DBA 7420, Organizational Behavior and Comparative Mana.docx

DBA 7420, Organizational Behavior and Comparative
Management 1
Course Learning Outcomes for Unit VII
Upon completion of this unit, students should be able to:
6. Examine how differentiating characteristics factor into
organizational behavior.
6.1 Summarize motivation in organizations.
6.2 Assess work-related attitudes such as feelings about the job,
organization, and people at work.
6.3 Examine emotions and their impact on the job.
Course/Unit
Learning Outcomes
Learning Activity
6.1
Unit Lesson
Unit VII Annotated Bibliography
6.2
Unit Lesson

Chapter 3, pp. 74–94
6.3
Unit Lesson
Reading Assignment
Chapter 3: Attitudes and Job Satisfaction, pp. 74–94
Chapter 4: Emotions and Moods, pp. 102–128
Unit Lesson
Introduction
As humans, we all deal with an influx of emotions and moods
daily. How many times have you heard people
dreading that Monday was approaching? How many times have
you overheard people celebrating that Friday
arrived? Life happens, and we all must deal with how we feel
about that. We have all heard people identify
some as having a good attitude or a bad attitude, but what does
that really mean? Many people think of
outlooks or perspectives about something when thinking about
attitudes; however, it is much more complex
than that. In this unit, we will learn about emotions and moods
and how they can influence our attitudes. We

will also explore how they impact the workplace and what this
means for managers.
Emotions and Moods
As we begin to delve into a discussion on feelings, we need to
have a solid understanding of some basic
terminology. Key words include affect, emotions, and moods.
Everyone experiences each of these from time
to time; however, few fully understand the difference. Would
you know how to distinguish an emotion from a
mood?
UNIT VII STUDY GUIDE
Attitudes, Emotions, and Impacts
Management 2
UNIT x STUDY GUIDE
Title
Whenever we experience something, it tends to affect us in
some way. The effect can encompass a broad
range of feelings from good to bad. Regardless of where the
effect is on the scale, it is how we feel. An
emotion, in this instance, is a short-lived feeling based upon a

specific event that occurred in our life (Robbins
& Judge, 2019). In contrast, a mood is more of a longer-term
emotion that is less intense and not necessarily
specific to a life event.
When we consider the many events that occur in the workplace,
any of these may trigger an emotion or lead
to a mood. What sets many of us apart from others is something
known as emotional intelligence. This
emotional intelligence is an ability to not only be in tune with
our emotions and that of others. We need to be
able to understand how we should handle and respond to those
emotions while doing so in a way in which we
remain respectful to others and still comply with social
expectations (Robbins & Judge, 2019).
Applications in the Workplace
In daily living, everyone experiences a broad range of emotions.
Some are good; others are not. Some are
positive, and others are not. The workplace is no exception.
Managers and leaders should not endeavor to
remove emotion from the workplace. Instead, the focus should
be on modeling positive emotions and moods
so that others will choose to exhibit those same types of
behaviors. Would you not prefer to work in a place
where everyone is working in harmony? Doing so can lead to a
more positive attitude among co-workers, and
customers notice this. The customers themselves are going to
benefit from that through improved customer
service. However, what workers may not initially realize is the
impact that they have on the overall mood or
culture of the organization based upon one’s attitude.
Components of an Attitude

To understand what an attitude truly is, we must consider the
three components that constitute an attitude.
These include affective, behavioral, and cognitive components
(Robbins & Judge, 2019). An affective
component pertains to a feeling or emotion. A behavioral
component relates to how we behave or react to
something. Finally, the cognitive component concerns an
opinion or belief. With all three working together,
this constitutes an attitude (Robbins & Judge, 2019). For
instance, the cognitive component can lead to a
feeling about something. The example included in the reading
relates to one’s pay. If one feels as though he
or she is not being paid enough, this could lead the individual to
not look favorably at the current position, the
affective element of an attitude. If one feels as though he or she
is being paid quite well for the work done,
then this could also lead to another feeling (affective
component) such as really enjoying the work being done
and an appreciation for the organization. In both cases, these
two elements can then lead to the third
component of an attitude, and that is the behavioral aspect.
Consider that if a person does not view one’s current position
favorably due to the amount of pay received,
this individual might choose to look for other employment or
even strive to do less work. These same workers
may opt to perform based upon the amount of work they believe
warrants the amount of pay. Conversely, if
one does view one’s position favorably, might the person
choose to stay with the company and pursue a
career path within the organization? Might this same individual
strive to do even better because of the view of
the position? Indeed, it is all about attitude and the three
components working together.
Relationship between Attitudes and Job Behaviors

