<p> This dissertation used a mixed-methods approach to investigate both how intergovernmental relationships influence collaboration between regulators and to what extent their regulatory tools affect nursing home regulatory violations. Chapter 1 examines the impact of the five-star quality rating system and market competition on nursing home violations. Chapter 2 explores the intergovernmental relationships between state and federal regulators and whether it is facilitated by collaborative action. Chapter 3 evaluates the impact of two government tools (one direct and one indirect) and their association with regulatory compliance in nursing homes. The findings suggest that the five-star quality rating system has a positive association with nursing home providers&rsquo; regulatory compliance. Meanwhile, communication among regulators appears to be the key to collaboration, and the current structure of their regulatory regime might be inhibiting collaboration. Furthermore, the findings suggest that the direct governance tool leads to improvements in subsequent regulatory compliance as compared to the indirect tool. These three essays on the intergovernmental regulation of nursing homes and the specific regulatory tools contribute to the future policy decisions that affect the well-being of approximately 1.4 million individuals residing in nursing homes and primarily funded by the public.</p><p>

<p> In the U.S. medical sector, software failures in safety-critical systems in healthcare have led to serious adverse health problems, including patient deaths and recalls of medical systems. Despite the efforts in developing techniques to build resilient systems, there is a lack of consensus regarding the definition of resilience metrics and a limited number of quantitative analysis approaches. In addition, there is insufficient guidance on evaluating resilience design patterns and the value they can bring to safety-critical systems. </p><p> This research employed the interdependency analysis framework to evaluate the static resilience of safety-critical systems used in the healthcare field and identified software subsystems that are vulnerable to failures. Resilience design patterns were first implemented to these subsystems to improve their ability to withstand failures. This implementation was followed by an evaluation to determine the overall impacts on system&rsquo;s static resilience. </p><p> The methodology used a common medical system structure that collects common attributes from various medical devices and reflects major functionalities offered by multiple medical systems. Fault tree analysis and Bayesian analysis were used to evaluate the static resilience aspects of medical safety-critical systems, and two design patterns were evaluated within the praxis context: <i> Monitoring</i> and <i>N-modular redundancy</i> resilience patterns. </p><p> The results ultimately showed that resilience design patterns improve the static resilience of safety-critical systems significantly. While this research suggests the importance of resilience design patterns, this study was limited to explore the impact of structural resilience patterns on static resilience. Thus, to evaluate the overall resilience of the system, more research is needed to evaluate dynamic resilience in addition to studying the impact of different types of resilience design patterns. </p><p>

<p> Supporting new nursing graduates (NGs) through the professional socialization transition process has been an ongoing challenge facing nursing leaders. As NGs begin their professional socialization transition process, they begin to acclimate themselves to their job responsibilities. Employers provide NGs with established education and training without established evidence-based sources of support. The literature frequently indicated that institutional support for NGs is provided or should be provided without describing how this is accomplished. Without support for NGs during their professional socialization transition period, they could feel unsatisfied within their roles and resign from their positions or leave the nursing profession. The purpose of this research study was to explore the reflective perceptions of NGs regarding the support they received as well as what support they would have liked to receive during their professional socialization transition process. Through this study, this researcher began to describe the support that NGs desire to successfully transition from NGs to registered nurses.</p><p>

