<p> Public health leaders lead a diverse workforce and organizations that are comprehensive in their breadth and scope of services. The purpose of this descriptive quantitative study was to describe the transformational and transactional leadership behaviors of federal public health leaders, their coaching practices, and the relationship between those leadership and coaching behaviors. Researcher recruited a convenience sample of 91 U.S. Public Health Service (USPHS) officers from training events between March-July 2014. Participants self-selected to voluntarily complete an internet-based survey comprising a researcher-designed questionnaire, the Multifactor Leadership Questionnaire 5X Form, and Get Fit for Coaching self-assessment. The first two research questions related to leadership and coaching behaviors were analyzed in SPSS 22 using Kruskal-Wallis H, Yates&rsquo; correction, and Monte Carlo significance tests. The Pearson&rsquo;s product-moment correlation analyzed the third research question examining the relationship between leadership and coaching behaviors. No difference was found in the leadership or coaching behaviors of junior and senior officers when examined by actual rank or seniority. The data revealed several relationships between leadership and coaching behaviors, with significant correlations found for 24 dichotomous pairs, indicating transformational and constructive transactional leadership and coaching behaviors as similar, complementary, and interrelated. The findings showed the act of providing feedback improved performance, while failure to take action or implement change stifles learning and growth. Recommendations for future research included: examining these behaviors among non-uniformed and non-federal public health leaders; exploring their leadership outcomes; and the inclusion of the 360-assessment to validate the self-reported leader data.</p><p>

<p> Women face great risks in pregnancy and childbirth, especially in developing countries where there are very few skilled birth attendants and negligible government investments in maternal health programs. As a result, obstetric fistula (OF), a potentially fatal but preventable and treatable condition, affects some 3 million women and girls globally. In Sierra Leone, the prevalence of OF is extremely high, but the absence of quality data to inform decision-making, both on prevalence and risk factors, is a barrier to creating an environment for OF prevention and care. The purpose of this phenomenological study was to explore and document the barriers to medical care, and the perceptions of patients and medical personnel concerning the complexities of OF. In-depth interviews were performed over a 2-month period with 12 patients and 8 medical personnel at the Aberdeen Women's Center in Freetown, Sierra Leone. Results showed that patients face multiple medical barriers including high costs, fear of hospital treatment, severely inadequate treatment, and severe physical sequelae including paralysis and foot dragging. Multiple emotional, social, and financial harms related to OF were also reported, including stigmatization, abandonment by family, embitterment, depression, and job loss. Most patients expressed a preference for traditional birth assistants over medical personnel. However, many also benefitted from the intervention of friends or other good Samaritans. The results and recommendations from this study should be helpful in informing the general public and policy-makers about OF as a major public health problem, and in the design and delivery of programs to eradicate or alleviate the problem of OF in Sierra Leone.</p><p>

As long as governmental institutions have existed, efforts have been undertaken to reform them. This research examines a particular strategy, coercive controls, exercised through a particular instrument, executive orders, by a singular reformer, the president of the United States. The presidents studied- Johnson, Nixon, Ford, Carter, Reagan, Bush, and Clinton-are those whose campaigns for office were characterized to varying degrees as against Washington bureaucracy and for executive reform. Executive order issuance is assessed through an examination of key factors for each president including political party affiliation, levels of political capital, and legislative experience. A classification typology is used to identify the topical dimensions and levels of coerciveness. The portrayal of the federal government is analyzed through examination of public, media, and presidential attention. The results show that executive orders are significant management tools for the president. Executive orders also represent an important component of the transition plans for incoming administrations. The findings indicate that overall, while executive orders have not increased in the aggregate, they are more intrusive and significant. When the factors of political party affiliation, political capital, and legislative experience are examined, it reveals a strong relationship between executive orders and previous executive experience, specifically presidents who served as a state governor prior to winning national election as president. Presidents Carter, Reagan, and Clinton (all former governors) have the highest percent of executive orders focusing on the federal bureaucracy. Additionally, the highest percent of forceful orders were issued by former governors (41.0%) as compared to their presidential counterparts who have not served as governors (19.9%). Secondly, political party affiliation is an important, but not significant, predictor for the use of executive orders. Thirdly, management strategies that provide the president with the greatest level of autonomy-executive orders redefine the concept of presidential power and autonomous action. Interviews of elite government officials and political observers support the idea that executive orders can provide the president with a successful management strategy, requiring less expenditure of political resources, less risk to political capital, and a way of achieving objectives without depending on an unresponsive Congress.

