This is the supporting documentation submitted for the degree of Doctor of Philosophy by publication. The research explores shared leadership and investigates its component parts in terms of leader and organizational longevity. A collection of the presented papers represent separate published research projects culminating in a 6D framework. Leadership – Default, Discretion, Dilemma, Deliberative Inquiry, Dialogue and Direction. The framework is equally divided into Individual and Corporate focus. It presents a collection of skills sets and attitudes which enable the modern leader to achieve more sustainable personal and organizational success. The methodology uses a balance of empirical and conceptual approaches which included a mix of primary interview and survey with a leaning towards qualitative data extraction. In depth semi-structured interviews from diagonal samples were used. These came from both local and international sources. An applied research approach was maintained for most relevance to leaders and the provided comment formed an inductive route on which to derive new theory. The results were analysed with an interpretivist approach. The research findings and conclusions show that developing a distinct awareness of leadership self and reactions contributes highly to the ability to serve the organizational need. Additionally, the research showed that considered approaches to achieve higher quality information from staff contributed to a better level of strategic alignment. The published shared leadership concepts and models benefitted from peer review in the academic community, in journals and at conference. These resulted in more robust contributions to modern opinions on distributed/collaborative leadership. The 6D framework, along with other original models from the author, have been used extensively with business people at different levels of leadership. Their use has contributed to the leadership impact and further understanding during times of great economic pressure, social and technological change.

Thesis (Ph. D.)--University of Queensland, 2003. / Includes bibliographical references.

Considerable research has been directed toward the study of consistent hashing and distributed hash tables. While many useful research results have emerged from this work, existing solutions can be improved in the areas of time efficiency, system growth and change to input distributions. For resolution, systems such as Chord [69][70], Memcached [23] and others use a binary search over the set of intervals to determine the node. Also, relying on a pseudo-random designation of partitions on the continuum can result in poor worst-case time performance due to load imbalance. The work proposes F^2DR, a system that maps an arithmetic distribution of intervals on a continuum to a fluid set of nodes. Any point on the continuum can be resolved to a node in O(1) time, and O(n) space. The system also contains flexible mechanisms for adapting to load patterns through dynamic restructuring. In all, F2DR provides a fresh formulation of consistent hashing that offers several advantages over previous work. / School of Computer Science, University of Guelph

Shared governance is a practice model that supports shared decision making between direct care nurses and their leaders. Developed from Kanter's theory of structural empowerment, shared governance allows employees to influence decisions made in an organization. Shared governance has been shown to increase nursing satisfaction, positively impact outcomes, and reduce nursing turnover. The purpose of this project was to examine the relationship between implementation of a system-wide, multihospital shared governance structure and registered nurse (RN) satisfaction, turnover, and perceptions of shared governance. The 3 sources of evidence used in the study were 2016-2017 organizational RN engagement survey results, 2016-2017 organizational RN turnover data, and RN perceptions of shared governance as measured by the Index of Professional Nursing Governance (IPNG) tool. Two similar hospitals within the system were selected for administration of the IPNG survey. Results showed that introduction of a multihospital shared governance structure had an impact on nursing turnover. The biggest change was in new nurse turnover, which reduced from a high of 32.10% to 27.30%. This 4.8% decrease translated in approximately $2 million in savings. A comparison of IPNG survey results showed that the hospital with lower turnover had higher perceptions of shared governance. The potential implications of these finding for social change could be an expansion of shared governance in the organization and social change in the region. Due to the relationship between shared governance and improved patient outcomes, a reduction in mortality and improvement in overall health could be seen for the 1 million patients served in these hospitals.

