<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.

<p> The purpose of this systematic review was to examine the factors associated with clinicians' effectiveness as first-time healthcare managers. The high demand for clinicians to become healthcare managers has been predicated on their strong clinical knowledge and their credibility among their peers. While existing medical expertise and credibility among peers are crucial when transitioning into management, there are other factors that could impact clinicians' effectiveness as first-time managers. Utilizing a conceptual framework that incorporates motivation theory, social identity theory, leader&ndash;follower theory, and leader&ndash;member exchange theory, this research sought to identify factors associated with the effectiveness of clinicians as first-time healthcare managers. Evidence from 67 studies was analyzed using a thematic synthesis approach. The following six major factors were identified as factors that are associated with clinicians' effectiveness as first-time healthcare managers: (1) clinicians' motivation to transition into management, (2) clinicians' ability to detach from their social identity as clinicians and adopt a new social identity associated with their new role, (3) quality and convenience of formal developmental programs, (4) utilization of succession planning, and (5) cultural alignment. Based on the findings of this study, implementation of evidence-based succession planning programs would allow organizations to identify current and future open management positions, to systematically screen high-potential clinicians who are motivated to solve healthcare issues and achieve excellence, and to provide convenient and high-quality in-house management training and mentorship programs prior to role transition.</p><p>

This work is an examination of contemporary public policy implementation. It seeks to isolate those features which need to be incorporated into implementation theory to assist in the analysis of the implementation of public policy The &quot;new right&quot; ideology requires that a particular organisational form be adopted by public implementing agencies. This form must reflect the need to introduce competition, the precepts of the &quot;new managerialism&quot; and to view the user of the public services as a &quot;customer&quot;. These three elements will have a bearing on the process of the implementation. In particular, the need to regard the user of the services as a consumer implies that these users have an active part to play in the implementation process. The primary aim of the dissertation is to examine the nature and extent of the users involvement. A secondary aim seeks to develop and test a model of policy implementation which can incorporate the so called &quot;top down&quot; and &quot;bottom up&quot; perspectives of policy implementation. The model incorporates features which facilitate the analysis of contemporary policy implementation. These features include: the need to recognise the large amount of conflict and bargaining which is characteristic of multi - agency implementations, the dynamic and interactive nature of the process and the inclusion of the consumer as part of the process. The research uses the implementation of N.H.S. and Community Care Act (1990) in a shire county in order to examine these issues.

Objetivo: Este artigo tem como objetivo avaliar o impacto da implantação da estratégia de triagem com classificação de risco e da unidade vascular no processo assistencial dos pacientes atendidos no serviço de emergência do Hospital de Clínicas de Porto Alegre, HCPA. Método:Trata-se de um quasi-experimento em que 3.700 pacientes atendidos na emergência nos meses de março a maio de 2005 e 4.954 pacientes atendidos no mesmo período de 2007, após a implantação das novas tecnologias, tiveram seu processo de atendimento medidos e comparados.O impacto da reorganização do serviço com a implantação destas tecnologias foi avaliado através da comparação dos indicadores de “Tempo de Permanência”, “Tempo de espera para realização de Exames” e “Tempo de espera para realização Cirurgias e Procedimentos” de todos os pacientes atendidos e especificamente dos pacientes com doenças cardiovasculares. Resultados: O tempo mediano de triagem de todos os pacientes foi de 11,8 minutos (0-92,5) e de 6,3 minutos (0-53) dos pacientes com doenças cardiovasculares. Foi evidenciado aumento significativo da mediana de tempo de permanência: 2005: 12,3h (0-510,8) e 2007:15,5h.(0-388,9), P<0,001. O mesmo ocorreu com os pacientes cardiovasculares que passaram de uma mediana de tempo de permanência de 24,5h (0,5- 341) em 2005 para 74h (0,6 -287,h), P <0,001.O exame de tomografia de crânio apresentou redução significativa no tempo mediano de espera para todos os pacientes 2005: 4h (0,08-76,4), 2007: 3h (0,2-62,7), P =0,006,e para os pacientes com doenças cardiovasculares, 2005: 4,2h (0,5-15,9), 2007: 0,9h (0,5-7,9), P =0,001.O cateterismo cardíaco realizado pelos doentes cardiovasculares agudos apresentou uma redução significativa no tempo mediano de espera, 2005: 55,6h (31,2-90,4) e 2007 13,6h (0,6-97,6), P =0,025. Conclusão: Embora tenha havido aumento de 25,3% nos casos atendidos entre 2005 e 2007, acompanhado do aumento da mediana de idade, do escore de gravidade e de casos demandando procedimentos cirúrgicos, a implantação de estratégia de triagem com estratificação de risco e da unidade vascular em serviço de emergência de hospital universitário esteve associada à redução dos tempos de espera para procedimentos diagnósticos e terapêuticos considerados como essenciais em pacientes com síndrome vascular aguda. / Objective: This study assesses the impact of implementing a strategy of screening using risk rating and creating a vascular unit for patients admitted to the emergency department of Hospital de Clinicas de Porto Alegre. Method: This study describes a quasi-experiment in which 3700 patients treated at the emergency department from March to May 2005 (P1) and 4954 patients treated during the same months of 2007 (P2), after the introduction of new care technologies. The process of care was measured and compared. The impact of department reorganization with these technologies was evaluated comparing length of stay, length of stay to perform tests and length of stay to perform surgery or procedure, measured for all patients and specifically for cardiovascular disease patients. Results: Screening median time was 11.8 min (0-92.5) for all patients and 6.3 min (0- 53) for cardiovascular disease patients. Our results showed a significant increase in median length of stay from P1 to P2 for all patients, 12.3 min (0-510.8) and 15.5 hr (0-388.9) respectively, P < 0.001. Cardiovascular disease patients had a median length of stay of 24.5 min (0.5-341) and 74 hr (0.6-287) in 2005 and 2007 respectively. Cranial tomography scan had a significant time reduction for all patients from P1 to P2, 4 hr (0.08-76.4) and 3 hr (0.2-62.7) respectively, P = 0.006, and for cardiovascular disease patients 4.2 hr (0.5-15.9) and 0.9 hr (0.5-7.9) respectively, P = 0.001. Cardiac catheterization for acute cardiovascular disease patients showed a significant decrease in median waiting time, from 55.6 min (31.2- 90.4) in P1 to 13.6 min (0.6-97.6) in P2, P = 0.025. Conclusion: Although there was a 25.3 percent increase in admitted patients from 2005 to 2007 and an increase in age, severity score and surgical patients, the implementation of a screening strategy with risk stratification and creation of a vascular unit in the emergency department was associated with reduction of waiting times of diagnostic and therapeutic procedures for acute cardiovascular disease patients.

