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Title: REDUCING NON-URGENT UTILIZATION OF THE EMERGENCY DEPARTMENT BY SELF-PAY PATIENTS: ANALYSIS OF THE IMPACT OF A COMMUNITY-WIDE PROVIDER NETWORK.
Creator: van Caulil, Karen, Liberman, Aaron, University of Central Florida
Abstract / Description: The purpose of this study was to determine whether a coordinated and comprehensive system of care for the uninsured changed the behavior of the uninsured by decreasing non-urgent utilization of the emergency departments within a large, urban county. The literature on emergency department trends and interventions designed to decrease "inappropriate" or non-urgent use of the emergency departments was reviewed and links to relevant theoretical concepts were identified. Utilization data from six...
Show moreThe purpose of this study was to determine whether a coordinated and comprehensive system of care for the uninsured changed the behavior of the uninsured by decreasing non-urgent utilization of the emergency departments within a large, urban county. The literature on emergency department trends and interventions designed to decrease "inappropriate" or non-urgent use of the emergency departments was reviewed and links to relevant theoretical concepts were identified. Utilization data from six emergency departments and six federally qualified health centers were evaluated. Secondary data over a three-year time period were abstracted from patient and organizational records at the hospitals and federally qualified health centers. The utilization data from the emergency departments and health centers were compared. The analysis revealed a significant change in the number of non-urgent visits by self-pay patients at the emergency departments when the health centers expanded. A 32.2 percent decrease in utilization of the emergency departments by self-pay patients was found. Non-parametric tests demonstrated significant differences in the population seen at the emergency departments and the clinics over the three-year study period. Regression analysis demonstrated a statistically significant decrease in non-urgent, self-pay visits at the emergency departments as a result of the increase in self-pay visits at the federally qualified health centers. Further analysis includes forecasting the impact of future federally qualified health centers on emergency department utilization. Recommendations for future research include evaluation of the increased numbers of non-urgent transports from the local emergency medical system by self-pay patients as well as the design of a pilot study to look at the effectiveness of transporting these patients to the federally qualified health centers for care instead of to the local emergency departments.
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Date Issued: 2005
Identifier: CFE0000436, ucf:46393
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0000436

Title: NURSING LEADERSHIP CHARACTERISTICS: EFFECT ON NURSING JOB SATISFACTION AND RETENTION OF BABY BOOMER AND GENERATION X NURSES.
Creator: Swearingen, Sandra, Liberman, Aaron, University of Central Florida
Abstract / Description: ABSTRACT The purpose of this research is to determine the degree to which a positive experience with nursing leadership increases nurse's job satisfaction. The different values and norms of the generational cohorts result in each cohort perceiving leadership characteristics differently. Factors such as length of exposure to leadership, location, shift worked, clinical versus non-clinical positions and the presence or absence of Servant-Leadership, all have the potential to impact nursing...
Show moreABSTRACT The purpose of this research is to determine the degree to which a positive experience with nursing leadership increases nurse's job satisfaction. The different values and norms of the generational cohorts result in each cohort perceiving leadership characteristics differently. Factors such as length of exposure to leadership, location, shift worked, clinical versus non-clinical positions and the presence or absence of Servant-Leadership, all have the potential to impact nursing satisfaction. Nursing satisfaction, or dissatisfaction impacts retention, further modifying nursing leadership practices. Conflict, Cohort, Servant-Leadership, and Self-Discrepancy theories were utilized to identify the relationships of generations to each other and to the leadership characteristics existing in their organizations. Two Central Florida healthcare organizations were utilized to obtain data regarding leadership characteristics, generational cohort and nursing satisfaction indicators. A total of 440 survey questionnaires were distributed, 182 were returned, a response rate of 41%. Factor Analysis utilizing principal component analysis was performed to reduce the 57 variables contained within questionnaires to one construct that represented a leadership characteristics variable. This variable was utilized to test 3 of the hypotheses. Principal component analysis was utilized to reduce 10 characteristics of Servant-Leadership, to a construct that represented a Servant-Leadership variable. Qualitative data was collected from 25 interviewees and was used to enrich and supplement the quantitative data from the survey questionnaires. Nursing leadership characteristics affect nursing satisfaction as demonstrated by this research. The more positive the perception or experience of nurses in relation to nursing leadership, the more job satisfaction increases. Even though literature states that Generation X employees exhibit less job satisfaction, due to generational specific values and norms, generational cohort did not demonstrate significance in this study. A positive perception of nursing leadership characteristics demonstrated a positive impact on nursing retention within an organization. Nurses who are satisfied with leadership characteristics tend to stay with that organization. The presence of Servant-Leadership characteristics also demonstrated a positive impact on nursing job satisfaction and retention. Leaders that demonstrate Servant-Leadership characteristics engender increased job satisfaction for their employees and increased retention of nurses for their organizations.
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Date Issued: 2004
Identifier: CFE0000205, ucf:46255
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0000205