<p> The Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct Community Health Needs Assessment (CHNA) every three years, formulate implementation strategies, and report yearly to the IRS and the public the progress of their work. The IRS CHNA incentivizes hospitals to provide programs responsive to community health needs. The purpose of this study was to examine the relationship between community benefit programs and prioritized community health needs in the context of a national IRS reporting requirement through analysis of published community benefit reports among North Carolina&rsquo;s (NC) tax-exempt hospitals. </p><p> This study employed quantitative research that analyzed longitudinal and cross-sectional data; qualitative research that reviewed published documents; and mixed-methods research that analyzed the integrated quantitative and qualitative results. The findings indicate that performing IRS-mandated CHNA did not substantially increase the alignment of community benefit programs with prioritized community health needs but did clearly highlight those needs. NC tax-exempt hospitals continue to focus on providing patient care financial assistance than population health, a strategy misaligned with community health needs. Although the hospitals are beginning to address population health and access to care concerns, their dollar expenditures in these areas paled in comparison to patient care financial assistance. If the IRS&rsquo; purpose in mandating CHNA was to spur a shift in community benefit priorities toward population health needs and away from the traditional patient care financial assistance, then, the evidence from 4 years after the requirement&rsquo;s implementation, indicates it is currently failing in North Carolina. As elucidated in the articles, their ingrained patient-level intervention perspective and desire to recover high unreimbursed costs or lost revenues for providing care to Medicare, Medicaid, and poor patients likely influence the hospitals&rsquo; community benefit programming to favor individual welfare over population health. Nevertheless, policymakers should continue to direct community benefit programs toward population health because it is a step in the right direction. Organizational change takes time and the desired results of policy interventions are usually incremental. Thus, conducting CHNA must remain a legal obligation by non-profit hospitals for maintaining their privileged tax status to facilitate organizational paradigm shift in community benefit programming toward population health programs or community building activities and away from individual welfare.</p><p>

<p> Millions of women are diagnosed with breast cancer every year in the United States. In San Bernardino County breast cancer rates are increasing each year among Asian American women. It is considered to be the second leading cause of death compared to other cancers among Asian women. In the Inland Empire, there is a lack of health services aimed specifically at Asian Americans. The foundation aspires to be culturally competent and bring breast cancer awareness to all women. Through an expansive service that includes a navigation program lead by breast cancer survivors, outreach to local health care institutions for breast cancer screenings, as well as offering mental health counseling and seminars to help women and their families cope with their diagnosis as well as post-treatment care. The Breast Cancer Foundation for Asian American Women (BCFAAW) is a not-for-profit organization that aims to provide education, support, and advocacy for the Asian community throughout the Inland Empire. </p><p>

<p> As healthcare consulting continues to grow, the improvement in healthcare companies&rsquo; finances, information technology, marketing, and management continues to increase as well. Despite this increase, one form of healthcare consulting is lacking. This is where HC³ (Healthcare Corporate Culture Consulting) steps in. HC³ will act as a consulting firm that will focus on the improvement of a healthcare company&rsquo;s culture and operations. It will work with different types of healthcare companies to improve their strategy, marketing, culture, training, and talent development. The following business proposal aims to provide a comprehensive analysis of how HC³ or Healthcare Corporate Culture Consulting aspires to change the way healthcare is operated today. The business proposal has been organized in four chapters: market analysis, feasibility analysis, legal and regulatory analysis, and financial analysis, so as to detail exactly how these changes will be carried out.</p><p>

<p> Despite the level of organizational investment in training and performance improvement, little is known about the use of different models of case management as interventions for the ever-increasing health care issues in the United States. Based on Van Tiem, Moseley, and Dessinger's Performance Improvement/Human Performance Technology model, this case study used qualitative semi-structured interviews and quantitative archival aggregate patient data to answer the following research questions: RQ1. How did the implementation of the triad model of case management process improvement change case management processes and implementation methods? RQ1a. What happens to key performance indicators (cost of service, patient satisfaction, and quality of care) when the triad model of case management process improvement is implemented? RQ2. How did acceptance and resistance to a new case management model manifest themselves during the implementation of the triad model of case management process improvement intervention? Seven hospital employees answered questions regarding possible resistance to change during the implementation phase of this model of case management. Data analysis included comparisons of the participants&rsquo; responses regarding cost of care, quality of care, and satisfaction with services to quantitative archival measures of those variables. Mean comparisons of all three areas, cost of service, quality of care, and satisfaction with services, revealed that differences before and after implementation of the triad model were not significant. Participant interviews provided general indications that cost of service, quality of care, and satisfaction with services improved with the intervention of the triad model of case management. Participants generally also approved of the change to the triad model of case management following an initial period of concern about work disparity, which resolved with the separation of utilization review and case manager job duties. Recommendations for future research include waiting beyond the time frame used in this study to assess for change and further evaluating possible resistance to change in an organization using emerging trends in human performance technology (HPT) and the completed HPT process.</p><p>