Background: Diabetes prevalence in Scotland is increasing at ~4.6% annually; 247,278 (4.7%) in 2011. My Diabetes My Way (MDMW) is the NHS Scotland information portal, containing validated educational materials for people with diabetes and their carers. Internet-based interventions have potential to enhance self-management and shift power towards the patient, with electronic personal health records (PHRs) identified as an ideal method of delivery. In December 2010, a new service was launched in MDMW, allowing patients across Scotland access to their shared electronic record. The following thesis aims to identify and quantify the benefits of a diabetes-focused electronic personal health record within NHS Scotland. Methods: A diabetes-focused, population-based PHR was developed based on data sourced from primary, secondary and tertiary care via the national diabetes system, Scottish Care Information - Diabetes Collaboration (SCI-DC). The system includes key diagnostic information; demography; laboratory tests; lifestyle factors, foot and eye screening results; prescribed medication and clinical correspondence. Changes are tracked by patients over time using history graphs and tables, data items link to detailed descriptions explaining why they are collected, what they are used for and what normal values are, while tailored information links refer individuals to facts related to their condition. A series of quasi-experimental studies have been designed to assess the intervention using subjectivist, mixed-methods approaches incorporating multivariate analysis and grounded theory. These studies assess patient expectations and experiences of records access, system usage and uptake and provide preliminary analysis on the impact on clinical process outcomes. Survey questionnaires were used to capture qualitative data, while quantitative data were obtained from system audit trails and from the analysis of clinical process outcomes before and after the intervention. Results: By the end of the second year, 2601 individuals registered to access their data (61% male; 30.4% with type 1 diabetes); 1297 completed the enrolment process and 625 accessed the system (most logins=346; total logins=5158; average=8.3/patient; median=3). Audit trails show 59599 page views (95/patient), laboratory test results proving the most popular (11818 accesses;19/patient). The most utilised history graph was HbA1c (2866 accesses;4.6/patient). Users are younger, more recently diagnosed and have a heavy bias towards type 1 diabetes when compared to the background population. They are also likely to be a more highly motivated ‘early adopting’ cohort. Further analysis was performed to compare pre- and post-intervention clinical outcomes after the system had been active for nearly two and a half years. Results of statistical significance were not forthcoming due to limited data availability, however there are grounds for encouragement. Creatinine tests in particular improved following 1 year of use, with type 1 females in particular faring better than those in patient other groups. For other clinical tests such as HbA1c, triglycerides, weight and body mass index improvements were shown in mean and/or median values.96% of users believe the system is usable. Users also stated that it useful to monitor diabetes control (93%), improve knowledge (89%) and enhance motivation (89%). Findings show that newly diagnosed patients may be more likely to learn more about their new condition, leading to more productive consultations with the clinical team (98%). In the pre-project analysis, 26% of registrants expressed concerns about the security of personal information online, although those who actually went on to use it reported 100% satisfaction that their data were safe. Engagement remains high. In the final month of year two, 44.6% of users logged in to the system. 55.3% of users had logged in within the previous 3 months, 78.9% within the previous 6 months and 91.4% within the previous year. Some legacy PHRs have failed due to lack of uptake and deficiencies in usability, so as new systems progress, it is essential not to repeat the mistakes of the past. Feedback: "It is great to be able to view all of my results so that I can be more in charge of my diabetes".Conclusion: The MDMW PHR is now a useful additional component for the self-management of diabetes in Scotland. Although there are other patient access systems available internationally, this system is unique in offering access to an entire national population, providing access to information collected from all diabetes-related sources. Despite its development for the NHS Scotland environment, it has the potential to connect to any electronic medical record. This local and domain-specific knowledge has much wider applicability as outlined in the recommendations detailed, particularly around health service and voluntary sector ownership, patient involvement, administrative processes, research activities and communication. The current project will reach 5000 patients by the end of 2013.

Thesis (Ph.D.)--Brown University, 2008. / Vita. Includes bibliographical references.