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Following the Supreme Court's decision in Dobbs v Jackson Women's Health in June 2022, many states restricted or banned abortion. Medical educators have focused on how this change impacts abortion training for residents, but schools must also adapt undergraduate medical education. Medical schools provide the foundation for future physicians' knowledge and attitudes on abortion. Comprehensive, high-quality abortion education for all medical students is essential for the future of abortion care. Here, we present how education champions can lead curricular improvements in abortion education in the preclinical, clerkship, and postclerkship phases of undergraduate medical education. [ABSTRACT FROM AUTHOR]

Background: Nurses have a critical role to play in achieving the United Nations' 17 Sustainable Development Goals (SDGs). While Goal 3 (good health and well-being) is of particular importance to nursing, every SDG contributes to the advancement of universal health and well-being. Yet many nurses are unfamiliar with the SDGs and how they relate to everyday nursing practices. Purpose: The purpose of this study was to examine RNs' knowledge of and attitudes toward the SDGs. Methods: This study used a descriptive correlational cross-sectional design. A convenience sample of RNs from multiple countries completed an anonymous online survey that included eight demographic items and 25 items exploring participants' knowledge of and attitudes toward the SDGs. Descriptive, parametric, and nonparametric statistics were used to analyze the data. Results: The majority of nurses in this study perceived themselves as lacking knowledge of the SDGs. Most wanted to know more, including how they could take action to help achieve the goals. Overall, participants agreed that the SDGs are relevant to nursing practice and that nurses are integral to their advancement. Participants who were younger than age 50, those living in the United States, and those who practiced primarily in a clinical or community setting were more likely than others to self-report lower SDG knowledge scores. Conclusions: The study findings contribute to our collective understanding of RNs' knowledge and attitudes regarding the SDGs. They can assist nurse educators and leaders worldwide in developing targeted strategies to better inform nurses and prepare them for actions that will advance these goals. Increasing nurses' knowledge of the SDGs, especially as these goals relate to daily clinical practice, may lead to greater nursing engagement and impact. [ABSTRACT FROM AUTHOR]

BACKGROUND: The American Board of Surgery has endorsed competency-based education as vital to the assessment of surgical training. From 2018 to 2020, a national pilot study was conducted at 28 general surgery programs to evaluate feasibility of implementing entrustable professional activities (EPAs) for 5 common general surgical conditions. ACGME core competency Milestones were also rated for each resident by program clinical competency committees. This study aimed to evaluate the validity of general surgery EPAs compared with Milestones. STUDY DESIGN: Prospectively collected, de-identified EPA Pilot Study data were analyzed. EPAs studied were EPA-1 (gallbladder), EPA-2 (inguinal hernia), EPA-3 (right lower quadrant pain), EPA-4 (trauma), and EPA-5 (consult). Variables abstracted included levels of EPA entrustment (1 to 5) and corresponding ACGME Milestone subcompetency ratings (1 to 5) for the same study cycle. Spearman's correlations were used to evaluate the relationship between summative EPA scores and corresponding Milestone ratings. RESULTS: A total of 493 unique residents received a summative entrustment decision. EPA summative entrustment scores had moderate-to-strong positive correlation with mapped Milestone subcompetencies, with median rho value of 0.703. Among operation-focused EPAs, median rho values were similar between EPA-1 (0.688) and EPA-2 (0.661), but higher for EPA-3 (0.833). EPA-4 showed a strong positive correlation with diagnosis and communication competencies (0.724), whereas EPA-5, mapped to the most Milestone subcompetencies, had the lowest median rho value (0.455). CONCLUSIONS: Moderate-to-strong positive correlation was noted between EPAs and patient care, medical knowledge, and communication Milestones. These findings support the validity of EPAs in general surgery and suggest that EPA assessments can be used to inform Milestone ratings by clinical competency committees. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to establish normative values of lower limb amputation mobility across primary etiologies based on age and amputation level. Design: This study is a cross-sectional observational analysis of outcomes. A total of 11,995 lower limb prosthesis users were included in the analysis. Participants were grouped by etiology into four categories: cancer, congenital, trauma, and diabetes/dysvascular. Mobility was assessed by using the Prosthetic Limb Users Survey of Mobility. Results: Mobility across seven age groups for the four etiologies was established for both above-the-knee amputation and below-the-knee amputation. Differences were found between age groups for individuals: above-the-knee amputation: cancer (χ2 (6) = 40.97, P < 0.001), congenital (χ2 (3) = 9.41, P = 0.024), trauma (χ2 (6) = 18.89, P = 0.004), and dysvascular (χ2 (5) = 39.73, P < 0.001; below-the-knee amputation: cancer (χ2 (6) = 29.77, P < 0.001), trauma (χ2 (6) = 28.22, P < 0.001), and dysvascular (χ2 (6) = 144.66, P < 0.001). Conclusions: The awareness of differences across amputation etiologies extending across the lifespan of ages can assist the goal-setting process as part of prosthetic rehabilitation. In addition, refined normative values provide the ability to benchmark new and innovative changes in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is prevalent worldwide, with 2.1 million new cases and 1.8 million deaths in 2020. In the United States, an estimated 131 880 lung cancer deaths are expected to occur in 2021, with most detected in later stages. Smokers are 15 to 30 times more likely to develop or die from lung cancer. Local Problem: Our community residents were more likely to be diagnosed with lung cancer in later stages (62%) compared with 56% nationally, resulting in an increased community mortality rate. Intervention: Evidence-based changes in an electronic health record system supported identification and referral of high-risk patients for low-dose computer tomography to improve early lung cancer detection rates. Results: Early-stage lung cancer detection increased 24%. Conclusions: Interprofessional teams used technology to adopt evidence-based practice and improve health outcomes in their communities. [ABSTRACT FROM AUTHOR]

