent variable was the type of hospital CEO: physician and nonphysician. Datasets from 2014-2015 were used, which were publically available on the websites of U.S. based hospitals, research organizations, and journals. A sample of 60 hospitals was drawn from U.S. non-federal, short-term, acute care hospitals, based on number of staffed beds (<i>n</i> = 60). No significant differences were found between nonphysician and physician CEOs on hospitals&rsquo; net income (<i>p</i> = .911), patient experience ratings <i>(p</i> = .166), or mortality rates (<i> p</i> = .636). Thus, the null hypotheses were retained. Findings suggest that physician and non-physician CEOs may produce similar outcomes in the hospitals they lead. Based on these findings, hospital boards can view CEO applicants equally when considering whom to hire and understanding U.S. hospital leadership.</p>

<p> High patient no-show rates increase health care costs, decrease healthcare access, and reduce the clinical efficiency and productivity of health care facilities. The purpose of this exploratory qualitative single case study was to explore and analyze the managerial intervention strategies healthcare administrators use to reduce patient no-show rates. The targeted research population was active American College of Healthcare Executives (ACHE), Hawaii-Pacific Chapter healthcare administrative members with operational and supervisory experience addressing administrative patient no-show interventions. The conceptual framework was the theory of planned behavior. Semistructured interviews were conducted with 4 healthcare administrators, and appointment cancellation policy documents were reviewed. Interpretations of the data were subjected to member checking to ensure the trustworthiness of the findings. Based on the methodological triangulation of the data collected, 5 common themes emerged after the data analysis: reform appointment cancellation policies, use text message appointment reminders, improve patient accessibility, fill patient no-show slots immediately, and create organizational and administrative efficiencies. Sharing the findings of this study may help healthcare administrators to improve patient health care accessibility, organizational performance and the social well-being of their communities.</p>

<p> The purpose of this qualitative multiple case study was to explore women&rsquo;s perceptions of provider influence in shaping their beliefs about protection against sexually transmitted diseases during provider-patient consultations. Women indicate they prefer to discuss sexual health issues with providers, yet research was not available to fully understand provider influence on women&rsquo;s beliefs regarding sexually transmitted diseases. Telephone interviews were conducted with a purposive sample of 12 adult women in Baton Rouge, Louisiana. Data collected from these interviews and analyzed for emerging themes using NVivo 10 software revealed how women perceived providers&rsquo; discussions and the dissemination of STD related information. Findings also revealed how women believed healthcare providers might present sexual health information to motivate changes in risky sexual behaviors. The three major themes emerging from the analyses of the data collected were providers did not initiate discussions about preventing STDs, no information was received about preventing STDs during consultations, and visuals could motivate changes in risky sexual behaviors. Recommendations based on the study&rsquo;s findings involved identifying opportunities to leverage staff members in healthcare providers&rsquo; settings, illuminate cues to action, develop STD awareness programs specifically for women, and to conduct future research.</p>