Revised 2013: "Recipes for Success"

Dissertation and Scholarly Research: Recipes for Success (Recipes) is a bestselling guide to writing your dissertation (5 star ranking on Amazon). The 2013 edition of Recipes offers students and faculty a comprehensive, up-to-date, user-friendly text that explains clearly how scholarly research is created, evaluated and, disseminated. This revision contains fresh content and more than 200 new references from reliable sources. Each section of the book has been updated to provide practical, actionable guidance for every phase of dissertation development, and is supported by continuous updates and new resources on our companion website: www.dissertationrecipes.com. While the text has been extensively revised, some things have not changed. Understanding quality research to become excellent consumers and producers of research continues to be the focus, leading to in-depth understanding of academic inquiry. Using a workbook approach rich in tools, templates, frameworks, examples, and hard-won lessons from experience, Recipes continues to provide easy to navigate processes for crafting issues and ideas into research and results. Whether you are just considering doctoral study, already in a doctoral program, working to develop and complete your dissertation, or mentoring doctoral students, you will find Recipes a key ingredient in your success. Recipes is available for purchase on Amazon.com and booksellers, or from website at http://dissertationrecipes.com/buy-the-book/

With complete credit to author Hardn Bush, Senior Editor, H&HN for the attention of doctoral students in Health Servicesn (REH).

Change Hospitals Can Believe In
By Haydn Bush H&HN Senior Online Editor	December 12, 2012
What can hospital executives do to drive the change their organizations desperately need?

ORLANDO — Health care providers are facing a moment of transformational change. But how can leaders motivate their institutions to go forward?
That's the central question Dan Heath, a senior fellow at Duke University's CASE center and the co-author of Switch: How to Change Things When Change is Hard, took on at the Institute for Healthcare Improvement's National Forum Wednesday, as he urged attendees to rethink their approach to change in both their institutions and the overall health care system.
"Sometimes when I overhear health care discussions, it sounds like people believe that you can align the incentives and everything magically changes," Heath said. "We believe we're one ingenious bribe away from revolutionizing health care."
Instead, Heath urged providers to both closely examine the structural and emotional barriers to transformation while searching for positive examples of change already present in their hospitals.
For instance, Heath described an effort at Kaiser Permanente Southern California to reduce opioid use. According to the Centers for Disease Control and Prevention, more people die each year from opioid abuse than from heroin and cocaine combined. Kaiser Permanente was not immune; an analysis found that many patients were getting multiple prescriptions from multiple providers, amassing large quantities of drugs like Oxycontin.
One Kaiser facility, though, had a rate of Oxycontin prescriptions a 10th that of the medical center with the highest rate. The secret? Pain management review teams that promoted the idea of nonmedication-based solutions, headed by a physician who put his cell phone number in the electronic health record as a contact point any time anyone had a concern about a prescription.
"They exported that idea to other medical centers," Heath said, along with a pledge to get physicians to self-restrict their ability to prescribe opioids. Two years later, Oxycontin prescriptions were down 70 percent throughout the system.
The lesson? While leaders are often preoccupied with solving problems and replicating best practices from elsewhere, they shouldn't be afraid to look for the bright spots in their own institutions.
"When we come to conferences like this, it's a wonderland of best practices. Let's not forget best practices are not the only way to make ourselves better," Heath said. "We can get better by being more like ourselves at our own best moments."
It's also important to consider the structural barriers to change, Heath said. Heath recalled a conversation with a nurse at Brigham and Women's Health Center in Boston, who told him that over time, clinicians were ignoring signs in patient rooms warning of fall risks. "She said that in acute care hospitals, 80 percent of patients are at high risk for falls, so the signs fade out of consciousness," Heath said.
However, the nursing team realized it had enough information on each patient — from whether they had ambulatory aids to how they toileted — to tailor the signs specifically to their needs. The newer, more specific signs led to a reduction in falls of 25 percent, Heath said.
"If you invest a little time in the environment, you can get better outcomes," Heath said. And while Heath is skeptical of realigning incentives as the key driver of change in health care — "it represents a deeply impoverished view of human motivation," he said — he believes that appeals to more emotional forms of motivation can have a lasting impact. For instance, he noted, when former IHI CEO Donald Berwick, M.D., launched the 100,000 Lives campaign eight years ago, "he did not offer you an incentive and you didn't ask for one. He said, 'If we make this journey together, we will celebrate together.'"
In my final blog from IHI's 24th National Forum tomorrow, I'll recap Berwick's address scheduled for later today.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

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Skills Needed to Lead the Hospital of the Future (Complete credit for authorship is given to Sita Ananth for this most interesting article published in H&HN Daily 11/29/12 and presented to doctoral students for reading & discussion. R. E. Hoye, Ph.D.)
By Sita Ananth	November 29, 2012
A hospital that integrates complementary and alternative medicine, focuses on the patient, delivers value, and functions in the accountable care world requires a CEO who has a strong vision, assembles a highly skilled leadership team and engages the community.

