Organizational culture associated with provider satisfaction

pre-printBackground: Organizational culture is key to the successful implementation of major improvement strategies. Transformation to a patient-centered medical home (PCHM) is such an improvement strategy, requiring a shift from provider-centric care to team-based care. Because this shift may impact provider satisfaction, it is important to understand the relationship between provider satisfaction and organizational culture, specifically in the context of practices that have transformed to a PCMH model. Methods: This was a cross-sectional study of surveys conducted in 2011 among providers and staff in 10 primary care clinics implementing their version of a PCMH: Care by Design. Measures included the Organizational Culture Assessment Instrument and the American Medical Group Association provider satisfaction survey. Results: Providers were most satisfied with quality of care (mean, 4.14; scale of 1-5) and interactions with patients (mean, 4.12) and were least satisfied with time spent working (mean, 3.47), paperwork (mean, 3.45), and compensation (mean, 3.35). Culture profiles differed across clinics, with family/clan and hierarchical cultures the most common. Significant correlations (P < .05) between provider satisfaction and clinic culture archetypes included family/clan culture negatively correlated with administrative work; entrepreneurial culture positively correlated with the Time Spent Working dimension; market/rational culture positively correlated with how practices were facing economic and strategic challenges; and hierarchical culture negatively correlated with the Relationships with Staff and Resource dimensions. Conclusions: Provider satisfaction is an important metric for assessing experiences with features of a PCMH model. Identification of clinic-specific culture archetypes and archetype associations with provider satisfaction can help inform practice redesign. Attention to effective methods for changing organizational culture is recommended

Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation

pre-printObjective: To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived.. Data Source/Study Setting: An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design™, its version of the Patient Centered Medical Home. Study Design: Mixed methods. Data Collection/Extraction Methods: Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semi-structured interviews, focus groups, Centers for Medicare and Medicaid Services database and the Utah All Payers Claims Database. Principal findings: Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change. Conclusions: Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence

Safety Consultation & Inspection: Reporting on a Manufacturing Facility

Safety Consultation & Inspection: Reporting on a Manufacturing Facility Holly Scammon, Nicholas Nieves, Lea Mahoney, Nelson Pusquin-Nieves, Alberto Carrillo Background: In October of 2021, a safety consultation and inspection were conducted within a manufacturing facility in the Daytona Beach area. The inspection was conducted by a group of students pursuing their Master of Science in Occupational Safety Management from Embry-Riddle Aeronautical University. The inspection began via a conversation with the facility’s safety manager and a senior employee. The group initially discussed the current state of the workplace, the policies and procedures in place for the different operations, and a serious violation the company was in the process of abating. As the conversation progressed it became apparent there were minimal written policies and training provided to employees. Following the discussion, an inspection was conducted using a checklist derived from similar industries and a review of top violations in those industries in 2021. Approach: Investigations into similar industries were conducted prior to the inspection of the facility to help identify key areas of interest. Furthermore, company history was investigated to determine if there were any active or past OSHA violations or citations. The finalized inspection checklist highlighted key areas of interest including lockout-tagout procedures, respiratory protection, hazard communication, machine guarding, and powered industrial trucks. Results: The facility was found to be non-compliant with multiple OSHA regulations listed in the 1910 standard. Further recommendations were made to the management staff regarding the integration of a Safety Management System (SMS) for the safety and wellbeing of their workers. Conclusions: The group provided the facility’s management staff with recommendations pertaining to the correction of identified hazards around the workplace. The final report also included suggestions regarding the implementation of an SMS at the facility. The management team\u27s willingness to change and implement those recommendations was positive, with relatively strong responsiveness to the final report submitted. The inspection team recommended a follow-up inspection be completed within the year to assess changes made by the management staff based on the safety consultation and inspection

Primary reading exercises for use with the Durrell Analysis of Reading Difficulty

Thesis (Ed.M.)--Boston Universit

1862-07-10 John L. Little requests a position in a new regiment

https://digitalmaine.com/cw_me_3rd_regiment_corr/1299/thumbnail.jp

Physical and optical properties of sol-gel nano-silver doped silica film on glass substrate as a function of heat-treatment temperature

