AND THE SURVEY SAYS ... A QUALITATIVE EXPLORATION OF STRUCTURATIONAL DIVERGENCE FROM THE PERSPECTIVES OF NURSE MANAGERS WHO ARE ACCOUNTABLE FOR PATIENT EXPERIENCE MEASURES

For more than a decade, hospital leaders have focused on boosting patient experience scores as part of the federal government’s value-based purchasing (VBP) program. Hospitals that receive federal financial assistance (such as Medicare) are mandated to participate in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a standardized survey that measures patients’ perceptions of their care. Results are publicly reported, and hospitals may be penalized on their reimbursements if they do not reach established benchmarks for patient experience. However, much debate has occurred about whether VBP has increased the quality of healthcare and whether the HCAHPS is an accurate measure of patient experience. Nurse managers on inpatient hospital units are, for their part, the ones held accountable for their units’ patient experience scores, which are scores that they often cannot control. This dissertation project is a qualitative exploration of how such accountability impacts nurse managers. With structurational divergence theory (SDT) as a framework, the study seeks to gain a deeper understanding about gridlock that exists and the resulting negative spirals of communication that occur when patient experience expectations by hospital leaders conflict with the needs of nurses on the frontline. Findings of this research suggest that the pressure to earn optimal patient experience scores is, by and large, a source of stress to inpatient nurse managers. Furthermore, findings reveal that opportunities exist within hospital organizations to enhance communication processes about patient experience, with the overarching finding being a need to better communicate to frontline staff the “why” behind the rationale for working toward patient experience goals. Also, findings indicate that expectations by hospital senior leaders to meet established patient experience goals can create conflict for nurse managers who are often caught in the middle between satisfying organizational goals and tending to the needs of frontline staff. Such conflict can spur a reactive work approach that is task- oriented and impedes the visualization of patient experience as a holistic concept. Several recommendations are offered to address issues from macro (policy), meso (organizational), and micro (nurse manager) levels. Additionally, this dissertation proposes an expansion to SDT. Ultimately, the research deduces that hospital organizations should work toward a more holistic consideration of patient experience, in lieu of an intense focus on patient experience metrics. This includes honing mutual understanding and embracing communication processes that will facilitate collaboration, rather than polarization, among organizational structures

First Cloud-to-Ground Lightning Timing Study

NASA's LSP, GSDO and other programs use the probability of cloud-to-ground (CG) lightning occurrence issued by the 45th Weather Squadron (45 WS) in their daily and weekly lightning probability forecasts. These organizations use this information when planning potentially hazardous outdoor activities, such as working with fuels, or rolling a vehicle to a launch pad, or whenever personnel will work outside and would be at-risk from lightning. These organizations would benefit greatly if the 45 WS could provide more accurate timing of the first CG lightning strike of the day. The Applied Meteorology Unit (AMU) has made significant improvements in forecasting the probability of lightning for the day, but forecasting the time of the first CG lightning with confidence has remained a challenge. To address this issue, the 45 WS requested the AMU to determine if flow regimes, wind speed categories, or a combination of the two could be used to forecast the timing of the first strike of the day in the Kennedy Space Center (KSC)/Cape Canaveral Air Force Station (CCAFS) lightning warning circles. The data was stratified by various sea breeze flow regimes and speed categories in the surface to 5,000-ft layer. The surface to 5,000-ft layer was selected since that is the layer the 45 WS uses to predict the behavior of sea breeze fronts, which are the dominant influence on the occurrence of first lightning in Florida during the warm season. Due to small data sample sizes after stratification, the AMU could not determine a statistical relationship between flow regimes or speed categories and the time of the first CG strike.. As expected, although the amount and timing of lightning activity varies by time of day based on the flow regimes and speed categories, there are extended tails of low lightning activity making it difficult to specify times when the threat of the first lightning flash can be avoided. However, the AMU developed a graphical user interface with input from the 45 WS that allows forecasters to visualize the climatological frequencies of the timing of the first lightning strike. This tool should contribute directly to the 45 WS goal of improving lightning timing capability for its NASA, US Air Force and commercial customers

