Continued escalation in health care expenditures in the United States has led to an unsustainable model that consumes almost 20% of GDP. Policymakers have recognized the need for industry reform and have taken action through the passage of the Affordable Care Act (ACA). The purpose of this quantitative, longitudinal study was to examine the relationship between the type of health insurance and health care costs. Mechanism theory and game theory provided the theoretical framework. The analysis of secondary data from the Healthcare Cost and Utilization Project included a sample of 1,956,790-inpatient hospital stays from 2007 to 2014. Results of one-way ANOVAs indicated that between 2% and 9% of health care costs could be attributed to type of health insurance, a statistically significant finding. Results also supported the effectiveness of the ACA in stabilizing health care costs. The average annual rate of health care cost increase was 38.6% from 2007 until 2010, decreasing to an average annual increase of 4.3% from 2011 until 2014. Results provide important information to generate positive social change for consumers, providers, and policymakers. This includes improving decisions related to health care costs, improved understanding of the costs of health care services, increased transparency, increased patient engagement, maximizing consumer utility, facilitation of reduction of waste within the industry, and increased understanding of the impact of health policy on health care costs and efficiencies within newly created health policies. Results may also improve transparency of health care costs, which allows consumers, providers, and policymakers to take specific action to reduce health care costs, resulting in a more just and sustainable health care model.

Despite the high rate of failure in merger and acquisition (M&A) transactions, many organizations continue to rely on M&As as their primary growth strategy and to address market competition. The purpose of this qualitative single case study was to explore strategies managers from a large healthcare payer in the midwestern United States used to achieve operational and strategic synergies during the postacquisition information technology (IT) integration phase. Haspeslagh and Jemison's acquisition integration approaches model was the conceptual framework for the study. Methodological triangulation was established by analyzing the data from the semistructured interviews of 6 senior executives and 6 IT strategists, discussion points produced in a focus group involving 4 acquisition integration leaders, and information gleaned from M&A periodicals. Data were analyzed using Saldaña's thematic analysis method and showed that the healthcare payer organization managers used the following 4 strategies to achieve the planned synergies: plan for expected business synergies from the postacquisition IT integration, make cultural harmonization a key element of change management, align and continuously evaluate the progress of postacquisition IT integration strategies against planned synergies, and preserve durability of acquired capabilities by granting autonomy to the acquired organization. The findings of this study could lead to positive social change by stimulating a business environment that might allow healthcare payers to expand their strategic capabilities and serve their local communities with new products and other choices that improve the quality of care, health outcomes, well-being, and longevity of the consumer.

. Abstract Health reform is forcing healthcare administrators to make rapid changes. A tendency to resist change can present problems for these organizations, including the large, not-for-profit Catholic healthcare systems. In order to make positive contributions towards healthcare, it's important to recognize the nature of the organization's involvement to change. The transformational leadership style has been shown to be positively correlated with change however, the relationship among leadership styles, employees' behaviors, and motivation to change are still not well understood and require further study. Further, although Oreg's Resistance to Change (RTC) approach has been researched in direct patient care areas, RTC research in non-patient settings is lacking and necessary in delivering the full spectrum of patient care. This study focused on the relationship of transformational leadership to RTC and if the relationships leaders' have with subordinates' influence change. A customized survey that included the Multifactor Leadership Questionnaire, RTC, and Leader Member Exchange (LMX 7) was emailed to 500 random individuals of various ages and races from 3 non-patient areas. Thirty leaders and 133 raters responded. The regression analysis showed a strong correlation between transformational leadership and RTC. Additionally, each of the variables from the LMX 7 section of the survey showed associations indicating the relationship leaders develop with their subordinates and leader transformational scores were positive. This study may contribute to the awareness of RTC and utilizing transformational leadership style to move change in a positive direction for a healthcare setting.