The major purpose of this study was to ascertain how needs assessment findings and methodologies are accepted by public decision makers in the U. S. Virgin Islands. To accomplish this, the following five different needs assessments were executed: (1) population survey; (2) key informants survey; (3) community forum; (4) rates-under-treatment (RUT); and (5) social indicators analysis. The assessments measured unmet needs of older persons regarding transportation, in-home care, and sociorecreation services, and determined which of the five methodologies is most costly, time consuming, and valid. The results of a five-way comparative analysis was presented to public sector decision makers who were surveyed to determine whether they are influenced more by needs assessment findings, or by the methodology used, and to ascertain the factors that lead to their acceptance of needs assessment findings and methodologies. The survey results revealed that acceptance of findings and methodology is influenced by the congruency of the findings with decision makers' goals and objectives, feasibility of the findings, and credibility of the researcher. The study also found that decision makers are influenced equally by needs assessment findings and methodology; that they prefer population surveys, although they are the most expensive and time consuming of the methodologies; that different types of needs assessments produce different results; and, that needs assessment is an essential program planning tool. Executive decision makers are found to be influenced more by management factors than by legal and political factors, while legislative decision makers are influenced more by legal factors. Decision makers overwhelmingly view their leadership style as democratic. A typology of the five needs assessments, highlighting their strengths and weaknesses is offered as a planning guide for public decision makers.

A Utah State Agriculture Extension Department was created by the Utah State Agricultural College in 1907 to be supported by state appropriations. Its purpose was to bring the information being gained by the College Experiment Station, and other knowledge applicable to agriculture, to the rural population of the State in order to improve the quality of Utah agriculture and the conditions of the farm population. The program began with college instructors holding Farmers' Institutes and schools and expanded into a state-wide system of agricultural and home extension work carried on by specially appointed county agents in each county. The purpose of the agent was to demonstrate to the farmer improved farm methods and help in any way the situation of the farm family. In 1914 the Smith-Lever Act was passed by the Congress of the United States which appropriated federal funds for county agent work. This made the extension program a joint government undertaking with funds appropriated by state, federal, and local governments. This also linked the Extension Service to the Federal Government through the United States Department of Agriculture and in times of national crisis it was called upon to assist in putting government programs into effect. The Utah Extension Service can be said to have rendered valuable service to the people of Utah. It has provided information, has been available for consultation in farm and home problems, and has helped unite the rural population by encouraging farm bureau organizations, cooperative associations, and community projects. Through programs involving both adults and young people it has, in one way or another, either directly or indirectly, affected the lives of most Utah citizens. It has become involved in every facet of farm living including economic, social, and political. The object of the Utah Extension Service has been improvement and progress through extending education.

