Doctor of Healthcare Administration (D.H.A.), Franklin University, 2020, Health Programs

Purpose: Preventable medical errors resulted in about 400,000 annual deaths in U.S. hospitals (Thornton et al., 2017) and cost the U.S. economy about $20 billion annually (Rodziewicz & Hipskind, 2020). Meanwhile, nurses continued embracing patient care and safety. However, limited research existed associating nurses' perceptions of safety culture with error reporting and patient safety outcomes (Han, Kim, & Seo, 2020). This study aimed to fill that literature gap, advance nurses' roles, and improve care quality. Framework: Self-determination theory (SDT) and Donabedian's Model guided this research. Method: This was a quantitative, cross-sectional correlation design study using bivariate, multivariate, and logistic regression analysis for multi-level modeling with 90,016 nurse participants. Ethical approval came from Franklin University Institutional Review Board. Data: Secondary, de-identified SOPS® data for the analysis was provided by the SOPS Database, funded by U.S. Agency for Healthcare Research and Quality (AHRQ) and administered by Westat under Contract Number HHSP233201500026I / HHSP23337004T. This study analyzed collected data (i.e., 2015 to 2017) from 565 U.S. hospitals that voluntarily submitted their HSOPSC data to the 2018 comparative dataset. Findings: Data findings for unit-level aggregation identified PSC composite Feedback and communication about errors with the most statistically significant positive association with Overall frequency of events reported. PSC composite Teamwork within unit had the greater odds for an increase in Number of events reported. PSC composite Staffing produced a higher, statistically significant positive association with Overall perceptions of patient safety. Furthermore, Organizational learning – continuous improvement produced the higher odds of increasing Patient safety grade. Hospital-level aggregation revealed that Management support for patient safety had the most positive, significant effect acro (open full item for complete abstract)

Committee: Dale Gooden DHSc, MBA (Committee Chair); Jesse Florang EdD, LIMHP (Committee Member); Shawishi Haynes EdD, FACHE, MHA (Committee Member) Subjects: Continuing Education; Cultural Resources Management; Health; Health Care; Health Care Management; Organizational Behavior; Public Health

Doctor of Education (Educational Leadership), Youngstown State University, 0, Department of Teacher Education and Leadership Studies

As members of Generation Z continue entering the workforce, organizational leaders who develop a deeper understanding of the unique traits and work-life expectations among these group members can provide more effective leadership for their organizations. This qualitative descriptive study focused on enhancing understanding of how members of Generation Z describe their workplace motivations and their perceptions of psychological safety and how these perceptions influence the culture of a non-profit organization. The research process used a series of interviews with Generation Z employees in a nonprofit organization as the primary data collection method. By deploying a phenomenological research method, the data and analysis helped to offer insights necessary to develop a narrative describing the lived experiences, mindset, and feelings of a Generation Z population in workplace settings. Building on previous research, the study found several themes that answered the research questions. The findings centered around patterns found among Generation Z employees emphasizing the importance of purpose, flexibility, and growth among these workers. Additionally, the findings revealed the importance of how Generation Z employees perceive interpersonal relationships among colleagues and organizational leaders and the influence on perceptions of psychological safety. The findings from the study help to illustrate important, practical context and action items for organizational leaders as they continue to navigate changes in the workforce with increases in the number of Generation Z members. The conclusions from this study can better equip organizational leaders with a strengthened ability to develop a renewed strategy that will enable them to effectively lead Generation Z employees and their organizations.

Committee: Jane Beese EdD (Committee Chair); Nathan Myers PhD (Committee Member); Joseph Hendershott EdD (Committee Member) Subjects: Adult Education; Educational Leadership; Management; Organizational Behavior; Public Administration

Doctor of Education (Educational Leadership), Youngstown State University, 2024, Department of Teacher Education and Leadership Studies