The Complementary and Alternative Medicine Survey of Hospitals I conducted in 2010 revealed some encouraging data about the role of hospital leaders in championing and supporting these initiatives. A high number of respondents (39 percent) said that hospital administrators were responsible for launching the complementary and alternative medicine program, and 33 percent stated that the administrators continued to be champions for the program.
"Hospitals are recognizing that many of their patients see CAM as an integral part of managing their health, illness and recovery. Smart hospital leaders will figure out how to integrate these services to broaden their appeal to a growing segment of patients who truly value these services (and are often prepared to pay out of pocket to secure them)," says Ian Morrison, author, consultant and futurist.
This brings up an important question. What are the skills required by hospital CEOs to lead the organization of the future — one that is patient-centered, delivers value rather than volume and operates in an era of accountable care organizations? I posed this question to a few leaders, consultants and leadership experts, and some key themes emerged.
Vision. Leaders, particularly CEOs, need to adhere to a vision of their organization as one that is truly committed to compassionate care and healing. "We are seeing a trend now where CEOs are required to have a clinical background so they can evaluate and understand the operational impact of these initiatives," says Laurie Eberst, senior vice president of Dignity Health, who has led the cultural turnaround of two Dignity Health hospitals in Oxnard, Calif., and has been tapped to do the same in Northridge, Calif. Eberst was responsible for building Mercy Gilbert (Ariz.) Medical Center from the ground up and creating an award-winning "healing hospital."
Building a senior team with the right skills. With patient satisfaction and theHospital Consumer Assessment of Healthcare Providers and Systemssurvey becoming a key determinant of reimbursement, organizations are creating a culture of compassion, healing and patient-centered care. To make that happen, says Eberst, CEOs must surround themselves with people with the right skill set who will support, consistently "enforce" and monitor this cultural change. The courage to lead these efforts in the  face of conflicting demands is crucial.
Modeling behaviors. Organizational culture begins with healthy leadership. It is expressed through vision, modeled by leaders, and defined by clear behaviors and rewards for healing interactions that extend from the bedside to the boardroom. It requires compassion, trust, communication, teamwork and an ongoing framework for honest evaluation and learning, says Mary Hassett, president and principal at Integrations Inc., a strategic consultancy in Greenville, S.C. Many CEOs — in spite of their understanding and good intentions — fail. They fail because they tend to neglect their own self-care and health. The result of their imbalance takes its toll in many ways. It is evident to all when the leader is not modeling what the organization espouses to be and commits to deliver, she says.
Leader as educator. "Hospital CEOs will lead in educating their teams in what CAM is all about — what is evidence-based, what works, what the community wants," says Kathryn Johnson, retired CEO of Health Forum. They need to convince their team (and their physician leaders) that CAM not only is the right thing to do, but it also shows that the hospital is responding to the needs of its community.
Engaging the community and CAM providers. Engaging the community and bringing its members into the conversation is also key, says Johnson. Understanding community needs demonstrates a commitment to community benefit and can help the hospital ensure that its services are responsive to those needs. Using the CAM providers in the community as extenders is another way not only to build a referral network, but also to improve the hospital s reputation in the community.
"We are educating the next generation of change agents," says Meg Jordan, Ph.D., R.N., C.W.P., chair of the integrative health studies department at the California Institute of Integral Studies, "and to do that these leaders need to transform themselves, celebrating diversity not merely in thought, and be advocates of true sustainability, not merely ecological but of cultural well-being."
It s a tall order, but one it appears they are ready to take on.
Sita Ananth, M.H.A., is a writer and content expert on complementary and alternative medicine based in Napa, Calif. She is also a regular contributor to H&HN Daily.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

Ethics, Confidence, and Training as Predictors of Decision-Making by Nurses During Disasters

I am pleased to present the ABSTRACT of the Ph.D. Dissertation prepared in May, 2012, by Dr. Joan Bold to Walden University.

