Master of Science (MS), Ohio University, 2020, Industrial and Systems Engineering (Engineering and Technology)

Process improvements in hospitals usually focus on a single department (eg. emergency department, operating theater, specialty clinic, etc). However, actions taken in one department inevitably affect the performance of other departments. Therefore, higher efficiency improvements can be obtained by considering the patient care process as one synergetic activity involving several departments and various sets of resources. In this research we propose an integrated approach for modeling the patient lifecycle for multiple departments. First we describe a patient flow from his/her entry into the hospital through a progressive care unit until the patient has fully recovered. We use process mapping methods to address value added activities and other necessary activities in the patient lifecycle. Then, a simulation model is developed in Simio using customized objects created in previous works. Those customized objects carry their own logic and behavior. For example, the Bed object includes logic for a patient recovering while using several hospital resources (nurses, therapist) in his/her hospital stay. Those objects were used to build several configurations of an integrated model with multiple departments. Data about patient arrival patterns, their health acuity, and procedure needs were obtained from a real hospital in order to test our approach. The procedures duration data (which were different for different levels of patient acuity and for different surgical and other procedures) were used to obtain service distribution using statistical analysis methods. Modular simulation objects and data distributions from real hospitals allowed us to build an integrated simulation model with several configurations of the process flow. Simulation experiments were performed on these models and performance recorded. The recommendation for implementations in the hospitals is also reported.

Committee: Dusan Sormaz (Advisor); Gursel Suer (Committee Member); Diana Schwerha (Committee Member); Vic Matta (Committee Member) Subjects: Engineering; Health Care; Industrial Engineering

Master of Science in Industrial Engineering, University of Toledo, 2008, Industrial Engineering

Six Sigma is a comprehensive and flexible system for achieving, sustaining andmaximizing business success. It strives to improve quality, productivity, and bottom line success using statistical tools. Six Sigma's methodology consists of five phases: Define, Measure, Analyze, Improve, and Control (DMAIC). In manufacturing, Six Sigma has been used extensively with great success. The application of Six Sigma to the healthcare field is in its early stages and, hence, has not been fully explored. This research investigated the use of Six Sigma with the goal of improving the renal implant process and demonstrating the positive impact of Six Sigma on the healthcare industry. The objective of the research was to improve the process for renal transplants at The University of Toledo Medical Center utilizing Six Sigma. This included aligning and optimizing processes and the removal of process-generated defects and errors. Improvements will primarily focus on: optimizing cycle times, enhancing customer satisfaction, improving efficiencies, reducing costs, streamlining administrative processes, elimination of errors, and improving protocol execution and effectiveness. This research identified ten improvements which could be applied to the renal transplant process. Implementing improvements could reduce the total process time by 45 days (20%) from 227 days to 182 days, and could also improve productivity, communication, and customer satisfaction.

Committee: Steven Kramer PhD (Advisor); Matthew Franchetti PhD (Other); Afjeh Abdollah PhD (Committee Member) Subjects: Engineering; Health Care

Doctor of Education, Miami University, 2023, Educational Leadership

In 2022, Ohio House Bill 436 went into effect. The law required Ohio reading teachers to shift their literacy instructional practices to be consistent with structured literacy based on The Science of Reading research. This large body of research may be in direct conflict with widely used instructional practices that are generally thought of as consistent with the Whole Language philosophy. Thus, helping teachers make the shift required by the Literacy Bill quickly became a problem of practice for educational leaders. The literature in the area of organizational change includes Weick's sensemaking theory which asserts that a lack of clarity could get in the way of policy implementation rather than a lack of compliance on the part of teachers. The Ohio Improvement Process provides a framework for leaders to support the sensemaking of new policy that includes a tool referred to as a practice profile. The practice profile, paired with components of a second framework referred to as The Lippitt-Knoster Model for Organizational Change are tools to support leaders as they help teachers make sense of policy and implement change in the classroom. A mixed-methods case study was conducted to determine the extent to which a practice profile and targeted professional development could support change in literacy instruction in kindergarten first grade, and second-grade classrooms in on suburban Ohio district. Semi-structured interviews with six teachers were conducted in an attempt to answer the research question. The study participants responded to a pre-and post-survey during the same weeks as their interviews in August and December. The survey questions were constructed with the goal of measuring the teachers' knowledge of key understandings from the Science of Reading before and after the study was completed. The survey and interview results revealed that it is unlikely that simply stating policy and providing materials will lead to meaningful change. Additiona (open full item for complete abstract)

Committee: Lucian Szilizewski (Committee Co-Chair); Noltemeyer Amity (Other); Kathleen Knight-Abowitz (Committee Co-Chair) Subjects: Educational Leadership

EdD, University of Cincinnati, 2002, Education : Curriculum and Instruction

This study was conducted to describe the selection and adoption of Carnegie Learning's Cognitive Tutor Algebra I, a computer assisted instructional program, with eighth grade students utilizing a continuous improvement plan mandated by the state of Ohio. Carnegie Learning provides technologically enriched solutions for Algebra I through the utilization of intelligent cognitive tutors and standards based curriculum (CarnegieLearning.com, 2000). Students discover the appropriate mathematics by solving real life/world problems, articulating their solutions, reasoning among multiple representations and making connections to prior knowledge. Students spend 60% of their time working cooperatively solving problems and 40% of their class time working with computer based intelligent tutors. This study describes the steps of a state mandated continuous improvement plan and one district's attempt to implement the steps. This study also describes attitudes of students regarding mathematics and teachers' perceptions regarding the process for selecting and implementing Cognitive Tutor Algebra I for eighth grade students.

Committee: Dr. Glenn Markle (Advisor) Subjects:

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

This study examined the representation of racial minorities in the demographic subpopulation of Hospital Consumers Assessment of Healthcare Providers and Services (HCAHPS) survey respondents. These survey scores are the basis for a substantial portion of financial compensation from the Centers for Medicare and Medicaid Services; they are used to drive the process improvement of patient-centered care. Considerable previous research has focused on factors that affect HCAHPS scores and made adjustments to the scores of many other demographic factors. However, none has focused specifically on race and representativeness, which is needed to ensure benefits for all health care consumers. Reliance on this mechanism as the single measure of patient experience on which financial decisions are made and improvement efforts are centered may be a further example of systemic racism in a system with an established history of racism. This study examined the use of a representative sample from a social justice perspective utilizing Rawls' framework from A Theory of Justice. Following the logic of this work, most people would not choose failing to hear diverse patient voices at a representative rate when blinded to their own identity, as this would not represent the choice most likely to result in patient-centered care for all health care consumers. This mixed-method, convergent parallel design study compared the sample of patients returning HCAHPS surveys, the inpatient population, and contextualized those results with semi-structured interviews with patient experience professionals to provide context to the need for a representative sample.

Committee: Alyncia Bowen (Committee Chair); Lori Salgado (Committee Member); Bora Pajo (Committee Member) Subjects: Health Care; Health Care Management; Public Health; Public Policy

Doctor of Philosophy, University of Akron, 2021, Engineering

Lean Management Systems (LMS) and Continuous Improvement (CI) program deployments are increasingly becoming an important strategy for many organizations for gaining competitive advantage. Such deployments promise success to organizations of any nature and size. Significant resources in the form of employee time, external consultants and training programs are spent on LMS/CI deployments by a vast number of companies every year. Yet despite the long history and evolution of CI methodology, ease of concepts and application, high amount of time and resources spent and furthermore proliferation of such deployments - the adoption and ultimately the success of such programs is highly variable. While many research papers and companies claim to have realized hundreds of millions in economic benefits from Lean deployments, just as many report to not even recover the cost of deployment. Researchers conclude that a complete systems approach to successfully deploy Lean methodology for long-term sustained gains is not widely understood or practiced. For this reason, in this research I present the design work of a new way to approach Lean/CI deployment methodology utilizing first-principles. The need for the new approach to deploying Lean/CI was engendered due to a mandate from the Senior Leadership Team (SLT) at the organization. The SLT desired a holistic approach that would align better to Company's Lean principles (first principles), show financial impact and bring about behavioral cultural change. This research presents the new approach - from First-Principles for the methodology, design criterion from SLT, to the design of the methodology, and then the application of the methodology to different businesses in the company. In essence, the research shows how any organization can build its own LMS utilizing first- principles to fit their own needs rather than copy pasting fragmented components offered by expensive consultants or snippets from literature – neither of w (open full item for complete abstract)

Committee: Shengyong Wang (Advisor); Asoke Dey (Committee Member); Xiaosheng Gao (Committee Member); Ping Yi (Committee Member); Chen Ling (Committee Member) Subjects: Banking; Engineering; Industrial Engineering; Management; Mechanical Engineering; Systems Design; Systems Science

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2021, Nursing

Day of surgery cancellations are multi-factorial and possibly preventable threats to the efficiency of an organization, contributing to delayed surgical care, wasted resources and rescheduling challenges for the patient. The evidence base recommends a comprehensive approach to surgical care quality assessment and multiple interventions to improve patient preparation processes. This organizational systems evaluation followed the Donabedian Model to thoroughly assess the structural features, surgical case preparation processes, and day of surgery cancellation outcomes at an academic outpatient surgery facility. Data from chart reviews and interviews of process experts were evaluated through construction of five process maps, a Pareto chart, and a fishbone diagram. Process failures included pre-surgical care coordination referrals for medically complex patients, scheduling errors, and communication of preoperative instructions. Key drivers for reducing day of surgery cancellations were identified and a process measure was defined for future quality improvement initiatives to reduce cancellations. Overall, variability and deficiencies in information-driven processes and communication were concluded to most likely affect the occurrence of day of surgery cancellations at this facility. In conjunction with other efforts to assess and improve perioperative efficiency, this evaluation supports the opportunity to reduce wasteful care and demonstrate value.

Committee: Betsy List PhD, MPH, RN (Advisor); Susan R. Allen PhD, RN-BC (Committee Member) Subjects: Health Care; Health Care Management; Nursing; Surgery

Doctor of Education, Miami University, 2021, Educational Leadership

This dissertation sought to answer questions about the sensemaking processes of teacher leaders in a middle school that was part of a state-wide improvement process called the Ohio Improvement Process (OIP). The context of the research was a historically under-performing school that had been part of the OIP for 6 years at the time the research was conducted. This case was chosen in part due to significant growth in academic student outcome measures that were reflected in changes in the building's report card grade shared by the state. It was also chosen because this researcher was already an active participant in the systems such that access to ongoing conversations and authentic reflection could be possible. Data were gathered using semi-structured individual interviews, and they were supported by review of historical records from the leadership team's work over the past 3-4 years. These data were analyzed in part through the use of definitions of teacher leadership from Moller & Katzenmeyer (2009) and of sensemaking from Spillane (2005). This study largely tells a shared narrative, and the story itself is the primary "finding" of the research. This study also may suggest an overall theme that teacher leaders can be more effective when they are empowered to engage in sensemaking so much that they serve as the final interpreters of policy. This can allow them to become policy makers themselves, not just policy implementers.

Committee: Lucian Szlizewski Dr. (Committee Co-Chair); Joel Malin Dr. (Committee Co-Chair); Nathaniel Bryan Dr. (Committee Member) Subjects: Education; Education Policy; Educational Evaluation; Educational Leadership; School Administration; Teaching

Master of Science in Engineering, Youngstown State University, 2020, Department of Mechanical, Industrial and Manufacturing Engineering

The effectiveness of The Six Sigma Breakthrough Management strategy was evaluated in the oil and gas industry, specifically at Vallourec Star. Statistical and process analysis were utilized to investigate the cause and effect relationship of input and output variables during the seamless rolling process. Implementation of the Six Sigma Breakthrough Management strategy has yielded significant results in various industries but there are not many examples of successful deployments in the oil and gas industry, more specifically in a seamless tube mill. Six Sigma was studied, adapted and deployed to meet the needs of the oil and gas industry and Vallourec Star. The adaptations included piloting on a high impact, high visibility opportunity within the seamless rolling mill. The chosen approach prioritized a hybrid bottom up and top down strategy rather than the traditional top down only approach adopted by more mature industries. Six Sigma has proven as an effective problem-solving methodology for the oil and gas industry and was successfully implemented. Vallourec Star was able to reduce pipe related defects by 70% while following the Six Sigma methodology.

Committee: Martin Cala PhD (Committee Chair); Darrell Wallace PhD (Committee Member); Nazanin Naderi PhD (Committee Member) Subjects: Industrial Engineering; Statistics

Doctor of Philosophy, The Ohio State University, 2017, Educational Studies

This study explored the relationship between the implementation of processes directed at improving school-level functions and student academic success. Specifically, the researcher used the Collaborative Leadership Organizational Practices Survey (CLOPS) to measure how fidelity of implementation of the Ohio Improvement Process (OIP) influenced sixth grade students' reading and mathematics achievement. The CLOPS identified areas of strength and weakness in school level OIP implementation, thereby exposing gaps in the school improvement process. The study was conducted in 57 schools in four midwestern districts. Each school administered the Northwest Evaluation Association's (NWEA) Measures of Academic Progress (MAP) formative assessment tool during fall and winter in two content areas, reading and mathematics. Those same schools adopted the OIP as the school improvement model. Research design employed the survey responses, publically available demographic data considered as control variables. The change from fall formative assessment scores to winter formative assessment scores for reading and mathematics in Grade 6 was identified as the dependent variable. Data included principal responses that reflected the principals' perceptions of the degree of OIP implementation at the school-level, demographic data retrieved from the state education agency website, and school aggregated formative assessment data from fall and winter assessments. Multiple regression analysis was used to determine if the degree of fidelity of OIP implementation in a school influenced student achievement from fall to winter assessment administrations. Results identified three OIP practices at the teacher-based team level positively impacted the change in student achievement from fall to winter: (a) teachers on a team, which is described as membership on the teacher-based teams; (b) common post-assessment results, which are described as teams working together to review stude (open full item for complete abstract)

Committee: Belinda Gimbert Ph.D. (Committee Chair) Subjects: Education; Education Policy; Educational Leadership

Master of Science (MS), Ohio University, 2017, Industrial and Systems Engineering (Engineering and Technology)

Process improvement and safety are two important factors to any successful manufacturing company. Employees, however, often seem to view them as competing demands. The objective of this research is to understand how employees view safety, process improvement, and the integration of the two. After a short training on an integration tool aimed to view safety and process improvement simultaneously, the employees provided their perception on safety, process improvement, and the integration of the two. Analysis of the qualitative data showed that there are often conflicting responses and behaviors when it comes to prioritizing safety over production. The research also indicated a divide in the perception of the correlation between safety and process improvement. Although limited data was collected after the focus group, the MOD VSSM was successful in improving communication across employees and was viewed by participants to be an asset for the company.

Committee: Diana Schwerha Dr. (Advisor); Bill Young Dr. (Committee Member); Tao Yuan Dr. (Committee Member); Gary Weckman Dr. (Committee Member) Subjects: Engineering; Industrial Engineering; Occupational Safety; Systems Science

Doctor of Philosophy, The Ohio State University, 2014, Statistics

Stochastic differential equations (SDEs) are used as statistical models in many disciplines. However, intractable likelihood functions for SDEs make inference challenging, and we need to resort to simulation-based techniques to estimate and maximize the likelihood function. While sequential Monte Carlo methods have allowed for the accurate evaluation of likelihoods at fixed parameter values, there is still a question of how to find the maximum likelihood estimate. In this dissertation we propose an efficient Gaussian-process-based method for exploring the parameter space using estimates of the likelihood from a sequential Monte Carlo sampler. Our method accounts for the inherent Monte Carlo variability of the estimated likelihood, and does not require knowledge of gradients. The procedure adds potential parameter values by maximizing the so-called expected improvement, leveraging the fact that the likelihood function is assumed to be smooth. Our simulations demonstrate that our method has significant computational and efficiency gains over existing grid- and gradient-based techniques. Our method is applied to modeling stock prices over the past ten years and compared to the most commonly used model.

Committee: Peter Craigmile Ph.D. (Advisor); Radu Herbei Ph.D. (Advisor); Laura Kubatko Ph.D. (Committee Member) Subjects: Statistics

Doctor of Education, Ashland University, 2013, College of Education

A distributed leadership model is aimed at creating leadership at multiple levels of an organization through the use of teams. The Ohio Department of Education has operationalized a distributed leadership model in the Ohio Improvement Process (OIP). The OIP is part of the overall improvement plan for school districts in Ohio failing to meet the targets of the No Child Left Behind Act, 2001. The purpose of this study was to gain greater understanding of the impact of the OIP on teachers' commitment and empowerment levels to the school district where they are employed. A posttest research study was designed with the OIP as the independent variable and commitment and empowerment used as the dependent variables. The results of the research suggest that when a recognized and organized team approach, such as the OIP is implemented to assist in school decision-making there are greater feelings of empowerment and higher levels of commitment among teachers. The overall effectiveness of a distributed leadership model was also found to be enhanced when the implementation was supported by adequate professional development for the staff.

Committee: Carla Edlefson Ph.D. (Committee Chair); James Olive Ph.D. (Committee Member); Larry Cook Ph.D. (Committee Member) Subjects: Education; Education Policy; Educational Leadership

Doctor of Philosophy, The Ohio State University, 2009, Statistics

We propose a methodology for the simultaneous optimization of multiple goal functions evaluated by a numerically intensive computer model. In a black box multiobjective problem, the goal is to identify a set of compromise solutions that provide a minimally sufficient representation of the Pareto front in the most efficient manner. To reduce the computational overhead, we adopt a surrogate-guided approach where we perform optimization sequentially via improvement. Our algorithm relies on a multivariate Gaussian process emulator which uses a novel multiobjective improvement criterion called the expected Pareto improvement function to guide the sampling of points in the Pareto efficient region. We show that the algorithm is capable of approximating the Pareto front within a computational budget.

Committee: Thomas Santner PhD (Advisor); Peter Craigmile PhD (Committee Member); William Notz PhD (Committee Member) Subjects: Statistics

Doctor of Philosophy, The Ohio State University, 2008, Business Administration

The business environment is always changing and change creates risk. Managing the risk of the uncertain future is a challenge that requires resilience – “the ability to survive, adapt and grow in the face of turbulent change.” Academics and industry leaders have seen the need to supplement traditional risk management techniques with the concept of resilience that is better designed to cope with extreme complexities, unpredictable events and adaptive threats. However, without standardized definitions, accepted variables or measurement tools, supply chain resilience is merely a theoretical concept. This dissertation will explore the current thought on supply chain resilience and develop the construct into a managerial process for implementation. In Phase I, the Supply Chain Resilience Framework was developed to provide a conceptual framework based on extant literature and refined through a focus group methodology. Findings suggest that supply chain resilience can be assessed in terms of two dimensions: vulnerabilities and capabilities. Research identified seven vulnerability factors composed of 40 specific attributes and 14 capability factors from 71 attributes that facilitate the measurement of resilience. Phase II created an assessment tool based on this framework – the Supply Chain Resilience Assessment and Management (SCRAM TM). Data gathered from seven global manufacturing supply chains was used to assess their current state of supply chain resilience. The tool was validated using a qualitative methodology comparing assessment scores to 1,369 items recorded from discussions of 14 recent disruptions. Phase III concluded the research project by identifying critical linkages between the inherent vulnerability factors and controllable capability factors. Accomplished through a mixed-method triangulation of theoretical linkages, assessment correlations and focus group connections, research identified 311 specific linkages that can be used to guide a resilience (open full item for complete abstract)

Committee: Keely Croxton PhD (Advisor); Martha Cooper PhD (Committee Member); Joseph Fiksel PhD (Committee Member); Walter Zinn PhD (Committee Member) Subjects: Management

Doctor of Education, Ashland University, 2009, College of Education

In the era of educational reform, many models have been used to improve student learning. One characteristic found often in successful reform models was the change in culture of the school. Although no one model worked for everyone, choosing a model whose values and ideals closely matched the school culture was important. This ethnographic case study investigated the implementation of the Baldrige in Education Initiative as one high school developed building level improvement processes. Data were collected relating process development and group collaboration to provide evidence of culture change. The research found that over the six years bounded by this study, the organization used the Baldrige framework to develop its own processes for change and used those processes as an accepted method of operation. The staff also developed a collaborative culture through the use of small school improvement teams called Design Teams. The staff used these teams to implement their change process. The collaborative decision making through the Design Teams became the accepted method of making change represented a change in culture.

Committee: Jane Piirto PhD (Committee Chair); David Kommer EdD (Committee Member); Ann Shelly PhD (Committee Member); David Silverberg EdD (Committee Member) Subjects: Education; School Administration

Doctor of Education (Ed.D.), Bowling Green State University, 2013, Leadership Studies

The Elementary Secondary Education Act (ESEA) of 1965, reauthorized as No Child Left Behind (NCLB), increased accountability measures in public schools across the nation. One component of NCLB dictated that school districts publicly report annual summative testing scores. Noting that previous research has shown that school district leadership engaged in the strategic planning process increases student achievement, the State of Ohio formed the Ohio Leadership Advisory Council (OLAC). OLAC's work embraced the use of leadership led strategic planning and thus wrote the Ohio Improvement Process (OIP) for use in all Ohio districts regardless of size, typology, leadership tenure, or average daily membership. This quantitative causal-comparative study investigates the effect of OIP on Local Report Card (LRC) ratings in Ohio school districts. To determine if differences exist school district leadership responded to a survey that reported 2011-2012 LRC ratings and measured their respective stage of implementation and commitment to OIP. Using responses from the 14-item research constructed survey, data were analyzed using descriptive and inferential statistics. The findings from the research show that the impact of OIP on LRC is more complex than previously assumed. Contrary to researcher expectations, the use of OIP did not statistically impact LRC. Future research using Value Added or Performance Index Scores (both growth measures of the LRC) could potentially produce statistically significant results, as they are more specific in nature than the LRC ratings are. Research Question 1 notes 94% of the survey respondents were school district central office administrators with 65% being in their current position three or more years. Seventy-four percent of respondents have been their district point of contact or OIP facilitator. Responses from Research Questions 2 and 3 highlight LRC data were positively significantly skewed. This created the foundati (open full item for complete abstract)

Committee: Patrick Pauken (Advisor); Eric Worch (Committee Member); Rachel Reinhart (Committee Member); Paul Johnson (Committee Member); James Lloyd (Committee Member) Subjects: Education; Education History; Education Policy; Educational Leadership; School Administration