In 1983, the original study “Magnet Hospitals: Attraction and Retention of Professional Nurses” identified professional development, continuing education, formal education, and career development as critical success factors in creating an environment that fosters nurse engagement. In alignment with the findings, the Magnet Recognition Program® requires organizations to have structures and processes to support nurse certification. In June of 2021, the Magnet Recognition Program announced only nursing and healthcare-related professional board certifications would be accepted as of January 1, 2024. The 2.5-year timeline allowed organizations the opportunity to prepare for the change. [ABSTRACT FROM AUTHOR]

During the coronavirus disease 2019 (COVID-19) pandemic, patients experienced rapid clinical decline requiring urgent conversations about their wishes for care. Palliative care advanced practice registered nurses developed a workflow to provide early palliative care consultation to every COVID-19 patient under investigation admitted to a 368-bed acute care hospital in the United States. A retrospective exploratory study was conducted on the initial surge from March 1 to May 31 of 2020. A nonrandomized 2-group design used descriptive and inferential statistics to compare elicitation of patient care preferences for patients who received early palliative care consultation with those patients who did not receive a palliative care consult. Early palliative care consultation resulted in a higher number of patients establishing a decision-maker (99%), changing code status (46%), changing goals of care (46%), and transitioning to comfort care (24%). In those patients not receiving palliative care, fewer patients established a decision-maker (10%), changed code status (7%), changed goals of care (4%), or transitioned to comfort care (3%). During the first COVID-19 surge, early palliative care consult performed by advanced practice registered nurses resulted in a higher number of patients establishing decision-makers and changing care preferences before decompensation due to COVID-19, thus helping patients avoid potential suffering caused by unwanted medical interventions. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the role of the U.S. Veterans Health Administration's (VHA) Innovators Network (iNET) in promoting innovative technologies in health care and cultural revolution. Other topics include various medical innovations over the years like the implantable cardiac pacemaker in 1960 and the nicotine patch in 1984, and the major human-centered design projects launched by Department of Veterans Affairs medical centers (VAMC) to promote innovation.