Title: THE INFLUENCES OF SYSTEM AFFILIATION, SIZE, AND LOCATION ON BIOTERRORISM PREPAREDNESS AMONG FLORIDA HOSPITALS.
Creator: Scharoun, Kourtney, Liberman, Aaron, University of Central Florida
Abstract / Description: In the event of a bioterrorist attack, emergency departments are considered the first line of response for all acute levels of care. This study focused on hospital emergency departments in Florida and the activities, policies, and procedures involved in preparing for a bioterrorist attack. Hospital size, location, and system affiliation were related to attaining these levels, and their impact was assessed. Through a cross-sectional survey design, the physical properties of the 77 hospitals (i...
Show moreIn the event of a bioterrorist attack, emergency departments are considered the first line of response for all acute levels of care. This study focused on hospital emergency departments in Florida and the activities, policies, and procedures involved in preparing for a bioterrorist attack. Hospital size, location, and system affiliation were related to attaining these levels, and their impact was assessed. Through a cross-sectional survey design, the physical properties of the 77 hospitals (i.e. facilities, equipment, communication systems, etc.), and the social characteristics of the organizations (managerial functions including: planning, training, financial, and environmental characteristics) were examined. One-way analysis of variance and t-tests revealed that bed size was a significant predictor of mean levels of preparedness. In addition, although more hospitals are conducting training activities, a disconnect between plans and communications of said plans still exists along with many deficiencies still needing to be corrected. Study limitations are discussed and important policy implications are presented. Suggestions for improving preparedness levels and implementing new policies include: conducting training exercises, developing community ties and mutual aid agreements, and using information technology with detection of an event and communication of the information garnered from these efforts.
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Date Issued: 2005
Identifier: CFE0000379, ucf:46344
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0000379

Title: HEALTHCARE COMMUNICATION NETWORKS: THE DISSEMINATION OF EMPLOYEE INFORMATION FOR HOSPITAL SECURITY.
Creator: Sumner, Jennifer, Liberman, Aaron, University of Central Florida
Abstract / Description: ABSTRACT: Healthcare in the United States is a system that, organizationally speaking, is fragmented. Each hospital facility is independently operated and is responsible for the hiring of its own employees. However, corrupt individuals can take advantage of this fragmentation and move from hospital to hospital, gaining employment while hiding previous employment history. Traditionally, hospitals have been reluctant to share information on their previous employees, even with other hospitals,...
Show moreABSTRACT: Healthcare in the United States is a system that, organizationally speaking, is fragmented. Each hospital facility is independently operated and is responsible for the hiring of its own employees. However, corrupt individuals can take advantage of this fragmentation and move from hospital to hospital, gaining employment while hiding previous employment history. Traditionally, hospitals have been reluctant to share information on their previous employees, even with other hospitals, for fear of issues surrounding defamation, negligent hiring, and violation of the employee's privacy. However, growth in healthcare services is expected to rise exponentially in the near future, increasing the demand for employees. The need, therefore, to exchange pertinent information regarding employees will become necessary as hospitals seek qualified employees to fill positions throughout their organizations. One way to promote this information exchange is to develop trusted information sharing networks among hospital units. This study examined the problems surrounding organizational information sharing as well as the current level of employee information sharing being conducted by hospitals nationwide. Utilizing a survey of hospital administrators, this study drew upon the theoretical foundations of the Diffusion of Innovation Theory, the Knowledge Management Theory, the Social Exchange Theory and the earlier organizational information sharing frameworks established by Dawes (1996) and Landsbergen and Wolken (1998; 2001) in order to examine the variables that contribute to propensity of hospital administrators to engage in the sharing of employee information with other organizations.
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Date Issued: 2008
Identifier: CFE0002010, ucf:47609
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002010