Aggressive management of diabetes using American Diabetes Association (ADA) best practice guidelines in hospitalized patients reduces morbidity and mortality. Inpatient electronic medical records systems improve care in chronic diseases by identifying care needs and improving the data available for decision making and disease management. The purpose of this quality improvement project was to evaluate the impact of ADA best practice guidelines of glycemic management once they have been entered into the electronic medical record (EMR) of hospitalized diabetics. Kotter's organizational change process guided the project. The project question investigated whether nurses' use of ADA Best Practice Guidelines incorporated into the EMR improves glycemic management in hospitalized patients. A quality improvement project pretest-posttest design evaluated the intervention to assess whether the program goals were met. A convenience sample of 8 nurses practicing in a subacute health care facility participated in the program with data obtained from a convenience sampling of diabetic patients admitted to the facility (n = 50). A1C, diabetes types, and hypo/hyperglycemic treatment event data were compared 30 days pre- and post-intervention. Outcome data calculated using descriptive statistics revealed improved documentation for A1C results (4% to 96%), the different types of diabetes (from 100% documented as Type 1 to 28 % documented as Type2), and increased corrective measures for abnormal glycemic events (increased 16% to 44%). EMR alerts and reminders provided timely information to health care practitioners, resulting in better management for the diabetic patient, thus affecting social change of diabetes care.

The fast-growing trend of using virtual teams comes with challenges including the lack of knowledge by some virtual team leaders for managing virtual teams. The purpose of this single case study was to explore the communication strategies that leaders use to manage virtual teams in real time to enhance team performance. The sample was composed of 4 successful virtual team leaders of a multinational accounting firm whose headquarters is in the northeastern region of the United States of America. The conceptual framework that guided this study was Tuckman's small group developmental model. Data consisted of semistructured interviews and the review of archival company documents. The interview protocol, interview transcription, member checking, and methodological triangulation allowed for data reliability and validity. Five themes emerged regarding completion of the 4 stages (comprehension, synthesizing, theorizing, and recontextualizing) of data analysis: time synchronization, face-to-face interaction, continuous training, communication tools and frequency, and leadership training and development. The findings of this study could contribute to social change enhancing communication strategies used in virtual teams, which could result in higher employee satisfaction, which in turn could benefit the organizations and virtual employees, their families, and communities.

Ineffective leadership and disengaged nurses reduce the quality of care and patient satisfaction in healthcare organizations. Healthcare leaders can benefit from understanding the factors that improve leadership ability and nurse engagement to improve healthcare outcomes. The purpose of this correlational study was to examine the relationship between the demonstration of authentic leadership characteristics and nurse engagement. The study's population comprised acute care registered nurses in a rural hospital in central Washington State. Authentic leadership theory and engagement theory constituted the theoretical framework. Independent variables were the 4 constructs of authentic leadership theory, self-awareness, balanced information processing, relational transparency, and internalized moral perspective; the dependent variable was nurse engagement. Three hundred sixty-nine registered nurses received 2 pen and paper, Likert-type scale surveys, the Authentic Leadership Questionnaire, and Utrecht Worker Engagement Scale- 9 item, to complete for data collection. Data were analyzed using multiple linear regression. There was no relationship between the 4 constructs of authentic leadership and nurse engagement. The coefficient of determination demonstrated only 11% variation in nurse engagement related to the independent variables. Healthcare leaders face significant challenges. With a better understanding of the factors that lead to higher nurse engagement, leaders can increase both nurse and patient satisfaction, leading to better healthcare outcomes.

Healthcare providers may impede the delivery of spiritual and emotional support to patients and their families by healthcare professional chaplains if they misunderstand how to effectively use chaplains, who often prefer to be engaged sooner than they are. This issue prevents highly trained, board-certified professional chaplains from providing services, thereby impacting the quality of patient care. The purpose of this phenomenological study was to examine, through the lived experiences of professional chaplains, the extent to which chaplains feel that others perceive them as valued members of an interdisciplinary team (IDT), as well as to determine how team inclusion may impact chaplains' physical and emotional well-being. An adaptation of the antecedents and outcomes of inclusion theoretical framework was used. Research questions were developed to elicit to what extent professional chaplains perceived that they were valued members of IDTs and what impact inclusion had on their well-being A semistructured interview protocol with open-ended questions was used with 9 board-certified professional chaplains in the northeastern region of the United States.. Data were analyzed through coding and comparison of significant responses into units of meaning to reflect the phenomenon of participants' experiences. Key findings revealed that inclusion did have an impact on the well-being of chaplains, and its impact was perceived as positive. This study may contribute to positive social change by helping to initiate training and education programs for healthcare organizations that work with and employ professional chaplains to effectively integrate chaplains into IDTs, ensuring more timely evaluation and care planning for patients and their families to achieve greater wholeness and healing.