Supplemental digital content is available in the text. OBJECTIVE: The aim of this study was to measure structural empowerment (SE) and capture short-term changes in perception for senior nurse leaders before and after a formal development experience. BACKGROUND: The body of literature related to SE in senior nurse leaders is limited. Applying the SE concept to senior levels of nursing leadership provides a vehicle to impact nurse leader retention and ultimately the organization beyond singular units. METHODS: The Advanced Leadership Program (ALP) was designed in collaboration with the American Nurses Association to support personal and professional development for senior nurse leaders. The sample included 28 participants from the United States and the United Kingdom over a 6-month period. RESULTS: The effect of the intervention was seen in the postintervention survey rating SE higher in 5 of 7 domains as compared with the preintervention survey, reduction in overall turnover, and improvements in patient experience scores. Additionally, the participants evaluated the program in top categories, and comments were highly positive around peer support, improved working relationships, and expectations. CONCLUSION: The ALP has shown promise in strengthening SE for senior nurse leaders by supporting leadership skill development, follow-up training, and peer network development. [ABSTRACT FROM AUTHOR]

Background and Objectives: The passage of the Affordable Care Act has ignited a shift from the pay-for-performance model to value-based care with a particular relevance in critical care settings. Provider incentive programs are widely considered as a means to reward providers based on the achievement of preset quality metrics. This article aims to demonstrate the effects of a provider incentive program in the critical care delivery system in a large academic center in the Northeastern United States. Methods: This article describes the results of a retrospective analysis of a performance-driven quality improvement initiative at a critical care facility of an academic medical center using a quasi-experimental pre-/posttest design. A set of quality measures was selected as outcome metrics. Selection criteria for the process measures are as follows: (i) the metric goals should be influenced by the physician's input to a large degree; (ii) the measure must be transparent and accessible within the hospital-wide data reporting system; (iii) the metric that required group effort and interdisciplinary collaboration to achieve; and (iv) the measure must directly affect patient outcome. The outcome metrics are central line--associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs), standardized infection ratio (SIR), Foley catheter and central line utilization standardized utilization ratio (SUR), hand hygiene compliance, and adherence to respiratory recovery pathway goals. These metrics were tracked from for 3 years with success defined as achieving set benchmarks for each metric. Results: The average CLABSI SIR and CAUTI SIR across all intensive care units (ICUs) decreased by 44% (P= .05) and 87% (P= .02) over 3 years as well as the central line and Foley catheter utilization falling by 41% and 30%, respectively. Hand hygiene compliance in the ICUs improved for the same period by 27 percentage points, as did compliance with the respiratory recovery pathway program by 4 percentage points. Conclusion: The use of a physician-driven financial incentive model in a critical care setting measured by outcome metrics dependent on physician input is successful with rigorous implementation and careful evaluation. [ABSTRACT FROM AUTHOR]

The US Department of Defense (DoD) recognizes the importance of warfighter brain health with the establishment of the Warfighter Brain Health Initiative and Strategy. For a warfighter, also known as a service member, to perform at their highest level, cognitive and physical capabilities must be optimized. This initiative addresses brain health, brain exposures, to include blast overpressure exposures from weapons and munitions, traumatic brain injury (TBI), and long-term or late effects of TBI. The DoD's pursuit of maximal strength hinges on the speed of decisions (neurocognitive) and detection of brain injury when it occurs. The strategy creates a framework for deliberate, prioritized, and rapid development of end-to-end solutions for warfighter brain health. Through this strategy, DoD is addressing the needs of our service members, their families, line leaders/commanders, and their communities at large. The implications of this initiative and strategy are noteworthy for practitioners because the DoD Warfighter Brain Health construct lends itself to nurse practitioner engagement in clinical practice, patient education, policy development, and emerging research. [ABSTRACT FROM AUTHOR]

Nursing leadership can play an essential role in the development of nursing informatics solutions by virtue of their broad understanding and oversight of nursing care. We describe a systems-level method for creating nursing informatics solutions with clearly defined structure and leadership from nursing executives. Based on the guiding principles of clear lines of responsibility, respect for expertise, and commitment to project aims, this allows nursing executive leadership to organize, set up, and own the development of nursing informatics solutions. [ABSTRACT FROM AUTHOR]

Background: Healthy People 2020 has made achieving health equity one of its overarching goals; another goal is increasing the number of accredited local agencies that have Community Health Improvement Plans (CHIPs). Community Health Improvement Plans are meant to serve agencies as guiding documents for multiple years. Objectives: This study investigates the prevalence with which health disparities are addressed within CHIPs and the specific health disparities targeted by these objectives. Methods: Researchers analyzed 4,094 objectives from CHIPs of 280 local Public Health Accreditation Board (PHAB)-accredited and nonaccredited public health agencies in the United States. Results: Despite the PHAB's focus on addressing health equity, not all PHAB-accredited agencies addressed health disparities (85.4% of CHIPs analyzed). However, more accredited than nonaccredited agencies (73.9%) contained at least one objective focused on health disparities. Discussion: Findings indicate that if health equity is truly a goal of national initiatives, agencies' planning documents (e.g., CHIPs) can do a better job addressing commonly ignored populations. [ABSTRACT FROM AUTHOR]

