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Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have been designed and implemented over several decades, this patient safety issue remains at the forefront of concern for most hospitals. In the first part of this study, the development and implementation of one type of highly studied and widely adopted rescue intervention, algorithm-based patient assessment tools, is examined. The analysis summarizes how a lack of systems-oriented approaches in the design and implementation of these tools has resulted in suboptimal understanding of patient risk of mortality and complications and the early recognition of patient deterioration. The gaps identified impact several critical aspects of excellent patient care, including information-sharing across care settings, support for the development of shared mental models within care teams, and access to timely and accurate patient information.

This chapter describes the use of several system-oriented design and implementation activities to establish design objectives, model clinical processes and workflows, and create an extensible information system model to maximize the benefits of patient state and risk assessment tools in the inpatient setting. A prototype based on the product of the design activities is discussed along with system-level considerations for implementation. This study also demonstrates the effectiveness and impact of applying systems design principles and practices to real-world clinical applications.

German legal historians of nineteenth and twentieth centuries defined the main characteristics of the corporations and believed that one renaissance institution, the Casa di San Giorgio at Genoa (1407–1805), was similar to the corporations of later centuries. This paper proposes to reverse this perspective: did the founders of early modern corporations know the financial model of the fifteenth century Casa di San Giorgio? The research shows the connection between the model of the Casa di San Giorgio and the Mississippi Company of John Law (1720), the famous financial scheme and bubble. The history of the Casa di San Giorgio was mainly transmitted through a passage of Machiavelli’s History of Florence (VIII, 29). The paper offers new biographical evidence that Law had been to Genoa and introduces sources connecting the genesis of Law’s scheme for the Mississippi Company in France with the model of the Casa di San Giorgio.

US citizens who attend international medical schools (US IMGs) are more likely to be of Hispanic, Black American, or Asian descent compared to US medical students. As physicians, US IMGs contribute diversity to the health-care workforce; their experiences and perspectives have improved the health outcomes for populations typically underserved. To become a competent medical professional is a challenging experience, especially for IMGs who may have entered medical school with less than optimal academic histories. During this journey, some students develop academic and clinical deficiencies. Addressing these deficits through remediation interventions are critical to the student’s performance as a physician. This study measured the resiliency, self-efficacy, and self-compassion of IMGs who completed remediation while in medical school. Results indicate older students experienced failure more often and were found to have significantly higher levels of self-compassion compared to younger students. Males were assigned significantly more remedial interventions compared to the female participants. Finally, strong positive correlations suggested that the more remediation interventions students were provided, the more likely they were satisfied with their overall remediation experience. These findings indicate that by varying support strategies and encouraging student’s orientation to resiliency, self-efficacy, and self-compassion may assist them in overcoming their deficits.

Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.

Organizational change is a key mechanism to ensure the sustainability of healthcare systems. However, healthcare organizations are persistently difficult to change, and literature is riddled with examples of failed change endeavors. In this chapter, we attempt to unravel the underlying causes for failed organizational change. We distinguish three types of change with different levels of depth that require different change approaches. Transformations are the deepest forms of change where beliefs and principles need to be modified to successfully influence routines. Renewals are deep forms of change where principles need to be modified to successfully influence routines. Improvements are shallow forms of change where only modifications at the level of routines are needed. Using deoxyribonucleic acid (DNA) as our metaphor, we propose a theory of “organizational DNA” to understand organizations and these three types of organizational changes. We posit that organizations are made up of a double helix consisting of a so-called “social string,” which contains the “soft” interaction or communication among the organization's members, and a so-called “technical string,” which contains “hard” organizational aspects such as structure and technology. Ladders of organizational nucleotides (i.e., Routines, Principles, and Beliefs) connect this double helix in various combinations. Together, the double helix and accompanying nucleotides make up the DNA of an organization. Without knowledge of the architecture of organizational DNA and whether a change addresses beliefs, principles, and/or routines, we believe that organizational change is constrained and based on luck rather than change management expertise. Following this metaphor, we show that organizational change fails when it attempts to change one part of the DNA (e.g., routines) in a way that renders it incompatible with the connecting components (e.g., principles and beliefs). We discuss how the theory can be applied in practice using an exemplar case.

This chapter offers insight on how existing paradigms within Black Studies, specifically the ideas of racial capitalism and the Black Radical Tradition, can advance sociological scholarship toward greater understanding of the macro-level factors that shape Black mobilizations. In this chapter, I assess mainstream sociological research on the Civil Rights Movement and theoretical paradigms that emerged from its study, using racial capitalism as a lens to explain dynamics such as the political process of movement emergence, state-sponsored repression, and demobilization. The chapter then focuses on the reparatory justice movement as an example of how racial capitalism perpetuates wide disparities between Black and white people historically and contemporarily, and how reparations activists actively deploy the idea of racial capitalism to address inequities and transform society.

To examine aging Puerto Ricans’ experiences with and perceptions of depression treatment.

In-depth analysis of eight exemplary cases from ethnographic interviews with a subsample of 16 aging Puerto Ricans in the Boston area who are part of the Boston Puerto Rican Health Study.

The results show that respondents were resistant to accepting pharmacological treatment for their depression, and they often characterized antidepressants as “dope.” Moreover, they claimed that in addition to their health problems, social stressors such as financial strain, lack of jobs, housing problems, and social isolation are triggering or contributing to their depression. Because of this, they express reluctance in accepting clinical treatment only, and suggest that broader social issues and other health needs ought to be addressed as part of an effective treatment. For many, pharmacological treatment is acceptable only in the more severe forms of depression.

These results have important implications for improving the quality of depression treatment and reducing health disparities for mainland Puerto Ricans.

Even though recent studies continue to show a high frequency of depression among Puerto Ricans, issues of treatment quality are still understudied and ethnographic accounts are especially lacking. Our study offers an exploratory investigation of this unresolved research issue.

Purpose: In this chapter, we develop a conceptual model, the relational anger model (RAM). The model aims to better understand the receivers' attributions and emotion regulation strategies used in the face of intense workplace anger. We also report a test of this model in a workplace setting. Study Design/Methodology/Approach: The data were collected through a survey using a split administration design conducted in various industries. The analysis used PROCESS based on data gathered from 122 employees. Findings: The results indicated that perceptions of greater anger intensity are associated with lower target positive health (e.g., lowered work functionality). When attributions of higher sender anger intensity are viewed as appropriate, targets experience better health outcomes. Targets' attribution of lower sender anger intensity appropriateness is also associated with targets' reporting higher negative health outcomes (e.g., lowered self-esteem). Support for the full moderated mediation model of the effects of the ER strategies is not found. However, separate paths within the model are significant as outlined in the analysis throughout this chapter. Originality/Value: Overall, the RAM increases our understanding of a receivers' internal cognitive and affective processes in the face of workplace anger manifestations in organizations. Research Limitations: There is a possibility of common method variance affecting the study results, but a split administration design was used to minimize this effect. The study may also be affected by memory of the anger incident, which we tried to overcome using the Day Reconstruction Method.