Title: HEALTH TRANSITIONS AND THE AGING POPULATION: A FRAMEWORK TO MEASURE THE VALUE OF RAPID REHABILITATION.
Creator: Ross, Dianne, Liberman, Aaron, University of Central Florida
Abstract / Description: Healthcare services for the aging population in the United States are a complex configuration of acute healthcare organizations, and post acute nursing facilities, home healthcare, and community based services. The system encompasses all services that imply the need for clinical, medical, or professional judgment (Baldrige National Quality Program, 2006). Most Americans believe the system exists to provide preventive services, management for chronic conditions, and health care services to...
Show moreHealthcare services for the aging population in the United States are a complex configuration of acute healthcare organizations, and post acute nursing facilities, home healthcare, and community based services. The system encompasses all services that imply the need for clinical, medical, or professional judgment (Baldrige National Quality Program, 2006). Most Americans believe the system exists to provide preventive services, management for chronic conditions, and health care services to meet the needs of the people (National Committee for Quality Assurance (NCQA), 2004). However, the healthcare delivery system is fragmented across a broad array of settings (Coleman, Smith, Frank, Min, Parry, & Kramer, 2004), plagued by gaps in quality of care, and does not provide optimal care to the majority of American citizens (NCQA, 2004). As a result, national efforts are focused on the identification of quality indicators, performance measures, and the driving need for consensus standards across a multiplicity of providers, payers, and stakeholders. The overarching focus of this effort is to bridge the gaps in health care quality, and reduce documented disparities for vulnerable populations (National Quality Forum (2004). Healthcare transitions occur as patients receive a broad range of services across a multiplicity of providers, payers, and settings. Aging patients > 65 are most vulnerable during these transitions. A poorly executed transition can result in complications for the patient, duplication of tests and services, discharge delays, increased lengths of stay, early readmissions to the acute care setting, frustration for families and care givers, and dissatisfaction with overall services. Management of care and accountability across settings is limited and patients are falling through the cracks in the foundation of the healthcare system (Covinsky, 2003). The intent of this research was to examine healthcare transitions for patients > 65 admitted to a large acute healthcare system, and to identify measurable quality indicators for an innovative delivery model designed to optimize early discharge from the hospital through rapid rehabilitation. This was a quasi-experimental, cross-sectional design measured at the patient level. The research included a total sample of 250 patients representing both the intervention and the control group. The intervention group consisted of 100 patients who were rapidly discharged to a transitional care facility in the community, and 150 patients randomly selected to a control group that did not transition to rapid rehabilitation. The groups were matched as closely as possible by age, gender, race, primary diagnoses, and the complexity of case. Inefficiency was measured by 3 indicators (1) length of stay, (2) total expenses before contractual allowances, and (3) discharge delays from the hospital. Ineffectiveness was measured by 3 indicators: (1) readmission within 30 days, (2) patient safety with falls serving as the proxy, and (3) overall patient satisfaction. Descriptive analysis was performed utilizing SPSS 15.0. Path analysis was method of choice for data analysis and AMOS 7.0 was utilized for the measurement model. Descriptive analysis found a broad range of diagnosis related groups across 183 women and 67 men with a mean age of 80 for both groups. Initial analysis found the intervention group had a mean length of stay of 9.17 days, and experienced 20 readmissions. The control group had a mean length of stay of 6.77 days, and 30 readmissions. The statistical analysis suggested length of stay and cost of healthcare services are statistically significant indicators at the 0.05 or lower level and that patient safety has the potential to be developed as an indicator for effective outcomes. The identification of quality indicators, measurement of efficiency and effectiveness, and establishing predictors for successful healthcare transitions is dependent on the quality and integrity of data abstracted from hospital information systems, accuracy of information in patient records, and the consensus of standards and definitions across a multiplicity of stakeholders. Further research and collaboration is necessary to ensure that patient transition to innovative care programs such as rapid rehabilitation is based on well-defined patient selection criteria. The intent of the methodologies and quality indicators explored in this research supports the increasing need to ensure that inferences and quality measurements drawn from healthcare information is based on valid, reliable, and well defined data sources (Pan, Fergusson, Schweitzer, & Hebert, 2005). This research suggests hospitals are making steady progress to overcome challenges to safe, quality health services as outlined by the Institute of Medicine (2001) for system redesign, but finds specific implications for hospital leadership. There is a need to thread evidence based practice initiatives into hospital and clinical structures to accommodate new delivery models, processes, and case management. Health services information needs to be housed in a central repository or data warehouse to increase transparency of reportable information across systems and to ensure that valid and reliable information is utilized to draw inferences about performance of hospital systems (Selden & Sowa, 2004) and that quality measurements are established to ensure a scientific foundation for the management of healthcare services (Wan, 2002).
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Date Issued: 2008
Identifier: CFE0002130, ucf:47543
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002130