Abstract

 Ethics, Confidence, and Training as Predictors of Decision-Making by Nurses During Disasters 

by

Joan A. Bold

MEd, University of West Florida, 1983

BSN, University of San Diego, 1981

Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Health Services

Walden University

May 2012

Abstract

The American Nurses Association (ANA) 2008 Code of Ethics and Adapting Standards of Care Under Extreme Conditions describes how nurses are placed in the forefront of all phases of disaster relief, from planning to recovery efforts.  A 20-question quantitative instrument was developed and tested for feasibility in the field using ethics theory and Dillman’s tailored design method. The tool was assessed by an expert panel of 5 and then administered to 26 nurses from the public and community health departments. Research questions addressed (a) the ability of nurses familiar with the 2008 ANA Code of Ethics to verbalize knowledge of their professional responsibilities, (b) nurses ability to make confident decisions, assume leadership roles, and treat patients fairly, (c) ethics training beyond the basic nursing coursework. Data analysis technique included 6 ANOVA tests for the hypotheses. The result of the analyses supports 2 of 3 hypotheses (a) confidence in ethical decisions-making, (b) training during all-hazard situations. Both are associated with decision-making for entire group years licensed (11-40 years) and years worked (10-35 years) p= .01 respectively. Two other ANOVA test failed to accept or reject the null for confidence p= .91 and training p= .80. The results failed to reject the null hypothesis for (a) professional responsibility for years licensed (11-15 years) and years worked (11-15 years), nurses had moderate ethical concerns for decision-making p= 1.90, (b) professional responsibility (self-determination) also revealed nurses had difficulty placing their needs before their patient’s needs p= 1.19 regardless of years licensed (11-40 years) or years worked (10-35 years).  Implications for positive social change include better ethical decision making which can lead to higher quality of care for victims of disasters and improved medical outcomes.

Experiences of Accessing Medical Care by African American Men with Hypertension

I am pleased to present the ABSTRACT of  the Ph.D. Dissertation prepared and presented by Dr. Sandra Grosvenor to Walden University, September, 2012.

Abstract

Experiences of Accessing Medical Care by African American Men with Hypertension

by

Sandra Grosvenor

M.H.S.A., University of St. Francis, 2004

B.S., University of St. Francis, 2000

Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Health Services

Walden University

August 2012

Abstract

The challenges and barriers that African American men with hypertension experience when accessing medical care on the Gulf Coast of Florida was the focus of this qualitative study. More than 50 million African Americans are affected by hypertension or high blood pressure. Still, many African American men may not understand the relationships between their social habits and their medical condition or how treatments such as receiving medical care for high blood pressure and eating certain foods could help improve their overall health. This descriptive qualitative study explored the lived experiences of working poor and indigent African American men between the ages of 25 and 55 with hypertension. Becker’s health belief model and Bracht’s health promotion model were used as conceptual frameworks to guide the research. Research questions were: What are the experiences of African American men when they access medical care for high blood pressure? How are African American men managing their blood pressure? What are some culturally acceptable ways to reach and competently treat African American men with high blood pressure? Four sources of data were analyzed and included questionnaires, surveys, interviews, and field notes.  A community center where African Americans frequent daily was utilized for the study. Findings showed that many African American men were not managing their high blood pressure, and had some challenges getting health care. The implications for  social change are that the health beliefs and perceptions of individuals,  have the potential to reduce the high incidences of hypertension through effective health services directly at the community level.   

Divided Government: Fiscal Cliff & Future of Reform

Credit for this article goes to author Haydn Bush, 11/9/2012 Health & Health Networks/ For use in Doctoral Research Forum.REH