Zimbabwe's catastrophic economic decline resulted in a high unemployment rate (95%), declining socioeconomic indicators, pharmacy stores' unprofitability and lower sustainability. Profitable pharmacy stores play a fundamental role in ensuring public access to medication. Lack of pharmacy profitability leads to poor healthcare delivery, resulting in increased morbidity and mortality. A healthy population is panacea to economic growth and prosperity and enhances human dignity, social cohesion, and the quality of life. In this qualitative, descriptive multicase study design, using Porter's business strategies theory and the Deming process of quality assurance as conceptual frameworks, data from 11 pharmacy stores leaders in Bulawayo, Zimbabwe were collected during interviews with open-ended questions. Participants were assumed to have influence, knowledge, and a personal stake in the pharmacy sector and that their views and experiences could address the research question of lack of pharmacy profitability and sustainability. Data were explored, categorized, and tabulated to assist drawing empirical findings and conclusions that could answer the research question. Using software the data were analyzed and themes such as the centrality of strategy in running profitable pharmacies, customer care, reimbursements by medical insurance firms, the role of the legal and regulatory frameworks on pharmacies, and mergers of single-owner pharmacies emerged. Findings from the results might provide strategies for those in the pharmacy retail sector and individuals who intend to explore the sector. Individuals who read results of the study might be influenced to lobby government on behalf of the sector to relax prohibitive regulations.

The recent economic crisis in Puerto Rico has created decreased health department fiscal capabilities, adding more responsibilities to health department officials in charge of restaurant inspections without adding more operational funds, which in turn led to less regulatory capacity. This situation instigated increased food safety regulation violations, and food safety legislation changes, imposing more economic pressure to restaurant owners, which leads to a lack of restaurant sustainability. The purpose of this case study was to explore strategies six business visionaries, smart entrepreneurs, who have positioned themselves as successful restaurateurs, in the restaurant industry in Puerto Rico. They were key factors in the understanding of the business strategies applied to comply with food safety regulations for the sustainability of their business. The study was grounded in the socio-economic theory of compliance. Semistructured interviews and company documents provided the data for the study. Through thematic analysis, 4 themes emerged, legislative impact and food safety regulations, reducing economic stress and cost controls, customer conduct, and employee knowledge transfer. Although, the fiscal crisis has severely affected the entire restaurant industry and the economy in general, also undoubtedly holds great opportunities for developing new strategies appropriate to the fiscal situation. One recommendation is to build cooperative relations with government agencies such as the CDC, or the state health department, use of mystery shopper programs, and embrace social impact strategies to improve food service practices that may optimize healthier food consumption for restaurant patrons and increase profitability.

The financial costs of U.S. federal health care fraud continue to increase, and as health care payments due to fraudulent claims increase, the portion of The Medicare Trust Fund available to pay for legitimate health care expenses decreases. Prosecution is one of several fraud management life cycle components that contributes to and can alter the course of increasing health care fraud; however, despite this recognition, there is a gap in the literature regarding the consistency of prosecution for federal health care fraud across different judicial districts. The purpose of this qualitative, exploratory multiple case study was to explore the federal sentencing consistency across 6 judicial districts in Georgia and Florida during 2011 and 2012 using Wilhelm's Fraud Management Life Cycle as the theoretical lens. Data consisted of publicly available records of 147 terminated federal cases in Georgia or Florida from 2011 and 2012 involving prosecutions for health care-related fraud. These data were inductively coded and analyzed using a content analysis procedure. Findings indicated physical and monetary sentencing inconsistencies when comparing the sentence delivered for similar federal health care fraud cases across judicial jurisdictions. This study promotes positive social change by demonstrating inconsistencies in federal health care sentencing and understanding that consistent sentencing will lead to greater deterrence. Prosecutors and judges will benefit from this knowledge in making more consistent sentencing decisions related to federal fraudulent health care payments.