<p> Shared leadership paradigms are becoming more popular in organizations because of the increased responsibilities placed on leaders within health care organizations. Researchers have conducted little research on how individuals on leadership teams perceive their role in engaging with others in their team. The qualitative phenomenological hermeneutic study involved examining how radiology administrators in Northern California describe their lived experiences on shared leadership teams, with an emphasis on their perceptions of team productivity and trust. The conceptual framework for the study included shared leadership theory, which scholars have noted is still a new field of study. Seven research participants representing from three to 18 years of experience as radiology managers with experience serving on shared leadership teams. From the five initial questions and sub questions, the analysis involved breaking down the responses into 175 separate areas of exploration. In addition to the demographics of the groups and types of teams served on, four themes emerged from this data: lived experience on shared leadership teams, knowledge and skills learned from shared leadership teams, key factors affecting team performance on shared leadership teams, and the effect of diversity on shared leadership teams. The implications of the research to leadership are that radiology managers may gain a better understanding of when to use shared leadership and how to best staff the teams to support organizational work, and how to improve shared leadership team dynamics.</p>

<p>Hospital leaders who fail to respond to poor patient satisfaction reports may experience lower organizational performance. The purpose of this qualitative case study was to explore strategies of leaders in private health care settings to improve patient satisfaction. This study may provide strategies that health care leaders in the public setting can apply to improve patient satisfaction and organizational performance. One private health care provider operating in Vancouver, British Columbia, Calgary and Edmonton, Alberta, was selected as both private and public healthcare centers are located in these areas. Data were gathered from 12 participant interviews and from an examination of available physical artifacts such as organizational documents provided by the participants and the company website. Transformational leadership was the underlying conceptual framework for this research. Triangulation was used to ensure the rigorousness of the study. In the study, themes were identified after member checking the transcribed open-ended interview questions. The 5 themes identified were cohesive culture of employee engagement, patient-focused model of care, timely access and follow-up of results and coordination of care, continuous system quality improvement, and employee accountability. These themes underscore the importance of a culture of employee engagement; they also illuminate care that focuses on the patient-care that ensures timely access, follow-up and coordination of care, quality improvement based on patient feedback, and employee accountability. Current publicly-funded hospitals and health care centers may apply these findings to improve patient satisfaction and organizational performance. </p>

<p> This quantitative study was an evaluation of the effectiveness of the online Training Home software program, designed for use with a national nonprofit business model. This study was undertaken because nonprofits have a difficult time resourcing training. If the Training Home program can deliver a comprehensive training program for minimal cost, then a nonprofit will be better able to deliver on the nonprofit&rsquo;s stated mission. For this study, six research questions centered on measuring the helpfulness of the program, the difference in job function training, improved knowledge of a national nonprofit, and perception of the Training Home program between those that had and or had not used the program. Additionally, cost per unit of training, the number of training vignettes delivered, time spent in training, ease of use by supervisors, and staff ratings of the effectiveness of the training home program. The population studied was the 450 staff at one affiliate of the national nonprofit. This staff group consisted of a mix of genders, ages, and education levels. This study used archival data gathered over the 2013, 2014, and 2015 calendar years and was analyzed using multivariate regression and descriptive analyses. The cost and number of training vignettes delivered in a 24-month period were compared to determine whether the Training Home program was a more cost-effective delivery model than the prior system for the year before the study. Analyses indicate that the Training Home program delivered more training to staff at a lower cost per unit of training when compared to the units of training delivered in the prior model. Supervisors and staff reported the program to be effective in knowledge management and tracking and the training of all staff. The study had positive results for the sample studied. It would be beneficial for any future studies to expand the sample size into other geographic regions.</p><p>

<p> This study examines methods and barriers to minority leadership recruitment in healthcare organizations. Minorities are underrepresented in healthcare organizations at the executive level, even though staff and patient demographics are becoming increasingly diverse. This disparity in minority representation presents the potential for staff and patient needs, interests, and values to be overlooked by senior management and the strategies, policies, and programs they implement. This study conducted interviews with human resources personnel at healthcare organizations identified as top performers to determine whether their organizations engaged in minority recruitment methods, what methods were successful, and what barriers existed to recruitment of minorities. These results were compared to survey data compiled by the Institute for Diversity in Health Management. The results show significant room for improvement in the implementation of comprehensive methods to recruit minority senior management, with significant variation among organizations in the amount and type of methods to recruit minority executives. These findings lead to the conclusion that more pressure needs to be placed on healthcare organizations to identify best practices in minority recruitment and implement these in formal, comprehensive human resources activities related to recruitment, retention, and professional development.</p>