Title: USING COMPUTER SIMULATION MODELING TO EVALUATE THE BIOTERRORISMRESPONSE PLAN AT A LOCAL HOSPITAL FACILITY.
Creator: Bebber, Robert, Liberman, Aaron, University of Central Florida
Abstract / Description: The terrorist attacks of September 11th, 2001 and the subsequent anthrax mail attack have forced health care administrators and policy makers to place a new emphasis on disaster planning at hospital facilities--specifically bioterrorism planning. Yet how does one truly "prepare" for the unpredictable? In spite of accreditation requirements, which demand hospitals put in to place preparations to deal with bioterrorism events, a recent study from the General Accounting Office (GAO) concluded...
Show moreThe terrorist attacks of September 11th, 2001 and the subsequent anthrax mail attack have forced health care administrators and policy makers to place a new emphasis on disaster planning at hospital facilities--specifically bioterrorism planning. Yet how does one truly "prepare" for the unpredictable? In spite of accreditation requirements, which demand hospitals put in to place preparations to deal with bioterrorism events, a recent study from the General Accounting Office (GAO) concluded that most hospitals are still not capable of dealing with such threats (Gonzalez, 2004). This dissertation uses computer simulation modeling to test the effectiveness of bioterrorism planning at a local hospital facility in Central Florida, Winter Park Memorial Hospital. It is limited to the response plan developed by the hospital's Emergency Department. It evaluates the plan's effectiveness in dealing with an inhalational anthrax attack. Using Arena computer simulation software, and grounded within the theoretical framework of Complexity Science, we were able to test the effectiveness of the response plan in relation to Emergency Department bed capacity. Our results indicated that the response plan's flexibility was able to accommodate an increased patient load due to an attack, including an influx of the "worried well." Topics of future work and study are proposed.
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Date Issued: 2007
Identifier: CFE0001712, ucf:47293
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0001712

Title: AIRPORT SECURITY: EXAMINING THE CURRENT STATE OF ACCEPTANCE OF BIOMETRICS AND THE PROPENSITY OF ADOPTING BIOMETRIC TECHNOLOGY FOR AIRPORT ACCESS CONTROL.
Creator: Sumner, Kristine, Liberman, Aaron, University of Central Florida
Abstract / Description: The terrorist attacks of September 11, 2001 propelled the issue of aviation security to the forefront of the U.S. domestic agenda. Although hundreds of individual airports exist in the U.S., the travel activities at each of these airports combine to holistically comprise an aviation system that represents a significant portion of the U.S. social and economic infrastructure. Disruption at one airport resulting from a criminal act, such as terrorism, could exert detrimental effects upon the...
Show moreThe terrorist attacks of September 11, 2001 propelled the issue of aviation security to the forefront of the U.S. domestic agenda. Although hundreds of individual airports exist in the U.S., the travel activities at each of these airports combine to holistically comprise an aviation system that represents a significant portion of the U.S. social and economic infrastructure. Disruption at one airport resulting from a criminal act, such as terrorism, could exert detrimental effects upon the aviation system and U.S national security (9/11 Commission, 2004). Each U.S. airport is individually responsible for various aspects of security including the control of physical access to sensitive and secure areas and facilities (9/11 Commission, 2004). Biometric technology has been examined as one method of enhancing airport access control to mitigate the possibility of criminal acts against airports. However, successful implementation of biometric technology depends largely on how individual security directors at each airport perceive, understand, and accept that technology. Backgrounds, attitudes, and personal characteristics influence individual decisions about technology implementation (Rogers, 1995; Tornatzky and Fleischer, 1990). This study examines the problem of airport access control, as well as, the current trends in biometric technology. Utilizing a survey of airport security directors and security managers, this study draws upon innovation diffusion theory and organizational theories to determine what personal, organizational, and technical variables contribute to the propensity of airport security directors and managers to adopt biometric technology for airport access control.
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Date Issued: 2007
Identifier: CFE0001693, ucf:47220
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0001693