Students today have various feelings of distrust among many of their teachers and administrators regarding the handling of violent episodes. As such, an examination of existing educational research to assess strategies that promote school safety and how to access community partnerships within this study is warranted. The efficacy of nonviolent and restorative disciplinary practices, with characteristics of social/emotional wellness programs supported by community partnership school resource officer (SRO) initiatives, are examined. Demonstrations of how positive school culture, features of emotional wellness programs, and an SRO's community-based role can promote school safety rather than exacerbate the school-to-prison pipeline are shared. This study further builds on the current pool of knowledge through an investigation of the viewpoints of 18 participants including school personnel and recent graduates in rural, suburban, and urban school districts across three counties in Northeast Ohio. Specifically, the researcher examined the perspectives of four key stakeholder groups to study their ideas regarding school safety, SROs performing law enforcement duties at the school and the associated impacts on learning, recommendations for ensuring building-wide safety, existing school climate and safety strategies, and SROs implementing the triad model (i.e., law enforcement, teacher/mentor, counselor). The investigation utilized Q-methodology and follow-up questions. Seventeen of the 18 Q-sorts loaded significantly on one of the three factors (summarized as Factor 1: We Are In This Together, Factor 2: Keep Us Safe, and Factor 3: Teachers Teach), which together explained 67% of the study variance. Follow-up questions provided additional support and context for the researcher's operationalization of the participants' collective viewpoints across these three main lines. Implications of this research will provide districts and educational professionals a blueprint for restor (open full item for complete abstract)

Committee: Karen Larwin PhD (Advisor); John Hazy PhD (Committee Member); Ronald Iarussi EdD (Committee Member) Subjects: Education; Educational Leadership; School Administration; School Counseling

Doctor of Business Administration (D.B.A.), Franklin University, 2024, Business Administration

This research study explores how employee resource groups (ERGs) impact individual employee voice behaviors. The study is grounded in the spiral of silence theoretical framework (Codington-Lacerte, 2020; Noelle-Neumann, 1974), with the concepts of psychological safety, social identity, social exchange, and self-efficacy explored as mediating factors. The study consists of a qualitative, single case study at an organization that recently established ERGs. Seventeen employees were interviewed, representing eleven of the organization's twelve ERGs. Results from the study support the application of the spiral of silence theoretical framework at the individual employee level. Thematic analysis was used to identify themes in the data, which demonstrate that ERGs impact individual voice behaviors through building relationships, creating cultural change, and empowering individuals.

Committee: Michelle Geiman (Committee Chair); Susan Campbell (Committee Member); David McCurry (Committee Member) Subjects: Business Administration; Business Education; Communication; Labor Relations; Management; Minority and Ethnic Groups; Organization Theory; Organizational Behavior

DNP, Otterbein University, 2023, Nursing

Second victim syndrome describes the constellation of symptoms suffered by healthcare clinicians because of the stresses of caregiving, experiencing adverse patient outcomes, and the increasing pressures of the care environment. The occurrence of second victim syndrome (SVS) in nurses is well supported in literature, along with resultant effects on patient safety, organizational culture, and the organization's financial outcomes. The interconnectedness of nurses with patients is undeniable, and relational impacts can be both profound and enduring. Burnout and stress, manifested by mental, psychological, and physical effects, are possible and may affect the ability of the nurse to provide effective nursing care to patients. The state of nursing in the facility ultimately determines whether the obligation to provide quality, safe patient care to the community is met by the organization. High rates of turnover and vacant positions, often necessitating the use of unknown travel nurses, can also compromise patient care, potentially increasing patient complications and worsening outcomes. The many implications of these factors on healthcare organizations cannot be understated, not the least of which are financial. Executives and other leaders must recognize the wellness of the staff and the state of facility culture when considering goals, initiatives, and the organization's overall sustainability. This project addresses the barriers to nursing support through the development of an educational infographic targeted for organizational executives, highlighting second victim syndrome and its potential consequences on nurses, patients, and the facility at large. The infographic directs leaders to examine current facility culture closely, suggesting why and how to ensure a supportive care culture.

