Antibiotic-resistant bacteria(ARB) is causing increased health risk and cost to society. Mathematical models have been developed to study the transmission of resistant bacteria and the efficacy of preventive measures to slow its spread within a hospital setting. The majority of these models have assumed a constant total hospital population with the admission and discharge rates being equal throughout the duration. But a typical hospital population varies from day to day and season to season. In this thesis, we apply variable admission and discharge daily rates to existing deterministic and stochastic models which examine the transmission of single and dual resistant bacteria. We perform stability and equilibrium analyses as well as a sensitivity analysis on the resulting model..

Shifting payment models from fee for service (FFS) to pay for performance (P4P) have fundamentally changed the environment of healthcare administration in the United States (Center for Medicaid and Medicare Services (CMS), 2011). Due to this shift, there has been an increase in demand for tracking and improving quality measures to ensure not only patient safety, but optimization of utilization. Constraints on resources and capacity, coupled with increasing safety measures has developed a new study of patient flow (Miró, Sánchez, Espinosa, et al., 2003). Decreasing patient room turnover times has the potential to maximize utilization while ensuring patient safety and quality (Dyrda, 2012). LEAN and A3 Methodology were applied to create a process improvement initiative at a 500-bed regional medical center (RMC). Using a Rapid Improvement Event (RIE), efforts were made to identify gaps and improve processes to address issues which prevented patients from being in the right place, for the appropriate amount of time, and patient rooms cleaned in a timely manner. These gaps prevented adequate patient flow in the RMC. After tracking the implemented improvements for a year, the RMC ceased following the newly designed process. This study examines the original RIE, factors that changed since the event, and additional process improvements made two years post-RIE.

Healthcare has recently begun a push towards more lean practices and management. Healthcare accounting, in an effort to reflect business practices, must change to accurately reflect reality. This research seeks to explore how healthcare providers improve their accounting systems to keep up with an ever-changing lean environment. By examining both healthcare and accounting literature, this comprehensive literature review seeks to answer the question, “How does healthcare accounting adapt to lean philosophies?”.

Relaying information from a Chief Communications Officer (CIO), or centralized communications departments to hospital employees is not always efficient or effective. Employees may not be informed of important changes to department protocols or hospital policies. The purpose of the study was to determine the most efficient and effective forms of internal communications in the hospital setting. A total of 83 surveys were mailed to communication officers working in Tennessee hospitals in and east of Nashville. Sixteen communication officers responded. This low response rate may be attributed to poor designation of communication responsibilities and an abdication of responsibilities to an off campus (corporate) source. One significant difference was found regarding the preference of supervisor contact to relay feedback in the age groups of 31-40 and 51-60. Those 31-40 were less likely to prefer direct supervisor contact as their favored communications channel as opposed to 51-60 year olds who favored this method.

In May of 2014 the Financial Accounting Standards Board (FASB) and the International Accounting Standards Board (IASB) issued a long-awaited joint updated standard on revenue recognition, ASU 2014-09 – Revenue from Contracts with Customers. While almost all entities will be affected to some extent by the new standard, particularly the changes in required disclosures, this research seeks to examine the impact the new standard will specifically have on the healthcare industry. By highlighting areas of significant challenge a better understanding will be gained of the impact health care service entities will experience as they transition to a new standard.

There is a growing interest in understanding recruitment, retention, and turnover of allied health professionals in consideration of employment trends and workforce mobility, an increased need to understand the healthcare delivery system and the dynamic nature of the allied health workforce, especially for rural areas. A survey was sent to allied health administrators across a variety of allied health disciplines from the state of Tennessee hospitals in order to gauge opinions on retention and recruitment strategies. Overall, successful strategies for recruitment and retention of radiography professionals were reported, as well as, differences between urban and rural areas, differences among allied health disciplines, perceptions of strategy effectiveness, and key strategies for rural allied health recruitment.

