Dissertations / Theses on the topic 'Organizational health'

This qualitative study focuses on the intersection of Organizational Studies and Public Health. Through the use of cross-sector work, the Public Health field coordinates work across multiple organizations to diagnose and prevent health issues. Interviewing several administrators from organizations who partake in the Healthy Ontario Initiative allowed me to examine how organizations of different types and sectors interact and connect around this project. This study will predominantly focus on the challenges they face, how they overcome them, and how they are evaluated. Highlighting the intersection of Public Health and Organizational Studies and the way a current Public Health initiative organizes and delivers services may impact the way in which the field evolves in the future.

In both academic and management literature it has been often stated that 70% of change efforts are not successful (Kotter, 1995; Smith, 2002). And while this failure rate may not be empirically tested, it points to a reality that most change efforts are not only difficult, but they are often unsuccessful (Hughes, 2011). When an organization undergoes a major organizational change process, the expected impacts include increased employee stress and overall productivity dips in the midst of the change (Dahl, 2011; Elrod II & Tippett, 2002). Measuring the impacts of change on employees and on organizational effectiveness during the change can add value and help increase the chances for change initiative success by allowing necessary adjustments and identifying and leveraging additional business improvement predictors along the way.

In this dissertation, I answer the question “What is the impact of going through a major organizational change on business outcomes and employee and organizational health?” My results suggest that an organization can transform the expected negative effects of a major change effort to positive effects by focusing on three things: 1) Improving employee mental health; 2) Increasing positive practices, including leadership’s impact on the organization; and 3) Improving employee involvement, communication, and teamwork. Finally, the results also show that improved employee mental health and improved positive practices are significantly related to improved business outcomes. Organizational change outcomes can be successfully informed by linking business outcomes with change impact measures.

Health care technology workers play an increasingly important role in meeting regulatory requirements, improving patient care and containing health care costs. However, their perceptions of work and job satisfaction are lightly studied in comparison to other health care workers such as physicians or nurses. This exploratory study used heuristic inquiry to investigate the perceptions of health care technology workers with regard to their feelings of task significance, mission valence, work meaning, and job satisfaction.

Nine research participants representing three not-for-profit, secular hospital systems which were selected to have variation in geographic scope and organization size were interviewed. All participants were full-time, senior professional, non-executive, employees with a minimum of five years of experience in health care technology and three years with their current employer.

Thematic analysis revealed themes within four categories: organization culture, organization mission, interactions with clinicians and perceived contribution. These organizations have strong cultures in which staff members police the cultural norms. The inculcation to the culture includes helping health care technology workers connect to the organization’s mission of patient care, and these employees perceive the mission to have high valence. While these employees feel that the mission of patient care is important and valuable, they have a conflicted relationship with physicians who they perceive as resistant to the adoption of new technology. Finally, health care technology workers recognized that their work tasks may not directly impact patient care; however, they felt their contribution was meaningful, in particular when they were able to contribute their unique talents.

Study conclusions and recommendations included how job rotations allowing health care technology workers to work at a care provider site provides an opportunity for health care companies to increase workers’ feelings of task significance and task identity, and therefore, job satisfaction. Contributing one’s unique gift is perceived as meaningful, and workers seek opportunities to do so. Recognizing the importance of these workers and facilitating improved interactions between health care technology workers and physicians particularly with regard to adoption of new technology is seen as critical for ensuring effective and efficient health care delivery.

This dissertation investigates whether differences in organizational innovation amongst health care providers can explain the huge variation in costs and outcomes. I specifically consider two facets of organizational innovation: the deployment of information technology and the relationships between hospitals and physicians. In the first chapter, I investigate IT adoption in a service setting by considering the impact of electronic medical records (EMRs) on the length of stay and clinical outcomes of patients in US hospitals. To uncover the distinct impacts of EMRs on operational efficiency and care coordination, I present evidence of heterogeneous effects by patient complexity. I find that EMRs have the largest impact for relatively less complex patients. Admission to a hospital with an EMR is associated with a 2\% reduction in length of stay and a 9\% reduction in thirty-day mortality for such patients. In contrast, there is no statistically significant benefit for more complex patients. However, I present three additional results for complex cases. First, patients returning to the same hospital benefit relative to those who previously went to a different hospital, which could be due to easier access to past electronic records. Second, computerized order entry is associated with higher billed charges. Finally, hospitals that have a high share of publicly insured patients, and hence a bigger incentive to curb resource use, achieve a greater reduction in length of stay for complex patients after EMR adoption. In the second chapter, co-authored with Robert Huckman, I investigate the role of process specialists in guiding customers through such complex service transactions by considering the management of patients admitted to U.S hospitals. Traditionally, a patient's primary care physician has been in charge of his or her hospital admission. Over the past decade, however, there has been a steady rise in the use of hospitalists - physicians who spend all their professional time at the hospital - in managing inpatient care. Using data from the American Hospital Association and the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample (NIS) database, we find that hospitals with hospitalist programs achieve reductions in the risk-adjusted length of stay of inpatients over the time period 2003 to 2010. The effect is strongest for complex patients who have a higher number of comorbidities. Our findings support the view that process specialists such as hospitalists are particularly beneficial for complex transactions that entail a greater degree of coordination. In the final chapter, I document the positive relationship between consolidation in the health care industry and technology adoption. I propose several mechanisms that could explain the association between the adoption of electronic medical records and greater hospital-physician integration. I show that the positive correlation between technology adoption and hospital consolidation has been increasing over time. I show that hospitals located in concentrated markets are more likely to adopt electronic medical records and to use hospitalists. Moreover, for a limited set of hospitals, the quality of management is positively associated with the adoption of electronic medical records and the use of hospitalists.
Business Economics

More than 4.9 million businesses exist in the United States, and leaders within these businesses have to acclimate to change. Clear and effective communication is vital to the success of an organization. According to scholars and health care leaders focusing on strategies to communicate change during organizational change is a critical aspect of sustainability and profitability. The conceptual framework of this study was communication theory. The purpose of this single case study was to explore successful strategies that some health care leaders used to communicate during organizational change in a health care organization in El Paso, Texas. The data collection process consisted of collecting data from semistructured interviews and organizational documents, and the analysis process included grouping key words and reconstructing data into themes. The 4 key themes that emerged from this process included building trust through organizational communication is critical during change, the use of technologies, as a tool for communication is key during change, 2-way communication needs to occur during organizational change, and communication about change is vital through comprehensive organizational meetings. Health care leaders provided insights on management and communication strategies and responsibilities leaders and employees go through during organizational change. The implications for positive social change include strategies to improve communication that could help health care leaders with their employees and their patients during organizational change, which could increase the profitability of the organization and potentially generate a more thriving and healthy community.

