Making corrections to the smartform document

Milestone Group 1

Milestone 1: Learner Completed CITI Modules

Milestone 2: Committee approved topic (Sections 1 & 2 of SMART form)

Milestone 3: Mentor Approved Research Plan (complete SMART form)

Milestone Group 2

Milestone 4: Committee Approved Research Plan

Milestone 5: School Approved Research Plan

Milestone 6: University Approved IRB

Milestone 7: Committee Conference Call

Section #1

To be completed by Learner

1.1 Learner Name

Aslie Burnett

1.2 Learner Program

Doctor of Health Admin: Health Care Leadership

1.3 Learner Email

[email protected]

1.4 Learner Phone

(832)651-4210

1.5 Mentor Name/Email

Dr. Heather Alonge / [email protected]

1.6 Committee Member #1 Name/Email

Dr. Tyler Zerwekh

1.7 Committee Member #2 Name/Email

Dr. Nita Stika

1.8 Dissertation Title

Leadership effectiveness in Healthcare Human Resource and Patient Management

1.9 Site Selected

Hospital Corporation of America (HCA) Pearland Medical Center -pending

1.10 Contact Info for Site Approver & Expected Approval Date

Jennifer Lopez (713)770-7107-pending & pending

Section #2

To be completed by Learner

2.1 Project

Write approximately one paragraph that describes the action research project and the basis for it being addressed.

The action research project deals with a pertinent leadership effectiveness issue created by the healthcare reform process in healthcare institutions in the United States. The reform process has created a dynamic environment that is in constant flux. The institutionalization process of the healthcare reforms is an important step in reducing the high costs of healthcare and ensuring effective delivery of primary care to reduce the prevalence of chronic illnesses such as diabetes and cardiac-related health problems. The shift towards preventive care for the reduction of chronic illnesses requires more engagement between the patients and the doctors and closer follow-ups of patient outcomes. This requires a leadership that is effective in engendering a workforce that is responsive to long-term patient needs. This means that the healthcare professionals need effective leadership in hospital management to ensure that they are motivated and engaged in the change process through teamwork and partnerships within hierarchical structures. Therefore, the action research will provide a leadership model and qualities of leadership that are most relevant for the dynamic healthcare environment. The action research project evaluates Hospital Corporation of America (HCA) case in Houston, Texas, to understand the leadership mechanisms within the institution and how they influence employee and patient outcomes. Based on the findings of the case study, the possibility of using the leadership model proposed to improve outcomes will be elaborated upon.

Reference

Thompson, J.M. (2007). Health Services Administration. Sudbury, MA: Jones and Bartlett.

Dageling, P. and Carr, A. (2004). Leadership for the systemization of health care: the unaddressed issue in health care reform. Journal of Health Organization and Management, 18(6), 399 – 414.

2.2 Contribution to Society

Using citations, answer the following questions in order:

1. How does your project improve a current practice?

2. If your action research project is successful, how could your project impact your field of interest?

3. What are the practical implications of your project? For example, what will be the impact of this project on your sample, your site location, or your workplace?

1. Leadership is a central issue in healthcare reform, not just in the United States but in other countries where health reforms are under implementation. In Australia and England, research conducted by Degeling and Carr (2004) conducted a study on the improvement in performance in reform implementation. They found that the lack of appropriate leadership models that include subcultures within the leadership framework leads to a disjunction between expectations and outcomes. Through the investigation of case studies on healthcare reform in various settings, the researchers suggest that leadership models that fail to take into account the importance of social constructs end up producing less than optimal results. For similar reasons, the action research process hopes to change the hierarchical model of leadership in implementation in most healthcare institutions through the shared leadership model that takes into account horizontal social dynamics in leadership effectiveness. This is similar to Degeling and Carr’s (2004) suggestion that leadership should pass authority to the subcultures that exist within the management hierarchy.

2. If the action research project research is successful, it could improve the healthcare reform implementation process and increase the efficiency of the healthcare system in delivery quality of care outcomes to patients and the employees.

3. The practical implications of the project on the sample is a reduction in the healthcare malpractices such as corrupt insurance claims, improvement of human resource management and increase in effectiveness of service deliver to patients through long-term engagement within a supportive healthcare environment aimed at preventive long-term primary care. This will benefit the field in terms of efficiency in healthcare delivery.

Reference

Dageling, P. and Carr, A. (2004). Leadership for the systemization of health care: the unaddressed issuein health care reform. Journal of Health Organization and Management, 18(6), 399 – 414.

2.3 Need and Evidence to Make Change

Provide current information on your needs assessment or analysis for change. Include the cost-benefit analysis if indicated by design.

