Abstract There is limited information regarding physician satisfaction as it relates to the presence of a surgical pathology department in rural hospitals. Physician satisfaction directly influences the quality of patient care. The theoretical frameworks that informed this study included institutional theory and population ecology. The research questions addressed differences in levels of physician satisfaction between physicians who have access to an on-site surgical pathology department and physicians who do not have such access. The research also examined differences in satisfaction between physician specialties that have or do not have access to an on-site surgical pathology department services. A quantitative, cross-sectional study was employed utilizing three primary instruments: the Henry Ford Hospital Survey, Standardized (Synoptic) Pathology Reports, and PAR Medical Colleague Questionnaire. Statistical analyses including ANOVA, linear regression, and t tests were used to examine the relationships between the study's variables. The results revealed that there is statistically significant evidence to support that on-site surgical pathology department services influence physician satisfaction. Potential implications for positive social change from this study include a better understanding and awareness of the relationship between physician satisfaction and utilization of on-site pathology services, which may ultimately benefit healthcare facilities by more intently addressing quality of care and patient satisfaction.

Sixty-four United States hospitals closed for poor organizational performance during 2010 through 2016. Because of hospital closures, community members experienced delays in obtaining needed care, reduced access to specialty care, and increased travel distances. Based on the balanced scorecard model theory, the purpose of this qualitative single case study was to explore strategies that 10 health care leaders used at a healthcare organization in central Texas to prevent financial distress. Semistructured interviews were conducted and archival organizational accounting records were reviewed, including company surveys with employees and patients. Data were thematically analyzed and triangulated to ensure the trustworthiness of interpretations. The findings identified 3 themes: effective leadership to improve organizational performance; training, skills development and continuous learning to improve performance; and customer focus strategies to increase customer satisfaction. The findings of this study may contribute to social change by improving access to healthcare services, increasing access to specialty care, and increasing customer satisfaction.

Accreditation is recognized worldwide as a tool to improve health care quality. In developing countries, the interest in attaining international accreditation is growing despite the considerable resources the accreditation process consumes and the lack of information about its impact on quality of care. The purpose of this study was to assess the impact of Joint Commission International (JCI) accreditation on health care quality and to explore the contributing factors that affect quality of care as perceived by nurses. The theoretical foundation for this study was based on total quality management theory and Donabedian's model. The research questions for the study examined the impact of JCI accreditation on quality of care and the relationship between quality improvement activities and quality of care. A cross-sectional quantitative design was employed in which a self-administered questionnaire was used to collect data. Participants from one accredited and another nonaccredited hospital in a developing country in the Middle East formed the purposive nonprobability sample that included 353 nurses. The results of a Wilcoxon Rank Sum Test and a correlation analysis indicated that JCI accreditation has a significant impact on quality of care ratings by nurses. Also, multiple regression analysis showed that leadership commitment is the best predictor of quality of care as perceived by nurses. This study may foster social change by encouraging hospital administrators and policy makers, particularly in developing countries, to implement quality improvement programs that will eventually improve the health care system in their countries.

Approximately 11% of patients diagnosed with a stroke or a transient ischemic attack are readmitted to the hospital, creating a cost burden of nearly $2 billion per year for Medicare beneficiaries. Because researchers and policy makers consider hospital readmission for patients with strokes or transient ischemic attack to be an indicator for the delivery of quality care, the Centers for Medicare and Medicaid Services has imposed financial penalties of up to 3% of a hospital's Medicare reimbursement in 1 year for excessive readmissions, potentially impacting the financial sustainability of various healthcare organizations. The ecological systems theory allows for the understanding of how microsystems, mesosystems, exosystems, macrosystems, and chronosystems impact the development, influence, and predictability characteristics of a specific population serviced in a healthcare setting. This quantitative study analyzed cross-sectional data from the 2016 National Hospital Ambulatory Care Survey, using cross-tabulations with chi-square followed by multiple regression analyses. Overall, this study addressed the gap in the existing literature by examining admission rates for patients with the diagnoses of strokes or TIA and the association between ancillary service use, insurance status, and provider level evaluation. The study concluded that few predictors that exist between the independent and dependent variables, with the exception of the amount of laboratory tests ordered. Maintaining the financial reasonability by avoiding penalties for stroke or transient ischemic attack unnecessary admission from value-based purchasing, the implication for social change is maintaining access to care for patients by avoiding hospital closures.

In 2013, 1% of Medicare reimbursements were withheld from U.S. hospitals, with a proposed cap of 2% in 2017 for redistribution to those hospitals that improve overall care and patient satisfaction. The purpose of this single case study was to explore the engagement strategies that some hospital middle managers used to improve employee performance to increase patient satisfaction. The sample included 4 health care middle managers in 1 hospital in northeast Connecticut. The conceptual framework that grounded this study was Kahn's personal engagement theory. Data were collected via semistructured interviews, participant observations, and review of hospital and public government documents. The process of member checking and methodological triangulation contributed to the study validity. The data were analyzed using Yin's 5-step method of analysis. Themes that emerged from the study were the importance of the role of the manager in fostering employee engagement, implementing explicit communication techniques, assisting employees in role performance, promoting employee wellbeing, commitment to patient care and satisfaction, and providing employees with rewards and recognition. Although this was a single case study, health care managers from other hospitals could benefit from the results of this study. The implications for social change include the potential for hospital managers to implement strategies to improve employees' engagement, thus improving patients' care and satisfaction, and the overall health and wellness of individuals in the community.