<p> The growth in the older adult population will result in an increasing number of individuals with functional and cognitive limitations. The demand for nursing home administrators will grow proportionately with the aging population and the need for effective leadership within nursing homes is and will continue to be imperative as the population ages. Identifying top-rated nursing homes that provide quality care is essential to understanding the operations of successful long-term care facilities. Nursing home administrators (NHAs) are tasked with leading and directing provision of skilled, intermediate and rehabilitation care on a 24-hour basis while ensuring high quality operations. Identifying the character strengths of nursing home administrators who lead exemplary nursing homes may benefit other nursing home leaders who lead lower rated or underperforming facilities. In this qualitative study, 19 nursing home administrators who lead exemplary facilities across Indiana completed the Value in Action Inventory Strengths (VIA-IS) questionnaire and engaged in face-to-face interviews. Analysis of the interview data via NVivo indicated how the use of character strengths is crucial to effective leadership within long-term care. Creativity, fairness, bravery, perspective, and judgment were identified by a majority of study participants as essential to decisionmaking and problem solving, especially in a heavily regulated environment. Humor, hope, courage, and spirituality were acknowledged as contributing to a positive and optimistic environment. Humor, hope, courage, and spirituality were also noted as coping mechanisms when faced with stress and adversity. Honesty, kindness, love, teamwork, and gratitude were emphasized by the study participants as essential to relationship development and formation of trust with staff, residents, and families. This study allowed participants the opportunity to reflect on their own character strengths and leadership both personally and professionally. This reflection resulted in increased self-awareness and appreciation of their staff, residents, and roles as nursing home administrators. </p><p>

<p> Mental health-related cases in the United States today are largely attributed to employment. Healthcare professionals in particular are at increased risk for mental health adversities due to stress, burnout, and chronic fatigue. As a result, healthcare workers become an occupational hazard and a hindrance to an organization&rsquo;s service delivery. The lack of adequate job resources and positive work climate and conditions have been found to contribute to employee stress and burnout. Organizations can then increase the health and wellness of their employees with the adoption of green and environmentally conscious workplace setting designs and expect a significant economic return annually. Having an all-inclusive green business plan such as that of GreenSpace, LLC&rsquo;s consulting company will supplement and fill in the gaps of existing research regarding the benefits of exposure to greenery and mental health in the healthcare workplace. GreenSpace, LLC, adopts the concept of green building by designing sustainable and health-conscious work spaces within the healthcare sector that seek to improve employee wellness, fuel environmental sustainability, and thus increase its clients&rsquo; profit. The company intends to distribute its services within the Orange County area; where over 10% of its working population belongs to healthcare, to the largest healthcare industries and employers. GreenSpace, LLC is poised for success and promises to target this industry. In what follows is GreenSpace, LLC&rsquo;s business plan which includes an analysis of the market, feasibility, SWOT, legal and regulatory issues, and assumptions for expenses under which the company will distribute its services.</p><p>

<p> Employee burnout has been a toxic concern in today&rsquo;s American workforce. The prevalence of stress in the healthcare workplace is costing America billions of dollars and leading to medical errors, absenteeism, and turnover. Research indicates that human-animal bond provides physical, physiological, and psychological health benefits for professionals. This project will present the benefit of human-animal interactions (HAI) therapy in promoting the well-being in healthcare professionals. It will address services which will deliver to healthcare employees in the convenience of their workplace as well as educate the reader about the role animals play in humans&rsquo; lives. A combined minimal overhead cost and scientifically-proven health benefits of HAI, overall enhanced feelings of employee well-being and decreased animal abandonment are the strengths to this project. Finally, a discussion outlining the market, feasibility, legal and regulatory considerations and the proposal of financial analysis to deliver the project&rsquo;s value with specific services from the human-animal interactions program.</p><p>