Title: DEMAND STUDY FOR DENTAL HYGIENE BACHELOR DEGREE PROGRAM.
Creator: Driscoll, Annelise, Liberman, Aaron, University of Central Florida
Abstract / Description: The following is a study to determine if sufficient demand exists to start a Bachelor of Science and Master of Science degree program in dental hygiene through a joint agreement for completion degrees between Valencia Community College and the University of Central Florida. To accomplish this objective two survey instruments were administered to randomly selected licensed dentists and dental hygienists in the state of Florida. Dental hygienists represented the potential student base for the...
Show moreThe following is a study to determine if sufficient demand exists to start a Bachelor of Science and Master of Science degree program in dental hygiene through a joint agreement for completion degrees between Valencia Community College and the University of Central Florida. To accomplish this objective two survey instruments were administered to randomly selected licensed dentists and dental hygienists in the state of Florida. Dental hygienists represented the potential student base for the proposed programs, and dentists represented the potential and prospective employers of graduated students of the proposed programs. To determine demand and demand characteristics, one survey instrument was mailed to 1,000 dental hygienists who were randomly selected using SAS software from a population of N=12,066 dental hygienists actively licensed to practice in the state of Florida. This sample of hygienists was approximately 8.3% of the total population. Of the 1,000 samples, 134 (or 13.4%) were returned. Of the 134 surveys returned, 123 (n=123) were included in this study. Eleven surveys were not included because of a majority of missing data or because the respondent indicated he or she already possessed a Bachelor or Master degree. A Likert-scale questionnaire was sent to each group of actively licensed dentists and actively licensed dental hygienists from the state of Florida. Responses from dental hygienists were overwhelmingly positive towards the addition of the Bachelor of Science degree program with an online distance-learning component. Those in favor of the Bachelor of Science degree program also provided a favorable response towards adding a Master of Science degree program in dental hygiene. The dentists, as potential future employers, also showed strong support in their responses for the additional degree programs with an additional management track component and believed it would elevate the professional standards of the dental hygiene field.
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Date Issued: 2009
Identifier: CFE0002842, ucf:48048
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002842

Title: Searching for Meaningful Use of Health Information Technology: A Study of Cardiovascular Disease Care in Veterans General Hospitals.
Creator: Thaldorf, Carey, Wan, Thomas, Fottler, Myron, Liberman, Aaron, Campbell, Robert, University of Central Florida
Abstract / Description: The cost of healthcare in the United States is on an upward trajectory towards an unsustainable level. In order to address this, Congress and the Obama Administration passed the American Recovery and Reinvestment Act (ARRA) of 2009 to begin the process of controlling these costs. Within the ARRA is the Health Information Technology for Economic and Clinical Health (HITECH) section which creates financial incentives to invest in Health Information Technology (HIT) and to develop a means to...
Show moreThe cost of healthcare in the United States is on an upward trajectory towards an unsustainable level. In order to address this, Congress and the Obama Administration passed the American Recovery and Reinvestment Act (ARRA) of 2009 to begin the process of controlling these costs. Within the ARRA is the Health Information Technology for Economic and Clinical Health (HITECH) section which creates financial incentives to invest in Health Information Technology (HIT) and to develop a means to measure the Meaningful Use of specific functions of Electronic Health Records (EHRs). This research examines the widely used Joint Commission datasets to determine their suitability as a basis of meeting the government mandated measuring of Meaningful Use. The datasets used for this study consists of hospital level performance measures with a sample size of 370 hospital samples of HIT Use Intensity and Cardiovascular Performance attained from the Veterans Health Administration (VHA). An Organizational Network Theoretical approach was applied to the data in a non-experimental, sample-resample design to data collected in 2007. A Structural Equation Model (SEM) was built to test for the strength of the correlation between HIT Use Intensity and Cardiovascular Performance and a Latent Growth Curve Model (LGM) was built to examine the effect of the trajectory of HIT Use Intensity on the trajectory of Cardiovascular Performance. The SEM found a weak (.18) correlation between HIT Use Intensity and Cardiovascular Performance and the model only captured 12 percent of the variance. The LGM found no convergence between the trajectories of HIT Use Intensity and Cardiovascular Performance. This may have been the result of the data being non-normally distributed and heavily skewed to the high end of the scale. The policy implications of this study indicate that while Joint Commission data capture only a small amount of the variance attributed to HIT Use it does show a weak but positive correlation between increases in HIT Use Intensity and Increases in Cardiovascular Performance at the hospital level. Future research into adjustments to Joint Commission data measures (or others) may prove to be valuable in measuring the Meaningful Use of HIT systems in order to help hospitals make educated decisions on which HIT systems to purchase and the potential benefits associated with them.
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Date Issued: 2011
Identifier: CFE0004488, ucf:49319
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004488