Attitudes can be predictors of behavior (Robbins & Judge,
2019). This can be seen when looking at one’s
response to job satisfaction or job dissatisfaction. Those
attitudes that are seen as good and positive often
can lead one to feelings of satisfaction. Those attitudes that are
less than optimal can often lead to
dissatisfaction. In both cases, the determination is based on the
individual’s view of one or more elements
such as job conditions, personality of individual, pay,
organizational culture, or an organization’s practice (or
lack thereof) of corporate social responsibility (Robbins &
Judge, 2019).
Impacts of Job Satisfaction
One person’s attitude—positive or negative—can spread to
other workers’ attitudes throughout a unit,
department, or organization. Those positive attitudes can lead to
job satisfaction which has a number of
benefits. The first can be seen when observing job performance.
Those workers who are happy tend to be
more productive. That satisfaction with job performance
typically leads to expressing appreciation for an
Management 3
UNIT x STUDY GUIDE
Title

organization, coming to the aid of other co-workers or
employees, and going above and beyond the minimum
set of requirements for the job. This is what is known as
organizational citizenship behavior. As these same
employees gladly interact with the customers daily, the same
job satisfaction can also lead to increased
customer satisfaction. This same satisfaction also leads to an
overall satisfaction with life in general. The
ripple effect becomes increasingly evident.
Impacts of Job Dissatisfaction
For all the good that can come from job satisfaction, the
impacts from job dissatisfaction can also be seen in
four perspectives. These responses are based on a two-
dimensional framework consisting of constructive or
destructive and active or passive possibilities (Robbins &
Judge, 2019). If an individual is looking at a
constructive and active response, this would indicate a voice
response. In other words, the individual would
engage in suggesting ways to improve, talking with others in
upper echelons about the problem, and perhaps
initiating change for the better. On the other hand, if the
individual is looking at a destructive and active
response, this would lead to an exit response where the
individual simply leaves the organization seeking
employment elsewhere and even becomes very active in
recruiting others to leave, while repeatedly talking
down the organization and its management. If the focus is on
passive responses, a constructive option might
be to focus on loyalty to the organization while remaining
positive and awaiting change. Conversely, the
passive and destructive response would be a neglect response;
whereas, the individual ignores the problem,

but this results in the condition worsening to the point the
employee becomes late more frequently if he or she
even comes in, and there is the potential for an increase in the
number of errors made.
Implications for Managers
The outcomes from both job satisfaction and dissatisfaction can
impact not only the organization itself, but it
can also influence the customers of the organization. The
challenge for managers is to remain cognizant of
the environmental circumstances and monitor those who work
there to create a satisfied workforce. The
challenges are great, but the outcomes from such actions are
even greater. Those organizations that do
maintain a satisfied workforce can typically expect to see an
increase in profits, more organizational
effectiveness, and improved customer satisfaction.
Conclusion
In this unit, we have learned the difference between emotions
and moods and how those influence our
attitudes. While all are inter-related, there are differences to be
understood. It is through this understanding
that managers are able to ascertain the wants and needs of the
workforce in order to provide aid and
guidance so as to achieve that optimum outcome in serving the
customer base. While no one ever said it
would be easy, it is certainly going to be worth it. Customers
will appreciate the positivity exuded by the
workers, and this will ultimately bring forth even greater
profits.

