In the United States, many small businesses fail within the first 5 years due to poor implementation of sustainability strategies. Researchers and business practitioners have indicated that small business owners face challenges on how to maintain their businesses beyond 5 years due to lack of sustainability strategies. The purpose of this qualitative multiple case study was to explore the strategies that health care small business owners and managers in New York State use to maintain their businesses beyond 5 years. Sustainability development theory was used for the study's conceptual framework. Semistructured face-to-face interviews were conducted with 6 purposively-selected participants who had owned and managed health care small businesses for more than 5 years together with companies' official documents on strategies used to sustain their businesses to achieve goals. The 5 themes that emerged from the thematic analysis of the interview data are education, training, and experience; customer-centricity, information technology update, development of business plan, and relationship and networking. The findings indicated that participants use similar strategies to sustain small businesses. The results from this study may contribute to positive social change by providing area healthcare small business owners and managers with more knowledge on strategies for sustaining businesses. By sustaining their businesses, these business owners and managers can improve economic growth by offering employment opportunities and paying more corporate taxes, which the municipal government could use to provide social amenities to local citizens.

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's hierarchy of needs theory, and the opposing theory, Vroom'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.

Qualitative studies exploring the factors behind a doctor's decisions to order clinical laboratory blood testing are lacking. A better understanding of these factors can help in formulating interventions that could improve the quality of health care and limit costs. The purpose of this qualitative case series study was to identify factors that influence a doctor's decision to order routine clinical laboratory blood tests. Fifteen doctors from Western New York, working in different hospital settings, were interviewed. There were 5 doctors in each case type: major, community, and private hospitals. When analyzed by case, there was a difference between the three groups in the ordering of tests based on fear of malpractice. The majority of the doctors from the community hospitals group (4 of 5) and private practice group (3 of 5) said that they had ordered tests based on the fear of malpractice. However, in the major hospital group, only 1 doctor followed this pattern. Although, the majority of the doctors (13 of 15) held favorable views of the guidelines for administering the blood tests, most (8 of 13) thought that they were impractical for use in their practice, and hence needed major modifications. To increase effectiveness for guideline adherence, a multifaceted local team approach is recommended that includes a review of guidelines by a committee comprised of respected local doctors in consultation with the area doctors. In addition, the development of continuing education could have a positive effect on guideline adherence and the reduction of unnecessary testing. This reduction could result in increased quality of care and reduced cost burden to the health care system.

Implementing successful value-centered care strategies that support patient-centeredness while reducing cost is a significant challenge for healthcare leaders. In 2001, the Committee on Quality of Healthcare in America and the Institute of Medicine identified patient-centeredness as 1 of 6 improvement goals to improve quality of care for the 21st century. The purpose of this multiple case study was to explore patient-centered strategies that healthcare managers used to reduce the cost of healthcare for elderly patients without reducing the quality of patient care. The conceptual framework that grounded this study was patient-centered care, and the opposing theory was the primary care team model. Data were collected using semistructured interviews with 6 healthcare leaders selected via purposive sampling throughout Virginia and a review of healthcare facilities' documents and website pages. Data were analyzed using Yin's 5-step process, which led to the identification of 4 themes. Themes that emerged from the study included patient-centered care matters, management leadership strategies, control methods for monitoring costs, and maximizing community healthcare services. The implications of this study for positive social change include the potential to improve the delivery of healthcare for elderly patients and access to quality patient-centered care that supports cost-reducing strategies healthcare managers can employ to increase profits through value-based healthcare.

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High no-show rates in the ambulatory setting lead to underutilized resources, decreased clinic revenue, and lower productivity. The purpose of this single case study was to explore strategies that administrators used to maintain acceptable no-show rates and maintain the sustainability of the healthcare practice. The target population for this study included local chapter members of a professional healthcare organization that provided access to practice managers and administrators in the Las Vegas, Nevada regional area where there are a large number of practices that are not part of a health system; the sustainability of these practices is dependent on allocation of adequate resources. The conceptual framework for this study was Kotter's 8-step change management model that uses 8 steps for successfully managing change within the organization and developing quality improvement initiatives. Data collection included semistructured interviews with 2 practice leaders, observation of the organization's practice management and appointment scheduling systems, and a review of internal reports related to appointment trends and no-show rates. Based on the data analysis using deductive and open coding techniques, 3 distinctive themes emerged from the data: appointment booking strategies, appointment reminder strategies, and provider flexibility. The results of this study might positively affect positive social change by helping administrators improve access to care in an outpatient setting through improved appointment utilization and improve patient care outcomes with more appointment availability.