Organizational perception and conception of interactions and relationships vary over time and space. This study focused on the capacity within and between healthcare organizations to collectively make sense of ambivalent and ambiguous environments in the context of social structuring actions (Czarniawska, 2008; Johnson, 2009; Weick, 1995). The purpose was to develop narrative frames from which a deeper understanding could be developed of how collective sensemaking is enacted through reciprocal and reflective interorganizational relationships during the final phases of an intended multiorganizational integration endeavor (Barki & Pinsonneault, 2005; Oliver, 1990). This study explored and described collective sensemaking as recognizable patterned social structuring actions that surfaced during integration efforts within the Military Health System's Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

A narrative approach illustrated emergent social processes. In the process of collaboration, ongoing generative conversations (Taylor & Van Every, 2000; Hardy, Lawrence, & Grant, 2005; Weick, 2004) affected the relationships between collective sensemaking and social structuring. An interpretive constructionist perspective revealed practices involving the interplay of assignment of meaning (signification), reducing equivocality and integration; formation of a sense of community, establishing structures and norms (legitimation); and the effects of collaboration and power (domination) distribution (Giddens, 1984; Weick, Sutcliffe, & Obstfeld, 2005).

More than 24 months of embedded observation aided the researcher's awareness of ongoing narrative dynamics of collaborative actions setting the conditions for the emergence of interorganizational relationships (Harquail & King, 2010; Hatch, 1997; Hatch & Schultz, 2002) and embodied practices (Varela, Thompson, & Rosch, 1991). Throughout experiences of collective sensemaking, organizations interpose mini-narratives as evidence of reciprocal patterns of social structuring revealing cooperative behaviors interweaving coordinated actions and setting conditions for the structuring of collaborative integrating nets of collective action. This supports both Carniawska's (2008) and Weick's (1995) theory of organizing during collective sensemaking as enacted processes within relational conceptualizations and perceptions. These findings contribute to understanding the dynamics of collective sensemaking and social structuring; moreover, they incorporate the new paradigm of enaction (Kuhn, 1996; Stewart, Gapenne, & Di Paolo, 2010) as embodied sensemaking into organizational theory.

This thesis explores alienated students' perceptions of the organizational health of a Year 7 to 10 A.C.T. high school. The study emerged at the theoretical level from a concern that school effectiveness studies focussed too narrowly on student academic attainment as an indicator of an effective school. A broader view of effectiveness would hopefully show that in the case of comprehensive co-educational government high schools, student alienation could have a powerful effect in undermining the achievement of academic goals in such schools. Because these schools have little control over their student clientele and require compulsory student attendance until age 15, it seemed a degree of alienation was inevitable. The task for high school administrators, it was hypothesized, lay in minimizing these alienation levels in order to reduce the impact such student alienation might have on other school effectiveness indicators like teacher commitment, teacher morale and time on task in classes. My experience as a practitioner, in the Student Welfare area of a large ACT government high school, also indicated that the traditional "top down" strategy of much research in the field of Educational Administration that concentrated on the perspectives of principals and teachers only gave one view of the processes within a school. The other, complementary "bottom up" view came from students. In particular, it was hypothesized, the perspectives the most alienated students in a government high school held towards the organizational health of the school might represent an unusual test of school effectiveness. This was because the commitment of such students towards the school and its stated academic goals was most problematic. The promotion of a school "culture" or "ethos" that could integrate low level and high level alienation students, and thereby foster school effectiveness, appeared to be possible only to the extent that high level alienation students could be kept on side or neutralized by high school administrators. These speculations were largely confirmed in this study. Apart from the interaction of sex and year level with alienation, the other major finding was that teacher consideration, or the extent to which teachers show concern for students as individuals, was the only organizational health dimension that produced a significant difference between students on the basis of alienation level. In short, the study is not concerned with student alienation as such. Rather it is concerned with understanding how alienated students perceive a relatively effective school. This would hopefully enable that alienation to be minimized and managed.

The full experience of mental illness cannot be described in isolation from the context in which one lives, yet the internal physical manifestation of symptoms has been the focus of treatment in western cultures. The “recovery” paradigm is emerging as best-practice philosophy for mental health practice and represents a significant departure from existing standards thereby challenging mental health organizations to re-negotiate their relationship with the dominant bio-medical model. Despite the growing acceptance of recovery philosophy, literature exploring large-scale recovery-oriented organizational change is sparse. The purpose of this research was twofold; 1) to outline the steps taken by change agents within an organization embarking on recovery organizational change, and 2) to understand the experience, including successes and challenges associated with change. The qualitative data obtained from interviewing seventeen participants revealed the impact of organizational contextual factors, leadership and communication on recovery organizational change. Further, the data exposed the complexity of challenging preconceptions and practice when trying to adopt recovery approaches. The findings may guide other community based mental health organizations in their recovery journey.

Thesis (Ph. D.) -- University of Maryland, College Park, 2009.
Thesis research directed by: Robert H. Smith School of Business. Dept. of Management and Organization . Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.

Health and wellness programs are being utilized by organizations at growing rates. Research on health and wellness programs is typically confined to the program of a single organization and the employees participating in that specific program. Typically, this research examines the outcomes of health and wellness programs in organizations, such as return on investment in terms of medical costs, as well as improvements in the health of the employees. However, little information is known about those who choose to participate in health and wellness programs and the characteristics that may influence their participation. This study examined the relationship between demographic characteristics and likelihood of participation in health and wellness programs, as well as the relationship between program characteristics and likelihood of participation. Differences in likelihood of participation were found between different program types. Women were found to be more likely to participate than men, in most cases. Likelihood of participation increased as the incentive amount increased and decreased if the program incentive had a loss frame. Likelihood of participation was also higher for participation-based incentives compared to outcome-based incentives.