Reference
Robbins, S. P., & Judge, T. A. (2019). Organizational behavior
(18th ed.). New York, NY: Pearson.
Emergency Department Management
Introduction
As one hospital CEO put it “The emergency room is the front
door to the hospital. As the ER goes, so goes the rest of the
hospital”. Think about it…a typical emergency department can
see 70,000 people walk through one of their doors (walk-in or
ambulance) each year. Many of those patients will require
diagnostics, treatment, and possibly surgery and/or admission to
the hospital. In many cases, the ER is the primary means of
generating revenue for the hospital or health system. True,
elective and emergent surgery that bypasses the ER is a
significant source of revenue. But left to that revenue stream
alone, the hospital could not survive without the ER. This is
even true in hospitals where there are lower or no trauma
ratings.
The Chamberlain nurse executive specialty track seeks to
prepare nurse leaders for senior and executive leadership
positions. As senior leaders in the organization, you become
responsible for the financial health and success of your hospital.
Without a healthy and thriving ER, your hospital is at risk.
Every senior nursing leader should have the finger on the pulse
of their ER. Even if you don’t have a background or experience
in emergency care, you need to be familiar with the health of
your emergency department. For that reason, in this virtual or
alternative practicum exercise, we will combine concepts of
leadership and practice change project management and
common ER metrics to help prepare you for your future

leadership role.
Emergency leaders are faced with seemingly insurmountable
challenges that test leadership and management skills daily.
With the advent of the trend toward Evidence Based Practice
(EBP), and a constant changing landscape of reimbursement
strategies, leaders are forced to adapt and manage both clinical
quality and financial issues as well. A director must have a
thorough understanding of quality improvement principles,
patient satisfaction initiatives, business skills, and service
delivery. When problems exist in ED throughput, quality, or
patient satisfaction, inconsistent, outdated processes are often
the reason.
Let’s now move from the general to the specific. Below you
will find the background information you will use to guide the
development of a hypothetical practice change project. You’ll
use this scenario for both the course and practicum aspects of
the course. The Project Management (PM) process presented in
the course is tied closely to the course text. The focus is on a
more formal PM process that can be used to guide practice
change projects that are at the systems level and are larger in
scope. The practicum aspect will utilize a practice change
model and process developed by Johns Hopkins University. The
Johns Hopkins model is geared toward a more focused practice
change. Both will be valuable to you as a nurse leader as you
will be expected to lead change at various levels in your
organizations.
Your mission (if you decide to accept it):
ADTALEM is a healthcare corporation that purchases struggling
hospitals and smaller health systems and sends in teams of
leaders and consultants to address critical issues and transform
the hospital or health system into a thriving and profitable
community resource. Prior to its acquisition by ADTALEM,
Chamberlain Hospital was an independent full-service hospital
with an emergency department and 500 medical surgical beds.
Chamberlain Hospital performs general surgeries but is not
nationally ranked or particularly known for a specialty area.

There are other competing health systems and hospitals in the
region including a nationally renowned level 1 trauma center
and a top-10 ranked cardiac hospital. Chamberlain hospital has
been losing market share to the competitors and its reputation
has been slowly declining. The competing hospitals would be
hard pressed to absorb all of Chamberlain Hospital’s patients if
Chamberlain were to close. But, in its current state,
Chamberlain Hospital must start turning a profit within the next
two years or it will be forced to close, leaving the community
without a valuable provider of care.
You are a part of a team of project managers from ADTALEM.
After completing an assignment at another ADTALEM hospital,
you are assigned to Chamberlain Hospital, along with two other
nurse project managers. You have been assigned to
Chamberlain Hospitals emergency department, a Level III
Trauma Center that see’s approximately 70,000 patient visits
per year. Your other two colleagues will be managing projects
in the critical care and surgical services areas of the hospital.
Chamberlain Hospital is a fictitious hospital but the data you
will see was based on data from a real hospital. The
benchmarks presented were taken from the latest data available
at the time the scenario was written. Chamberlain Hospital
could be anywhere in the U.S. To make this more realistic, go
to https://censusreporter.org to establish a community profile
for YOUR Chamberlain Hospital. From that site, in the search
box next to “Profile”, type in the name of the city you would
like your Chamberlain Hospital to be located. Be sure to type
the word “metro” after the city name as this will then provide
you with demographics of the larger metropolitan statistical
area around your city. For example, if you wanted Chamberlain
Hospital to be located in Cleveland, OH, you would type
“Cleveland metro” and then click on “Cleveland-Elyria, OH
Metro Area”. This will provide you with a profile of the
population that your ER serves.
Here is what you know:
You are part of a team of leaders who are tasked with turning