Title: An Ecological Analysis of Social and Economic Influences on Black and White Infant Mortality Risk In Orange County, FL.
Creator: Lopez-Littleton, Vanessa, Liberman, Aaron, Wan, Thomas, Wright, James, Lieberman, Leslie, University of Central Florida
Abstract / Description: Black health disparities are a salient public health issue with blacks in every socioeconomic level at a greater health disadvantage than their white counterparts. In particular, disparity in infant mortality rates between blacks and whites have widened in recent decades to differentials never before experienced in the United States. Social ecologists investigating the myriad of individual and environmental risk factors have failed to fully account for the persistent differential. This study...
Show moreBlack health disparities are a salient public health issue with blacks in every socioeconomic level at a greater health disadvantage than their white counterparts. In particular, disparity in infant mortality rates between blacks and whites have widened in recent decades to differentials never before experienced in the United States. Social ecologists investigating the myriad of individual and environmental risk factors have failed to fully account for the persistent differential. This study examines the relationships between individual and environmental influences on the health risk experienced by blacks, whites, as well as the differential between the two populations. This multi-level analysis was conducted using five-year aggregate data centering on the 2000 decennial census (1998 - 2002) as the most recent census data available. During the study period, the 193 census tracts in Orange County, Florida, experienced 504 infant deaths which included 242 black and 241 white infant deaths. Using the infant mortality target rate developed for Healthy People 2000 as the (")normal(") infant mortality rate, risk was calculated as the percentage of deviation from the (")normal("). A rate was also calculated to demonstrate the difference between black and white percent deviations from the (")normal("). Structural equation modeling was used to examine the relationship between socioeconomic influences (Socioeconomic Disadvantage), social risk factors (Social Disorganization), and behavioral risk factors (Poor Behavioral Choices) using a latent variable approach based on a conceptual model which integrated the social determinants of health framework and conflict theory. In this study, an inverse association was found between socioeconomic disadvantage and infant mortality risk for black infants. This finding is contradictory to the expected finding and may have been due to multicollinearity or the operationalization of the endogenous study variable for black infant mortality risk. Thus, this study highlights the complexity of unraveling the interrelationship between social and economic risk factors. The results of this study demonstrate the importance of the latent variable approach in public health research as well as the need to broaden the approach to selecting indicators. This study concludes with specific policy recommendations aimed at improving the health outcomes of vulnerable populations using the social determinants of health framework.
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Date Issued: 2011
Identifier: CFE0004129, ucf:49109
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004129

