The complex nature of healthcare requires nurse leaders to be skilled in professional practice, communication, teamwork, and problem solving to improve staff satisfaction and patient outcomes. The American Association of Colleges of Nursing and Institute of Medicine promotes graduate education for nurse leaders to enhance the delivery of quality care to the nation's diverse patient populations. Guided by the diffusion of innovation theory, this project explored the differences in nursing care hours, staff turnover, nurse quality indicators, as well as leadership characteristics on units lead by masters-prepared and non-masters-prepared nurses. Forty-eight nurse leaders completed the impact of graduate education among nurse leaders (IGENL) survey addressing perceptions of their ability to change practice, teamwork, communication, and problem-solving skills. Staffing reports, Nurse Quality Indicators (NQI), and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data were collected from 34 hospital units. Data were summarized and t tests were conducted to examine the differences in NQI and HCAHPS data from units lead by nurses with and without a graduate degree. No significant differences were noted in these measures. In the IGENL survey data, the nurse leaders with a graduate degree had significantly higher scores on the leadership characteristic subscales of professional practice, communication and teamwork, and problem solving than did those without. The outcome of this project can contribute to positive social change within healthcare organizations by supporting the pursuit of graduate education for nurse leaders, which could enhance leadership attributes and subsequently improve staff satisfaction and patient outcomes.

Fragmentation in healthcare has led to a desire to align and integrate care processes horizontally. The concept of value-based healthcare has been introduced, suggesting a maximized value creation to occur when optimal conditions are created for selected patient segments, integrating all activities that jointly determine the success in meeting a set of patient needs. While targeting specialized segments has been shown to be beneficial, theories of diversification suggests that an increased scope may be an even more efficient approach to improve performance. By sharing resources and capabilities across several specialized units, coordination and knowledge sharing of a hospital’s ancillary services becomes important.   In this study, we examine how an ancillary service function, providing resources and capabilities that are shared across specialized units, can be organized to ensure contribution to the overarching goal of maximizing value for patients. This is done through a qualitative case study of the Karolinska University Laboratory – an ancillary service function of the Karolinska University Hospital. It is concluded that an ancillary service function can, in a diversified context, facilitate and support the value creation around medical conditions by developing a comprehensive structure for knowledge management and sharing, both externally towards medical conditions and internally within the ancillary service function. If structured properly, clear benefits, such as economies of scale, scope and knowledge spillovers, can be achieved by separating sharable resources from the patient flows.

The Patient Protection and Affordable Care Act, which promoted quality of care, started the transformation of healthcare systems in the United States. The purpose of this qualitative multiple case study was to explore clinical practice innovation strategies used by hospital middle managers to improve quality of care and profitability. Pettigrew's theory was the conceptual framework for this study. Participants were 8 middle managers from 2 high-performing hospitals in the southwestern region of the United States. Data were collected from semistructured interviews, personal notes, and review of the hospital's publicly reported documents and literature. Member checking and methodological triangulation increased the credibility, validity, reliability, and trustworthiness of the study findings. Content and thematic data analysis provided the basis for coding the findings. Data analysis resulted in the emergence of 4 themes: organizational culture, leadership, systematic approach to management by objectives, and staff engagement. The findings showed the interactions among internal context, content, and process constructs of Pettigrew's theory as relevant to clinical practice innovation strategies for improving the quality of care and organizational profitability. The implications for positive social change include the potential for hospital middle managers to implement innovative strategies to improve patients' quality of care and save lives and the overall health and wellness of individuals in the communities they serve.

Introduktion: Prehospital sjukvårdsledning är ett koncept som används vid skadehändelser och är en ledningsstruktur med definierade roller och beredskapslägen. Sjukvårdsledare är ansvarig för att bedriva sjukvårdsinsatsers ledningsarbete på skadeplatser. Syfte: Att beskriva ambulanssjuksköterskors upplevelser av att vara sjukvårdsledare vid arbete på skadeplats. Metod: Studien har en kvalitativ design med induktiv ansats. Åtta ambulanssjuksköterskor i södra Norrland intervjuades via semistrukturerade intervjuer. Manifest innehållsanalys användes som analysmetod. Resultat: Analysen resulterade i fyra huvudkategorier: Att ta sig an en stor och oviss uppgift, att ha ett stort ansvar i en utmanade situation, att uppnå kontroll genom samverkan samt att utvecklas i sin roll som sjukvårdsledare. Majoriteten kände stress inför ankomst till en skadeplats samt att brist på information påverkade möjligheten att förbereda sig. Allvarliga skadehändelser kunde ge en känsla av hopplöshet. Sjukvårdsledarrollen är viktig och krävande och stärks av erfarenhet. Besluttagandet upplevdes utmanande samt innebar ett stort ansvar. Vikten av att ha kontroll genom strukturerad och organiserad ledning samt att kunna anpassa sig och samverka med andra aktörer som polis och räddningstjänst var något som betonades. Det fanns behov av att reflektera och dela lärdomar efter händelser för att utvecklas. Slutsats: Att vara sjukvårdsledare är en komplicerad och krävande roll för ambulanssjuksköterskor. De kan uppleva stress, oro och rädsla att misslyckas. Trots utmaningen är ambulanssjuksköterskor stolta över arbetet när de lyckas. Det behövs kontinuerlig och verklighetstrogen utbildning samt reflektion för att känna sig trygg som sjukvårdsledare.

