<p> In today's modern world of medicine, most, if not all, physician employment contracts contain non-compete clauses. Non-competes, also known as restrictive covenants, essentially function as restraints on trade. Non-competes act as a restraint in the medical arena by preventing physicians from taking patients with them when physicians begin new employment or, alternatively, depart on a self-employment basis. They also restrain physicians from competitively practicing medicine in a predetermined geographic area for a specified period of time. </p><p> Restraints on trade have a long noteworthy history. One case that emphasized the importance of having checks and balances on such restraints is Lochner v. New York. While not relating to the practice of medicine and non-compete provisions, Lochner is nonetheless an important case to the analysis of non-compete provisions in physician employment contracts. Lochner is necessary to the discussion of non-competes because it emphasizes how the history of restrictions on restraints on trade have changed so that now private parties, and not just the government, are allowed to implement restrictions. Additionally, these restrictions vary depending on the profession and where professionals practice. </p><p> Non-compete provisions are found in contracts created by both small private medical practices, as well as bigger entities, such as hospitals and managed care organizations. Therefore, this is not an issue limited to the size of the practice. The physician-patient relationship has gradually become more and more of an impersonal one due to managed care organizations and legislation such as the Affordable Care Act (ACA). This does not, however, mean that physicians and patients approve of this interference and push towards an impersonal relationship. Thus, if patients are unhappy with the resulting impersonal relationship from managed care plans and legislation, patients may suffer further from these non-compete clauses interfering with the patients' utilization of physician services. </p><p> These clauses hurt not only the physicians trying to practice, but also have the capacity to conflict with patient choice in regard to selecting the physician they want for treatment purposes. More importantly, such non-competes negatively interfere with the continuity of patient care. It is for these aforementioned reasons that it would behoove the American Medical Association (AMA) to model its non-compete guidelines after those found in the American Bar Association (ABA), which strictly limit the use of such non-compete provisions in attorney employment contracts.</p>

<p> The purpose of this case study was to explore the perceptions and experiences of hospital emergency preparedness coordinators of preparing for and responding to incidents. Stakeholder and protection motivation theories provided the theoretical framework for the study. The nonprobability sampling technique of purposive sample was used to identify 10 hospital preparedness coordinators employed at acute care hospitals with emergency departments located in Connecticut and Massachusetts. A field-tested researcher developed 20-question interview questionnaire guided data collection. This qualitative case study answers the questions: What are hospital emergency preparedness coordinators perspectives of hospital preparedness? How do hospital emergency preparedness coordinators prepare for a hospital incident? How do hospital emergency preparedness coordinators respond to a hospital incident? What factors do hospital emergency preparedness coordinators believe best prepares a hospital for incidents? Ranked in order of replication, the researcher identified three themes using first and second cycle coding techniques with pattern coding: (a) planning, (b) training, and (c) communication. Control and motivation emerged as subthemes. Results of the study provide detail rich data for hospital emergency preparedness coordinators, and provide insight and information for stakeholders from all types of private and public organizations to improve hospital emergency preparedness programs. </p>

<p> The purpose of this study was to examine the utilization of emergency department services by homeless adults in Pomona, California achieved through quantitative cross-sectional research. The results revealed that many homeless adults frequent the emergency department for mental health reasons and those homeless adults with physical ailments required longer lengths of stay and extensive discharge planning. Most participants had insurance coverage, but many appeared to lack social or primary care resources in the community, leading to frequent emergency department usage. This study may be beneficial to individuals, communities, and professionals to better understand the healthcare experiences of homeless individuals. The tangible and nontangible barriers to healthcare, as well as outside social resources affect the general public health through risks of contagious diseases and the rise in emergency department overcrowding. </p><p>