Title: A Root Cause Analysis of the Barriers to Transparency among Physicians: A Systemic Perspective.
Creator: Perez, Bianca, Liberman, Aaron, Oetjen, Dawn, Wan, Thomas, Abel, Eileen, University of Central Florida
Abstract / Description: Transparency in healthcare relates to formally reporting medical errors and disclosing bad outcomes to patients and families. Unfortunately, most physicians are not in the habit of communicating transparently, as many studies have shown the existence of a large medical error information gap. Research also shows that creating a culture of transparency would mutually support patient safety and risk management goals by concomitantly reducing medical errors and alleviating the malpractice crisis....
Show moreTransparency in healthcare relates to formally reporting medical errors and disclosing bad outcomes to patients and families. Unfortunately, most physicians are not in the habit of communicating transparently, as many studies have shown the existence of a large medical error information gap. Research also shows that creating a culture of transparency would mutually support patient safety and risk management goals by concomitantly reducing medical errors and alleviating the malpractice crisis. Three predictor variables are used to represent the various dimensions of the context just described. Perfectionism represents the intrapersonal domain, socio-organizational climate represents the interpersonal and institutional domains, and medico-legal environment represents the societal domain. Chin and Benne's normative re-educative strategy provides theoretical support for the notion that successful organizational change hinges upon addressing the structural and cultural barriers displayed by individuals and groups.The Physician Transparency Questionnaire was completed by 270 physicians who were drawn from a multi-site healthcare organization in Central Florida. Structural equation modeling was used to determine whether perfectionism, socio-organizational climate, and medico-legal environment significantly predict two transparency outcomes, namely, error reporting transparency and provider-patient transparency. Perfectionism and socio-organizational climate were found to be statistically significant predictors. Collectively, these variables accounted for nearly half of the variance in each transparency outcome. Within socio-organizational climate, policies had the greatest influence on transparency, followed by immunity and professional norms. Multiple group analysis showed that the covariance model developed in this study generalizes across gender, medical specialty, and occupation. In addition, group means comparisons tests revealed a number of interesting trends in error reporting and disclosure practices that provide insights about the behavioral and cognitive psychology behind transparent communication: 1) Physicians are more inclined to engage in provider-patient transparency compared to error reporting transparency, 2) physicians are more inclined to report serious errors compared to less serious errors, and 3) physicians are more inclined to express sympathy for bad outcomes than they are to apologize for a preventable error or be honest about the details surrounding bad outcomes. These results suggest that change efforts would need to be directed at medical education curricula and health provider organizations to ensure that current and future generations of physicians replace the pursuit for perfectionism with the pursuit for excellence. Also, a number of institutional changes are recommended, such as clearly communicating transparency policies and guidelines, promoting professional norms that encourage learning from mistakes rather than an aversion to error, and reassuring physicians that reporting and disclosure activities will not compromise their reputation. From the perspective of patient safety advocates and risk managers, the results are heartening because they emphasize a key principle in quality improvement - i.e., small changes can yield big results. From an ethical standpoint, this research suggests that healthcare organizations can inhibit (or facilitate) the emergence of professional virtues. Thus, although organizations cannot make a physician become virtuous, it is within their power to create conditions that encourage the physician to practice certain virtues. With respect to leadership styles, this research finds that bottom-up, grassroots change efforts can elicit professional virtues, and that culture change in healthcare lies beyond the scope of the medico-legal system.
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Date Issued: 2011
Identifier: CFE0004153, ucf:49083
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004153

bioterrorism (2)	+ -
preparedness (2)	+ -
Chronic Conditions (1)	+ -
Generational Diversity (1)	+ -
HPV (1)	+ -

Health Information Technology (1)	+ -
Healthcare transitions (1)	+ -
Meaningful Use (1)	+ -
Nursing Job Satisfaction (1)	+ -
Nursing Leadership (1)	+ -
Nursing Retention (1)	+ -
Oral Cancer (1)	+ -
Performance (1)	+ -
Servant-Leadership (1)	+ -
Transparency (1)	+ -
access control (1)	+ -
aging population (1)	+ -
airport access control (1)	+ -
biometric technology (1)	+ -
community health center (1)	+ -
computer simulation modeling (1)	+ -
demand study (1)	+ -
dental education (1)	+ -
dental hygiene (1)	+ -
dentistry (1)	+ -
diabetes (1)	+ -
emergency department (1)	+ -
employee information (1)	+ -
environmental influences (1)	+ -
error disclosure (1)	+ -

Liberman, Aaron (11)	+ -
University of Central Florida (11)	+ -
Wan, Thomas (3)	+ -
Abel, Eileen (1)	+ -
Bebber, Robert (1)	+ -

Campbell, Robert (1)	+ -
Driscoll, Annelise (1)	+ -
Fottler, Myron (1)	+ -
Lieberman, Leslie (1)	+ -
Lopez-Littleton, Vanessa (1)	+ -
Oetjen, Dawn (1)	+ -
Perez, Bianca (1)	+ -
Ross, Dianne (1)	+ -
Scharoun, Kourtney (1)	+ -
Sumner, Jennifer (1)	+ -
Sumner, Kristine (1)	+ -
Swearingen, Sandra (1)	+ -
Thaldorf, Carey (1)	+ -
Wright, James (1)	+ -
van Caulil, Karen (1)	+ -

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