 Divided Government, Fiscal Cliff and the Future of Reform By Haydn Bush H&HN Senior Online Editor November 07, 2012 The focus in Washington moves from the election to the fiscal cliff and the implementation of reform. What will that mean for hospitals? The grueling, seemingly endless presidential campaign is now a memory, and with no changes to control of the White House, Senate and House of Representatives, attention now shifts in earnest to the looming Fiscal Cliff. To be sure, there will be some time for celebration by the Obama camp and soul searching by the GOP, but those are bound to be short-lived. Even before we all sit down to gobble up turkey, stuffing and pumpkin pie in a couple of weeks, lawmakers are sure to stake out positions on the contentious issue of sequester and the 2 percent cuts in Medicare reimbursements that are slated to take hold next year. Oh, and hospitals, physicians and insurers eagerly await a slew of expected rules on the Affordable Care Act that were essentially put on hold during the last weeks of the campaign. "The election has been decided and the time for politics is over," says AHA President and CEO Rich Umbdenstock. "It is now time for governance. We must address the serious issues facing our country and have conversations that address real reform to improve the nation's health care system for patients and communities. Cuts to hospital care are not real reform. It is now clear that implementation of the ACA will move forward and we will continue to improve and build on it to advance quality of care and reduce cost." In a statement, Jeremy Lazarus, M.D., president of the American Medical Association, congratulated the president while focusing squarely on the projected cuts to physician payment scheduled to take effect next year. "The AMA is also committed to working with Congress and the administration to stop the nearly 27 percent cut scheduled to hit physicians who care for Medicare patients on January 1," Lazarus stated. "It is time to transition to a plan that will move Medicare away from this broken physician payment system and toward a Medicare program that rewards physicians for providing well-coordinated, efficient, high-quality patient care while reducing health care costs." Many experts, however, believe that in the short-term, the president and Congress will delay action on these issues well into next year. "My gut tells me that they punt the tax rates, the sequester and the debt ceilings," says Christopher Condeluci, who served as tax and benefits counsel to the Senate Finance Committee during the crafting of the Affordable Care Act and now is an attorney with the Washington, D.C.-based law firm Venable. While it's unclear at what point the federal debt limit would have to be raised — forcing action to alleviate a default — Condeluci guesses that action to move those conversations into February or March could occur, creating a new deadline of the August 2013 Congressional recess to make meaningful progress on a grand bargain around federal spending and taxes. Reform Moves Ahead In the meantime, the president's reelection means that implementation of key provisions of the ACA will continue. Most notably, open enrollment in health insurance exchanges is slated to begin Oct. 1, 2013, to prepare for coverage under the exchanges at the start of 2014. And while the final rules on the exchanges are out, Condeluci says there are a slew of other insurance market reform issues that still need to be resolved. "There will be an onslaught of regulations issued by the end of the month, and the end of the year," Condeluci says. Allowing time for the public comment process, he says, the rules could be in place by February, giving health insurance carriers eight months to prepare for open enrollment. From a longer-term perspective, of course, that means hospitals will need to continue preparations to care for the estimated 32 million Americans who are anticipated to have new access to health coverage. That means hospitals will have to carefully anticipate shifts in utilization and the impact on ED use, says Steve Valentine, president of the health care consulting firm Camden Group. One potential scenario: the potential growth in primary care offered by federally qualified health centers could contribute to a reduction in hospital utilization, he says, adding, "Inpatient use will get squeezed." And while it will take years, if not decades, to sort out all of the impacts of reform, Valentine says that in the short term participation in the Centers for Medicare & Medicaid experiments around cost containment and quality improvement, including its bundled payment and shared savings ACO programs, may not be high enough to hit the expected cost savings associated with those programs. Ultimately, the success or failure of those initiatives will trickle out to providers, he adds. "The goals of the Obama administration are not being met in terms of people in bundled payment [programs] and ACOs," Valentine says. "He's overestimated the savings, so taxes will have to go up or payment will have to go down. That's a wake-up call." 'Hospitals Will Double Down' Beyond the Beltway, of course, the health care industry is already in the midst of a major internal transformation outside of government reimbursement and oversight, from consolidation of hospitals and physician groups to the advent of insurance innovations like "narrow networks," or health plans linked to services offered by a single or handful of providers. Both Condeluci and Valentine expect these trends to pick up speed, with Condeluci predicting continued movement in the private market to embrace narrow networks, even if the plans may not initially pass muster for inclusion in the health insurance exchanges. And regardless of how federal changes to health care spending and ACA implementation shakes out, Valentine says the movement in recent years to aggressive cost containment — an issue we've covered extensively in our Fiscal Fitness series — will continue no matter what happens in Washington. Ultimately, Valentine says, that means more scrutiny for all nonclinical positions, the reevaluation of operations as they relate to the hospital's mission and a renewed focus on fundraising. "Hospitals will double down on squeezing more expense out," Valentine says. "There is no getting around this." The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.