<p> Mental health-related cases in the United States today are largely attributed to employment. Healthcare professionals in particular are at increased risk for mental health adversities due to stress, burnout, and chronic fatigue. As a result, healthcare workers become an occupational hazard and a hindrance to an organization&rsquo;s service delivery. The lack of adequate job resources and positive work climate and conditions have been found to contribute to employee stress and burnout. Organizations can then increase the health and wellness of their employees with the adoption of green and environmentally conscious workplace setting designs and expect a significant economic return annually. Having an all-inclusive green business plan such as that of GreenSpace, LLC&rsquo;s consulting company will supplement and fill in the gaps of existing research regarding the benefits of exposure to greenery and mental health in the healthcare workplace. GreenSpace, LLC, adopts the concept of green building by designing sustainable and health-conscious work spaces within the healthcare sector that seek to improve employee wellness, fuel environmental sustainability, and thus increase its clients&rsquo; profit. The company intends to distribute its services within the Orange County area; where over 10% of its working population belongs to healthcare, to the largest healthcare industries and employers. GreenSpace, LLC is poised for success and promises to target this industry. In what follows is GreenSpace, LLC&rsquo;s business plan which includes an analysis of the market, feasibility, SWOT, legal and regulatory issues, and assumptions for expenses under which the company will distribute its services.</p><p>

<p> The purpose for this qualitative research was to provide comparative data to determine if there was areas in need of improvement when it pertained to medical errors. Researchers have validated that initiating measures for continuous improvement would minimize error rates and benefit the clinicians and their patients. Patient safety was important and cause major concerns, therefore this research explored categories that influenced decision-making processes or conditions that causes deficit in reasoning, which could have an impact on cognitive abilities. Therefore, medical errors are a research worthy problem; since they cause phenomenon, conflict within managerial processes, and was a contributing factor for malpractice payouts, per a report from 2015 Institute of Medicine. As a result, researchers validated that initiating measures for continuous improvement would benefit the clinicians and their patients by minimizing errors or keeping them at a minimum. Utilizing the qualitative approach provided the best framework to narrow down cause and effects to validate the importance of support that relates to memory and relational network through retrieval-mediated learning. This research provides evidence that medical errors occurred during decision-making processes with (90%) cognitive errors, anchoring (75.7%), and (78.6%) premature closure. As a result, this qualitative research concentrated on constructs, such as, data collection from observation of prior research from scholarly, empirical, peered reviewed articles; <i>Medical Journals</i>, and education materials to provide pertinent information on diagnostic medical errors for the material within this investigation. The results from this study indicated, although, there was suggestions to improve patient-safety no significant decrease in medical harm occurred, therefore additional investigations will provide a valuable contribution to the body of knowledge and conditions for continuous improvement.</p><p>

<p> The purpose of this study was to collaborate with one of the New England VA Healthcare Systems to conduct research to evaluate the current leadership competencies at the Department of Veterans Affairs (VA) to identified competencies essential for leadership by the VA. The researcher also assessed how VA front-line staff, first-line supervisors, mid-level managers, and senior/executive leadership rate their performance and that of their supervisors. Lastly, the researcher evaluated how these leaders are trained to assume their important roles at the VA and how much of a role are executive coaching and mentoring play in this training process. The research is a quantitative research study, and the competencies and specific behavior indicators were assessed using a web-based survey via a self-administered competency instrument designated to determine employee&rsquo;s perceptions. The data collected comprised data from four different surveys/questionnaires for each position level within the organization including the demographic data. A total of 143 VA employees participated in the research study and completed surveys to measure the frequency of behaviors on a 10-point scale to answer the research questions. The results answered the key research questions asked in this study to measure leaders and emerging leader competence.</p><p>

<p> The disconnect between what evidence-based research indicates is best care for the seriously ill patient and what is delivered is significant. Local communities are charged with addressing the impact of this breakdown in care for their residents. In a system initially designed to cure, medical care is focused now on slowing the progression of complex, chronic illnesses in an aging population. The opportunities for a breakdown in care are significant. This participant action research study explored factors contributing to the breakdown of care for the seriously ill in an isolated, medically under-served County in Northwestern U.S. The combined action research and appreciative inquiry approach in this study focused on what were the actionable interventions community stakeholders considered taking in supporting improvement in the care of the County&rsquo;s population. Purposeful sampling of community providers identified 14 physicians, registered nurses and clinical social workers, who participated in semi-structured interviews. Data was analyzed through the theoretical lenses of general systems, complexity, and working whole systems theories. Issues related to trust, turf, and respect emerged as stakeholders minimized the role and effectiveness of others, and overemphasized both the capacity and burden of their agency or profession&rsquo;s ability and responsibility to address the problem. Professional training and position in the medical hierarchy were linked to the perceptions of stakeholders across all work settings and need to be acknowledged in future collaborations across disciplines. County specific recommendations are included along with recommendations for additional research.</p><p>