Health literacy (HL) is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Low HL has been associated with poorer self-reported health status, inability to manage chronic conditions, and less use of preventive services. More research is needed to explore the relationship between HL and sugar-sweetened beverage (SSB) intake and physical activity (PA). Although numerous HL interventions are evident in the literature, those that test HL as a moderator of effectiveness are lacking. Additionally, it has been recognized that systems-level HL efforts are necessary to lessen the burden of low HL. This dissertation addresses these needs with three unique studies that took place within the rural, medically underserved southwest Virginia region. Study 1 was a secondary analysis that examined the relationship and responsiveness of the Stanford Leisure-Time Activity Categorical Item (L-Cat) and adapted Godin Leisure-Time Exercise Questionnaire (GLTEQ) and determined if baseline HL status moderated intervention effects. There was high agreement L-Cat and adapted GLTEQ for classifying individuals as meeting PA recommendations. Baseline HL status did not moderate change in L-Cat or adapted GLTEQ measures. Study 2 was a secondary analysis that determined if 6-month change in SSB intake predicted 6-month change in body mass index (BMI), weight, and quality of life (QOL), and determined if HL moderated these relationships. The regression models for weight and QOL were not significant. The BMI model was significant. Six-month change in SSB intake, experimental condition, and age were significant predictors for the BMI model. As hypothesized, HL did not moderate relationships in any models. Study 3 details a multilevel mixed-methods needs assessment and collaboratively developed organizational HL improvement plan within the Virginia Department of Health (VDH). Staff responses revealed about half reported doing well across HL domains (written communication, oral communication, self-management and empowerment, supportive systems). However, needs were observed across all domains, with most improvement needed in written communication domain. There were significant correlations between clients' HL status and their perceptions of VDHs' HL practices, indicating potential areas of improvement within VDH.
Ph. D.

Background: Health systems around the world are facing significant shifts in demographic profiles due to increasing ethnic, cultural and linguistic diversity of populations they serve. However, the provision of health care and health services in the language of the minority has been difficult and inconsistent. The concept of the health-literate organization has been developed amid growing recognition that system changes are needed to align health-care delivery with the needs, skills, and abilities of the population. Despite the recent proliferation of research on health literacy, studies of organizational health literacy are still uncommon. Objective: This dissertation addresses the concept and practical application of “organizational health literacy” in the context of an active offer of health services in French in Ontario, Canada. I attempt to answer the question “How can health literacy advance the development of health-care designs that are responsive and accessible to official language minority?” Methods: My research consists of a three-part project that used health services research methodology and has been accomplished in academic partnership with the French Language Health Services Network of Eastern Ontario. I first conducted a review both of the literature on health literacy in linguistic minorities and of the content of organizational health literacy guides. Using a practical example of an active offer of French-language services in Ontario, I applied the organizational health-literacy framework in order to examine the strategies used by health-care organizations to provide for the active offer of health services in French. My analysis focuses on health-literacy dimensions (e.g., access and navigation, communication), quality improvement characteristics (e.g., assessment, improvement actions), and also organizational-level changes (e.g., administrative strategies, direct client services, governance). A focus group of health-care administrators provided a unique insight into the planning and implementation of the active offer and organizational health literacy and associated challenges. Results: Overall, my results show that, although organizational changes may be implemented with the purpose of improving the quality of care by providing linguistically appropriate services, these changes are largely insufficient to achieve this goal. Conclusions: The concept of organizational health literacy has not yet received the attention it deserves, but its relevance is clear: Health-care organizations must be health-literate to be able to address healthcare needs of their diverse patients. There is a significant gap between where health services are and where they ought to be to satisfy the designation criteria for the active offer of services in French. The concept and the novel theoretical framework of organizational health literacy offers the potential of improving and strengthening the process of designation and planning of an active offer of health services in French.