With the increase in health system Mergers and Acquisitions (MandA’s) since the Affordable Care Act [Brown TC, Werling KA, Walker BC, et al. Current trends in hospital mergers and acquisitions. Healthc Financ Manage. March, 2012], health systems must carefully weigh and measure the current organizational culture prior to the consummation of the merger, seeking to understand differentiation within and between the merging organizations, and requires that the organization be analyzed by employee levels or tiers. This study seeks to understand the organizational culture of two merging partners before the merger is consummated, identifying levels of differentiation among employee tiers. Cultural domination from an acquiring organization is also considered. The cultures are analyzed utilizing the Competing Values Framework (CVF). The population included all employees of both health systems with the survey respondent sample stratified by the following employee types: (Tier 1), entry-level employee; (Tier 2), supervisory level, and, (Tier 3), executive level. Statistical procedures included independent t tests and indicated a statistically significant difference between the current cultures of the health systems prior to the merger with significant differences in the cultural perceptions of Tier 1 employees and Tier 2 employees.

Afin de répondre à l’augmentation des besoins au niveau des ressources hospitalières causées par pandémie de la maladie à coronavirus de 2019 (COVID-19), différents sites non traditionnels (SNT) ont été déployés au Québec et mondialement. Le SNT de la Place Bell a été déployé à Laval durant la première vague de la pandémie et avait comme fonctions de libérer des lits en milieu hospitalier en accueillant des usagers atteints de la COVID-19. Le but de cette étude de cas était d’examiner la capacité du SNT de la Place Bell à remplir ces fonctions. Un devis mixte convergent a été utilisé, incluant une analyse descriptive des données quantitatives ainsi que des entrevues semi-dirigées auprès de sept participants, incluant des professionnels, des non professionnels et un gestionnaire. Malgré un faible taux d’occupation et une ouverture tardive, le SNT a permis de libérer 29% des lits occupés par des usagers atteints de la COVID-19 à l’hôpital. Le cout par nuit au site était plus élevé qu’en centre d’hébergement et de soins de longue durée et que pour un autre SNT dans la province, mais moins élevé qu’en milieu hospitalier. En considérant le risque de transmission de la maladie dans les milieux de vie et qu’une des options alternatives était de garder les usagers en milieu hospitalier, le SNT semble avoir été un choix financier efficient. Le SNT a été un environnement favorable au déploiement d’une plus grande étendue de pratique infirmière, en raison du haut ratio de personnel-patient, l’absence de médecin sur place et l’autoorganisation du travail au site. En conclusion, plusieurs éléments contribuent à l’efficience d’un SNT, dont son déploiement rapide, la composition des équipes, le soutien offert aux employés et l’autonomie et l’indépendance du site. / In order to respond to the rapidly increasing needs in hospital resources caused by the coronavirus disease of 2019 (COVID-19) pandemic, different alternate care sites (ACS) were deployed in Quebec and worldwide. The Place Bell ACS was deployed in Laval during the first wave of the pandemic with the aim of offloading the volume of patients in the hospital by admitting patients with COVID-19. The aim of this case study was to examine the capacity of the Place Bell ACS in achieving these functions. A mixed convergent design was used, including a descriptive analysis of the quantitative data and semi-structured interviews with seven participants including professionals, non-professionals and a manager. Despite the low occupancy rate and the late opening, the ACS was able to free up 29% of the beds occupied by COVID-19 patients at the hospital. The cost per night at the site was greater than that of a residential and long-term care center and of another ACS in the province, but lower than the cost per night in the affiliated hospital. In considering the risk of propagating the virus in certain home environments and an alternative option of keeping the patients in the hospital, the ACS seems to have been an efficient financial option. The high staff-to-patient ratios, the absence of doctors on site and the self-organization of the team’s work contributed to making the ACS a favorable environment to a larger scope of practice for nurses. In conclusion, several elements contribute to the efficiency of an ACS, including its rapid deployment, the team compositions, the support offered to the employees as well as the site’s autonomy and independence.