<p> Strategic sourcing has long been utilized by organizations to maximize budget and supply chain efficiency, usually through leveraged buying, but also through the formation of strategic partnerships with suppliers. When considering leveraged buys, the strategic sourcing process begins with a spend analysis, and the data obtained during the analysis is used by stakeholders to begin defining requirements. Traditional spend analysis restricts the data used in the spend analysis process to basic transactional information, and does not considered corporate social responsibility objectives as part of the strategic sourcing process. This research modifies an existing spend analysis process framework, and applies the framework in a case study that uses additional data points to identify opportunities to allow an organization to simultaneously achieve both strategic purchasing and social responsibility objectives. The study also examines strategic healthcare purchasing in a single source environment, and combines best practices developed using decentralized purchasing strategies by healthcare facilities and successful buyer-supplier relationships from multiple industries to create a process map for hospital systems transitioning to strategic centralized purchasing models. Systems engineering frameworks, process modeling, regression analysis, and cross functional process maps are used in this study&rsquo;s analysis. (Abstract shortened by ProQuest.) </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> The United States (U.S.) healthcare system is the most expensive in the world. To improve the quality and safety of care, health information technology (HIT) is broadly adopted in hospitals. While EHR systems form a critical data backbone for the facility, we need improved 'work-flow' coordination tools and platforms that can enhance real-time situational awareness and facilitate effective management of resources for enhanced and efficient care. Especially, these IT systems are mostly applied for reactive management of care services and are lacking when they come to improving the real-time "operational intelligence" of service networks that promote efficiency and quality of operations in a proactive manner. In particular, we leverage operations research and predictive analytics techniques to develop proactive coordination mechanisms and decision methods to improve the operational efficiency of bed management service in the network spanning the emergency department (ED) to inpatient units (IUs) in a hospital, a key component of healthcare in most hospitals. The purpose of this study is to deepen our knowledge on proactive coordination empowered by predictive analytics in dynamic healthcare environments populated by clinically heterogeneous patients with individual information changing throughout ED caregiving processes. To enable proactive coordination for improved resource allocation and patient flow in the ED-IU network, we address two components of modeling/analysis tasks, i.e., the design of coordination mechanisms and the generation of future state information for ED patients. </p><p> First, we explore the benefits of early task initiation for the service network spanning the emergency department (ED) and inpatient units (IUs) within a hospital. In particular, we investigate the value of proactive inpatient bed request signals from the ED to reduce ED patient boarding. Using data from a major healthcare system, we show that the EDs suffer from severe crowding and boarding not necessarily due to high IU bed occupancy but due to poor coordination of IU bed management activity. The proposed proactive IU bed allocation scheme addresses this coordination requirement without requiring additional staff resources. While the modeling framework is designed based on the inclusion of two analytical requirements, i.e., ED disposition decision prediction and remaining ED length of stay (LoS) estimation, the framework also accounts for imperfect patient disposition predictions and multiple patient sources (besides ED) to IUs. The ED-IU network setting is modeled as a fork-join queueing system. Unlike typical fork-join queue structures that respond identically to a transition, the proposed system exhibits state-dependent transition behaviors as a function of the types of entities being processed in servers. We characterize the state sets and sequences to facilitate analytical tractability. The proposed proactive bed allocation strategy can lead to significant reductions in bed allocation delay for ED patients (up to ~50%), while not increasing delays for other IU admission sources. We also demonstrate that benefits of proactive coordination can be attained even in the absence of highly accurate models for predicting ED patient dispositions. The insights from our models should give confidence to hospital managers in embracing proactive coordination and adaptive work flow technologies enabled by modern health IT systems. </p><p> Second, we investigate the quantitative modeling that analyzes the patterns of decreasing uncertainty in ED patient disposition decision making throughout the course of ED caregiving processes. The classification task of ED disposition decision prediction can be evaluated as a hierarchical classification problem, while dealing with temporal evolution and buildup of clinical information throughout the ED caregiving processes. Four different time stages within the ED course (registration, triage, first lab/imaging orders, and first lab/imaging results) are identified as the main milestone care stages. The study took place at an academic urban level 1 trauma center with an annual census of 100,000. Data for the modeling was extracted from all ED visits between May 2014 and April 2016. Both a hierarchical disposition class structure and a progressive prediction modeling approach are introduced and combined to fully facilitate the operationalization of prediction results. Multinomial logistic regression models are built for carrying out the predictions under three different classification group structures: (1) discharge vs. admission, (2) discharge vs. observation unit vs. inpatient unit, and (3) discharge vs. observation unit vs. general practice unit vs. telemetry unit vs. intensive care unit. We characterize how the accumulation of clinical information for ED patients throughout the ED caregiving processes can help improve prediction results for the three-different class groups. Each class group can enable and contribute to unique proactive coordination strategies according to the obtained future state information and prediction quality, to enhance the quality of care and operational efficiency around the ED. We also reveal that for different disposition classes, the prediction quality evolution behaves in its own unique way according to the gain of relevant information. (Abstract shortened by ProQuest.) </p><p>

<p> Healthcare industry faces major challenges in providing care to the aging American population. Strong leaders are needed to address the chaotic, changing healthcare environment. The specific problem is the increasing lack of leaders to address healthcare organization issues involving aging, baby boomer workforce retiring. High-stress jobs and retirements create a leader gap. Succession planning and management (SPM) become significant to healthcare organizations to ensure an appropriately developed pool of internal candidates is available to move individuals forward as leadership positions become available. Leadership development (LD) is critical to SPM processes. Individuals require specific training and mentoring to develop skill sets to meet healthcare industry challenges. The purpose of this qualitative multiple case study was to obtain senior healthcare leaders&rsquo; perceptions on leadership practices and SPM processes; and explore if there was a link between LD practices and SPM in an integrated healthcare delivery system to query lived experiences for in-depth understanding. A sample of 11 interviews conducted with multi-levels of senior leaders from corporate to regional and local areas in Southern and Central California. Senior leaders guide SPM processes and implement LD practices. Three research questions guided interviews to seek senior leader perspectives on SPM processes and LD practice in healthcare organizations. NVivo, a computer-assisted data quality analysis software provided the ability to perform coding process following manual coding. Six themes identified involving the need for formal, structured SPM and leadership development to ensure the right person is in the right leader role. The selection process should begin at the employment interview for specific criteria. Measurable outcomes are needed on LD and SPM to ensure success and sustainability. The findings from the study are important in application to healthcare organizations to support an integrated, linked system of SPM and LD to ensure a pipeline to fill leader gaps successfully by identifying individuals from employment interview and through career movement. Future research is needed to enhance the study in various healthcare organization milieus. Qualitative research measuring outcomes would address effectiveness and sustainability of SPM and LD. Qualitative study with lower level leaders&rsquo; perceptions would corroborate importance of linking the concepts.</p><p>

<p> The healthcare industry is going through many changes. As we progress with technology, medicine, strategies, the current healthcare facilities will also need to be updated. In 1946, the first year of the baby boomer generation, it was noted that the time would come when they would retire and look for ways to have their healthcare needs met. With the recent recession, it made building new nursing homes very difficult. Aurora aims to provide services for the renovation and development of healthcare facilities that need to create or acquire space to meet the industry demand.</p><p>

Supply chains for time-sensitive products, and, in particular, for perishable products, pose specific and unique challenges. By definition, a perishable product has a limited lifetime during which it can be used, after which it should be discarded (Federgruen, Prastacos, and Zipkin (1986)). In this dissertation, I contribute to the analysis, design, and management of supply chain networks for perishable products with applications to healthcare. Specifically, I construct generalized network frameworks to capture perishable product supply chains in healthcare operating under either centralized or decentralized decision-making behavior. The dissertation is motivated by applications ranging from blood supply chains to pharmaceuticals, such as vaccines and medicines. The novelty of the modeling and computational framework includes the use of arc multipliers to capture the perishability of the healthcare product(s), along with waste management costs, and risk. The first part of the dissertation consists of a literature review of perishable product supply chains with a focus on healthcare along with an overview of the relevant methodologies. The second part of the dissertation formulates supply chains in healthcare operating under centralized decision-making behavior. In this part, I focus on both the operations management of and the sustainable design of blood supply chains and construct models for regionalized blood banking systems as belonging to the Red Cross. The third part of the dissertation considers competitive behavior, with a focus on the pharmaceutical industry. I construct an oligopoly supply chain network model, with differentiated brands to capture the competition among producers of substitutable drugs using game theory and variational inequality theory. Furthermore, using a case study based on real-world scenarios of a highly popular cholesterol-reducing branded drug, the impact of patent rights expiration of that brand is explored which coincides the time when its equivalent generic emerges into the markets. The calculated results are then compared to the observations from the real-word problem. Finally, the projected dynamical system formulation of the pharmaceutical network oligopoly model is derived. This dissertation is based on the following papers: Nagurney, Masoumi, and Yu (2012), Nagurney and Masoumi (2012), and Masoumi, Yu, and Nagurney (2012) as well as additional results and conclusions.