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 elderly population, defined as 65 and older, is the fastest growing demographic group in the United States. As baby boomers' reliance on healthcare systems increase, housing with medical accessibility becomes a vital need in today's economy. As the market appears to signal an increase in the need and desire for home and community based services, important questions arise about how assisted living executives' leadership styles affects his/her entrepreneurial orientation. This study analyzed the relationship between the full range of leadership model as measured by the multifactor leadership questionnaire and entrepreneurial orientation (innovativeness, proactiveness, and risktaking) of executives within the licensed assisted living facility industry in Indiana. The researcher used the multifactor leadership questionnaire and the entrepreneurial orientation questionnaire to determine whether assisted living executives were innovative, proactive, and risk-taking based on their leadership style. </p>

The safety literature describes senior managers as crucially influencing organisational safety. Yet, it is not fully understood, what contributes to their influence. This thesis investigated senior managers’ characteristics in relation to their impact on safety in air traffic management organisations. A review of the safety literature indicated research in this area would benefit from the introduction of a research model as a theoretical basis. The skills-based leadership model by Mumford and colleagues was proposed as a suitable model for senior managers’ influence on organisational safety. A safety–specific version of the model was devised, consisting of traits (Big Fives, regulatory focus), skills (problem solving, social competence) and safety knowledge as antecedents of safety commitment and organisational safety outcomes. Study 1 explored the relevance of these characteristics for senior managers’ work on safety using semi-structured interviews with senior managers (N = 9). Responses were coded into the characteristics with sufficient reliability using qualitative content analysis. The characteristics were found to be relevant for senior managers’ influence on safety and their content was refined based on the findings. Safety knowledge and social competence were frequently indicated. Interpersonal leadership emerged as additionally relevant. Study 2 investigated the characteristics’ relevance for safety managers’ and CEOs’ influence on safety with questionnaires consisting of open questions (N = 49). Responses were coded using qualitative content analysis with acceptable reliability. The results re-confirmed the relevance of the characteristics. As in the previous study, interpersonal leadership emerged. Furthermore, problem-solving, leadership and safety knowledge were found more frequently for CEOs than for safety managers, whereas personality was more frequently indicated for safety managers than for CEOs. Finally, Study 3 tested the characteristics’ influence on safety commitment, which was conceptualised as indicated through behaviours that reflect a positive attitude towards safety. Interview questions, scenarios and questionnaires were used to measure characteristics and safety commitment in a sample of senior managers (N = 60). Interview and scenario responses were quantified with acceptable reliability. The results indicated that not all characteristics that were previously found to be relevant for senior managers’ influence on organisational safety were also related to safety commitment. Mainly, problem solving was shown to influence safety commitment, with the ability to understand problems, to identify useful information-sources and to generate ideas that relate to changes in the organisation’s culture as most influential. The findings can inform guidance and training for senior managers. Future research in this area could benefit from a focus on the conceptualisation of safety commitment, the role of interpersonal leadership style, as well as safety knowledge and the skills included in the research model.

<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>

<p> The purpose of this study was to determine if a cancer patient will experience less nausea and a better quality of life if a non-clinical caregiver is present with them while receiving chemotherapy. Primary data was collected at the oncology outpatient infusion center at Kaiser Permanente West Los Angeles Medical Center. Of the 39 participants, 23 had a caregiver with them and 16 came to receive treatment alone. Each participant was asked their nausea level 24 hours after they received chemotherapy. Seventy-two hours after receiving chemotherapy they were asked to complete the Functional Living Index-Emesis (FLIE) survey to evaluate their quality of life during the last 3 days. The data were analyzed by using descriptive and inferential statistics. </p><p> Although neither group of patients experienced less nausea or took less anti-nausea medication, those that did have a caregiver present with them did report that they had a better quality of life.</p>

<p> The purpose of this grounded theory study was to develop a construct that describes the motivations of physicians to lead multidisciplinary prostate cancer clinics (MPCCs). Medical leaders play a key role in increasing the number of MPCCs, which are not yet widely available to patients in the United States. Understanding what motivates these physicians to lead is an important dimension of developing, recruiting, and retaining MPCC leaders. </p><p> This study collected qualitative, empirical data from 12 MPCC medical leaders located throughout the United States. Utilizing theoretical sampling and constant comparison, the data derived from face-to-face interviews were used to create a new construct of MPCC medical leaders' motives called <i> Leader-Stage Motivation</i> (LSM). </p><p> In the LSM construct a physician experiences 11 motivational factors while leading a multidisciplinary prostate cancer clinic. These 11 factors are grouped into 5 motivational patterns: mentored self-efficacy, purpose-driven goal, multidisciplinary relatedness, time-moderated challenge, and achievement-driven goal. Each of these 5 patterns is directly related to the leader's role during 3 stages of MPCC development: leader-creator, leader-sustainer, and leader-renewer. </p><p> The LSM construct is distinct from other leadership motivation theories such as leadership motive pattern (McClelland, 1975), role motivation theory (Miner, 1978) and motivation to lead (Chan &amp; Drasgow, 2001). Unlike these previous theories LSM establishes a relationship between the leader's motivations and changing leadership roles during the life cycle of an organization. The LSM construct also provides a new model of leadership motivation that is specific to medical leaders. </p><p> This study contributes to leadership motivation research by modeling physicians' motivations to lead in one type of multidisciplinary, patient-centered environment. The LSM construct gives health care providers a development, recruitment, and retention framework for future multidisciplinary prostate cancer clinic medical leaders. Results of this study may also contribute more broadly to an understanding of what motivates physicians to lead their peers. </p>

