Thesis (Ph. D.)--University of Missouri-Columbia, 2008. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "August 2008" Includes bibliographical references.

Free-standing birth centres (FSBCs) were formed in Ontario in 2014 and operate with the support of birth centre aides (BCAs), a novel birth worker role. As a recent introduction to the Ontario maternity care system, there have been no academic inquiries into BCAs and only a hand full of investigations on birth centres (Mattison, 2015; Mattison et al., 2020; Murray-Davis et al., 2014; Sprague et al., 2018). From a feminist perspective, an analysis of the BCA role offers a unique opportunity to conduct a feminist analysis of work in healthcare between largely women care providers (i.e., midwives and BCAs), leadership, and reproductive justice activism. My dissertation consists of three standalone papers based on empirical data gathered through in-depth semi-structured interviews and document analysis at the Ottawa Birth and Wellness Centre (OBWC). For my first paper, “Mapping the Development of Birth Centre Aides at the Ottawa Birth and Wellness Centre”, I applied a feminist sociology of professions framework (Davies, 1996; Witz, 1992) and employed an institutional ethnographic methodology (Smith, 1990) to understand how the BCA role was developed and operationalized in the OBWC. I mapped the development of the BCA role at the OBWC descriptively and visually using the documentary and interview data with key stakeholders from the OBWC (n=16), including BCAs, administrators, and midwives. In the second paper, “Feminist Leadership in Healthcare: The Case of Birth Centre Aides and the Ottawa Birth and Wellness Centre,” I integrated Tronto’s (1993) ethic of care with Dickson and Tholl’s (2014) LEADS in a Caring Environment leadership framework in an instrumental case study (Stake, 2005) to understand how BCAs lead from their position within the OBWC and how they experience feminist leadership practices in the OBWC. Finally, in my third paper, “Birth Work as Reproductive Activism: The Case of Birth Centre Aides at the Ottawa Birth and Wellness Centre,” I applied a reproductive justice theoretical framework (Ross, 2017; SisterSong, 2015) through an instrumental case study (Stake, 2005) to understand how BCAs undertake quiet reproductive activism at the OBWC. Taken together, my dissertation offers new knowledge on the role and development of BCAs in the OBWC and contributes to advancing feminist scholarship on healthcare leadership and reproductive justice activism.

Reducing hospital readmissions is critical to the success and sustainability of both hospitals and the communities in which they reside. The purpose of this multiple case study was to explore organizational strategies hospital leaders use to reduce hospital readmissions. The study was limited to hospitals in Southwest Missouri with readmission rates below the state average. Complex adaptive systems was the conceptual framework for the study because of the complex nature and numerous stakeholders of the healthcare system. Data were collected from a purposive sample of 15 hospital leaders via semistructured interviews and an analysis of organizational artifacts. Member checking was used to increase reliability and validity of the results. Data analysis was conducted using Yin's 5 step process including qualitative analysis software to identify major and core themes. The major themes identified in the study included population health, hospital operations and patient interactions, leadership and mission, and barriers to reducing readmissions. The implications for positive social change include the potential to improve services hospital team members provide to patients, which may improve the overall health of the communities they serve. By promoting improved health outcomes for local communities, society benefits through reduction of costs to the federal government and an overall improvement in the health of communities.

abstract: Nurses are using health information technology during patient care activities in acute care at an unprecedented rate. Previous literature has presented nurses' response to technology obstacles as a work-around, a negative behavior. Using a narrative inquiry in one hospital unit, this dissertation examines nurses' interactions when they encounter technology obstacles from a complexity science perspective. In this alternative view, outcomes are understood to emerge from tensions in the environment through nonlinear and self-organizing interactions. Innovation is a process of changing interaction patterns to bring about transformation in practices or products that have the potential to contribute to social wellbeing, such as better care. Innovation was found when nurses responded to health information technology obstacles with self-organizing interactions, sensitivity to initial conditions, multidirectionality, and their actions were influenced by a plethora of sets of rules. Nurses self-organized with co-workers to find a better way to deliver care to patients when using technology. Nurses rarely told others outside their work-group of the obstacles that occurred in their everyday interactions, including hospital-wide process improvement committees. Managers were infrequently consulted when nurses encountered technology obstacles, and often nurses did not find solutions to their obstacles when they contacted the Help Desk. Opportunities exist to facilitate interactions among nurses and other members of the organization to realize better use of health information technology that improves quality and safety while decreasing cost in the patient experience. / Dissertation/Thesis / Ph.D. Nursing and Healthcare Innovation 2013