Bakgrund: Anställdas hälsa, individuella beteenden i ett organisatoriskt sammanhang och upplevd organisatorisk rättvisa är teoretiskt förenade av social utbytesteori, copingteori och teorier som beskriver konsekvenserna av social ojämlikhet. Empiriskt är förhållandet mer oklart. De få studier som hitintills har granskat relationen mellan organisatoriskt beteende och rättvisa visar på ett samband mellan hög grad av upplevd rättvisa och konstruktiva beteenden och mellan låg grad av upplevd rättvisa och destruktiva beteenden. Flera tidigare studier har visat på ett samband mellan organisatorisk rättvisa och hög hälsa och låg grad av utbrändhet. Relationen mellan organisatoriskt beteende, särskilt rörlighet mellan olika arbetsplatser, och hälsa är överhuvudtaget inte studerat i någon större omfattning och denna relation är i stort sett okänd. Syfte: Det övergripande syftet med föreliggande avhandling är att studera sambandet mellan organisatorisk rättvisa, individuellt organisatorisk beteende och hälsa. Metod: De ingående delstudierna i föreliggande avhandling ingår i en longitudinell panelstudie med tre olika datainsamlingstillfällen. Ett frågeformulär sändes ut till samtliga anställda, även de som hade slutat eller gått i pension under studietiden, i Arbetsmarknadsverket, AMV, i tre mellan svenska län 2001 (N=1010, svarsfrekvens: 78%), 2002 (N=1078, svarsfrekvens 75%) samt 2003 (N=1122, svarsfrekvens 74%). I delstudie I, en tvärsnitts och longitudinell valideringsstudie, användes variansanalys, ”multi-trait/multi-item”, logistisk regressionsanalys samt olika former av faktoranalys för att validera och utvärdera ett instrument (Hagedoorn m fl., 1999) avsett för att skatta individuella beteenden i ett organisatoriskt sammanhang. I delstudie II, en longitudinell panelstudie, användes korrelationsanalys och strukturell ekvationsmodellering, SEM, för att studera den reciproka relationen mellan individuella organisatoriska beteenden och hälsa. I delstudie III, en longitudinell panelstudie, användes faktor-, korrelations- och SEM-analyser för att belysa sambandet mellan upplevd organisatorisk rättvisa, hälsa och utbrändhet. I delstudie IV, en longitudinell panelstudie, användes varians och generell linjär modellering, GLM, ”repeated measures” analyser för att belysa sambandet mellan önskan att byta arbetsplats, faktiskt byte av arbetsplats, hälsa och utbrändhet. I delstudie V, en longitudinell panelstudie, användes varians-, korrelations- och SEM-analyser för att studera det reciproka sambandet mellan hälsa, utbrändhet och byte av arbetsplats. Resultat: Resultatet av delstudie I visade att Hagedoorn m.fl. (1999) instrument kan anses ha godkända psykometriska egenskaper, bortsett från delskalan ”aggressive voice” som uppvisade flera uppenbara svagheter. Delstudie II visade att relationen mellan individuella organisatoriska beteenden och hälsa framförallt är ensidigt: beteendet predicerar hälsan. Typbeteendet ”exit” predicerade sämre hälsa efter två år, medan typbeteendet ”considerate voice” predicerade bättre hälsa efter två år. Slutligen predicerade god fysisk hälsa typbeteendet ”exit” efter två år. Resultatet av Delstudie III visade att upplevd organisatorisk rättvisa är relaterat till god hälsa och låg grad av utbrändhet, både vid en tvärsnitts- och longitudinell jämförelse. De två olika sätten att studera organisatorisk rättvisa, antingen som ett globalt eller tredelat begrepp, bör betraktas som komplementära. I delstudie IV visade sig extern rörlighet, d.v.s. mellan olika arbetsplatser, i jämförelse med icke-rörlighet, har en gynnsam effekt på personlig och arbetsrelaterad utbrändhet. Resultatet visade också att samspelet mellan en önskan att byta arbetsplats och att faktiskt genomföra ett byte snarare är additiv snarare än interaktiv. Slutligen visade resultatet i delstudie V att rörlighet mellan olika arbetsplatser är en mer distinkt prediktor till hälsa och utbrändhet än hälsa och utbrändhet som prediktor till extern rörlighet. Önskan att byta arbetsplats, men inte upplevd organisatorisk rättvisa, visade sig ha effekt på faktiskt byte av arbetsplats. Slutsatser: Föreliggande avhandling har belyst det socialpsykologiska förhållandet mellan organisatorisk rättvisa, beteende och hälsa. Resultatet visar att upplevd organisatorisk rättvisa predicerar hälsa och låg grad av utbrändhet. Resultatet visar också att aktiva individuella organisatoriska beteenden predicerar psykosocial hälsa: ett proorganisatoriskt beteende predicerar psykosocial hälsa medan ett anti-organistoriskt beteende predicerar psykosocial ohälsa. Extern rörlighet har en positiv effekt på utbrändhet och rörlighet är en tydligare prediktor till psykosocial hälsa och utbrändhet än vad hälsa och utbrändhet är till rörlighet.
Introduction: Employee health, individual behaviors in an organizational context and perceived organizational justice are theoretically united. The empirical relationship, especially between behavioral responses and organizational justice and between behavioral responses, and especially job mobility, and health are not previously studied in any apparent extent. Aim: The main aim with the present dissertation was to study the relationship between organizational justice, behavioral responses, and health. Methods: The present study was designed as a longitudinal, three-wave, panel study. A questionnaire was mailed to all employees in three regional organizations of the Swedish National Labour Market Administration (AMV) at 2001 (N=1010, response rate: 78%), 2002 (N=1078, response rate: 75%) and 2003 (N=1122, response rate: 74%). In study I, a cross-sectional and longitudinal validation study, was analyses of variance, multi-trait/multiitem analyses, logistic regression analyses and different forms of factor analyses used to validate and evaluate the Hagedoorn et al. EVLN instrument. In study II, a longitudinal panel study, correlation and Structural Equation Modeling (SEM) analyses were used to elucidate the reciprocal relationship between behavioral responses and health. In study III, a longitudinal panel study, factor, correlation and SEM analyses were used to investigate the association between organizational justice, health and burnout. In study IV, a longitudinal panel study, was variance and General Linear Modeling (GLM) repeated measures analyses used to examine the relationship between turnover intentions, job mobility and health and burnout. In study V, a longitudinal panel study, variance, correlation, and SEM analyses were used to shed light upon the reciprocal relationship between health, burnout and job mobility with turnover intentions, organizational justice and age as affecting factors. Results: Study I showed that the Hagedoorn et al. EVLN instrument was a valid instrument with the exception for the aggressive voice subscale that presents some obvious and distinct deficiencies. The results of study II indicate that the relation between behavioural responses versus health is mainly one-sided: behavioural responses predict psychosocial health. The behavioural response ‘exit’ at baseline was associated with worse psychosocial health at the two-year follow-up, while ‘considerate voice’ predicted good psychosocial health at the two-year follow-up. Good baseline physical health predicted a high degree of ‘exit’ behaviour after two years. Study III showed that organizational justice is cross-sectionally and longitudinally associated with physical, psychosocial health, and burnout. The two approaches to study organizational justice, as a global or threefold construct, should be regarded as complementary rather than exclusive. The results of study IV showed that external mobility had a positive effect on personal and work-related burnout compared with non-mobility and that the combined effects of turnover intentions and job mobility are additive rather than interactive. Finally, the results of study V showed that job mobility is a more distinct predictor of health and burnout than health and burnout is of job mobility. Turnover intentions, but not organizational justice, proved to have an effect on job mobility. Conclusion: The present dissertation has elucidated the social-psychological relationship between organizational justice, behavioral responses and health. The results show that perceived organizational justice predicted good health and low degree of burnout. The results also show that active behavioural responses predict psychosocial health: pro-organizational behaviour, (considerate voice), was associated with high psychosocial health and a contra-organizational behaviour (exit) was associated with low psychosocial health. External job mobility showed a positive effect on burnout and is a more distinct predictor of health and burnout than health and burnout is of job mobility.

The primary purpose for this study was to investigate small businesses organizational support and interest in health promotion. The research question for this study was, "Are small businesses actively involved with the organizational support of health promotion programs?"A survey was distributed via mail to small businesses in the Lynchburg, Virginia area, with a follow up three weeks later because an appropriate number of surveys had not been returned. The results of this study have provided insight into the current status of worksite wellness programs of businesses with fewer than 250 employees.Small businesses do actively support healthy food and smoking policies at the worksite. Some small businesses provided activities to measure employee health risks. The main issue small businesses deal with are safety/accident prevention. Other health topics are not prevalent in small businesses. Small businesses that had a health promotion program in place offered more programs and awareness materials than those who did not and are actively involved in the organizational support of health promotion programs.
Fisher Institute for Wellness

In the United States, since 1980, excess weight reached epidemic levels and labeled a public health crisis. Obesity rates correlated with chronic disease drive health care expenditures, absenteeism, worker compensation claims, co-morbidities, mortality rates, and more.