Job-related stress occurs as one of the most serious issues in modern era in developed nations. It has direct and negative effects on employees' productivity and it may have negative impacts on employees' health. One of the potential results of prolonged stressors at work place is burnout and this response may lead to physical, emotional, and psychological exhaustion that can occur at both individual and organizational levels. Burnout is a job related threat that provokes social stress and can directly affect an individual's health. Health-related quality of life (HRQoL) is commonly used to measure an individual's overall/global health and quality of life. Another serious issue, mobbing, usually leads to some individual and organizational complications. It affects the organizational commitment, motivation and efficiency of staff, job satisfaction of employee, and may lead to potential burnout of the employees. The primary objective of this study is to determine whether stress and mobbing are directly related to burnout; and, whether burnout leads to an adverse effect on the HRQoL of Turkish territorial state representatives (TSRs). This study examines four specific research questions: 1) Whether and to what extent do the levels of perceived job related stress and mobbing affect the level of perceived burnout syndrome of TSRs? 2) Whether and to what extent is the level of perceived burnout syndrome associated with HRQoL of TSRs? 3) To what extent does the level of perceived burnout mediate the effects of job-related stress on HRQoL of TSRs? 4) What are the mediating factors between job burnout and HRQoL? This study is expected to offer valuable and insightful information about the role of job burnout factors influencing the variability in TSRs' HRQoL. The study utilized two statistical analyses, which were descriptive analysis and Structural Equation Modelling (SEM) which allows for the assessment of the relationships specified in the hypotheses and the SEM was used to validate the theoretically driven model. The findings of the study supported the hypotheses of the study, which asserted that there were correlations between job-related stress and burnout, mobbing and burnout, and burnout and HRQoL. The CFA results established that job-related stress was positively and significantly associated with the burnout of TSRs, while perceived mobbing was positively and significantly related to the burnout of TSRs. Moreover, perceived HRQoL of TSRs was negatively associated with the burnout of TSRs. Further, the findings indicated that the relationship between job-related stress and burnout and the relationship between burnout and HRQoL of TSRs were statistically significant. Thus the variable had a positive effect on burnout and a negative effect on the HRQoL of TSRs. In summary, the findings of the study showed that results and propositions of the theoretical frameworks of the study and literature were consistent with one another.

This study examines the factors that facilitate and hinder the use of performance information by public administrators in local governments in Florida. Acknowledging the incompleteness of many theoretical and conceptual models in previous performance management studies and the absence of theory on the use of performance information; this study utilizes a grounded theory approach to develop and test a model analyzing the use of performance information. The research focuses on cities and counties, members of the Florida Benchmarking Consortium (FBC), and surveys public administrators whose tasks are related with the collection and/or reporting of performance information. The study examines three research questions: First, to what extent and in what capacity do local government administrators use performance information? Second, what are the predictors of the use of performance information among local government administrators? Finally, to what extent does the design adequacy of a performance measurement system (PMS), institutionalization of performance measurement (IPM), organizational support (OS), individual factors (IF) and external influences (EI) impact the use of performance information among local government administrators? To collect data on the above questions, an online survey was administrated to public administrators involved in the 2015-2016 FBC data collection cycle. The data were analyzed with structural equation modeling (SEM). The results of the study demonstrate that institutionalization of performance measurement has the strongest statistically significant positive association with the use of performance information followed by the influence of the design adequacy of the performance measurement system. Organizational support, through institutionalization of performance measurement, has an indirect influence on the use of performance information. Interestingly, in this study individual factors were not found to be significantly associated with the use of performance information.

The cost of healthcare in the United States is on an upward trajectory towards an unsustainable level. In order to address this, Congress and the Obama Administration passed the American Recovery and Reinvestment Act (ARRA) of 2009 to begin the process of controlling these costs. Within the ARRA is the Health Information Technology for Economic and Clinical Health (HITECH) section which creates financial incentives to invest in Health Information Technology (HIT) and to develop a means to measure the Meaningful Use of specific functions of Electronic Health Records (EHRs). This research examines the widely used Joint Commission datasets to determine their suitability as a basis of meeting the government mandated measuring of Meaningful Use. The datasets used for this study consists of hospital level performance measures with a sample size of 370 hospital samples of HIT Use Intensity and Cardiovascular Performance attained from the Veterans Health Administration (VHA). An Organizational Network Theoretical approach was applied to the data in a non-experimental, sample-resample design to data collected in 2007. A Structural Equation Model (SEM) was built to test for the strength of the correlation between HIT Use Intensity and Cardiovascular Performance and a Latent Growth Curve Model (LGM) was built to examine the effect of the trajectory of HIT Use Intensity on the trajectory of Cardiovascular Performance. The SEM found a weak (.18) correlation between HIT Use Intensity and Cardiovascular Performance and the model only captured 12 percent of the variance. The LGM found no convergence between the trajectories of HIT Use Intensity and Cardiovascular Performance. This may have been the result of the data being non-normally distributed and heavily skewed to the high end of the scale. The policy implications of this study indicate that while Joint vi Commission data capture only a small amount of the variance attributed to HIT Use it does show a weak but positive correlation between increases in HIT Use Intensity and Increases in Cardiovascular Performance at the hospital level. Future research into adjustments to Joint Commission data measures (or others) may prove to be valuable in measuring the Meaningful Use of HIT systems in order to help hospitals make educated decisions on which HIT systems to purchase and the potential benefits associated with them.