<p> Mississippi has an abundant supply of underground aquifers which are utilized by community water systems as their source of drinking water. As the demand for water increases through the increasing population and the influx of industries, there is a need to manage the consumption and distribution of this valuable resource. Since its inception, the Mississippi drinking water industry has spawned new regulations, new management options, and creative ideas to promote a safer more efficient community water system. </p><p> The Mississippi State Department of Health-Bureau of Public Water Supply's Capacity Development Assessment is a comprehensive survey completed annually for every community water system in Mississippi. The Capacity Development Assessment will be used to gauge the quality of performance of the specified community water systems based exclusively on size classification, exclusively on government structure classification, and government structure by size classification. </p><p> Over the past 15 years, Mississippi has seen several centralization efforts occur, where a municipality, utility district, and/or a rural water association merges with one or multiple adjoining or close proximity community water systems. This results in one of the three main legal structures of government over community water systems increasing in size in an effort to heighten performance. This research has analyzed the size (population) and government structures of Mississippi community water systems and has determined that economies of scale do exist. Government structure alone does not have an effect on the performance of community water systems but size alone does have an effect on the performance of community water systems. Municipalities and rural water associations reach optimal performance at the medium size classification and utility districts reach optimal performance at the small size classification. </p><p> Regardless of the driving force, it is valuable to see that all of the Mississippi consolidating government structures are able to achieve optimal performance. Future state and/or federal legislatures, county governments, city governments, public water supply associations, and business economic drivers can benefit by knowing which structure(s) of community water system governance is the most productive and efficient when the time comes to explore the option of persuasion or mandates to increase viability or heighten performance. </p>

<p> A qualitative exploratory case study was undertaken to explore the role of physician assistants (PAs) in a small, rural hospital in the Virgin Islands. The concept of task transfer was examined to determine if PAs could take on more roles assumed by physicians. The study involved the perceptions and experiences of 16 physicians, 11 PAs, 12 hospital administrators, and 10 potential patients. Emerging themes fell into three categories: benefits and challenges of working with PAs, role of PAs, and acceptance of PAs. Within these categories, the following themes were identified: limited/basic PA roles, reduction of the physician workload, and variable PA competency levels. Subthemes to emerge included the role of PAs, improving patient care, filling shortages, the supervision of PAs, developing protocols for duty, and establishing a procedure for delegation of responsibilities. The conclusion was that in patient service in rural areas, maximizing the efficiency of a PA could be improved when task transfer was implemented as a means to the division of labor. The results of this study may assist legislators when re-evaluating and revising physician assistant scope of practice policies.</p>

<p> This quantitative study of paid home care workers (N=572) used an ex post facto survey design for data collection and structural equation modeling for data analysis in order to explain and predict the relationships among key identity constructs that are inherent in caregiving. The study examined the relationship between predictor variables of (1) role occupancy in caregiving, (2) relational identification within the caregiving dyad, and (3) organizational identification within the caregiving organization as these affected the criterion variable of the caregiving self. A final research question sought to understand (4) how dirty work acted as a moderating variable impacting the relationship between each of the predictor variables and the outcome variable. The outcome variable was measured using the Callero (1985) role merger scale. Predictor variables of relational identification and organizational identification were also measured using scales (Sluss et al., 2012; Mael &amp; Ashforth, 1992). Results supported some but not all of the <i>a priori</i> hypotheses established prior to the research study. Findings supported the hypothesized positive relationships between 1) caregiving role occupancy and the caregiving self, 2) caregiving relational identification and the caregiving self, and 3) caregiving organizational identification and the caregiving self. The hypothesis suggesting the moderating effect of dirty caregiving tasks was partially supported, with findings indicating that higher experience in dirty caregiving tasks moderates the positive association between organizational identification and the caregiving self.</p>

<p> For several decades, the cost of medical care in the United States has increased exponentially. Congress enacted the Patient Protection and Affordable Care Act (PPACA) of 2010 to ensure affordable healthcare to the citizens of the United States. The purpose of this case study was to explore physicians' perspectives regarding physician-centric business models evolving under the requirements of PPACA legislation. Complex adaptive systems formed the conceptual framework for this study. Data were gathered through face-to-face, semistructured interviews and e-mail questionnaires with a purposeful sample of 20 participants across 14 medical specialties within Northeast Texas. Participant perceptions were elicited regarding opinions of PPACA legislation and the viability of business models under the PPACA. In addition, a word cloud was used to identify 3 prevalent or universal themes that emerged from participant interviews and questionnaires, including (a) use of mid-level practitioners, (b) changes to provider practices, and (c) lack of business education. The implications for positive social change include the potential to develop innovative models for the delivery of medical care that will improve the health of the aggregate population. Healthcare leaders may use the findings to advance the evolution of physician business models that meet the needs of healthcare stakeholders. These findings may also inform healthcare leaders of the need to develop cost-effective and innovative organizational models that are distinct to individual patient populations.</p>