Intravenous immunoglobulin (IVIG) is a common treatment for the neurological autoimmune diseases multiple sclerosis, multifocal motor neuropathy, myasthenia gravis, and chronic inflammatory demyelinating polyneuropathy. However, there is scant literature regarding the psychological effects of this treatment on quality of life (QOL). Using illness intrusiveness theory and personal control theory, this correlational, cross-sectional study examined the relationship between the IVIG treatment experience and QOL in neurological autoimmune patients. Surveys were employed to collect data from 79 patients at a neurological infusion center in Phoenix, AZ. Quantitative analyses included correlation, multiple regression, and mediation analyses to determine whether (a) IVIG treatment experience predicted QOL measured by 10 Neuro-QOL scales, (b) illness intrusiveness mediated the relationship between IVIG treatment experience and QOL, and (c) personal control mediated the relationship between illness intrusiveness and QOL. IVIG treatment experience predicted QOL in 1 Neuro-QOL subscale; illness intrusiveness mediated 9 of the Neuro-QOL subscales using bias-corrected bootstrapping for statistical significance; and personal control did not mediate the relationship between illness intrusiveness and QOL. These results may affect social change by increasing the understanding of physicians, nurses, and patients regarding the psychosocial impact of IVIG treatment. Results from the study may provide insight for interventions to assist patients in adjusting to this form of treatment.

The need for mental health service is increasing in American Indian/Alaska Native (AI/AN) communities. While research has examined the availability, access, and effectiveness of provided services to the AI/AN, very little is known about the influence of the attitude and perceptions of both clinicians and clients in their therapeutic relationship in the treatment process. Using the frameworks of liberation, oppression, and trauma theory, this qualitative phenomenological study explored mental health service delivery and utilization issues within an AI/AN community. Data were collected through semistructured interviews with 14 clinician and client participants. The data were sorted into themes and subthemes and analyzed using the NVivo 11 computer software. Intergenerational struggle represented the primary theme and other subthemes such as assimilation, acculturation, and communication were among some of the secondary themes gathered from the data. Analysis of the themes provided greater insights into the dynamics of the participant's lived experience in various organizational structures within the larger community as well as a better understanding of mental health service delivery and utilization in maintaining sobriety in their daily struggles. The results indicated that intergenerational struggle along with other environmental factors were the chief causes of their cyclical journey through the penal and other systems; thus reducing their ability in maintaining longer sobriety and in improving their mental health. The implications for positive social change in this study include the reduction of stigma associated with these health issues through the education of the community and in training clinicians in factor-specific issues impacting life altering critical events in AI/AN struggles.

Research-informed practice is crucial to ensure best possible decisions are made during care delivery. In reality, research-based evidence often does not reach patient care due to many elements that impede the implementation process. The purpose of this phenomenological study was to discover the lived experiences of nurses involved in implementing evidence-based practice (EBP) in clinical settings within hospitals in United Arab Emirates. The theoretical and conceptual basis for the study was derived from Promoting Action on Research Implementation in Health Services framework for knowledge translation and Benner's Novice to Expert theory. Twelve nurses who had experience implementing evidence to practice were the participants of this study. Data were collected through semi-structured interviews and analyzed using a qualitative hermeneutic phenomenological approach. Three themes emerged from the study that included the significance of EBP, the process of evidence translation, and the outcome of evidence translation. Nurses in the clinical settings had basic understanding of EBP and were motivated to translate evidence, but their knowledge and skill in EBP were still limited. The implication for positive social change of this study is the recommendation that leaders in healthcare and nursing, as well as educators, and researchers to recognize the need for building EBP capabilities among nurses. Organizations must include current theories, frameworks, and tools of evidence translation to cultivate a culture of EBP as a foundation for patient care.

Development partners and donors increasingly acknowledge the importance of coordinating their activities to achieve the outcome of the official development assistance to developing countries. Although stakeholders have recognized the importance of harmonizing donors and development partners' efforts in the Nigerian health sector, little research has addressed the influence of coordination on the health aid effectiveness. This qualitative case study determined the influence of coordination among the donors and development partners involved in the HIV/AIDS, malaria, and nutrition program on the outcome of these programs in Nigeria. Data were collected through interviews with 22 program officers participating in the health programs and through document review. The document reviewed were reports of coordination efforts, and outcome evaluation reports. Data were managed using NVivo, while coding and themes were adopted for data analysis. Findings revealed the partial coordination efforts in the health system development. Coordination efforts should be at both national and state level to ensure adequate implementation of the health program. Most participants reported a need for the government of the recipient country to strengthen their commitment and own coordination process for development partners to adhere to the guidelines of the coordination platforms. These results could have implications for positive change by identifying the bases to achieve sustainable effectiveness of health aid in Nigeria through development of Country Coordination Mechanism for all health programs to provide guideline of harmonizing activities of development partners.