Many organizations offer employee wellness programs but are difficult to measure benefits and determine the most effective strategies. Wellness program effectiveness was seldom linked to organizational variables. Research questions were: (1) What organizational variable effects, such as organizational size, engagement in policies that encourage participation, and median income of the school district, determined by zip code income census data, have on school employee health outcomes, perceived health and wellness participation rates; and (2) Will the employee's residence effect health outcomes, perceived health and wellness participation rates, determined by employee's residence zip code and median income zip code census data.

Research generally focused on one organizational variable or health outcome in a variety of organizations, whereas this study examined multiple organizational variables and health outcomes within many school districts. The hypotheses were: (1) Mid-sized districts have better employee health outcomes, perceived health and participation rates than larger-sized districts; (2) Districts with better developed wellness policies using best practices have a positive effect on employee health outcomes, perceived health and participation rates; and (3) Organizational effects on employee health outcomes, perceived and participation rates vary by where the employees' resides and works, as it links to median income zip code census data, with employees residing and working in lower/medium income areas having the worst health outcomes, perceived health and participation rates, and best results with the highest income.

This longitudinal study had several layers of organizational effects on employee wellness in Southern California School Districts. The program impacted almost 10,000 employees, self-selecting a variety wellness options, such as wellness challenges, health screenings, coaching, incentives, and staff development workshops. Data collected yearly included: (a) objective health measurements, such as body mass index and systolic/diastolic blood pressure; (b) self-reported perceived health measurements, such as health, stress, energy, confidence, self-esteem, and body image; and (c) the type of interventions. The data was archival and collected from 2005 to 2012.

A considerable deficit of Licensed Mental Health Professionals (LMHPs) is expected in the United States because of the rapid professional burnout and turnover. Research has related various leadership styles to job satisfaction, organizational commitment, and retention. This study focused on authentic leadership theory and the relationship between authentic leadership and burnout. The researcher conducted a causal-comparative study with a convenience sample of 116 licensed mental health professionals to assess the relationship between authentic leadership and LMHP leader burnout in an attempt to identify a solution to the systemic burnout and turnover problems in community mental health centers. The results indicated that authentic leadership was a statistically significant predictor of all three subscales of the MBI. The multiple linear regression analysis indicated that the subcomponents of authentic leadership had a relationship with the three subscales of the MBI. The transparency sub-component of authentic leadership was particularly important because it was a statistically significant predictor of the emotional exhaustion subscale, while the balanced processing and self-awareness subcomponents were also statistically significant predictors of the depersonalization subscale. The moral sub-component of authentic leadership was a statistically significant predictor of the personal accomplishment subscale, which makes this study useful for development of leadership trainings designed to promote work environments that are able to minimize burnout and turnover in LMHPs.

Sickness absence not only causes significant costs for organizations but also leads to other negative consequences for individuals and societies. Previous research has shown that working with organizational values within Quality Management affects job satisfaction and results in increased profitability and customer satisfaction. There would, in addition, seem to be great gains if managers, by working with Quality Management, can manage to establish sustainable health among co-workers.   The purpose of the research described in this thesis was to examine how Quality Management could be practised in order to support sustainable health among co-workers and what it is within Quality Management that influences sustainable co-worker health. Accordingly, the purpose was also to contribute to the understanding of the relation between sustainable health and Quality Management. To fulfil this purpose, three research questions were asked. The results are described in three parts related to the three research questions and are the product of six case studies carried out in seven different organizations.   Interviews with managers and workshops with co-workers were carried out to investigate how Quality Management can be practised within organizations in order to promote sustainable co-worker health. These investigations took place in four organizations that had received awards. Three had been awarded for their excellence in leadership, work environment and co-workership, along with improved profitability; one for its successful implementation of quality programmes. The results are descriptions of methodologies, behaviours, values and organization structure used by the organizations to support sustainable health. These are exemplified with practical examples. The methodologies, behaviours, values, and organizational structure are considered possible for other organizations to adopt and all of them are already supported in the quality, management and leadership literature. Support from the health literature is also found for most of the behaviours, methodologies, values, and organizational structure.   Surveys and focus groups interviews were carried out in five different organizations in order to find out what is of most importance when practising Quality Management in order to influence sustainable co-worker health. The results pointed to ‘Leadership Commitment’ as the most central of the values for achieving sustainable health among the co-workers. Furthermore, the values ‘Continuous Improvements’, ‘Participation of Everybody’ and ‘Customer Orientation’ were found to be related to sustainable health among the co-workers. The values ‘Leadership Commitment’ and the value ‘Participation of Everybody’ were then further elaborated to find aspects of importance for sustainable co-worker health. From the value ‘Leadership Commitment’ four aspects were extracted. These were labelled ‘Empathy’, ‘Presence and Communication’, ‘Integrity’, and ‘Continuity’. The results showed relations between the value ‘Leadership Commitment’ within Quality Management and sustainable health among the co-workers. Thus it is essential for leaders to work in accordance with that value to achieve results in the work towards sustainable co-worker health. The results indicate that this requires management and leadership that are characterized by the aspects above. The leaders have to:   • Really understand the co-workers and their work situation. • Be present and available for co-workers and communicate with them. • Act as a role model, be fair and keep their promises. • Stay in their positions long enough to build up trust and confidence.   The value ‘Participation of Everybody’ has also been shown to be related to sustainable health among the co-workers. This indicates that it is important to work in accordance with that value in the struggle to achieve sustainable health among the co-workers. The results imply that this value is characterized by the aspects ‘Development’, ‘Influence’ and ‘Being informed’. This could be done by:   • Giving the co-workers opportunities to develop their skills and develop personally. • Letting the co-workers influence their work situation and taking suggestions and proposals from them seriously. • Having good communication within the whole organization.   To manage this; the managers have to delegate more and empower the co-workers.   These results were then further elaborated within another organization in order to develop a measurement approach that can clarify the extent to which the values, ‘Leadership Commitment’ and ‘Participation of Everybody’ permeate an organization. The developed measurement approach can be used to clarify the extent to which the organization is practising the health-promoting values within Quality Management and in what areas improvement is needed to increase co-worker health. The approach can also help the organization to detect those shortcomings within the management which are important for co-worker well-being. The developed measurement approach can be used to establish and enhance co-worker health by improving their well-being, satisfaction and motivation.