The American Hospital Association (2013) highlights the need for change in human resource planning through workforce planning. This is the process of estimating current and future workforce needs and developing a workforce plan to reduce the gap between the current and future needs. Workforce planning is important because the healthcare system is increasingly dynamic and subject to change Institutions need to ensure that there are adaptive systems for the change process.

The cost would be increased need for workforce deployment and engagement to deal with the change process . The benefit is the improved adaptation to the dynamic healthcare system and speedy implementation of healthcare reform to deliver quality of care to patients.

Reference

American Hospital Association. (2013). Developing an Effective Health Care Workforce Planning Model. Retrieved July 16, 2015 from

http://www.aha.org/content/13/13wpmwhitepaperfinal.pdf

2.4 Theoretical Foundation

Describe the theory or theories that serve as the backbone of your project. Provide references for each theory.

Shared leadership is the theoretical approach adopted for improving leadership effectiveness in the healthcare system. This model of leadership includes a systems thinking of the organization as an organism that is influenced by internal and external factors (Thompson, 2007; Luckett and Grossenbacher, 2003) that chart its course towards patient and employee outcomes . Other important aspects of the proposed leadership model that makes it relevant to the dynamic healthcare environment include transformational leadership (Atkinson, 2011), improvement of human resource management (Robbins and Davidhizar, 2007) and engendering teamwork in horizontal hierarchies in organizational subcultures (Wood, 2005).

References

Atkinson, S. (2011). Are you a transformational leader? Nursing Management, (September, 2011).DOI:10.1097/01.NUMA.0000403279.

04379.6a

Luckett S, Grossenbacher K (2003). A critical systems intervention to improve the Implementation of a District Health System in Kwa Zulu-Natal. Systems Research and Behavioral Science 20,147–162.

Wood, M. (2005). Determinants of shared leadership in management teams. International Journal of

2.5 Researcher Positionality:

· Insider

· Insider w/collaboration

· Reciprocal collaboration

· Outsider, collaboration w/ insiders

Define your role, position, and how positionality will impact your research study.

The researcher position is an outsider with insider collaboration . This position will allow for objectivity since the researcher will not have conflict of interests between the research needs and the organizational influence. Collaboration with insiders will help to acquire case study data that includes the formal and informal organizational mechanisms that can help in obtaining a clear picture of the leadership structures and practices in the organization.

2.6 Research Questions and Project Goals/Objectives

List the research questions or project goals. These should align with the need for organizational structure or activities/outcomes of the project.

Research questions:

· How adaptive are the hospital’s human resource and patient outcomes to the changing healthcare environment?

· Is the hierarchical leadership model at the hospital conducive to best practices in terms of human resource and patient outcomes?

· What is the employee rating of well-being at the company?

· Do business considerations trump quality of care for patients?

Section #3

To be completed by Learner

3.1 Action Plan

Provide detailed steps to implementing your research plan. This should read like a recipe for conducting your project.

Be sure to include all the necessary details so that someone else would be able to follow this and replicate the project exactly.

The strategy of the action plan is to conduct a case study in informal settings using qualitative methods using questionnaires and surveys. The following are the steps of the action plan:

1. The first step is to obtain authorization and cooperation from hospital’s top management and other relevant authorities and establish timelines for the data collection

2. The researchers will then administer the questionnaires and surveys on-site to the top management and other subordinate staff while collecting informal data on the observations made in the hospital setting regarding leadership practices

3. The next step is to compile the qualitative data from the case study and establish a narrative on the leadership mechanisms from the case study

4. The researcher will then compare the collected qualitative data with primary and secondary sources of information during the data analysis phase

5. The researcher will then make recommendations on implementation of the proposed leadership model for future practice at the HCA in particular and other hospitals in general

6. Finally, the researcher will disseminate the information to relevant professional journals and publications, informal media outlets and the HCA hospital

3.2 Results

Describe your program evaluation and dissemination of results plan.

Program evaluation will be based on comparison of findings with primary and secondary sources featuring case studies on leadership effectiveness in healthcare reform. Follow-up studies might be done to monitor progress. Dissemination will involve sharing information with relevant professional journals for peer review, which is also part of the program evaluation process. Information relevant for policy formulation and leadership improvement at the HCA is also shared with the relevant authorities.

3.3. Measures and Instruments

List and describe each data collection instrument or measurement tool you will use. This includes questionnaires, formal interview protocols, forms, etc. Include:

a. Data type(s) generated by each measure

b. Available psychometric information (including validity and reliability coefficients)

c. How this data will be used

Attach a copy of each instrument you plan to use as an appendix to your SMART form.

N/A

3.4 If Modifying an Instrument:

Describe any pilot test or field test that may be required for any instruments. Type NA if not applicable. Field tests must be done:

a. For new instruments or questions developed by the learner.

b. With expert panelists. Field tests require no IRB review. A pilot test requires IRB review.