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Motivation: Shared Services (SS) is a cost cutting and quality improvement strategy, which is receiving increasing attention from academics and practitioners. However, previous research focuses primarily on the potential benefits of these strategies; while very little research explains the role of SS resources and capabilities in the achievement of SS goals. The purpose of this thesis is to address this gap by explaining how SS resources and capabilities influence the achievement of SS goals. Approach: A multiple-case study approach is adopted, following a qualitative methodology, with data collection occurring at four SS organisations. Findings: This thesis introduces a taxonomy of SS resources and identifies three SS operational capabilities and seven SS dynamic capabilities, grouped into four areas of competence. Furthermore, this research uncovers the capability development process in an SS context, through the identification of the specific routines that precede each capability. Finally this research extends SS research, not only by identifying additional SS goals not mentioned by previous research, but also by recognising what specific SS capabilities contribute to what goals, thus uncovering the goal achievement process in a shared service centre. Academic Contributions: This research contributes to the negligible literature focusing on SS resources and capabilities and responds to the claims that a further understanding of shared services is needed in order to provide practitioners with advice and procedural guidelines on how to design, implement and manage SS. It also lays the foundation for future research on resources and capabilities in an SS context. Managerial Contributions: The findings enable managers to identify and further develop the necessary resources, routines and capabilities to achieve their specific SS goals. Additionally, this research supports managers in identifying additional goals they can achieve, considering the resources, routines and capabilities their SSCs already have.

Shared governance is a model in which staff collaborate through a decentralized decision-making structure, sharing ownership and accountability and partnering to make decisions about clinical practice, professional development, patient experience, quality improvement, and research. The hospital shared governance project team aligned its shared governance model with the American Nurses Credentialing Center Pathway to Excellence standards. The purposes of this project were to do a process evaluation of shared governance implementation at one 64-bed community hospital in central Florida and make recommendations for continuous quality improvement. The project followed the plan-do-study-act methodology developed by Deming. Through the collection of meeting minutes and other shared governance documents, semi structured interviews with nurse leaders, and the results of an anonymous survey through SurveyMonkey, the process of shared governance implementation was evaluated. The major themes included the hospitals need to establish an effective communication system to ensure all 185 RNs are aware of its shared governance, restructure of the Nurse Practice Council, and a reinitiating of shared governance. Limitations of the project included the immaturity of the hospital at the time of implementation, nursing lack of knowledge about shared governance, lack of dedicated resources and competing priorities, and nursing leadership and unit turnover, which were barriers to shared governance implementation. Supporting shared governance contributes to social change by creating a nursing culture that promotes quality, nursing excellence, professional decision making, and a healthy work environment, ultimately improving outcomes for all stakeholders.

Providers are encouraged to view patients with chronic disease as ??partners?? in their care, and to collaborate with them in developing care plans. Yet there is little guidance in how collaboration should occur, and little evidence that collaborative care improves patient outcomes. Related models and measures of patient centred care and shared decision making have not been developed specifically for the context of chronic disease care. This thesis aimed to develop a theoretical understanding of how providers and patients make decisions in chronic disease care planning, how patients experience involvement in care planning, and to develop a measure of patient involvement. It consists of two studies: a qualitative study to develop a grounded theory of decision-making in diabetes care planning, and a scale development and psychometrics study. The qualitative study involved 29 providers and 16 patients with diabetes. It found that providers were concerned with a process described as ??managing patient involvement to do the right thing??, while patients were concerned with ??being involved to make sure care is appropriate??. This led to the theory of ??delivering respectful care??, a grounded theory that integrates provider and patient perspectives by showing how providers and patients can resolve their concerns while achieving mutually acceptable outcomes. Central to this theory is the process of finding common ground, while the key conditions are provider responsiveness and an ongoing, trusting and respectful provider-patient relationship. The Collaborative Care Planning Scale (CCPS), based on these findings, is a patient self-report scale that measures patients?? perceptions of involvement in care planning. After piloting the CCPS was tested amongst 166 patients with diabetes. Exploratory factor analysis resulted in a 27-item scale comprising two factors: ??receiving appropriately personalised care?? and ??feeling actively involved in decision-making??. Psychometrics tests revealed the CCPS has adequate internal consistency and test-retest reliability, and findings support construct validity. ??Delivering respectful care?? enriches understanding of the nature of collaboration in chronic disease care, and identifies those elements necessary to ensure patients receive best possible care. The CCPS provides the means for measuring what patients say they value, and is thus an important measure of quality chronic disease care.

Thesis (Ph. D.)--Ohio State University, 2003. / Title from first page of PDF file. Document formatted into pages; contains xi, 365 p.; also includes graphics. Includes abstract and vita. Advisor: Lesley K. Ferris, Dept. of Theatre. Includes bibliographical references (p. 353-365).

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