Degree awarded (2003): DPhPH, Health Services Management and Leadership, George Washington University
Abstract Community partnerships are an increasingly popular strategy for improving community health. This popularity is based less on evidence than on rhetoric. This research developed and tested a systems model of partnership to improve the practice of collaboration in public health. Basing the need for partnerships on the multi-sectoral nature of health, the model used open systems theory to set out requirements for partnership. Institutional theory suggested that problems faced by partnerships may result from partners meeting requirements for legitimacy. Change is, therefore, required, both in organizations and in their institutional environment. Using exploratory case studies, the study design involved site visits to two community health partnerships (West Virginia Community Voices and Healthy New Orleans). Mixed qualitative methods included semi-structured interviews, focus groups, and document review. Analysis involved interpreting informants responses in terms of evidence representing the model and for new elements. Evidence from practice suggested several revisions to the model. One involved applying a typology of organizational affiliation, with partnership toward one end of the continuum. Use of this typology permitted an extension of the model to understand the form of affiliation practiced by Community Voices and of Healthy New Orleans. Multiple opportunities to network and build coalitions in Community Voices led to increased chances of success in achieving health improvement goals. Networking opportunities for individual volunteers led to an informal Healthy New Orleans organization. Results of this research led to an analytic fit between the two sites and the community health partnership model. Recommendations are offered for practice, research, and for funding agencies. With further research, the model can be used to develop practical tools to guide and assess partnerships as a strategy to improve health, as well as to identify environmental barriers to partnership and strategies for change.
Advisory Committee: Kathleen Maloy JD PhD (Chair), Vincent Lafronza ScD, Chris Johnson EdD

The relationship between an individual's level of spirituality, health locus of control, and participating in wellness activity was investigated. The relationship between spirituality, health locus of control on physical health was also investigated. The research question was based on prior studies that reported people who are more spiritual are healthier. Does their spirituality lead to increased levels of health, or are individual's who are more spiritual more likely to proactively take control of their health and engage in health promoting behaviors? One hundred and fifteen male and female employees completed The Spiritual Involvement and Beliefs Scale (SIBS), a spirituality measure, The Multidimensional Health Locus of Control Scale, a measure of locus of control related to health and healthcare, and The Center for Disease Control's (CDC) Health Risk Appraisal, a self-report measure of participation in health behaviors. Physical measures of health were obtained by obtaining Body Mass Index, blood pressure readings, and a cholesterol screening. The current study looked at level of spirituality (internal, external), level of health locus of control (internal, powerful other, chance) and participation in wellness/health promoting behaviors and health. Correlational analyses were performed on the relationship between spirituality and health locus of control. Hierarchical multiple regressions were performed on the internal spirituality and internal health locus of control to examine the relationship between spirituality, health locus of control and positive health behaviors and level of physical health. Stepwise discriminant function analysis using spirituality and health locus of control as predictor variables for the health-behavior criterion variables were performed. Discussion of the results, limitations of the current study and recommendations for future research were presented.

The convergence of political and technical challenges is demonstrated in a case study on a collaborative initiative to develop a pan-Canadian Electronic Health Record (EHR) system. It is argued that the juxtaposition of different domains, procedures, knowledge bases, and entities involved in establishing a pan-Canadian EHR has resulted in the development of a new, hybrid form of collaboration.
Cette étude de cas d'un projet collaboratif de développement d'un dossier de santé électronique (DSE) pan-canadien démontre que le déroulement de ce projet a donné lieu à une convergence d'enjeux politiques et techniques. La juxtaposition de différents domaines, procédures, bases de connaissances, et entités impliqués dans l'établissement d'un DSE pancanadien a ainsi abouti à l'élaboration d'une nouvelle forme hybride de collaboration.

Health care organizations are facing increasing challenges as they strive to keep pace with evolving service delivery and reimbursement models. In this context, the effective use of Information Technology (IT) is widely acknowledged as a critical factor for achieving the quadruple aim of health care: better outcomes, lower cost, improved patient experience, and improved clinician experience. Even so, health care organizations have struggled to develop effective working relationships between IT and business units and there remains a dearth of research on the impact that the quality of the relationship between IT and business employees has on organizational performance outcomes.

Applying social capital theory, the purpose of this study was to investigate the extent to which the quality of the relationship between IT and non-IT employees is correlated with organizational performance outcomes in a hospital setting. Hypothesized relationships between the structural, cognitive, and relational dimensions of social capital and intellectual capital were examined. Multi-level SEM path analysis was employed to analyze survey data from 143 IT Field Service workers who provide services in one of 34 hospitals within a single health system in the western United States. Multivariate and ordinary least squares linear regression was used to investigate the relationship between intellectual capital (aggregated by hospital, N = 34) and extant data from four hospital performance metrics: hospital quality, employee productivity, patient length of stay, and patient satisfaction.

A positive correlation was observed between structural and cognitive dimensions of social capital (Std. β = 0.550, p = 0.003), cognitive and relational dimensions of social capital (Std. β = 0.581, p = 0.001), and between the cognitive dimension of social capital and intellectual capital ( Std. β = 0.643, p = 0.001). Intellectual capital was positively correlated with employee productivity (Std. β = 0.468, p = 0.005) and negatively correlated with patient length of stay (Std. β = –0.422, p = 0.032). These correlational results provide direction for future experimental research and offer guidance for health care and IT leaders as they examine whether the development of structural and cognitive social capital between IT and non-IT employees has a causal impact on hospital performance.

Thesis (Ed. D.)--Illinois State University, 1997.
Title from title page screen, viewed June 14, 2006. Dissertation Committee: Edward R. Hines (chair), Ronald Halinski, Kathleen Hogan, Anita Lupo. Includes bibliographical references (leaves 187-200) and abstract. Also available in print.