Credentialing in hospitals is the first line of defense for improving patient safety and reducing medical errors by verifying a physician's medical knowledge and skills. There is no single set of standards for physician credentialing followed by all hospitals in the United States. Using May's normalization process theory, the purpose of this quantitative study was to survey medical services professionals (MSPs) to determine which physician credentialing standards were being used, the sources being used, and the frequency of standards used. The dependent variables in this study were the 13 ideal credentialing standards developed by the National Association of Medical Staff Services (NAMSS). The independent variables were the methods MSPs use to satisfy the credentialing standard, or the way in which a hospital performs this function. The independent variables were measured using Likert-scale responses (always, almost always, sometimes, almost never, and never) and the dependent variables were measured by frequency of responses to each standard. A questionnaire was sent to 5,634 members of NAMSS. Findings from 364 responses indicated every facility had at least 1% of MSPs who almost never or never performed a particular standard in accordance with the ideal credentialing standards. A distribution table was used to measure the results, both individually and percentages of the total. To determine if there was a difference in credentialing standards based on hospital size or geographic location, a chi square was used. The results of this study demonstrated there are areas for improvement in physician credentialing. Results may be used to safeguard the public from fraudulent representation through implementation of a national credentialing standard.

Implementing effective strategies to address the challenges of volunteer engagement is critical for helping ensure the sustainability of nonprofit healthcare organizations. Nonprofit healthcare leaders seek strategies to increase the volunteer workforce and enhance volunteer engagement. Through the conceptual lens of Deci and Ryan's self-determination theory, the strategies nonprofit healthcare leaders used to reduce volunteer turnover were explored in this single-case study. Data were collected using semistructured interviews with 5 nonprofit healthcare leaders from a single organization in the southwestern United States. Analysis of internal and external organizational documents and publicly available data were manually coded and thematically organized. The use of a methodological triangulation process and member checking increased the reliability of data interpretation. Using the thematic approach, 3 themes emerged: volunteer recognition improved volunteer turnover, open communication improved volunteer turnover, and relationship building improved volunteer turnover. Nonprofit healthcare leaders can use these findings to gain a better understanding of how supporting the expectations, needs, and requirements of volunteers can improve engagement and reduce turnover. The findings from this study may contribute to positive social change by providing nonprofit leaders with strategies to reduce volunteer turnover, enhance operational processes, and improve organizational performance. Nonprofit healthcare leaders who develop volunteer engagement strategies can increase organizational success and develop successful work habits among volunteers to improve economic growth in communities they serve.

Some hospital emergency departments (EDs) are negatively affected by extended patient wait times, resulting in reduced hospital profitability. Therefore, it is critical hospital leaders understand factors impacting ED average patient wait times. Grounded in the business process improvement theoretical framework, the purpose of this causal comparative study was to examine the impact of an ED rapid evaluation unit (REU) patient flow model and emergency severity index (ESI) on average weekly patient wait times. Data collection comprised a census of 26 archival data records pre and postimplementation of an ED REU patient flow model from a hospital ED in Upstate New York from April 18-October 18, 2015, and October 19, 2015- April 19, 2016. The results of the mixed-method ANOVA indicated there was a significant time (pre and postimplementation) and emergency severity index interaction effect: Wilks lambda = .55, F(2, 24) = 9.86, p = .001, partial eta squared = .45. There was also a main effect for time: Wilks lambda = .72, F(1, 25) = 9.74, p = .005, partial eta squared = .28. In addition, there was significant main effect for ESI: Wilks lambda = .084, F(2, 24) = 130.28, p < .001, partial eta squared = .92. At ESI triage level 2, there was less difference in the door to provider time than there was for ESI triage level 4. The implications for social change include the potential to reduce patient wait times; improving on patient health outcomes and satisfaction.

The Centers for Medicare and Medicaid Services issued over 144,000 payments totaling $7.1 billion to medical facilities that have adopted and successfully demonstrated meaningful use of certified electronic health record (EHR). Hospital organizations can increase cost savings by using the electronic components of EHRs to improve medical coding and reduce medical errors and transcription costs. Despite the incentives, some rural health care facilities are failing to progress. The purpose of this multiple case study was to explore the strategies rural hospital leaders used to implement an EHR. The target population consisted of rural hospital leaders who were involved in the successful implementation of an EHR in South Texas. The conceptual framework chosen for this study was the sociotechnical systems theory. Data were collected through telephone interviews using open-ended semistructured interviews with 5 participants from 4 rural hospitals who were involved in the EHR implementation. Data analysis occurred using Yin's 5-step process which includes compiling, disassembling, reassembling, interpreting, and concluding. Data analysis included collecting information from government websites, company documents, and open-ended information to develop recurring themes. Several themes emerged including ongoing training, provider buy-in, constant communication, use of super users, and workflow maintenance. The findings could influence social change by making the delivery of health care more efficient and improving quality, safety, and access to health care services for patients.

Healthcare managers face an incredible challenge today; understanding and implementing financially and economically sound decisions in the complex healthcare environment of the United States. The pressure to be profitable managers is greater than ever. Considering current research, past studies, and articles focused on the demands of healthcare managers will illuminate the state of health care administration, and the importance of real world application of accounting and economics in healthcare. This thesis will explore and examine research about industry standards, and the need for preparedness in healthcare finance management. It will also examine the important and complex role of accounting and economics in healthcare administration by answering the three following questions: What do administrators, according to studies and literature available, believe is essential to becoming and remaining effective managers? What financial and economic concepts are understood and implemented by healthcare managers? What changes, if any, are necessary to adequately train and educate future healthcare administrators for successful financial management? The answers to these questions will highlight the impact of the economic, political, and social changes on administrators, as well as the best ways to succeed despite the difficulties often faced by those in this field.