around major issues at Chamberlain Hospital. You will be
tasked with creating a practice change project to enhance
throughput and reduce the LWBS rate in the ER. Other
colleagues will be working on projects in the critical care and
surgical services service lines. Your Senior Vice President
(SVP) from ADTALEM shares the following background with
you:
You are tasked with solving some important management issues.
You need to assess problems as presented and apply
management strategies to not only solve them but put processes
in place to sustain them.
Chamberlain Hospital has been experiencing capacity issues in
the emergency department (ED) due to high volume surges and
boarding of inpatients in the ED. This has led to a higher than
average walkout rate, lengthy waits for patients to see an ED
provider, and declining patient satisfaction scores.
The SVP has requested your assessment of the emergency
department as one of your first duties. She is hopeful you can
improve front-end processes, improve bottlenecks in
throughput, and work with all ED team members to consistently
incorporate standards of behavior that promote positive patient
experience. She would like you to implement evidence-based
leadership methodology and practice change project
management principles to sustain process improvement changes.
You have been initially allocated $1 million to use for the
planning and implementation of your plan. This money must
cover all personnel, training, capital, subscription and
construction/reconstruction costs that may be part of your plan.
If you find that more money must be allocated, you will need to
submit a request to the project sponsor for consideration. Other
projects are being undertaken in the hospital including in
critical care services and surgical services and money for these
projects is controlled very strictly. Every penny (literally)
counts!
The concern is twofold: exposure to liability for the patients
leaving without care, and the financial loss to the facility. She

goes on to say the national benchmark for LWBS is 2.0%.
The Left Without Being Treated rate is high in this facility. It is
calculated at 4.6%. Last year they lost 2013 patients. The
average collected revenue on a patient in the ED is $668.55.
This results in an average yearly loss of revenue upward of
$1,345,791.00.
The ED is responsible for nearly all of the hospital’s admissions
and 35% of surgical procedures. The hospital also misses out
on revenue from diagnostic testing (labs, radiology, CT, MRI,
etc.). Losing patients from the ED is financially tough on the
hospitals bottom line. Currently, only about 29% of patients
seeking care in the ED are admitted to the facility. The average
collected revenue on each admission is 13,497.00. With a
calculated 372 patients leaving before admission, a financial
loss of 5,021,130.00 is calculated.
Total overall financial impact to the facility is roughly
$6,366,941.00.
By comparison, if the rate were brought down to the national
benchmark of 2%, only 880 patients would have been lost,
resulting in a greatly reduced loss only of 588,333.00.
This would increase revenue by 757,478.00. If lost admissions
were reduced to 163, the financial impact would be cut to
2,200,119.00. At 2%, the total patients lost would be reduced to
1043 and the total loss would be 2,788,451.00.
By reducing the LWBS (left without being seen) or LWBT (left
without being treated) rate, the overall increase in revenue can
be shown to be 3,578,489.00.
The CNO expects you to use your leadership and project
management skills to solve this problem and keep Chamberlain
Hospital from having to shut its doors to the community. She
needs you to promote a culture of quality. She needs someone to

take the reins and turn the department around. Are you up for
the task?
Chamberlain Hospital Mission, Vision, and Values
Mission:To provide better care of the sick, investigation in their
problems and further education of those who serve.
Vision:Our vision for Chamberlain Hospital is to be the best
place for care anywhere and the best place to work in
healthcare.
Our relationship to stakeholders:
· Patients: Care for the patients as if they are your own family
· Caregivers: Treat fellow caregivers as if they were your own
family
· Community: We are committed to the communities we serve
· Organization: Treat the organization as your home
Core Values:
· Quality& Safety
· Empathy
· Teamwork
· Integrity
· Inclusion
· Innovation