The Accountable Care Organization (ACO) has been introduced in the US as a health system reform initiative with potential to achieve the immediate and long-term goals of improving population health, improving quality and producing greater value for the healthcare dollars spent. Over the past half-century, a number of health system reforms have been designed and implemented with these goals as the intended outcomes. These efforts have produced, at best, incremental learning, variable improvements in performance outcomes, and modest cost-savings. Early evaluations of the health, quality and cost outcomes from ACO sites suggest that the long-term effectiveness of the ACO care model faces obstacles similar to those that have impeded the long-term success of past health system reform efforts. The fundamental question of how to transform the existing construct of care delivery towards one of open collaboration, team-based care and active management of health and patient populations remains elusive (Institute of Medicine, 2012).

It is under these conditions that three independent but thematically linked investigations were conducted. The first investigation, a comparative policy analysis of US-based health system reform efforts found that transforming the construct of care delivery—how care is organized and how care is delivered are fundamentally social and relational processes that impact the outcomes of reform. These processes have been underexplored alongside other change levers in the health services research and practice communities to the detriment of healthcare organizations confronted by the need to transform the construct of care delivery as the healthcare environment transitions towards accountable care.

The second and third investigations were focused at the level of the healthcare organization and its members. The instrumental case of a large integrated delivery system transforming its disease management program for diabetes towards an ACO model was used to further examine the social and relational dynamics of health system reform. The second investigation, a qualitative analysis of the social-psychological dimensions of the change process, found that ACO characterization, Uncertainty, conceptual perceptions of the notion of accountability, and Electronic Health Record implementation influenced how the network of providers made sense of transformation towards accountable care and their perception of system readiness to engage in change and be successful.

The third investigation, an applied example, demonstrated how relational coordination and social network analysis can be used as complementary tools to inform the design and implementation of interventions intended to transform the construct of care delivery in support of the goals of health system reform. Measurement of the quality of team performance found weak relational coordination ties across each network and among the roles treating and managing diabetes in a network. Social Network Analysis (SNA) of relational coordination found differential pathways for leveraging roles structures within a network in support of change efforts.

Collectively, these investigations suggest that if ACOs are to achieve the short- and long-term goals of health system reform, the social and relational dynamics of change are important to incorporate and consider alongside of other health system reform change levers.

Thesis (DrPH)--University of North Carolina at Chapel Hill, 2007.
Title from electronic title page (viewed Apr. 25, 2008). "... in partial fulfillment of the requirements for the degree of Doctor of Public Health in the Department of Health Policy and Administration in the School of Public Health." Discipline: Health Policy and Administration; Department/School: Public Health.

Healthcare as an industry included over 14 million workers in the United States and accounted for more than 15 percent of total Gross Domestic Product in 2008. Healthcare, particularly hospitals, played a significant role in shaping the culture, economy and quality of life throughout the United States beginning in the late nineteenth century and continuing to the present. For this reason, it was important to understand the nature of hospitals as healthcare organizations and the nature of leadership within these organizations. Metaphors were identified as a viable way to capture the structure and functioning of hospitals through their evolution as organizations over the past century and were used to evaluate the effectiveness of hospital leadership in responding to environmental, financial and societal changes. Based on this assessment, the role of metaphors as a leadership tool was examined and as well as the potential role of metaphors in promoting organizations development.

A survey of Certified Professionals in Healthcare Quality (CPHQ) in the Northeastern United States was used to assess the prevalence of the two most common metaphors cited in the literature for healthcare organizations, mechanistic and complex adaptive system. A unique aspect of this survey was the use of paired statements reflecting characteristics of the two most common metaphors to evaluate their use in healthcare organizations. Surprisingly, the metaphors frequently cited in the literature were identified infrequently and no metaphors were identified consistently across hospitals in the region.

Interprofessional collaboration is recognized as the innovative, evidence-based strategy that strengthens health systems and improves performance and health outcomes. While resource-rich countries have benefited much from the implementation of this initiative, literature is scarce regarding sub-Sahara Africa. This quantitative cross-sectional descriptive study described the extent of interprofessional collaborative practice at the tertiary care level in Nigeria and its implications on patient health outcomes, professionals' performance, satisfaction, and healthy practice environment. The relational coordination theory (RCT) provided the conceptual framework for the study. Key research questions were on the association between the extents of interprofessional practice and each of the outcome implications. Data were collected using a questionnaire survey and were analyzed using means, standard deviations, t tests, correlation and regression statistics, and Chi-square tests. Results showed that the health professionals rated the practice of interprofessional collaboration low and perceived that the extents of the practice negatively affected patient's mortality, professionals' work performance, job satisfaction, and the frequency of interprofessional conflicts and strike actions. Recommendations included policy formulation and implementation, commitment and willingness by the health professionals to teamwork and patient-centered care. The implications for positive social change is that these results could be used as a tool to advocate for policy formulation and policy change for effective implementation of interprofessional collaboration; and as a database for future training intervention on collaborative practices among health professionals.

As millennials and young adults under the age of 40 become the growing majority, it is critical to understand their leadership profile, the workplace challenges they face, and their strategies for overcoming obstacles as young leaders. Specifically, in healthcare, the rapidly changing industry presents internal and external environmental challenges that must be handled in the most professional and proficient manner to be an effective leader. As such, the purpose of this study is to gather best strategies and practices that healthcare leaders under the age of 40 can adopt for their respective organizations. There are 4 research questions that address the research study’s purpose: (a) strategies and practices employed by healthcare leaders under 40, (b) challenges faced by healthcare leaders under 40, (c) definition and measurement of leadership success and organizational performance, and (d) recommendations for young aspiring leaders. 15 healthcare leaders under the age of 40 participated in the research study and responded to 12 questions in a semi-structured interview format. The results of the phenomenological qualitative study yielded 62 themes. In particular, the following emerged as top themes with regard to strategies and practices: servant leadership, authentic leadership, transformational leadership, emotional intelligence. Challenges faced by healthcare leaders included regulatory changes, healthcare reform, competing priorities, managing financial and human capital, and managing change. In terms of managing resistance to change, a four-part framework was developed through the following themes: educate people on the change, engage people in the process, listen and empathize, build a guiding coalition. As for obstacles experienced by young leaders, themes included proving credibility, perceptions of youth, lack of experience or knowledge. 60% stated that their definition of leadership success would be based on team development and success, followed by organizational success, personal achievement, and reduced staff turnover. A high performing organization focused on quality, engaging the workforce, patient experience, cost savings, financial growth and stability, and community outreach. To measure and track organizational performance, key performance indicators, dashboards, and balance scorecards were mentioned. The research study wrapped up with advice for young aspiring leaders with emotional intelligence emerging as a top theme.