<p><b>Introduction</b>: Cancer registries collect tumor-related data to monitor incident rates and support population-based research. A common concern with using population-based registry data for research is reporting timeliness. Data timeliness have been recognized as an important data characteristic by both the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM). Yet, few recent studies in the United States (U.S.) have systemically measured timeliness. </p><p> The goal of this research is to evaluate the quality of cancer data and examine methods by which the reporting process can be improved. The study aims are: 1- evaluate the timeliness of cancer cases at the Indiana State Department of Health (ISDH) Cancer Registry, 2- identify the perceived barriers and facilitators to timely reporting, and 3-reengineer the current reporting process to improve turnaround time. </p><p> <b>Method</b>: For Aim 1: Using the ISDH dataset from 2000 to 2009, we evaluated the reporting timeliness and subtask within the process cycle. For Aim 2: Certified cancer registrars reporting for ISDH were invited to a semi-structured interview. The interviews were recorded and qualitatively analyzed. For Aim 3: We designed a reengineered workflow to minimize the reporting timeliness and tested it using simulation. </p><p> <b>Result</b>: The results show variation in the mean reporting time, which ranged from 426 days in 2003 to 252 days in 2009. The barriers identified were categorized into six themes and the most common barrier was accessing medical records at external facilities. </p><p> We also found that cases reside for a few months in the local hospital database while waiting for treatment data to become available. The recommended workflow focused on leveraging a health information exchange for data access and adding a notification system to inform registrars when new treatments are available. </p>

<p> This study utilized secondary data to understand weight-loss behaviors in obese adult women with hypertension. There are multifactorial reasons for obesity. This study attempted to clarify why people cannot lose weight and why many often regain weight. The gap in the literature relates to why the concepts such as perception of risk, benefits, and obstacles to action have not been found to cause individuals to achieve weight loss or to maintain weight loss. Secondary data were used from the NHANES dataset, a weighted dataset representative of the U.S. population. The sample used in this study included 411 obese hypertensive women over the age of 18. In all, six years of data from 2009&ndash;2014 were derived from the National Health and Nutrition Examination Survey (NHANES) dataset. Perception about the obstacles an individual confronts can be a barrier to successful weight loss. If an individual thinks success cannot be attained, efforts to lose weight will fail. Hierarchical regression analysis was used to assess the variables. The results indicated that only perception of weight acted as a cue to action for losing weight. That is, the perception of weight was the only statistically significant finding of reasons obese hypertensive women initiate weight loss efforts. Recommendations for future research include an investigation of the perception of weight status and body habitus, and to assess what triggers a poor perception of weight and body habitus as a cue to action to lose weight. </p><p>

The purpose of this study was to identify, through a needs analysis, the skills required of the clinical supervisory role in certified home health agencies as described in the literature and as perceived by clinical supervisors and agency administrators. The identified skills were then used to propose elements for a training curriculum. The general problem guiding this research is the lack of a systematic approach to supervisory training and development in certified home health agencies in Massachusetts that may result in supervisory employees being inadequately prepared to assume the responsibility of that role. A descriptive survey design was utilized. A questionnaire was mailed to first-line clinical supervisors and their administrators to assess the skill requirements of the supervisory role as perceived by these respective groups. The sample survey, which consisted of 125 certified home health agencies, was obtained from the Massachusetts Department of Public Health. The response rate was 63% for the administrators and 65% for the supervisors. A modified version of the conceptual framework of the needs identification process as presented by Watson (1979) was utilized in conducting the analysis, and the skills were categorized using Katz's model (1974) of conceptual, technical, and human competencies. The findings of the analyses showed that the administrative respondents perceived a greater need for the skill development of their supervisors in all three areas of conceptual, technical, and human skills than the supervisors perceived for themselves. In addition, supervisory respondents with 6-10 years of professional experience and those with over 21 years of supervisory experience reported the greatest need in all three areas. The findings also showed that the majority of incumbent supervisors in certified home health agencies were technically at an entry-level stage of management, and that the combined responses of both the administrative and supervisory respondents supported the need for additional training in the technical and human skill areas. As a result, the concluding recommendations for curricula development for training programs for incumbent and future clinical supervisors were focused on those skills specific to the technical and human competency areas as described in the study.