Current Floor Plan:
Images of ER Lobby, Ambulance Bay, and Triage Areas:
Lobby:
Ambulance Bay:
Triage area:
Your Observations:
As you familiarize yourself with the current emergency room
layout and practices, several questions emerge in your thinking:
1. What are the barriers keeping people from being seen or
treated?
2. How are resources utilized?
3. Is staff utilized appropriately?
4. How is capacity managed and what plan is in place to manage
patient surge?

5. How are resources utilized and are they utilized in the most
productive manner?
6. Are there better ways to utilize licensed and unlicensed staff?
7. Is capacity managed effectively? Are there issues that limit
access to safe care or service in the triage area.
Patients are queuing near the front entrance in the ED lobby.
The physical space is limited, and the patient line often backs
out the door. Pt’s are met by a registration clerk. Initial triage is
done by a paramedic. The triage area consists of three “bays”
separated only by a curtain. A solid partition which obstructs
any view of patients coming into the lobby. The registration
clerk is a trained medical assistant and is the first contact with
the patient. If the registration clerk feels a medic or nurse
should be notified of an urgent issue, they let her know via
radio headsets. Otherwise the chief complaint is entered into the
EMR and the patient is seen in triage in the order of their
arrival time to the ED. After being triaged by a paramedic,
patients are again instructed to have a seat in the lobby and will
then be called back to be seen by a provider as soon as possible.
If the patient complains of chest pain on arrival, they are
escorted by a paramedic to a side room and an EKG is
performed. The paramedic attending to patients is off the floor
during this time leaving patients arriving to be met by only the
registration clerk.
Patients in the lobby are now on the board in the Electronic
Medical Record (EMR). The Charge Nurse in the main ED
watches the board and assigns patients in beds as they become
available. The nurses in the main ED are not able to pull
assigned patients from the lobby and the registration clerk from
the lobby tries to move them back between new arrivals. When a
registration clerk calls off sick, a paramedic is pulled from the
floor for that role. If that paramedic is the only medic on duty,
a nurse is pulled from treating patients to cover triage.
The lobby is crowded and due to limitations in staffing, it is
impossible to round on lobby patients. Changing patient
conditions are not noted unless they come back to the triage

nurse. Last week, a man went into the bathroom and arrested
while waiting for a bed in the ED.
Your Assessment:
1. You decide to follow the path of the patient. You begin by
assessing how well patients move through the system. Your
observations are to be both on a departmental process level, as
well as to and from the department. What process issues exist,
and how do they affect patient flow? Considering patient safety,
is the ED Triage Nurse positioned ideally? Are you comfortable
with the way patients are greeted?
2. The triage nurse completes a full triage when the patient is
called to her booth. She assigns an Emergency Severity Index
level (ESI). You notice all patients, no matter the complaint, get
an Emergency Severity Index (ESI) level 4.
3. The triage nurse documents chief complaint, as well as full
medical history including medications etc. The Electronic
Medical Record is cumbersome, and each triage takes
approximately 15 - 20 minutes. Triaged patients with assigned
beds cannot be moved to the back effectively.
4. When the ED has open beds, patients are still required to stop
in triage, no matter their complaint. You ask about immediate
bedding and the triage nurse looks blankly at you.
Hospital Metrics
You observe the emergency department is suffering from
throughput issues. The facility is spacious and well laid out.
The hospitals reputation is suffering in the community as wait
times have been increasing. The “Left Without Being Seen”
(LWBS) rate is between 3% and 6% on most days with an
average of 4.6%.
Many hospitals rely on benchmarks to determine optimal
performance. We know that while benchmarks give an idea