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. This reform, it is argued, is projected to increase insurance coverage of pre-existing conditions, to expand access to insurance for more than 30 million Americans, and to increase estimated National medical spending while lowering projected Medicare spending. This thesis sought to investigate and analyze the perceptions of senior citizens in Central Florida about PPACA and their perceived effects on the healthcare quality provided to them under this law. Four sections of PPACA bill, thought to specifically pertain to the elderly, were selected for this study; respondents were asked their opinions regarding PPACA's aspects of: (1) the reform on preventive healthcare services; (2) Medicare Part D (prescription drugs); (3) Medicare; and (4) Medicaid. This thesis employed both qualitative and quantitative methodologies; data were collected and analyzed with findings presented and discussed.

Submitted by Mariana Baleeiro Martins Carrera (marianacarrera@hotmail.com) on 2014-09-22T15:17:00Z No. of bitstreams: 1 TESE VERSÃO FINAL - MARIANA CARRERA 22.09.2014.pdf: 1391085 bytes, checksum: a0380a49f7b6d3c7112ffd16f2715714 (MD5) / Approved for entry into archive by PAMELA BELTRAN TONSA (pamela.tonsa@fgv.br) on 2014-09-22T16:03:09Z (GMT) No. of bitstreams: 1 TESE VERSÃO FINAL - MARIANA CARRERA 22.09.2014.pdf: 1391085 bytes, checksum: a0380a49f7b6d3c7112ffd16f2715714 (MD5) / Made available in DSpace on 2014-09-22T16:04:04Z (GMT). No. of bitstreams: 1 TESE VERSÃO FINAL - MARIANA CARRERA 22.09.2014.pdf: 1391085 bytes, checksum: a0380a49f7b6d3c7112ffd16f2715714 (MD5) Previous issue date: 2014-08-22 / The goal of this study is to understand the merit evaluation models of PPP projects and to study existing projects in the healthcare sector in Brazil, as of June, 2014. The methodology was a qualitative research of exploratory nature, through a bibliography and document review, interviews with key stakeholders and analysis of projects. It also involved the study of national and international merit assessment models – Value for Money. Key parameters presented by VFM are: discussions of projects based on results, competition, risk transfer to the private initiative, innovation and responsibility sharing. It is composed of three basic elements: economy, efficacy and efficiency. However, achieving economy and efficiency is meaningless if the efficacy (guaranteeing that a given activity achieves its goals) is not observed. The results point out that the utilization of PPPs is, slowly, becoming more frequent in the healthcare sector in Brazil. Nevertheless, such partnerships need to mature and to improve their administration, technical, managerial and political aspects. As such, it intends to contribute for a better knowledge and understanding of PPP as a new institutional way to manage healthcare, documenting the early stages of this process and presenting the most critical dimensions for the success of its implementation in the healthcare sector in Brazil. / O presente trabalho tem como objetivo compreender a análise do mérito de projetos de PPP, com ênfase no setor saúde. A metodologia utilizada foi a pesquisa qualitativa de natureza exploratória, com levantamento bibliográfico e documental, entrevistas com os principais stakeholders e análise de projetos. Foram estudados, também, modelos nacionais e internacionais de análise de mérito – Value for Money. O VFM apresenta como principais parâmetros a discussão sobre contratos baseados em resultados, competição, transferência de risco para a iniciativa privada, inovação e divisão de responsabilidades. São três seus elementos básicos: economia, eficácia e eficiência. Porém, a obtenção de economia e eficiência não tem valor se a eficácia (garantia de que uma determinada atividade alcance os resultados desejados) não for observada. Os resultados apontam que a utilização de PPP está, progressivamente, se tornando mais freqüente no setor saúde no Brasil. No entanto, essas parcerias necessitam de amadurecimento e aperfeiçoamento administrativo, técnico, gerencial e político. Com isso, pretende-se contribuir para o maior conhecimento e entendimento da PPP como uma nova modalidade institucional para a gestão da saúde, documentando um momento ainda inicial desse processo e apresentando as dimensões mais críticas para o sucesso da sua implantação no setor saúde no Brasil.