Obtaining information about employee engagement and retention practices is vital for organizations. Affective organizational commitment reflects the extent to which organizational members are loyal and willing to work toward organizational objectives. In particular, affective organizational commitment holds important implications at all organizational levels (e.g., turnover rates, performance, and citizenship behavior). Using general systems theory and transformational leadership theory, the purpose of this single case study was to explore strategies used to improve employee engagement and retention from 5 senior leaders with hiring responsibilities from a midsize hospital in Austin, Texas that have been successful with employee engagement and retention strategies. All participants volunteered to participate in semistructured interviews. The interviews were transcribed and participants were asked to member check the drafted findings to reinforce credibility and trustworthiness. Interview data and researcher reflexive memos were inductively analyzed and coded through NVivo. Five themes emerged that focused on employee engagement and retention: development and training, reward and recognition, compensation, work-life balance, and leadership skills and behaviors. By implementing practices that improve employee engagement and retention, hiring managers can increase employee productivity, reduce employee turnover cost, create a stable life for the individuals in need of support, and develop relationships with the community where integration occurs

Many drug overdoses in the United States are from prescription drugs, most of which are classified as opioid pain relievers (OPRs) and commonly prescribed in emergency departments (EDs) to treat pain. OPR abuse and addiction is a major public health issue. Researchers have identified the role of various patient characteristics (race, gender, demographics, etc.) in the variation in OPR prescription rates, but the contribution of provider-type differences to that variation has not been exposed. The purpose of this study was to evaluate the strength of the association between provider type and the likelihood of an opioid prescription by ED providers using national-level population data. Drawing from symbolic interaction theory, which served as the study's theoretical framework, it was postulated that the training and background of ED providers influence their interaction and OPR prescription decisions. The National Hospital Ambulatory Medical Care Survey 2015 data were used to evaluate the association between provider type and the likelihood of an OPR prescription, and the possible confounding effect of patients' race and payment type. Logistic regression analysis showed that attending physicians, consulting physicians, and physician assistants were more likely (OR = 1.491, 1.318, and 1.315, respectively) to prescribe an OPR in the ED, while controlling for age and pain level. Both race and payment type had predictive relationships with the outcome variable, but only payment type interacted significantly with provider type. These findings can serve as the basis for evidence-based training, procedure guidelines, and policy development, as well as inform patient-provider interactions, potentially leading to safer, more effective pain management encounters in the ED.

Over 500,000 hysterectomies are performed yearly in the United States, and they often result in a moderate to severe amount of pain. Nurses play a significant role in postoperative pain management. However, studies have shown that despite technological advances and nurses' theoretical knowledge of pain, postoperative pain management remains a challenge among healthcare providers. The purpose of this study was to examine how nurses' and patients' attitude towards abdominal hysterectomy can impact postoperative pain management and hospital length of stay after a hysterectomy. Informed by the theory of reasoned action, the study examined the differences in the nurses' and patients' attitudes to abdominal hysterectomy and postoperative pain management. It also examined the correlation between attitudes toward postoperative pain management and hospital length of stay after a hysterectomy. A convenience sample of 147 participants were recruited from a self-administered online survey. Using the SPSS software, data was analyzed by an independent t test, Pearson correlation, and multiple regression. No statistical difference was found between patients and nurses' attitudes toward abdominal hysterectomy. However, a significant difference was found between the attitudes of each group toward postoperative pain management. There was also a strong negative correlation between attitudes to postoperative pain management and hospital length of stay. This study may aide nurses on ongoing pain management education for both new and seasoned nurses in practice. It will also help hospitals with pre- and postoperative patient education, which will lead to better collaboration with their nurse caregivers. Finally, this study will add to the existing body of research.

Health care spending accounts for 17.7% of the gross domestic product in the United States, and it is expected to continue rising at an annual rate of 5.3%. Despite high costs, health care quality lags behind other high-income countries; yet, over 70% of change initiatives fail. The purpose of this multiple case study was to explore strategies primary care leaders use for implementing quality improvement initiatives to improve patient outcomes and reduce waste in primary care facilities. The target population consisted of 3 health care leaders of 3 primary care facilities in southern California who successfully implemented quality improvement initiatives. The conceptual framework for this study was Kotter's 8-step of change management. Data were collected through face-to-face semistructured interviews with senior health care managers, document review, and quality reports. Member checking of interview transcripts strengthened the credibility of the findings. Data analysis included Yin's 5-phase process, which consisted of compiling, disassembling, reassembling, interpreting, and concluding the data. Themes emerged from the use of methodological triangulation of data. The themes included communication, leadership support, inclusive decision-making, and employee recognition. The implications of the findings of this study for positive social change include assisting primary care leaders in improving strategies for implementing quality improvement initiatives to increase efficiency, reduce health care cost, and improve patient and community health.