about how an organization compares to others, benchmarks
(denoted in green) are inherently fallible. Departments vary in
terms of physical layout, acuity, customer expectations, and
physician practice patterns. The development of internal
performance metrics is necessary for sustainable, achievable
results.
Hospital Throughput Stats
National Benchmark
Chamberlain Hospital
Arrival to Triage
2 minutes
17 minutes
Arrival to Bed
5 minutes
48 minutes
Arrival to Provider
20 minutes
61 minutes
Discharge Length of Stay
130 minutes
310 minutes
Admit Length of Stay
268 minutes
433 minutes
Overall Length of Stay
168 minutes
344 minutes
You examine the metrics and the following challenges are
identified:
1. 4.6% of patients leave before their treatment is complete
(Slow throughput once in the department leading to a failure to
decompress the ED efficiently).

2. 48% of patients wait longer than 30 minutes to see a provider
3. 2013 patients per year leave prior to completing treatment
4. 68% of patients wait greater than 15 miutes for a bed
(Contributary to high walk out rate and exposure of the facility
to risk).
You realize these metrics are not encouraging. You notice these
metrics are not posted anywhere nor are they shared at huddle.
You realize losing 2013 patients last year was finacially
devastating for the hospital and know this must be priority one
to stop.
Departmental Flow Assessment:
Once the patient arrives in the ED treatment area, you note a
delay in the provider seeing the patient. Patients are assigned to
a room and the team leader for that pod is notified. Each pod
has 10 beds with 3 nurses assigned. Ratio for the RN is either
3:1 or 4:1.
There is no verticle treatment area, all patients get assigned to a
bed and occupy that same space until discharge. Advance
practice providers (APP)such as Nurse Practitioners and
Physicians Assistants see all patients rather than focusing on
the ESI 4 and 5 patients. Because these patients are not seen by
the APP’s, they bog the throughput down when they could be
moved expeditiously if kept verticle. You notice critical
patients are in the hallways on gurneys during busy times.
Emergency Department physicians are often frustrated by the
inequitable distribution of patients. They feel assignments are
nurse centric in nature and lack consideration of provider flow.
They also feel there is no standardized work for throughput and
bedding of patients. The patients are placed randomly in beds,
without thought to acuity. Often times one pod receives
multiple critical patients at once.
There are standardized nurse protocol orders within the
electronic medical record and each nurse is encouraged to use
these when a patient arrives with a complaint covered by a
standardized nursing protocol. The theory behind this practice is
to enable results to be in hand when the physician sees the

patient. The hope is to expedite throughput. Nurses however are
reluctant to use protocols as they are fearful of physician
reaction as some of the physicians push back on their use.
Patient Experience
Chamberlain Hospital has been using the “ED Patient
Experience of Care Survey”, created by the Center for Medicare
& Medicaid Services (CMS) (copy of the survey available at
https://www.cms.gov/files/document/edpec-50-2-column-
survey-english.pdf). Although the survey has been administered
for several years, nobody at Chamberlain Hospital was
responsible for evaulating the survey results. Your review of
the survey results over the last 12 months reveal the following
means for each of the 43 questions (see actual survey for
question wording):
Question #
Responses
Going to the Emergency Room
1
· Accident or Injury – 27%
· A new health issue – 45%
· An ongoing health condition or concern – 28%
2
· Yes – 22%
· No – 78%
3
· Less than 5 minutes – 8%
· 5to 15 minutes – 17%
· More than 15 minutes – 75%
4
· 0 – 2%
· 1 – 6%
· 2 – 3%
· 3 – 4%
· 4 – 8%
· 5 – 12%
· 6 – 10%

· 7 – 16%
· 8 – 19%
· 9 – 12%
· 10 – 8%
During Your Emergency Room Visit
5
· Yes – 21%
· No – 79%
6
· Yes, definitely – 10%
· Yes, somewhat – 23%
· No – 67%
7
· Yes – 27%
· Don’t know – 44%
· No – 29%
8
· No – 11%
9
· No – 7%
10
· No – 11%
11
· No – 19%
12
· Yes – 75%
· No – 25%
13