Indicadores de qualidade hospitalar correspondem a medidas que contém informações relevantes sobre determinados atributos e dimensões que caracterizam a qualidade de diferentes instituições de saúde. Tais medidas são capazes de sinalizar eventuais deficiências ou práticas de sucesso associadas à qualidade dos serviços de saúde. O presente estudo teve por finalidade desenvolver uma ferramenta computacional de análise, voltada para o gerenciamento hospitalar, com o objetivo de se obter um instrumento que possa ser utilizado para monitorar e avaliar a qualidade dos serviços oferecidos por instituições hospitalares através da análise e gerenciamento de indicadores de qualidade hospitalar. Os indicadores alvo para avaliar a qualidade dos serviços representaram um subconjunto de indicadores de qualidade denominados Inpatient Quality Indicators (IQIs) da Agency for Healthcare Research and Quality (AHRQ). A partir da revisão bibliográfica de textos científicos na área e com base nas dimensões de processo e resultado do Modelo Donabediano, foram selecionados vinte e dois indicadores da AHRQ, que avaliam a mortalidade por determinadas afecções e procedimentos cirúrgicos, bem como a quantidade e a qualidade dos procedimentos realizados nas instituições de saúde. A ferramenta foi construída em dois módulos: um módulo responsável pela geração dos indicadores a partir de dados coletados de um banco de dados relacional; e outro destinado ao estudo e análise das séries temporais dos indicadores, permitindo o acompanhamento da evolução dos mesmos de forma histórica. Os dados utilizados para a geração dos indicadores são oriundos da base de dados do Observatório Regional de Atenção Hospitalar (ORAH), que consiste numa entidade responsável pelo processamento de dados de internação de quarenta hospitais públicos e privados, distribuídos ao longo de vinte e seis municípios da região de Ribeirão Preto, São Paulo, Brasil, que compõem a Departamento Regional de Saúde XIII (DRS-XIII). A ferramenta computacional foi concluída e validade com êxito e suas funcionalidades foram disponibilizadas para gestores de saúde e acadêmicos através do portal web de conteúdo vinculado ao ORAH. Em adição, os resultados obtidos através do uso da ferramenta foram utilizados para analisar a situação da assistência hospitalar na região de Ribeirão Preto através da comparação histórica dos indicadores entre as três microrregiões de saúde que compõem a DRS-XIII: Aquífero Guarani, Vale das Cachoeiras e Horizonte Verde. A análise destes resultados também foi essencial para verificar a capacidade da ferramenta em prover informações relevantes para a gestão hospitalar. A partir da análise dos resultados obtidos, concluímos que a ferramenta permite a definição de um panorama geral da assistência hospitalar na região de Ribeirão Preto. De acordo com os achados deste estudo, também verificamos que os indicadores de qualidade hospitalar da AHRQ cumpriram seu papel como medidas sentinela e foram capazes de identificar certos aspectos associados à realidade. Entretanto, a análise dos resultados também remeteu à necessidade de introduzir novas variáveis que permitam conhecer o real estado dos pacientes e as condições estruturais das diferentes instituições de saúde, visto que os indicadores selecionados, por si só, não fornecem aos gestores de saúde uma avaliação final da qualidade das instituições hospitalares. / Inpatient quality indicators are measures that provide relevant inforrnation on the level of quality of care delivered by hospitals and healthcare services. These measures are capable of signaling eventual problems or successful practices associated with the quality of care provided by health services. This project was aimed to create an instrument to assess the quality of care delivered by hospitals by developing a web application whose functionalities focused on monitoring a subset of inpatient quality indicators (IQIs), extracted from the Agency for Healthcare Research and Quality (AHRQ). Based on literature review and on the components of process and outcomes defined by the Donabedian model, there were selected twenty-two AHRQ\'s inpatient quality indicators that are commonly used to evaluate the mortality associated with certain conditions and procedures, as well as the quantity and quality of certain medical procedures. The software is composed by two components: one is responsible for calculating the indicators using admission data extracted from an operational database; the other one is meant for the study and analysis of time series of the indicators, which allows the monitoring of its values over the years. The indicators were ca1culated using administrative data from the Observatory for Hospital Care\'s database (ORAH, from the acronyrn in Portuguese \"Observatório Regional de Atenção Hospitalar\"). The Observatory for Hospital Care is responsible for processing admission data collected from forty hospitals located throughout Ribeirao Preto region, in the Brazilian state of Sao Paulo. The management of hospitals located in the Ribeirao Preto region is conducted by the Regional Department of Health XIII (DRS-XIII, from the acronyrn in Portuguese \"Departamento Regional de Saúde XIII). The web application\'s services were made available to health service administrators and academic personnel through the ORAH\'s website. The results provided by this computational tool were also used to analyze the situation of care delivered by the hospitals in Ribeirao Preto region, which is subdivided into three microregions: Aquifero Guarani, Horizonte Verde e Vale das Cachoeiras. The historic values of the indicators were compared between these three microregions. The analysis of these results was also important to verify whether the web application is actually able to provi de enough inforrnation to acknowledge the reality of the hospitals in Ribeirao Preto region. According to the results, we verified that the AHRQ\'s inpatient quality indicators have fulfilled their role in signalizing certain aspects related to the quality of care of the hospitals, but they do not provi de enough inforrnation to establish a defini tive quality assessment of hospital services. Therefore, we verified the need of introducing new attributes in order to understand and acknowledge the clinical condition of the hospitalized patients, as well as the structure and resources available in the hospitals.

The target of dissertation's work is creation of optimal cooperation model between The Faculty of Management the University of Economics Prague and Nemocnice Jindřichův Hradec, a. s., based on present system of cooperation with a view to mutual utility and benefits. Output of our dissertation's work is set the parameters of cooperation and full made new contract and approval of it by both sides.