Committee: Joy Shoemaker DNP, RN, APRN.CNP, FNP-C, CNE (Advisor); John Chovan PhD, DNP, RN, CNP, PMHNP-BC (Committee Member); Chai Sribanditmongkol PhD, RN, IBCLC, CNS (Committee Member) Subjects: Health Care; Health Care Management; Nursing

Doctor of Nursing Practice , Case Western Reserve University, 2019, School of Nursing

Abstract Many healthcare institutions have implemented second victim support programs, but there are no published findings on the effectiveness of the programs. It is vital to have published findings of successful second victim program content, implementation, and evaluation for healthcare organizations to have supportive services and positive outcomes for second victims. Carilion Clinic instituted The TRUST Team (TTT), a second victim support program, in spring 2014. Evaluation of TTT had not been performed. The purpose of the project was to evaluate the effectiveness of TTT and to describe how TTT's services affected health care team members' desire to remain in their profession after an adverse event or medical error. The program evaluation used survey research to conduct a simultaneous pre-post survey on healthcare team members that were referred to The TRUST Team. The program evaluation used a demographic questionnaire and the Second Victim Experience and Support Tool (SVEST) survey plus four additional items. The survey was sent anonymously to 307 Carilion Clinic healthcare team members who had received a TTT referral after an adverse event or medical error. Data was collected over four weeks. Thirty-nine healthcare team members responded to the survey. Out of 39 responses, 16 responses met the inclusion criteria. There was no significant difference in pre-post survey data in the dimensions of physical support, colleague support, supervisor, institutional support, and professional self-efficacy or the variable of absenteeism after receiving support from TTT. There was statistical significance in the dimension of psychological distress and the variable, job retention after receiving TTT support. Fifteen out of 16 respondents rated their experience with the TTT as moderately to extremely satisfied. Three qualitative questions were added to the post-survey. Survey respondents reported they stayed in their positions because of the supportive environment. One resp (open full item for complete abstract)

Committee: Deborah Lindell DNP, MSN, RN, CNE, ANEF, FAAN (Committee Chair); Mary Dolansky Ph.D., RN (Committee Member); Catherine Hiler DNP, RN (Committee Member); Neely Conner LCSW, LSATP, CEAP, ACC (Committee Member) Subjects: Health Care; Nursing

Doctor of Nursing Practice , Case Western Reserve University, 2016, School of Nursing

Abstract This study describes the clinical nurse leadership skills of operating room nurses. Despite intense focus on patient safety cultures, two of the top ten reported sentinel events to the Joint Commission from 2012 – 2014 occurred in the surgical environment: unintended retention of foreign objects and wrong patient, wrong site, wrong procedure surgery. With leadership identified as a significant root cause for operating room error, no research exists to support evidence based practice specific to clinical nurse leadership at the bedside of the patient. This descriptive, correlational study will provide information regarding clinical nurse leadership within the operating room environment. This study will draw on the conceptual model of staff nurse clinical leadership by Chavez and Yoder to hypothesize the relationship amongst the variables of interest: (1) clinical nurse leadership competency, (2) certification in operating room specialty, (3) organizational culture, and (4) years of operating room experience. The hypothesis for this study is that clinical nurse leadership competency will be greater in operating room nurses within Magnet accredited institutions or specialty certification or greater than ten years of operating room experience. The Leadership Practice Inventory® tool will be used to evaluate clinical nurse leadership in operating room nurses. This is the first study to examine clinical nurse leadership skills of nurses in the operating room environment. Findings may provide evidence to support leadership training for operating room nurses making safety decisions that are essential to preventing patient errors.

Committee: Gayle Petty DNP, RN (Committee Chair); Ronald Hickman PhD, RN (Committee Member); Rebecca Patton MSN, RN (Committee Member) Subjects: Health Care; Nursing

Doctor of Philosophy, The Ohio State University, 2016, Food Science and Technology

Unwanted microorganisms greatly affect the quality and safety of the final food products. For instance, besides foodborne pathogens, quality defects in Swiss cheese result in great economic loss annually to the industry. Ohio has the largest Swiss cheese industry in the U.S., and to reveal microbial causative agents in Swiss cheese with quality defects has become a critical need to solve the problem for the industry. While conventional approaches were insufficient to identify the risk factors promptly and accurately, recent advancements in molecular techniques enabled in-depth investigation of potential causative agents and the development of rapid detection method for safety and quality control. In Chapter 1, an extensive literature review was conducted in terms of cheese quality and safety issues. The Swiss cheese microbiota consist of starter cultures and environmental microorganisms. The major safety risk in cheese is the contamination of pathogenic bacteria from raw milk or post-pasteurization handling. Non-pathogenic bacteria usually cause quality issues in cheese. In Chapter 2, a rapid detection system for Propionibacterium in food matrices were successfully developed. One pair of genus-specific primers targeting the 16S ribosomal RNA of the genus Propionibacterium, and four pairs of species-specific primers targeting different protein coding genes of P. freudenreichii, P. acidipropionici, P. acnes, P. avidum, were designed and evaluated. This detection system showed no cross-reactivity with other dairy-related bacteria, indicating its utility in dairy industry. In Chapter 3, the starter cultures and non-starter microbiota from split Swiss cheese blocks made by two different factories were analyzed. Result showed the relative abundance of Enterobacteriaceae was significantly higher in split Swiss cheese than that of non-split samples, providing evidence that Enterobacteriaceae could be a microbial causing candidate for split defects. A comprehensive (open full item for complete abstract)

Committee: Hua Wang (Advisor); Curtis Knipe (Committee Member); Melvin Pascall (Committee Member); Zhongtang Yu (Committee Member) Subjects: Food Science

Doctor of Philosophy, The Ohio State University, 2015, Nursing

More than 400,000 premature deaths per year occur due to preventable harm in U.S. hospitals, costing over $20 billion per year in healthcare expenses, lost worker productivity, and disability. Conceptual frameworks, such as the Generic Reference Model, contribute to a greater understanding of patient safety because they explain the context of patient harm. The healthcare context, including organizational factors such as strong safety culture and human factors like teamwork, may improve patient outcomes. Patient outcomes, such as adverse events, are more readily detected using instruments such as the Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT), which may detect up to ten times more adverse events than existing methods. The GTT uses keywords or triggers to guide chart reviews. Currently, relationships between safety culture and teamwork and adverse event detection using trigger-tools remain underexplored. The purpose of this study was to explore relationships between organizational and human factors with adverse events that result in patient harm detected using a modified trigger-tool methodology. The descriptive, cross-sectional design used the Safety Attitudes Questionnaire (SAQ) to measure interprofessional staff perceptions of safety culture using safety climate and teamwork climate subscales, and a retrospective, modified IHI GTT chart review methodology to measure patient outcomes at the unit level. The convenience sample was comprised of 32 nursing units/departments from one 750+-bed Midwestern U.S. regional acute care hospital that employed over 1000 nurses. Safety and teamwork climate percentage agreement averages were 75.61% and 70.07%, respectively. Medical surgical units reported the strongest safety climate whereas critical care units reported the strongest teamwork. An average of 69 adverse events occurred per 1,000 patient days, 21.83 adverse events per 100 admissions, and approximately 20% of admissions experienced a (open full item for complete abstract)

Committee: Pamela Salsberry Ph.D., RN (Advisor); Laura Szalacha Ph.D. (Committee Member); Emily Patterson Ph.D. (Committee Member); Esther Chipps Ph.D., RN (Committee Member) Subjects: Health Care; Nursing

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2015, American Culture Studies

Using Johan Huizinga's concept of the magic circle as a context for understanding how sacred spaces reserved for play manifest within role-playing game (RPG) environments both digital and table-top, this dissertation argues that while certain elements of the magic circle are still present, the vast amount of work produced to monitor the boundaries of sacred game space stem from the intimate relationships between players. Online RPG environments are open to critique due to the seemingly wide-spread use of hostility as a gate-keeping tactic. Numerous studies and digital media scholars have examined how bullying, harassment, and bodily threats present within toxic digital gaming cultures act as a means of limiting access to participation. Because marginalized players, whether due to gender, race, or sexual identity, are often playing in gaming environments that get coded as toxic, this dissertation chooses to interrogate the ways in which some players negotiate game environments that are complicated at best and overtly hostile at worst. While the dissertation is careful to note the distinctions between online RPGs and offline table-top RPGs, the core argument made stems from the consistencies present between both: both the online and table-top groups who participated in the study use tools of intimacy both actively and passively as a means of fostering individual as well as group identity. In so doing, the use of intimacy acts as a buffer against hostile acts that would otherwise inhibit participation. But this dissertation does not just attempt to understand how players weather and negotiate hostility outside of their gaming groups. It also seeks to understand how some players are able to absorb the hostility and redirect it as a creative play-style. In this case, “playing ugly” becomes a means of performance not directed outward, but rather, inward. Taboo play, in this case, becomes a cathartic way in which players process hostility by becoming hostile. While this p (open full item for complete abstract)

Committee: Radhika Gajjala (Advisor); Faulkner Sandra (Committee Member); Blair Kristine (Committee Member); Lockford Lesa (Other) Subjects: American Studies; Communication; Gender Studies

Doctor of Philosophy, Case Western Reserve University, 2015, Nursing

Background and significance: Globally, medical errors kill and seriously injure millions of people every year. Jordan is a developing country intent on improving patient safety and quality of care. The literature indicates that improving patient safety culture is an effective strategy to decrease the incidence of medical errors. Understanding nursing perception of patient safety culture and its determinants is an important step to improve patient safety inside Jordanian hospitals. Objectives: To assess nurses' perceptions of patient safety culture, to identify the main determinants of patient safety culture, and to examine the relationship between nurses' perceptions of patient safety culture and reporting of adverse events in Jordanian public hospitals. Design and sample: The study is exploratory using a mixed-methods design. Qualitative data were provided by interviews with nurse managers (N = 9) at three managerial levels. Quantitative data were obtained through a survey from a convenient sample of staff nurses (N = 150) from five public hospitals in Jordan. Measurements: The survey included the Hospital Survey on Patient Safety Culture (HSOPSC) and two investigator-developed questions that measured nurses' reporting of adverse events (medication errors and patient falls). Results: A total of 136 completed questionnaires were returned (response rate = 90.6%). The percent of positive responses to the 12 dimensions of the HSOPSC ranged from 25% to 74%, compared with 44% to 81% reported by the Agency for Healthcare Research and Quality (AHRQ) in 2014. The results indicate that nurses' positive perceptions of safety culture were lower than in the US benchmark AHRQ study. The study found significant negative relationships between several dimensions of the HSOPSC and the nurses' reporting of medication errors and patient falls. The findings indicate nurses with more positive perceptions toward patient safety culture reported fewer adverse events. The nursing manag (open full item for complete abstract)

Committee: Joyce Fitzpatrick (Advisor); Mary Quinn Griffin (Committee Member); Mary Dolansky (Committee Member); David Aron (Committee Member) Subjects: Nursing

PhD, University of Cincinnati, 2013, Engineering and Applied Science: Industrial Engineering

The field of Occupational Health and Safety (OHS) is currently facing two main challenges: 1) Increasing awareness and buy-in among stakeholders and 2) Considering differences (cultural, behavioral and anthropometric) in an increasingly diverse and global workforce; work environments and practices designed for one group of workers may not be appropriate for other groups. These challenges are most relevant in the context of worker health and safety in emerging economies; a large and comparatively cheaper workforce is a mainstay of these countries and OHS is an imperative to make their economic growth sustainable. This study addresses needs on two fronts: From a research perspective, there is a dearth of data on contextual and cultural variables in a developing country work environment that impact safety performance; most existing safety research on this topic is Western or developed country centric. From a practitioner perspective, worker health and safety is a relatively nascent field in developing countries; practitioners are struggling to understand safety perceptions and attitudes that can help localize safety practices and enable more effective implementation of safety programs. This empirical study has 3 objectives: 1) Determine if a safety culture is present in a developing country, 2) Understand contextual influences (perceptions, behaviors and cultural context) that affect safety culture, and 3) Demonstrate a positive correlation between improved worker health and safety and key business outcomes; a "business case" for worker health and safety will especially help gain support from management teams in the highly cost competitive business climate in developing countries. For the first two objectives, an empirical study was conducted in India using a sample set of 500 individuals (senior managers/executives, supervisors and workers) derived from 22 organizations across 5 sectors (Infrastructure/Energy, Mining, Biotech, Services/IT and Manufacturing) and (open full item for complete abstract)