N/A

3.5 Assumptions

Identify the key assumptions of the project; use citations to support their adoption.

The following are the key assumptions made for the case study:

· The action research assumes that the healthcare environment predictions made will come into effect (Bureau of Labor Statistics, 2010; American Hospital Association, 2013)

· The project assumes that private hospitals will be equally affected by the healthcare reform process as government hospitals

· The HCA at Houston is assumed to have similar organizational structure and practices as other branches of the HCA

Reference

Bureau of Labor Statistics. (2010). Occupational Outlook Handbook 2010-2011. Retrieved July 16, 2015from www.bls.org/oco/ocos014.htm

3.6 Limitations

Evaluate the weaknesses of your project at this time. Indicate areas to be improved before starting your project and areas that cannot be improved. Give reasons for not redesigning to address any of the limitations identified.

The following are the limitations of the research:

· The qualitative research design means that the data obtained from the research is not easily generalizable to other hospital institutions

· The HCA is a hospital with private equity firm financing and therefore might not be representative of the other hospitals without such funding

· The future of healthcare reform might change in case of changes in government during elections in the near future

To address generalizability and differences between privately funded hospitals and other hospital institutions issues, the researcher will ask follow-up questions in the survey that pertain to general practices in hospital institutions.

Changes in political structures and their influence on policy on healthcare reform are not easily predictable and therefore there is no project redesign to address this issue.

3.7 Population and Sampling

Describe the key stakeholders or population of your project. Briefly describe the characteristics of this sample, including:

a. Demographics

b. Inclusion criteria, if any

c. Exclusion criteria, if any

Describe how you plan to select the sample. Include the steps you will take to include participants.

Since the action research project is a case study utilizing qualitative data collection methods in informal settings, the researchers will choose the sample population depending on the situation on the ground and adaptive this sample in a manner that provides the greatest insight into the hospital’s leadership and management mechanisms. Demographic characteristics are not a major preoccupation of the study since the action research project aims at addressing general issues associated with leadership effectiveness.

3.8 Sample Size

What is the expected sample size? Provide citations to support the sample size decision.

N/A

3.9 Expected Site

Describe the organization or site(s) from which you expect to draw your sample.

The organization is the Hospital Corporation of America branch in Houston, Texas. The hospital is tied to private equity firms that influence the human resource practices and patient outcomes. This hospital and its other branches are likely to be greatly affected by healthcare reforms leaning towards long-term preventive care and therefore form a suitable case study for the action research project.

3.10 Site Permission

Who is authorized to provide permission to use this organization or site? Does the site have an IRB? What do you need to do to obtain permission to access the stakeholders, population, or data source?

The top management is the source of authorization for access to the site since it is an organization with private holdings.

3.11 Participant Contact

How will potential participants first be contacted? How will participants be contacted following the study?

Participants will be contacted on-site during the reconnaissance and through e-mail data obtained from the hospital with permission from the management and the participants.

3.12 Data Analysis

Describe analysis procedures for each data type including: audiotapes, transcripts, videotape, field notes, photos, descriptive analysis, other quantitative analysis, etc.

Describe all methods and procedures for data analysis including:

a. Types of data to be analyzed

b. Organization of raw data

c. Management and processing of data

d. Preparation of data for analysis

e. Storage and protection of data

The data collected will comprise data from informal interviews, testimonials and observational data that the researchers make.

The raw data will be organized into a narrative that provides the overall leadership mechanisms within the organization for analysis. The data is stored on hard drives and removable disks for safe keeping. The data storage might also include uploading to a cloud network for additional safety.

3.13 Ethical Considerations

Describe any ethical considerations given the sample population and/or topic. Please explain as fully as possible.

Describe any ethical concerns about defined researcher positionality. Address any potential for coercion.

There are few ethical considerations because of the general nature of the research. However, during the collection of observational data, the researcher should be objective and include assumptions and potential biases in perception for comparison with the other qualitative data collected to ensure validity and accuracy in reporting. The researcher positionality also requires objectivity in data collection to ensure that biases and prejudices do not obscure the intent of the action research project. The comparison of the collected data to primary and secondary sources before drawing conclusions and recommendations will deal with the potential for biases and prejudices.

3.14 Risk Assessment

Is your study more than minimal risk? Refer to your CITI course for more information about minimal risk. Please explain.

The study is minimal risk because of the generality and benign nature of assessing leadership effectiveness in the case organization. There is reduced potential for violation of participant anonymity since the data will not contain references to actual persons. No personal data on individuals or the organization will be collected during the study.

To be completed by Mentor

Mentor: Name

Member #1: Name

Member #2: Name

Date & Reason for Deferral (if needed)

Topic Approval

SMART Approval

First Review

Second Review (if needed)

Third Review (if needed)

Faculty Chair consult (if needed)

NOTES: