<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>

Thesis (Ph. D.)--University of Texas at Austin, 2002. / Vita. Includes bibliographical references. Available also from UMI Company.

<p> Public health agencies at all levels have struggled to identify the optimum structure to support administrative and programmatic efficiencies that will maximize public health impact with the available resources. Although public health effectiveness literature documents how a state health department should function to achieve the intended impact on population health, little is known about how organizational structure changes actually affect function, and ultimately, population health. Focusing on the chronic disease unit of a state health department, this case study examined attributes (how an organization is structured) and practices (how an organization operates). Methods for this case study included document review and key informant interviews of health department staff and external stakeholders. </p><p> Data analysis suggests that the relationship between attributes and practices is complex and that organizational structure may influence not just practice but also other attributes such as goal ambiguity and workforce competency. Although the correlation analysis did not show a significant association between effectiveness and any of the elements in the conceptual model, qualitative responses indicate a belief that evidence-based decision-making, goal ambiguity, political support, responsiveness, and workforce competency all facilitate effectiveness, and that collaboration plays a fundamental role in contributing to each of those elements. Structure was identified as an influence on collaboration, responsiveness, goal ambiguity, and hierarchical authority. However, the roles of three other elements&mdash;culture, leadership, and physical proximity&mdash;were less clear, and either mitigated the effects of structure, enhanced the effects of structure, or were amplified by structure. </p><p> This study has served both to document a point in time for Montana's Bureau of Chronic Disease Prevention and Health Promotion and to explore the elements of the conceptual model that may facilitate effectiveness for chronic disease units in other states, other units in within state health departments, and public health agencies at other levels. The results of the qualitative and quantitative analysis suggest interrelationships between the elements of the model rather than a simple linear cause and effect pathway. These findings identify levers around which capacity can be built that may strengthen the effectiveness of state health department chronic disease units.</p>

<p> The pace of globalization continues to accelerate, which is demanding new approaches to leadership. One area where global mergers, acquisitions, alliances, and partnerships have become commonplace is in the pharmaceutical industry. This growing globalization has made it significantly more important to understand how culture impacts and influences effective leadership. Outstanding global leadership will continue to be a business imperative for the future. </p><p> This study used a mixed-method approach to identify the characteristics and behaviors that contribute to outstanding global leadership and to recommend methods for developing these characteristics. For the quantitative portion of the study, the GLOBE Research Survey was administered to mid-level leaders in a global pharmaceutical company. The qualitative portion of the study included semi-structured interviews with a smaller set of participants from the original sample group. </p><p> The quantitative survey indicated that the characteristics of integrity, performance-oriented, inspirational, visionary, and decisive strongly contribute to outstanding global leadership. The qualitative interviews supported these findings and offered recommendations on how to develop these characteristics, including the implementation of role models, feedback, coaching, learning environments, and culturally diverse opportunities. </p><p> This study provides preliminary evidence that there are specific characteristics that contribute to outstanding global leadership. The results of this study may be used to contribute to the success of global corporations, specifically in the pharmaceutical industry.</p>

<p> The success of Chinese professional athletes is attributable to the government-run elite sport system; it is seen as one of the most effective and successful systems at nurturing high-skilled athletes. However, within the Chinese professional sport system, tensions between athletes' athletic skills and overall personal development have been widely documented. Among all studies, very few have employed in-depth interviews with professional wushu athletes. In this study, the researcher utilized in-depth semi-structured interviews with professional wushu athletes from three of the 25 professional wushu teams in mainland China. The study was conducted in order to understand the potential conflicts between athletes' athletic skills development and overall personal development. Findings revealed that athletes bear the training at great cost to their future potential as self-sufficient members of Chinese society. Their academic, social, and vocational skills are subject to deep neglect that negatively impacts their post-competition careers. The system considers investment in preparation for the post-competitive lives of the athletes to be a distraction from, or even an impediment to, their success in competition. It is suggested that the Chinese sport system undertake a review and reformation of its approach to wushu training to provide athletes with the skills needed to successfully navigate a life outside of athletics.</p>

<p> The Bureau of Labor Statistics projected a shortage of registered nurses (RNs) growing to an estimated 581,500 by the year 2025 (an increase of 22 percent since 2008). Recent economical downturns have found many healthcare organizations experiencing a positive effect with the stabilization of nursing turnover. Once the economy begins to recover, however, experts predict the profession of nursing will still face the largest shortage in history according to projections by the American Nurses Association. Because lack of job satisfaction is a precursor to resignation, additional research regarding the identification of interventions that increase RN job satisfaction may result in retaining professionally qualified and prepared staff. This study proposed to identify through focus groups, staff nurse perceptions of nurse manager behaviors that influence RN staff nurse job satisfaction. A sample of 28 RNs, each participating in one of five focus groups, answered questions related to satisfaction with nurse manager behaviors. The investigator used qualitative content analysis to identify patterns within and across focus group data. </p><p> Major findings of the study resulted in the identification of two conceptual categories (manager behaviors supportive of RNs and RN's perceived disconnect of work issues from the manager's role) and three major themes related to supportive behaviors (communication, respect, and feeling cared for). The results suggest the following as staff nurse preferences for nurse manager behaviors: open and honest communication that involves listening, consistency, and confidentiality; an increased level of respect including fairness and recognition of a job well done; and the sense of feeling cared for as when a manager meets individual needs and supports staff as professionals. The investigator compared the categories and themes to previous tools used in healthcare, which indicate the need for further item and/or tool development as well as further research regarding RNs' perceived disconnect of work issues from the manager's role.</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>