Committee: Henry Spitz Ph.D. (Committee Chair); Sundararaman Anand Ph.D. (Committee Member); Thomas Richard Huston Ph.D. (Committee Member); David Thompson Ph.D. (Committee Member) Subjects: Industrial Engineering

Doctor of Philosophy, The Ohio State University, 2012, Business Administration

This dissertation examines the effects of safety culture, including operational climate and practices, as well as the adoption and use of information systems for delivering high quality healthcare and improved patient experience. Chapter 2 studies the influence of both general and outcome-specific hospital climate and quality practices on process of care. Primary survey data from 272 hospitals across the U.S. is combined with process of care performance data reported by the Center for Medicare and Medicaid Services (CMS). The results indicate that general safety climate and quality practices establish an environment in which outcome-specific efforts enable process quality improvement. A split-group structural equation modeling (SEM) analysis shows the employment of practices focused on specific outcome goals is found to relate to higher quality of patient care in smaller hospitals, whereas a climate focused on specific outcome goals is found to relate to higher quality of patient care in larger hospitals. In Chapter 3, we test the influence of the adoption of healthcare information technologies (HIT) in relation to the use of data and analysis for organizational planning and error reduction. Secondary data on the levels of HIT adoption as reported by HIMSS and the Dorenfest Institute is combined with primary survey data from 2009 on the use and analysis of data in 272 U.S. hospitals; these data are combined with secondary data on hospital performance of process of care and patient satisfaction as reported by CMS. The results of hierarchical regression analyses indicate that HIT adoption and data use and analysis influence outcomes in different ways: hospitals with higher levels of HIT adoption and error data analysis are associated with higher process of care quality, while hospitals with higher levels of organizational data use are associated with higher patient satisfaction. Chapter 4 examines the use of information systems for developing higher reliability in c (open full item for complete abstract)

Committee: Kenneth Boyer (Committee Co-Chair); Peter Ward (Committee Co-Chair); John Gray (Committee Member); Sharon Schweikhart (Committee Member) Subjects: Business Administration; Health Care; Health Care Management; Information Systems

Doctor of Philosophy, The Ohio State University, 2013, Public Health

Patient safety is a significant problem and one that merits further attention. Errors are underreported, handoffs are inadequate, and central line-associated bloodstream infections (CLABSIs) continue to occur unnecessarily. As many as 70 percent of medical errors result from poor patient handoffs. Underreporting of these adverse events may be as high as 96 percent. Furthermore, a conservative estimate puts annual deaths from CLABSIs at 31,000. The objective of this three-study dissertation was to identify perceived organizational factors of safety associated with a high frequency of error reporting, successful handoffs, and lower CLABSI rates. The error reporting and handoff studies aimed to find an organizational factor that had the highest association with that outcome. Those studies also assessed differences in perceptions between management and clinical staff, as well as between different clinical staff groups. The CLABSI study sought to identify the organizational factors of safety associated with reduced CLABSI rates. Another goal of that study was to try to identify the hospital units most likely to achieve zero CLABSIs after implementation of the Comprehensive Unit Based Safety (CUSP) methodology. The Hospital Survey on Patient Safety Culture (HSOPS) was analyzed in conjunction with data on CLABSIs from On the CUSP: Stop BSI program funded by the Agency for Healthcare Research and Quality (AHRQ). The data set for the handoff and error reporting studies consisted of 515,637 respondents in 1,052 hospitals. It was analyzed using weighted least squares multiple regressions. Poisson, and logistic regressions were used for the CLABSI study of 438 hospitals. Management support for safety, error feedback, and organizational learning were all significantly associated with error reporting. Feedback on error reports had the most significant association with error reporting. Management support for safety was not a significant predictor of error reporti (open full item for complete abstract)

Committee: Ann Scheck McAlearney (Advisor); Michael Pennell (Committee Member); Thomas Wickizer (Committee Member) Subjects: Health Care Management; Operations Research; Organization Theory