High Reliability Organizational Suggestions to Reduce the Risk of Hospital-Associated Infections

Over 1.7 million hospital-associated infections (HAIs), resulting in 99,000 deaths, occur each year in the United States. HAIs are defined as infections that occur within 48 hours of hospital admission without evidence of the infection being present or incubating at the time of admission. HAIs are a major concern to the medical community due to the potential loss of life and high costs. Healthcare providers should be accountable for reducing the rates of HAIs and society needs to hold them accountable for the safe implementation and outcomes of the services they provide. A high-reliability organization (HRO) is commonly described as an organization that performs high-risk work but without rare, catastrophic events. Any industry relying heavily on human performance, such as healthcare, can benefit from emulating an HRO. Embedding high-reliability principles in a healthcare organization is a proven way to increase quality and meet the demands of higher quality expectations. The ways HROs generate and maintain high levels of safety cannot be directly applied to today’s hospitals; however, a commitment to achieving zero patient harm events and the deployment of effective process improvement tools can enable hospitals to reach a safety standard comparable to HROs. Steps to becoming an HRO are not clearly defined; characteristics are. Correlating high-reliability constructs with safety culture surveys provides an opportunity for survey developers and hospital accrediting bodies to offer better tools and guidelines pursuant to a hospital becoming an HRO. Positively responding to societal needs for safe implementation and improved hospital-associated infections outcomes will increase hospital accountability for patient safety

Medication Reconciliation, Competency, Timely and Effective Care, and Hospital Readmissions

Hospital readmissions within 30 days of discharge result in significant multimillion-dollar penalties to thousands of Medicare-eligible hospitals throughout the United States and are indicators of suboptimal patient healthcare leading to less than ideal health outcomes for previously hospitalized patients. The purpose of this correlation study was to examine the relationship between medication reconciliation, nursing workforce competency, timely and effective care, and Medicare-eligible hospital 30-day readmission rates. The sample of 269 hospitals came from the population of Medicare-eligible hospitals throughout the United States. Complexity theory and the general model of readmission were theoretical frameworks grounding this study. Secondary data were from publicly available governmental databases. The reporting of the F statistic resulted in rejection of the null hypothesis in this study, based on evidence of the existence of a significant correlation between the variables. Findings shows a statistically significant relationship between nursing workforce competency, timely and effective care, and Medicare-eligible hospital 30-day readmission rates. Medication reconciliation, as measured in this study, was not a significant predictor of 30-day readmission rates. Implications of this study for positive social change include an understanding of factors related to hospital 30-day readmission rates to help leaders take action to enhance patient care, reduce inpatient care expenses, and decrease Medicare-imposed hospital penalties

Investigating the User Experience of Electronic Data Capture Systems: Perspectives of Clinical Research Coordinators

The purpose of this study is to explore the user experiences (UX) of clinical research coordinators (CRCs) with electronic data capture (EDC) systems. Fifteen CRCs were recruited and participated in semi-structured interviews. Interview transcripts were coded and analyzed thematically. Themes were further contextualized within a theoretical framework comprised of the Technology Acceptance (TAM) Model, the Task-Technology-Fit (TTF) Model, and concepts from usability theory. Themes emerging from the data included EDC usability and task-technology-fit challenges, and identification of organizational and technological barriers towards EDC acceptance and performance. This study contributes to the literature by evaluating EDC systems from the perspective of a previously uninvestigated user group—CRCs—for the first time. Future work shall expand the results of this study by quantitatively evaluating EDC usability and informing the design of EDC systems.Master of Science in Information Scienc