Graduate nutrition training in the United States prepares graduates for careers in academia, industry, and government and nongovernment sectors by enhancing critical thinking skills and providing specific technical skills necessary for doctoral-level employment. However, it is often not designed to develop skills in leadership that are key to fully successful careers. The Dannon Institute's Nutrition Leadership Institute was initiated in 1998 to provide leadership training to fill this gap and to enable early-career nutrition scientists to achieve their career goals. After 20 years of experience with the Nutrition Leadership Institute, this article describes the program's genesis and evolution, captures its key features and principal outcomes as expressed by alumni, and highlights its value to its participants and the larger nutrition community. [ABSTRACT FROM AUTHOR]

The authors explore how nurses can contextualize the United Nations 17 Sustainable Development Goals within their daily practice and create holistic plans of care for patients, families, communities, and nations. While health care often focuses on acute or chronic illness, the elements necessary for good health are far more complex than we tend to recognize. Florence Nightingale understood this complexity and wrote extensively on the myriad social and environmental factors that influence well-being. Today these factors are termed "health determinants" and undergird the United Nations 17 Sustainable Development Goals (SDGs). This article explores how nurses can contextualize the SDGs within their daily practice and create holistic plans of care for patients, families, communities, and nations. [ABSTRACT FROM AUTHOR]

An interview with Michael O. Ugwueke, president and chief executive officer of healthcare company Methodist Le Bonheur Healthcare, is presented. Topics covered include how the career of Ugwueke in healthcare administration has started, the 100th anniversary of Methodist Le Bonheur Healthcare in 2018, and requirement for all tax-exempt hospitals to submit a community health needs assessment to the Internal Revenue Service every three years.

The article offers information on the Covid-19 vaccine reluctance among U.S. nurses.

This specialty provides fertile ground for professional development. [ABSTRACT FROM AUTHOR]

The current status and future directions of early childhood inclusion in the United States are discussed from the perspective of 4 key goals: access, accommodations and feasibility, developmental progress, and social integration. Recommendations are put forward to promote inclusion goals emphasizing administrative structures, personnel preparation, licensing and national standards, team processes, and expansion of inclusive practices beyond school settings. These recommendations are discussed within the context of an early childhood systems framework that encompasses all children. [ABSTRACT FROM AUTHOR]

Purpose Approximately 70% of United States [or U.S.] adults are either overweight or obese. Obesity increases the risk of chronic disease and strains healthcare access, quality, and cost. Weight gain occurs in college students threatening optimal weight maintenance. Physical activity is fundamental to preventing disease. College students incur multiple challenges in weight management. The purpose of the article is to describe the opportunity for Advanced Practice Registered Nurses (APRNs) to intentionally become wellness promoters. Data sources The literature was reviewed and interventions developed. Guided by Bandura's Social Cognitive Theory, focus was concentrated on environmental influences through a proposed Staying Active Campaign (SAC). Conclusions College students are a vulnerable population at risk for unhealthful practices. Young adulthood is a critical period of weight gain that carries risk for later adulthood. College students desire and require assistance for successful weight management. Interventions can be directed by APRNs to achieve healthful weight management and create a campus-wide culture that reinforces healthful practices. Implications for practice Obesity in the college population is a twofold circumstance. Action by APRNs is needed to address obesity and advocate for the prevention of future obesity. The SAC decreases the confounding college environment and supports the students' ability to be physically active while establishing personal lifelong behaviors to emulate and share with others. [ABSTRACT FROM AUTHOR]