The purpose of this research project was to examine whether frontline nurse managers who had attended a leadership program, perceived their leadership style as containing behaviors representative of transformational leadership. A secondary purpose was to determine the participant's opinions about the value of a leadership program for their practice. Current literature was utilized to support this research project examining a nursing systems issue.The primary instrument used to collect data about leader practice was the Leadership Practices Inventory (LPI) (University of Georgia, 2002). An evaluation tool was also designed and utilized to gather information about the participant's perception of their leadership behaviors after completion of a training program. Survey participants were selected from nurses who completed the Arizona Healthcare Leadership Academy (AzHCLA) (2007) course in the last four years.A course survey and results from the LPI revealed that study participants perceived an increase in their behaviors related to leading others as well as having learned new skills by having completed the AzHCLA course. Nurse's educational levels were compared to the five leadership practice subgroups from the LPI to examine whether a nurse's educational level could better account for an increase in leadership competencies. Research data revealed that no relationship between educational levels existed but that certain leadership skills were gained by having completed a leadership educational program. By using descriptive statistics, mean scores were used to identify differences in how nurses perceived their individual competencies and behaviors after having completed leadership education. Reported perceptions of competencies and behaviors indicated that educational programs can be beneficial to frontline nurse leaders.While results from an ANOVA showed there was no statistical significance related to education and LPI subgroups, there was a trend in the mean differences for those individuals with a master's degree. Qualitative data revealed that course participants perceived having gained new leadership skills and behaviors. The data from this study created a baseline of information that warrants further investigation to identify if indeed education makes a difference in perceived leadership practices.

Background:Sweden is known for having a good infrastructure in health care that enables the medical profession to provide effective patient care. The pandemic struck the world in March 2019 and has since then shown transparency, strengths and weaknesses in the system. Transit zones, modern solutions, and overworked staff have been noticed. The medical teams have been affected and the medical leaders with the right leadership skills have therefore been more important than ever.   Problem statement:The management and leadership structure are interconnected in health care, but there are some distinguishments, like personnel administration and budgeting within management, and vision and inspiration within the leadership concept. Physician leadership is provided in medical teams on wards and this person has two job responsibilities, as a leader and as a specialist. Their job has been greatly challenged these two years with an overloaded system and overworked staff. It has therefore been of great interest to provide good leadership.   Research purpose:The purpose of this thesis is to examine how Swedish physician leaders maintain good managerial power in a complex system and elaborate on the situational theory in health care. This is investigated by interviews with medical professions in different specialties. The findings are expected to contribute additional insights to the previous theoretical framework on contingent leadership. Method:This study has used a qualitative research design by conducting 8 semi-structured interviews. An interpretive paradigm was applied, and the data was supported by the theory which allowed subjectivity from the interviewed. The judgment sampling presented medical professionals that have worked during the pandemic on different wards, but with different amounts and different kinds of experience in health care. A thematic analysis was used for data analysis, providing the research with reflection regarding the professions’ experience of a medical team and the effect the crisis had on it.   Results:The work cycle is coherent for all professions, yet complex and changeable throughout the day. The physician leader is responsible for patient rounds and patient care and must be situational since the job comes with different challenges and work. Communication is deeply important in providing a good environment for team members’ competency improvement, as well as making them feel empowered. The team must have a hierarchy in emergencies and in crises, but it must be neglected in other situations, for example during consultations between a nurse and a physician. Subjective perception of the balance between these two must be present from a leader’s point of view, and health care lacks education on this perspective today. At the same time, the follower must be aware of the team structure in the room and not overestimate their own legitimacy. The professional designated color of the badge is there for the reason; to maintain order.

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