Co-Simulation in Virtual Verification of Vehicles with Mechatronic Systems

In virtual verification of vehicle and mechatronic systems, a mixture of subsystems are integrated numerically in an offline simulation or integrated physically in a hardware-in-loop (HIL) simulation. This heterogeneous engineering approach is crucial for system-level development and widely spreads with\ua0the industrial standard, e.g. Functional Mock-Up Interface (FMI) standard.For the engineers, not only the local subsystem and solver should be known,\ua0but also the global coupled dynamic system and its coupling effect need to be\ua0understood. Both the local and global factors influence the stability, accuracy, numerical efficiency and further on the real-time simulation capability.In this thesis, the explicit parallel co-simulation, which is the most common and closest to the integration with a physical system, is investigated.In the vehicle development, the vehicle and the mechatronic system, e.g. an\ua0Electrcial Power Assisted Steering (EPAS) system can be simulated moreefficiently by a tailored solver and communicative step. The accuracy and\ua0numerical stability problem, which highly depends on the interface dynamics, can be investigated similarly in the linear robust control framework. The\ua0vehicle-mechatronic system should be coupled to give a smaller loop gain for robustness and stability. Physically, it indicates that the splitting part\ua0should be less stiff and the force or torque variable should be applied towardsthe part with a higher impedance in the force-displacement coupling. Furthermore, to compensate the troublesome low-passed and delay effect fromthe coupling, a new coupling method based on H∞ synthesis is developed,\ua0which can improve the accuracy of co-simulation. The method shows robustness to the system dynamics, which makes it more applicable for a complex\ua0vehicle-mechatronic system

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

Additional file 1: of S2O – A software tool for integrating research data from general purpose statistic software into electronic data capture systems

Sample SPSS file. The data contains variables with all possible data types and example cases with values. (SAV 3 kb

Value platform evolution in service innovation ecosystems: an examination of the dynamism of tensions resulting from co-existing institutional logics

Advanced technologies assist diverse entities in becoming network actors, exchanging resources and co-creating value together to achieve service innovation. However, tensions emerge when multiple actors have different goals and expectations during the service innovation process. This thesis extends the service ecosystems literature by incorporating the evolution of value platforms in the service innovation process over time. The notion of value platforms facilitates our understanding of the dynamic interactions among actors to co-create value for the development of service innovation. The theoretical lens of institutional logics was applied in this study to explore the dynamic resource-related activities that occur as value platforms evolve. This thesis explores the evolution of value platforms embedded in service ecosystems during the service innovation process. It investigates how the resource-related activities evolve in service ecosystems throughout the process of service innovation and seeks to unravel the mechanism of actor interaction in platform-based service innovation. In particular, the study investigates how value platforms embedded in service ecosystems evolve, what tensions arise throughout the evolution due to the multiple institutional logics of the actors within the ecosystem, and how multiple institutional logics are navigated as value platforms evolve. A critical realist approach is adopted to explore the phenomenon of value platform evolution. A process-based single-case study design with two embedded cases is implemented to investigate value platforms embedded in service ecosystems to develop telematics insurance services. The researcher conducted a two-phased data collection to gather semi-structured interviews and participant-generated drawings as primary data from different actors along with archival documents as the secondary data. A realist evaluation enabled the delineation of the five stages that form the building blocks of the evolution of the value platforms. Moreover, an abductive approach identified three types of process-related tensions and three types of navigating mechanisms that emerge dynamically as value platforms evolve. This research offers theoretical contributions to a processual understanding of value co-creation in service ecosystems by explaining the evolution of tensions resulting from co-existing institutional logics and navigating mechanisms inherent in value platforms. It also highlights how regulatory actors affect service ecosystems during the process of service innovation. Furthermore, the study offers practitioners a processual understanding of tensions that occur in the service innovation process, and the approaches to navigating those tensions in service ecosystems during the service innovation process

Value platform evolution in service innovation ecosystems: an examination of the dynamism of tensions resulting from co-existing institutional logics