Nano-silver doped silica films were deposited on glass slides using a sol-gel process and heat-treated at different temperatures. The films were characterized by ultraviolet-visible spectroscopy, x-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM), Rutherford backscattering spectrometry (RBS), and transmission electron microscopy for their optical, chemical, and structural properties. The absorption peak of silver colloids (wavelength from 400 to 460 nm) was present and a blueshift and intensity reduction of the absorption peak was observed during heat-treatment. Particle size reduction and surface morphology changes in the films were observed by AFM as a function of varying heat treatment temperatures. Silver nanoparticles were formed through spontaneous reduction of silver ions. The oxidation of silver occurs during heat-treatment, causing a reduction of absorption intensity. An interdiffusion between the Ag in the film and Na in the substrate glass was observed by XPS and RBS. Sodium in the coating likely increased the stability of silver oxide at high temperature treated samples

PBX 9501 high explosive violent response/low amplitude insult project: Phase I

Preliminary modeling and experimental analyses of the violent reaction threshold of semi-heavily confined PBX 9501 to low velocity impact have been completed. Experimental threshold measurements were obtained with ten tests using a spigot gun design to launch a hemispherical projectile at the high explosive contained in stainless steel. Powder curves were determined for several gun barrel designs, powders, and projectile materials and have proven to be very reproducible over the range of 75 to 325 ft/s. A threshold velocity of approximately 246 ft/s for violent reaction of the PBX 9501 was determined with experimental gauge and switch measurements and the remaining physical test evidence. Preliminary analyses of the PBX 9501 samples retrieved from both unreacted and partially reacted targets have been completed. Core samples were obtained from the unreacted targets and submitted for density determinations. The subsequent analysis supports the concept that the PBX 9501 yields and fractures under the low velocity compression event to expand and fill the annular gap in the target design. Samples of PBX 9501 from the partially reacted targets were examined with scanning electron microscope and light microscope techniques. Increased evidence of mechanical twinning effects are noted in the HMX crystals from the partially reacted targets. Finite element calculations using DYNA213, with a modified ORION post processor, without reaction or chemistry models, were used to support the design of targets, to compare predictive analyses with experimental measurements, and to evaluate a proposed ignition criterion in a power law form for threshold to reaction with dependence on pressure, maximum shear strain rate, and time variables. The calculations show good agreement with the physical dent and deformation data from the remaining target evidence; however, they do not match the experimental pressure gauge measurements well

Patient care experiences and perceptions of the patient-provider relationship: A mixed method study

Improving interpersonal continuity of care—the personal relationship forged between a patient and their primary care provider (PCP) over time—is often considered a goal of primary care. Continuity of care is frequently assessed in terms of longitudinal continuity, or the proportion of encounters with one practitioner, overlooking aspects of the patient-provider relationship that are key to interpersonal continuity of care. Further, few studies explore patients’ perspectives regarding which care experiences enhance or detract from the patient-provider relationship. This study, using focus group interviews, a patient experience CAHPS-PCMH survey, and electronic medical records, explored how patients’ experiences at 10 primary care clinics influenced their perceptions of their relationship with their PCPs. Focus group interviews with 63 participants indicated that patients’ experiences in the clinics, such as wait-times, influenced their perceptions of the patient-provider relationship. The relationship between patient experience and interpersonal continuity was empirically assessed using survey responses and medical records (n=645). We used patients’ perceptions that their provider knows them as a person as a measure of interpersonal continuity. Logistic regression results indicated that being seen within 15 minutes, receiving visit reminders, effective provider communication, and satisfaction, positively influenced patient perceptions of the patient-provider relationship. Furthermore, patients’ care experiences shaped their perceptions of the patient-provider relationship independent of their satisfaction with care. The mixed methods design adds depth to our understanding of patients’ care experiences, and illustrates that these experiences are critical for understanding the patient-provider relationship. Future research on interpersonal continuity should take patient experiences into account