Dual-Doppler Feasibility Study

When two or more Doppler weather radar systems are monitoring the same region, the Doppler velocities can be combined to form a three-dimensional (3-D) wind vector field thus providing for a more intuitive analysis of the wind field. A real-time display of the 3-D winds can assist forecasters in predicting the onset of convection and severe weather. The data can also be used to initialize local numerical weather prediction models. Two operational Doppler Radar systems are in the vicinity of Kennedy Space Center (KSC) and Cape Canaveral Air Force Station (CCAFS); these systems are operated by the 45th Space Wing (45 SW) and the National Weather Service Melbourne, Fla. (NWS MLB). Dual-Doppler applications were considered by the 45 SW in choosing the site for the new radar. Accordingly, the 45th Weather Squadron (45 WS), NWS MLB and the National Aeronautics and Space Administration tasked the Applied Meteorology Unit (AMU) to investigate the feasibility of establishing dual-Doppler capability using the two existing systems. This study investigated technical, hardware, and software requirements necessary to enable the establishment of a dual-Doppler capability. Review of the available literature pertaining to the dual-Doppler technique and consultation with experts revealed that the physical locations and resulting beam crossing angles of the 45 SW and NWS MLB radars make them ideally suited for a dual-Doppler capability. The dual-Doppler equations were derived to facilitate complete understanding of dual-Doppler synthesis; to determine the technical information requirements; and to determine the components of wind velocity from the equation of continuity and radial velocity data collected by the two Doppler radars. Analysis confirmed the suitability of the existing systems to provide the desired capability. In addition, it is possible that both 45 SW radar data and Terminal Doppler Weather Radar data from Orlando International Airport could be used to alleviate any radar geometry issues at the NWS MLB radar, such as the "cone of silence" or beam blockage. In the event of a radar outage at one of the sites, the multi-radar algorithms would provide continuing coverage of the area through use of the data from the remaining operational radar sites. There are several options to collect, edit, synthesize and display dual-Doppler data sets. These options include commercial packages available for purchase and a variety of freeware packages available from the National Center for Atmospheric Research (NCAR) for processing raw radar data. However, evaluation of the freeware packages revealed that they do not have sufficient documentation and configuration control to be certified for 45 SW use. Additionally, a TI data line must be installed/leased from the NWS MLB office and CCAFS to enable the receipt of NWS MLB raw radar data to use in the dual-Doppler synthesis. Integration of the TI data line into the Eastern Range infrastructure that will meet the security requirements necessary for 45 SW use is time-consuming and costly. Overall evaluation indicates that establishment of the dual-Doppler capability using the existing operational radar systems is desirable and feasible with no technical concerns. Installation of such a system represents a significant enhancement to forecasting capabilities at the 45 WS and at NWS MLB. However, data security and cost considerations must be evaluated in light of current budgetary constraints. In any case, gaining the dual-Doppler capability will provide opportunities for better visualization of the wind field and better forecasting of the onset of convection and severe weather events to support space launch operations at KSC and CCAFS

Assessment of a Technique for Estimating Total Column Water Vapor Using Measurements of the Infrared Sky Temperature

A method for estimating the integrated precipitable water (IPW) content of the atmosphere using measurements of indicated infrared zenith sky temperature was validated over east-central Florida. The method uses inexpensive, commercial off the shelf, hand-held infrared thermometers (IRT). Two such IRTs were obtained from a commercial vendor, calibrated against several laboratory reference sources at KSC, and used to make IR zenith sky temperature measurements in the vicinity of KSC and Cape Canaveral Air Force Station (CCAFS). The calibration and comparison data showed that these inexpensive IRTs provided reliable, stable IR temperature measurements that were well correlated with the NOAA IPW observations

Statistics Examples from Kennedy Space Center and Cape Canaveral Air Force Station

A few examples of projects in meteorology and engineering that used statistics at Kennedy Space Center and Cape Canaveral Air Force Station

A Method to Estimate the Probability That Any Individual Lightning Stroke Contacted the Surface Within Any Radius of Any Point

A technique has been developed to calculate the probability that any nearby lightning stroke is within any radius of any point of interest. In practice, this provides the probability that a nearby lightning stroke was within a key distance of a facility, rather than the error ellipses centered on the stroke. This process takes the current bivariate Gaussian distribution of probability density provided by the current lightning location error ellipse for the most likely location of a lightning stroke and integrates it to get the probability that the stroke is inside any specified radius. This new facility-centric technique will be much more useful to the space launch customers and may supersede the lightning error ellipse approach discussed in [5], [6]

Resolution of an Orbital Issue: A Designed Experiment

Design of Experiments (DOE) is a systematic approach to investigation of a system or process. A series of structured tests are designed in which planned changes are made to the input variables of a process or system. The effects of these changes on a pre-defined output are then assessed. DOE is a formal method of maximizing information gained while minimizing resources required

Maximizing Educator Enhancement: Aligned Seminar And Online Professional Development

Professional development and learning has a long history in seminar-like models, as well as in the more educator-personal delivery approaches.  The question is whether an intentionally coordinated, integrated combination of the two PDL approaches will have best impacts for educators as quantified in improved student performance.  Contrasts between baseline and Post-Program performance levels showed 19% gains in Reading and 24% gains in Math, significantly beyond expectation.  Analyses for Title 1 schools showed significant shrinkage of performance gaps with contrasted non-Title 1 schools.  These gains outpaced those found for either PDL approach alone, indicating that educational leaders will be wise to undertake implementation of intentionally aligned and coordinated approaches combining PDL Seminars with online, on-demand PDL.

Applied Meteorology Unit (AMU) Quarterly Report

No abstract availabl

A Probabilistic, Facility-Centric Approach to Lightning Strike Location

A new probabilistic facility-centric approach to lightning strike location has been developed. This process uses the bivariate Gaussian distribution of probability density provided by the current lightning location error ellipse for the most likely location of a lightning stroke and integrates it to determine the probability that the stroke is inside any specified radius of any location, even if that location is not centered on or even with the location error ellipse. This technique is adapted from a method of calculating the probability of debris collision~ith spacecraft. Such a technique is important in spaceport processing activities because it allows engineers to quantify the risk of induced current damage to critical electronics due to nearby lightning strokes. This technique was tested extensively and is now in use by space launch organizations at Kennedy Space Center and Cape Canaveral Air Force Station. Future applications could include forensic meteorology