· No – 15%
14
· Yes – 88%
· No – 12%
15
· No – 7%
People Who Took Care of You
16
· Never – 4%
· Sometimes – 5%
· Usually – 44%
· Always – 47%
17
· Never – 12%
· Sometimes – 8%
· Usually – 37%
· Always – 43%
18
· Never – 9%
· Sometimes – 6%
· Usually – 39%
· Always – 46%
19
· Never – 6%
· Sometimes – 12%
· Usually – 51%
· Always – 31%
20
· Never – 9%
· Usually – 31%
· Always – 38%

21
· Never – 18%
· Usually – 20%
· Always – 41%
Leaving the Emergency Room
22
· Yes – 55%
· No – 45%
23
· No – 9%
24
· Yes – 38%
· No – 62%
25
· Yes – 61%
· No – 39%
26
· Yes – 64%
· No – 36%
27
· Yes – 71%
· No – 29%
28
· Yes – 43%
· No – 12%
· I did not need to treat pain – 45%
29
· OTC
· Yes – 84%
· No – 10%
· Prescription Pain Meds
· Yes – 72%
· No – 18%

· Ice pack or cold compress
· Yes – 56%
· No – 42%
· Heating Pads or hot compress
· Yes – 52%
· No – 39%
· Relaxation or meditation
· Yes – 19%
· No – 66%
· Massage
· Yes – 14%
· No – 77%
· Something else
· Yes – 5%
· No – 91%
Overall Experience
30
· 0 – 13%
· 1 – 8%
· 2 – 9%
· 3 – 4%
· 4 – 5%
· 5 – 11%
· 6 – 15%
· 7 – 8%
· 8 – 12%
· 9 – 10%
· 10 – 5%
31
· Definitely no – 7%
· Probably no – 29%
· Probably yes – 37%
· Definitely yes – 27%
32
· 1 time – 36%
· 2 times – 21%

· 3 times – 12%
· 4 times – 9%
· 5-9 times – 15%
· 10 or more times – 7%
33
· Yes – 86%
· No – 14%
34
· None – 23%
· 1 time – 42%
· 2 times – 17%
· 3 times – 10%
· 4 times – 0%
· 5-9 times – 5%
· 10 times or more – 3%
About You
35
· Excellent – 9%
· Very good – 18%
· Good – 42%
· Fair – 20%
· Poor – 11%
36
· Excellent – 21%
· Very good – 23%
· Good – 26%
· Fair – 18%
· Poor – 12%
37
· 8th grade or less – 9%
· Some high school, did not graduate – 12%
· High school graduate or GED – 27%
· Some college or 2-year degree – 31%
· 4-year college graduate – 18%
· More than 4-year college degree – 3%
38

· No
· Yes, Puerto Rican
· Yes, Mexican, Mexican American, Chicano
· Yes, Cuban
· Yes, other Spanish/Hispanic/Latino
· NOTE (obtain this information from your demographic
research above for your community)
39
· White
· Black or African American
· Asian
· Native Hawaiian or other Pacific Islander
· American Indian or Alaska Native
40
· English
· Spanish
· Chinese
· Russian
· Vietnamese
· Portuguese
· Some other language
41
· Yes – 12%
· No – 88%
42
· Read questions to me – 31%
· Wrote down the answers I gave – 35%
· Answered the questions for me – 4%
· Translated the questions into my language – 16%
· Helped in some other way – 14%
43
· Yes – 58%