The purpose of this study was to determine which factor(s), including job satisfaction, employee-employer relationship, organizational climate, and ethnicity predict retention of mental health professionals employed by African American and Caucasian privately owned mental health agencies. Due to high turnover in the private sector in mental health in central Virginia, many agencies are closing after 5 years of business. The importance of this study was to determine which factor(s) can assist in reducing turnover in the mental health field and to determine which factor(s) assist in maintaining mental health professionals in order for the agency to remain operable. The variables were evaluated through 4 valid and reliable self-report surveys to determine their prediction of employee retention. The study used Vroom's expectancy theory as the theoretical framework, which focuses on the importance of rewards and incentives in the workplace. The study's research questions determined the predictive validity of the variables on employee retention among 46 African-Americans and 15 Caucasian mental health employees. The results from multiple linear regression indicated that job satisfaction was the only significant predictor of employee retention. The implications from this finding suggest that mental health professionals need a sense of job satisfaction from their agency in order to remain at their current agency. From the findings, social change can occur when African American and Caucasian privately owned mental health agencies increase retention and are able to continue to provide continued mental health services.

Approved for public release; distribution is unlimited.
Approved for public release; distribution is unlimited.
This thesis is a qualitative analysis of the managed care approach to delivering health care in the Tidewater area of Virginia. The thesis begins with the development of civilian health care as well as the history of Navy and military medicine. This is followed by the development of managed care within the Department of Defense. A sociotechnical systems approach is then used to analyze the central function of accessing health care through the TRICARE service Center in the Tidewater area. The analysis disclosed some key deviations from providing the patient quick, dependable access into the military health care system. To control these variances, the establishment of horizontal coordination and communication linkages are recommended.

This qualitative study IS underpinned by interpretive-constructionist methodological governing principles, and took shape around a developing research focus and aim rather than in relation to pre-existing research questions. The focus of the research is on clinical supervision activity. This refers to formal and informal research encounters with participants and significant others in the organization in which the study was carried out, about: the experience of the practice of clinical supervision; attempts to translate textual prescription and description of clinical supervision into organizational reality; finally, the meaning endowment placed on both of the above by myself, my participants, and significant others associated with my research. In order to address an important gap in the literature, the aim of the research developed as the need to unpack and clarify the meaning, and the affective and organizational theoretical implications of clinical supervision activity. Part one of the ethnographic report is constructed around three overlapping categories: owning, resisting and feeling. These categories are developed around the proposition that the bureaucratic rationality inscribed within both the literature on clinical supervision, and in organizational attempts to implement it, fails to take account of both the emotional underlife of the organization and otherorganizational factors. Specifically, I argue that clinical supervision activity, and my inscription within it as 'insider' researcher', was influenced, shaped and constrained by the pre-existing interpersonal rules and norms of the organization in which my research was conducted. Those governed what could and could not be done or said in or about clinical supervision activity, arguably undermining organizational goals to implement it. Part two of the ethnography explores the maIn theoretical and conceptual implications an sIng from the preceding ethnographic construction, around structural organizational power and politics. This addresses a significant gap in the contemporary literature in clinical supervision in nursing and mental health nursing. I conclude with a critical auto-critique of the study itself, around a discussion of its strengths and limitations and possible future research directions

Educators are compelled by federal and state legislation to investigate multiple aspects of the school organization to address factors that may increase student achievement. This study addressed this issue by investigating organizational health and school safety in urban elementary schools and their relationships to student achievement. The study explored elementary school teachers' perceptions regarding organizational health and school safety. These data were correlated to student achievement on the Virginia Standards of Learning Tests in English and mathematics for fifth grade.;The Organizational Health Inventory (OHI) for elementary schools was used to survey teachers' perceptions of institutional integrity, collegial leadership, resource influence, teacher affiliation, and academic emphasis in 24 urban elementary schools in Virginia. The School Safety Survey (SSS) gathered data on teachers' perceptions of school safety. The fifth grade Virginia Standards of Learning (SOL) tests in the areas of English and mathematics were the measurement tools for student achievement. This study compared the overall health indices and the subscale scores of organizational health to school safety, achievement in English, and achievement in mathematics. It further investigated the relationship between school safety and achievement in English as well as achievement in mathematics.;The study showed that there was a strong positive relationship between organizational health and safety, organizational health and student achievement in both English and mathematics, and school safety and student achievement in both English and mathematics. Regression analysis of the subscales of organizational health revealed that academic emphasis had a strong independent effect on student achievement in English and mathematics. Correlation and regression analysis with regard to organizational health and safety indicated that organizational health had an independent effect on English, but not mathematics.

Workplace stress has become a frequent occurrence in the race for competitive business advantage. This stress leads to negative physiological consequences in the workplace, causing productivity and profitability to suffer. The purpose of this single case study was to explore the stress management strategies that some health care business leaders used to reduce the effects of work-related stress on their employees to improve productivity. The interview process included 3 managers employed at a health care institution in Houston, Texas, with records of implementing successful strategies for mitigating the effects of workplace stress. The conceptual framework was job demands-resources model, pertinent to the research question to shape this study. Data collection occurred through: (a) face-to-face semistructured interviews, (b) document reviews including the policy and procedure manual, employee annual evaluations, returned satisfaction surveys; and (c) direct observations, using observational protocol. Using the exploratory standard data analysis process, coded input of interview transcripts produced emergent themes to reduce workplace stress including: (a) adequate work resources, (b) work-life balance, and (c) sound management responsibilities. Findings from this study indicate that business managers using these themes could mitigate some of the negative consequences of organizational stress. The data from this study may contribute to social change through conveying to healthcare functionaries anti-stress strategies, increasing community awareness, and making members of the communities healthier.