Advanced technologies assist diverse entities in becoming network actors, exchanging resources and co-creating value together to achieve service innovation. However, tensions emerge when multiple actors have different goals and expectations during the service innovation process. This thesis extends the service ecosystems literature by incorporating the evolution of value platforms in the service innovation process over time. The notion of value platforms facilitates our understanding of the dynamic interactions among actors to co-create value for the development of service innovation. The theoretical lens of institutional logics was applied in this study to explore the dynamic resource-related activities that occur as value platforms evolve. This thesis explores the evolution of value platforms embedded in service ecosystems during the service innovation process. It investigates how the resource-related activities evolve in service ecosystems throughout the process of service innovation and seeks to unravel the mechanism of actor interaction in platform-based service innovation. In particular, the study investigates how value platforms embedded in service ecosystems evolve, what tensions arise throughout the evolution due to the multiple institutional logics of the actors within the ecosystem, and how multiple institutional logics are navigated as value platforms evolve. A critical realist approach is adopted to explore the phenomenon of value platform evolution. A process-based single-case study design with two embedded cases is implemented to investigate value platforms embedded in service ecosystems to develop telematics insurance services. The researcher conducted a two-phased data collection to gather semi-structured interviews and participant-generated drawings as primary data from different actors along with archival documents as the secondary data. A realist evaluation enabled the delineation of the five stages that form the building blocks of the evolution of the value platforms. Moreover, an abductive approach identified three types of process-related tensions and three types of navigating mechanisms that emerge dynamically as value platforms evolve. This research offers theoretical contributions to a processual understanding of value co-creation in service ecosystems by explaining the evolution of tensions resulting from co-existing institutional logics and navigating mechanisms inherent in value platforms. It also highlights how regulatory actors affect service ecosystems during the process of service innovation. Furthermore, the study offers practitioners a processual understanding of tensions that occur in the service innovation process, and the approaches to navigating those tensions in service ecosystems during the service innovation process

Modeling Life History and Population Dynamics of American Lobster and Atlantic Sea Scallops in a Warming Gulf of Maine

Climate change is impacting many marine species distributions, life histories, and behaviors, as well as their associated fisheries and overall production. This is perhaps especially true for the Gulf of Maine (GOM). Here, warming rates are exceeding a vast majority of the world’s oceans. This highly dynamic system supports myriad species, but is both economically recognized and culturally known for its Atlantic sea scallop (Placopecten magellanicus) and American lobster (Homarus americanus) fisheries. This dissertation examines the influence of regional climate change on these species in an effort to predict how these stocks and their fisheries may change in the future. For scallops, this was accomplished by examining and aging shells collected throughout the GOM to determine if spatial and temporal differences in growth patterns could be explained by regional thermal habitats and salinities. For lobster, a five-step process was developed. Firstly, I conducted a simulation study to evaluate the stock assessment model performance under possible changes in lobster molting probability, lobster molt increment size, and size-at-maturity as a result of changes in thermal habitat. Secondly, using two temperature covariates important for early survival and development, a stock-wide, thermally-explicit Beverton-Holt stock-recruit relationship was estimated for the GOM. This relationship served as the basis of a framework to be used by management to test what levels of spawning biomass are necessary in the current year to achieve the desired levels of recruitment in the near future. Thirdly, a delta-generalized linear mixed model was used to predict lobster spatial density throughout the GOM. This spatial density informed a stock-wide abundance index which was used to replace the traditionally used design-based indices in the stock assessment model. Fourthly, a stock forecasting model was developed that could utilize the aforementioned stock-recruit relationship and consequences of ignoring this thermal influence on recruitment estimations were explored. Lastly, a bioclimate envelope model was used to determine relationships of multiple habitat covariates to lobster abundance from trawl survey data before using these relationships to map and forecast lobster habitat in the GOM

Relationship Between Social Support and Childhood Trauma on Resilience

People who have not overcome childhood trauma and who have developed mental illnesses have difficulties dealing with life challenges. The purpose of this quantitative study used a correlational design to test any relationship between childhood trauma experience levels and resilience against life challenges in adulthood. The theoretical framework used for this study was Barnes’ social support theory. Data were collected from 104 participants over a 7-week period. Participants voluntarily answered the ACE questionnaire, 2-way support scale, and resilience scale. Key results indicate that people with mental illness who receive social support are positive impacted by that support. Receiving adequate levels of social support is beneficial for increasing the well-being of people with mental illness. Future research can narrow the focus of childhood trauma by evaluating topics such as experiencing acute trauma, repetitive trauma, and chronic trauma on resilience to cope with life challenges for adults with mental illness. The results of this study have implications for positive social change by highlighting the importance of social support systems for improving the quality of life for people with mental illness. The results can lead to positive social change by demonstrating that people with mental illness benefit when receiving social support