The Russian invasion of Ukraine in February 2022 has resulted in numerous civilian deaths, damage of transportation and power infrastructure, and forced millions of Ukrainians to seek safety, protection, and assistance abroad. The humanitarian crisis caused by war is beyond the normal capacity of any single agency, institution, or organization and requires collaboration and coordination of various public, private, and nonprofit organizations. Networks connect various organizations and agencies to share and accumulate resources, including financial, human, technological, knowledge, and information, necessary to respond to the changing and uncertain environment and to achieve goals that cannot be accomplished by a single organization. The collaboration of actors within a network is a crucial aspect for service delivery and assistance during the humanitarian crisis caused by war. Even though collaboration among network participants is desirable, the establishment of collaborative ties within the network remains a challenging task for various reasons. This study uses a mixed method approach to answer eight research questions: 1) What is the role of collaborative capacity within interorganizational networks? 2) How do organizations manage the process of collaboration in serving the impacted people in a constantly changing military environment? 3) What is the structure of the humanitarian response network in the response to the crisis caused by war in Ukraine? 4) What humanitarian response partners were involved and what were their roles and responsibilities? 5) What humanitarian response partners were involved and what were their roles and responsibilities? 6) What are the characteristics of the network aiming to respond to the humanitarian crisis? 7) How does network structure impact the collaborative capacity of an interorganizational network during a humanitarian crisis? 8) How do key environmental and organizational factors impact the collaborative capacity of a network during humanitarian crisis? Content analysis (n=229), social network analysis (SNA), and semi-structured interviews (n=14) were used to analyze network collaborative capacity in humanitarian response network in Ukraine. The findings suggest that the network collaborative capacity is influenced by common goals and shared visions, pre-existing ties and relationships between humanitarian response partners, organizational learning, and knowledge sharing. Power asymmetry can both facilitate and hinder network collaborative capacity. The strength of ties, communication, resource dependence, and environmental complexity were also found to play influential roles in building, developing and sustaining the network collaborative capacity. Powerful network members should consider developing better information system that reflects ongoing projects and allow participants to share data and report, and exchange ideas and feedback. Moreover, the efforts should be focused on involving Ukrainian nonprofit organizations in the response because currently they are excluded from the response due to the lack of experience and language barriers.

The concept of clinical governance was first introduced to the National Health Service in the White Paper published in 1997 (Department of Health); it has been described as the 'linchpin' of the quality reforms and, as of April 1999, is one of the statutory duties placed on NHS Trust Boards. Clinical governance is defined as: 'A framework through which NHS organisations are accountable for continuously improving the quality if their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.' (Department of Health, 1998; p33). The research project upon which this thesis is based took place over an 18 month period and has followed one NHS Trust as it implemented this new policy. Implementation may be conceptualised as both a change process and an end state; to capture this duality, two broad research questions are posed namely: what constitutes the local clinical governance agenda (content) and how has clinical governance been implemented (process). Given that the main purpose of these research questions is to explore and describe, an overarching qualitative framework has been adopted and, within this, an action research approach utilised