Chassin and Loeb argue persuasively that healthcare organizations (HCOs) can and should be "high-reliability organizations" (HROs) seeking zero defects in outcomes quality. They suggest that the Baldrige model is a sound platform for achieving high reliability. This article analyzes the similarity of the HRO concept to the Baldrige model using a recent Malcolm Baldrige National Quality Award recipient's application. The analysis suggests that neither high reliability nor Baldrige criteria are easily achieved, but the two have strong similarities. The principal difference is in Baldrige's emphasis on strategic independence versus the HRO commitment to "zero patient harm" and quality as "the organization's highest-priority strategic goal." Based on this analysis, the article reviews data on the actual performance of Baldrige recipients as recorded at WhyNotTheBest.org. The data show that the Baldrige approach is an effective method of generating above-average performance. Award recipients have made substantial strides in safety, reductions of infections, immunizations, and patient satisfaction, but receipt of the award has not translated as effectively to reduced readmissions, mortality, and costs. The pattern of results suggests that Baldrige recipients have exploited the right to establish their own strategic goals and are likely to respond to strengthened financial rewards for quality. The Baldrige model has documented successes in quality improvement and should be the standard of excellence in managing all HCOs. [ABSTRACT FROM AUTHOR]

Objective: We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. Methods: We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. Results and Conclusions: We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or con text. [ABSTRACT FROM AUTHOR]

Background: The establishment of accountable rare organizations (ACOs) in the Affordable Care Act (ACA) was intended to support both cost savings and high-quality care. However, a key challenge will be to ensure that governance and accountability mechanisms are sufficient to support those twin ambitions. Purpose: This exploratory study considers how recently developed ACOs have established governance structures and accountability mechanisms, particularly focusing on attempts at collaborative accountability and shared governance arrangements. Methodology: Four case studies of ACOs across the United States were undertaken, with data collected throughout 2012. These involved 34 semistructured interviews with ACO administrative and clinical leaders, observation of nine meetings, and a review of documentary materials from each ACO. Findings: We identified very few examples of physicians being held to account as a collective and therefore only limited evidence of collaborative accountability impacting on behavior change. However, ACO leaders do have many mechanisms available to stimulate change across physicians. The challenge is to determine governance structure(s) and accountability mechanisms that facilitate the most effective combination of approaches, measures, incentives, and sanctions to achieve the goals of more accountable care. Practice Implications: Accountability structures and processes will need to be tailored to local membership composition, historical evolution, and current stage of development. There are also some common lessons to be drawn. Shared goals and incentives should be reflected through performance criteria. It is important to align measures and thresholds across payers to ensure ACOs are not unnecessarily burdened or compromised by reporting on different and potentially disjointed measures. Finally, emphasis needs to be placed on the importance of credible, transparent data. This exploratory study provides early evidence regarding how ACOs are establishing their governance and accountability arrangements and provides a foundation for future research and theory-building in this area. [ABSTRACT FROM AUTHOR]

Health care organizations are under intense pressure to improve the efficiency and effectiveness of care delivery and, increasingly, they are using quality improvement teams to identify and target projects to improve performance outcomes. This raises the question of what factors actually drive the performance of these projects in a health care environment. Using data from a survey of health care professionals acting as informants for 244 patient care, clinical-administrative, and nonclinical administrative quality improvement project types in 93 health care organizations, we focus on 2 factors--goal setting and quality training--as potential drivers of quality improvement project performance. We find that project-level goals and quality training have positive associations with process quality, while organizational-level goals have no impact. In addition, the relationship between project-level goals and process quality is stronger for patient care projects than for administrative projects. This indicates that the motivational and cognitive effects of goal setting are greater for projects that involve interactions with clinicians than for ones that involve interactions with other staff. Although project-level goal setting is beneficial for improving process quality overall, our findings suggest the importance of being especially attentive to goal setting for projects that impact direct patient care. [ABSTRACT FROM AUTHOR]

Background: Leadership by health care professionals is likely to vary because of differences in the social contexts within which they are situated, socialization processes and societal expectations, education and training, and the way their professions define and operationalize key concepts such as teamwork, collaboration, and partnership. This research examines the effect of the nurse and physician leaders on interdependence and encounter preparedness in chronic disease management practice groups. Purpose: The aim of this study was to examine the effect of complementary leadership by nurses and physicians involved in jointly producing a health care service on care team functioning. Methodology: The design is a retrospective observational study based on survey data. The unit of analysis is heart failure care groups in U.S. Veterans Health Administration medical centers. Survey and administrative data were collected in 2009 from 68 Veterans Health Administration medical centers. Key variables include nurse and physician leadership, interdependence, psychological safety, coordination, and encounter preparedness. [ABSTRACT FROM AUTHOR]

