From 2014 to 2015, deficiency fines cost Pennsylvania nursing homes more than $2.5 million. Costs associated with adhering to increased health care regulations can reduce profit and affect the financial sustainability of the nursing home industry. Some nursing home administrators (NHAs) lack successful strategies to improve state and federal regulation compliance and promote financial sustainability. Drucker's management by objectives theory was the conceptual framework for this study. The purpose of this qualitative multiple case study was to explore successful strategies NHAs use to improve state and federal regulation compliance to mitigate deficiencies and derivative fines to promote financial sustainability of nursing homes. NHAs who manage 5-star rated nursing homes within a 100-mile radius of Pittsburgh, Pennsylvania use effective management strategies to mitigate deficiencies and derivative fines to earn a 5-star rating which, helps promote financial sustainability. Data were collected from semistructured face-to-face and telephone interviews with 4 NHAs and from Medicare's Nursing Home Compare website. The data on the website provided information on the 3 domains of health inspections, staffing, and quality measures, that made up the overall star rating of nursing homes. Data were analyzed using Yin's 5-phase cycle. The findings revealed 3 major themes: develop knowledgeable staff, enhance communication with staff and residents, and promote innovation for continuous quality improvement. The implications for positive social change could include increased quality of patients' health care, creation of employment opportunities to promote prosperity in communities, and financial sustainability in the United States nursing home industry.

Visam pasaulyje stebimos tendencijos ieškinių dėl gydymo metu patirtos žalos daugėjimo, kurios neabejotinai palies ir Lietuvą. Gydytojų ir paciento santykių institutas formavosi įtakojamas etikos, teisės ir medicinos mokslų. Šių mokslų specifikos nepakankamas įvertinimas, sprendžiant gydytojų civilinės atsakomybės klausimus, kaip ir netinkamas šių santykių teisinis reguliavimas ir teismų formuojama teisės normų aiškinimo praktika, žinomi, kaip svarbiausi veiksniai įtakojantys „gynybinės medicinos“ praktikavimą, darantį didelę žalą sveikatos priežiūros sistemos finansiniams ištekliams ir sukeliantį papildomos žalos riziką pacientams. Gynybinę mediciną nuo rūpestingo ir atidaus gydytojo pareigos vykdymo skiria labai plona ir lengvai peržengiama linija. Lietuvoje esantis sveikatos priežiūros paslaugų teisinio reguliavimo nenuoseklumas, vieningo gydytojų etikos kodekso nebuvimas, neįgyvendinta bendrų diagnostikos ir gydymo metodikų koncepcija, sukelia teorinį pavojų atsirasti naujoms civilinės atsakomybės taikymo problemoms. Teismų praktikoje įtvirtintas maksimaliai atidaus, rūpestingo ir kvalifikuoto gydytojo elgesio standartas, vertinant jį pasaulinės teismų praktikos ir medicinos specifikos požiūriu, turi būti keistinas, kaip nustatantis nerealius ir neįgyvendinamus kriterijus, galinčius tapti pagrindu neteisingam gydytojų civilinės atsakomybės taikymui. Skirtingai nuo aiškių kriterijų vertinant paciento informavimo institutą, priežastinio ryšio nustatymas, bylose dėl gydytojų... [toliau žr. visą tekstą] / All over the world we observe a tendency for the increase of claims for damages of treatment that will with no doubt come to Lithuania. The establishment of the institute of doctor and patient was influenced by the science of ethics, law and medicine. The fact that these sciences were underestimated when discussing doctors’ liability as well as improper legal regulation and explanation of normative legal acts formed by courts are the main factors that brought “defensive medicine” in practice, that makes a lot of harm to the formation of the health care system financial recourses and puts the patients in the risk of getting additional damage. Thoughtful and attentive doctors’ duties and “defensive medicine” is separated by a hairline which is easy to trespass. The incoherence of the health care legal regulations in Lithuania, the non-existence of united doctors’ ethic code, the unfulfilled concept of diagnosis and treatment bring a danger of emerging new problems in applying the civil liability. A standard of most attentive, careful and qualified doctor treatment is established in court practice. It has to change taking into consideration the worldwide court practice and particularities of medicine as that sets unrealistic and impracticable criteria, which makes base for misapplication of doctors’ civil liability. Differently from the clear criteria for the evaluation of the institute of patient information, the establishment of causality in cases of doctors’ civil liability... [to full text]