Health reform is bringing about changes in the healthcare environment, but an equally significant transformation is occurring in science with the sequencing of the human genome and the increasing role of personalized medicine in the delivery of new cancer therapies. These changes directly affect the ability of hospitals to provide value-based, state-of-the-art care and represent major strategic decisions that must be made by management. In the United States, an estimated 85% of cancer patients receive care in community settings, but patients' outcomes are often not equivalent to those achieved in academic health centers. Care of cancer patients in the community is often fragmented, as most oncologists are in private practice and have limited access to formal mechanisms for coordinating care across specialties or with primary care physicians. Furthermore, genetic analysis, advanced diagnostic tests, and clinical trials are not always available to patients in these settings. The evolution of cancer care requires a reconfiguration of processes and investment in new services. In response, the National Cancer Institute launched the Community Cancer Centers Program in 2007 as a public-private partnership with 16 community hospitals. This article draws on the results of an external evaluation of the pilot program and assesses the role of such a partnership as a means of facilitating the translation of the developing science to the community setting, with reference to the role of management in the implementation of such partnerships. [ABSTRACT FROM AUTHOR]

Background: In the advent of generic statins becoming increasingly available and with the recent addition of atorvastatin to the generic market, healthcare providers are often encouraged by payers to switch from a branded statin to an alternate, less costly agent. Objective: The aim of this study was to determine the impact of a therapeutic switch on cholesterol goal attainment among patients with existing cardiovascular disease (CVD) or risk factors for CVD. Study Design: A cross-sectional, multisite retrospective review of patient records evaluating low-density lipoprotein cholesterol (LDL-C) control before and after switching statins was conducted. Methods: Participants were 18 to 89 years olds who were stable on statin therapy and had 1 or more risk factors for CVD. Patients meeting switch criteria (n = 833) were evaluated for changes in their statin therapy and LDL-C goal attainment. Drug/dose information, cholesterol values, and goal attainment in accordance with National Cholesterol Education Panel Third Adult Treatment Panel guidelines were determined before and after the switch. Dose potency was based on mean LDL-C reductions. Results: Data were collected from 22 US sites. Risk factors for CVD were common, with 88.5% of patients identified as high risk. Overall, patients' mean LDL-C levels improved from 87.1 to 81.5 mgidL, and goal attainment increased from 75.5% to 82.5% (P < .05). Switches to a comparable or higher statin/dose improved mean LDL-C and goal attainment (P < .05). However, in patients transitioned to a lower statin/dose equivalency (36.4%), mean LDL-C level increased from 79.8 to 85.6 mg/dL and goal attainment fell from 84.2% to 78.6% (P < .05). Logistic regression confirmed that LDL-C goal attainment was reduced by 53% in patients switched to a lower statin/dose (odds ratio, 0.47; 95% confidence interval, 0.30-0.76; P = .002) compared with patients switched to an equipotent dose. The use of adjunctive lipid-lowering therapies increased in patients switched to a lower statin/dose (P < .05). Conclusions: Cholesterol values and goal attainment can be negatively impacted when a systematic approach is not used and patients are switched to lower potency therapies. [ABSTRACT FROM AUTHOR]

Retail clinics-while innovative-can no longer be considered a new model of healthcare delivery, as an increasing number of hospitals and health systems now own them. The purpose of this article is to explore the extent to which hospital systems are satisfied with their ownership of retail clinics. In terms of operational challenges, respondents to our survey, administered to representatives from 19 health systems, were relatively satisfied with clinic staffing and their relationship with the retailers regarding lease terms, store locations, and shopper demographics. They expressed mostly neutral levels of satisfaction with regulations and laws related to retail clinics and low satisfaction with insurance reimbursement and clinics' seasonal patterns. The two areas that received the lowest respondent satisfaction ratings were patient volume and response to marketing initiatives. When asked to share their perceptions of their organization's satisfaction with various strategic aspects of retail clinic ownership, respondents revealed that the clinics were achieving several important strategic goals, such as improved access, increased referrals, defense against competitors, and increased brand exposure. They indicated overall dissatisfaction with profitability and cost-reduction outcomes. We conclude that serious operational challenges and strategic threats must be overcome if retail clinics are to be a successful service line for hospitals and health systems. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluates the relationship between alliance-oriented change and alliance-decision making among health care organizations. It notes that the study utilized two rounds of survey data gathered from the participating organizations of 14 health alliances in the Robert Wood Johnson Foundation's Aligning Forces for Quality program. The study has revealed the low levels of alliance-oriented change within the organizations has been reported by alliance participants.

The article assesses the significant role of disciplinary literacy in an individual's educational, career and life success and its link to the implications of the academic Common Core State Standards. It discusses several academic disciplines including disciplinary literacy, adolescent literacy and student assessment. The author asserts that advanced educational instruction and progressive learning are needed in meeting the demands of modern literacy.

The article offers information on a 2-day workshop held in October 2009 by the National Quality Forum to accelerate the adoption of the National Priorities Partnership (NPP) agenda. The workshop was funded by the Robert Wood Johnson Foundation (RWJF), and aimed to identify the opportunities for advancement in nursing. The workshop was attended by several healthcare professionals, including officials of the Joint Commission and the Center for Medicare & Medicaid Services (CMS).

The article examines the evolution of the shared governance model for nursing departments and organizations from 1996-2010 in the U.S. It cites the origin of shared governance at the bedside wherein members of a unit belong to council based on unit. It states the implementation of the first shared governance model in 1996, which is composed of the leadership, practice, professional development, coordinating, quality, and nursing research councils with by laws and operational calendar. It explains the revision of the 1996 model in 2007, in which unit based councils and divisional councils were added and the coordinating council was dissolved. It also discusses the significance, by laws, and objectives of shared governance models.

The article discusses various approaches on how to improve consumer expectation in public or private healthcare system in the U.S. The government must establish accountable and quantifiable reforms that distinguish its role with private organizations. Partnership of public and private organizations allows them to learn from each other and become more service-oriented. Furthermore, strategic goals, outcomes and projects must be defined, however they must be accompanied with operational goals that meet organizational commitment.

The article discusses several lessons that can have an effect on the treatments of geriatric adults who suffered a traumatic injury. It cites several ailments that could complicate recovery from trauma, including emphysema, diabetes and renal failure. It presents several suggestions on how to properly care for older patients with trauma, including the familiarization on the medications that are inappropriate for adults aged 65 or more and learning simple communication strategies.

The author examines several issues related to the Patient Protection and Affordable Care Act signed by U.S. President Barack Obama on March 23, 2010. He argues that the law will have a profound impact on healthcare delivery in the future by placing increasing emphasis on value-based care. According to him, the basic assumption of this legislation is that the cost and quality of healthcare should not be seen as separate entities but as a complete whole. Its implications for nurses are also cited.

The article explores the future of nursing in the U.S. during the period from 2020 to 2030. It references the report "The Future of Nursing: Leading Change, Advancing Health" from the Robert Wood Johnson Foundation and the Institute of Medicine which extends the vision for the nursing profession into 2030. The nursing profession has been expected to create a culture of health, reduce health disparities, and improve the health and well-being of the people.

The article discusses the importance of organizational culture within the healthcare system, in response to a paper by Prenestini and Lega about the relationship between senior management culture and performance. The author notes that impact of a free-market business model on the orientation and type of culture adopted in the American healthcare system. In contrast to the Italian model of focusing more on government-led health service, the American counterpart emphasizes consumer choice.

The article reports that according to a study there have been considerable achievements in diabetes management over the last 20 years but the achievement towards haemoglobin A1C, blood pressure (BP), and low-density lipoprotein (LDL) among adults with diabetes remain limited.

In this article the author reflects on the recommendations of a study conducted by the Institute of Medicine (IOM), in collaboration with the Robert Wood Johnson Foundation, on the future of nursing. He informs that the study recommended nurses to work according to their fullest skills, improvement in the access to education of nurses, and their increased role in healthcare decision making and discusses the impact that these recommendations, if implemented, will have on the practice of nursing.