· No – 42%
As you evaluate the survey results from the most recent twelve
months you consider if there are any particular questions or
sections that cause concern. Could these survey results help
identify areas of need and drive needed change? Should I
consider this as part of my evidence to help support my
intervention? Could a particular question or survey section
become one or more of my outcome measures for the
intervention?
There is little to no leader rounding on patients or staff. No
whiteboards are used in the patient care area. A culture of
optionality is noted among the staff as there is a distinct lack of
connection to purpose in patient experience tactics. Handover
occurs in the nurses station and not at the bedside. Duration of
care is not discussed and patients are on their call lights often.
The nurses are often on their personal cell phones, texting, and
failing to round on patients. Call lights go unanswered and there
have been several falls recently. Delays in lab results often
occur and the average time for a CT interpretation is 120
minutes. You realize this is overlong as CT results are usually
60 minutes.
Patients get exasperated from the prolonged wait times during
the treatment process, due to a to a lack of rounding and
communication.
Lack of capacity management process results in the need to go
on diversion from ambulance traffic, a majority of these runs
are Advanced Life Support (ALS) runs which result in a
significant loss of revenue. The department averages 118 hours
per month in diversion time.
Patients marked for discharge are often delayed as nurses do not
wish to take a new patient so discharges slow down at the end
of the shifts. Unfortunately, these delays occur at peak flow
times as nurses do not wish to start new patients. Rooms are
often left uncleaned as there is no dedicated environmental
services and there is a shortage of techs.

Shift huddle is unstructured and no metrics are shared. Shift
changes/handoff are chaotic with nurses giving report at the
desk.
Emergency Department Throughput
Further review of metrics reveals patients are moving slowly
once bedded in the ED. Admitted patients are held in rooms in
the ED and discharged patients become upset waiting long
periods to receive discharge paperwork. Many leave before the
nurse comes to sign them out.
Emergency Department Length of Stay
Admitted Patient Length of Stay 433 minutes
Discharged Patient Length of Stay 314 minutes
Overall Length of Stay 344 minutes
Daily Patient Volume by Day of Week
Patient Arrivals Per Hour
The busiest time of day is between 0900 and 2200 peaking at
1200.
Hour
Sun
Mon
Tue
Wed
Thu
Fri
Sat
12 AM
5.5
4.5
5.3
4.4
5.3
4.8
5.2

1 AM
4.2
4.3
3.8
4
4.1
3.3
4.4
2 AM
4.2
3.3
3.3
3.1
3.5
3
4
3 AM
3.6
2.8
3.4
3
2.9
2.9
3.5
4 AM
3.4
3.5
3.1
3
3.6
3.4
3.3
5 AM
3.7
4.1
4

3.8
3.9
4
3.7
6 AM
5
5
5.4
4.8
4.9
5
5.2
7 AM
6.7
8.3
7.2
6.8
7.3
7.8
6.1
8 AM
8.6
10.7
10.2
9.7
9.3
8.9
8.8
9 AM
10.3
13.4
11.9
11.4
11
11
11.3

10 AM
12.5
13.8
13.3
12.9
12.2
12.4
11.4
11 AM
11.7
12.6
13.2
12.3
12.9
13.3
11.6
12 PM
12.4
13.6
12.8
12.4
12.4
12.1
12.1
1 PM
11.6
11.9
11
11.9
11.6
12.1
11.7
2 PM
11.6
11.9
11.9

10.7
11.5
11.8
11.4
3 PM
10.6
11.8
12.4
11.2
10.9
11.9
10.8
4 PM
11.7
12.2
12
12.4
11.7
11.7
9.8
5 PM
10.9
12.8
12.1
12.2
11.7
11.7
11.2
6 PM
10.8
12.8
11.5
12.1
11.8
12.5
11.2

7 PM
11.2
12.3
11.6
11.9
11.4
12.1
10.5
8 PM
10.3
10.9
11.2
10.8
10.2
10.4
10.1
9 PM
9.2
8.7
8
9.3
7.9
8.8
9.1
10 PM
7.6
7.1
7.5
7.9
7.1
7.5
8.9
11 PM
5.8
5.8
5.9

6.1
5.8
6.6
7.4
Some questions begin to formulate in your head…considering
the above data, how should staff be scheduled to handle the
patient surge? Patients are sent back to the lobby after being
triaged, no matter what the triage findings are. Beds fill up as
the day gets busy. Less critical patients occupy beds while
sicker patients are waiting in the lobby. There is no flow
coordinator present. Patient distribution is random rather than
methodical and ESI is not considered.
Other Delays in Throughput
You’ve been observing the ED for barriers to throughput and
you notice in addition to the other problems previously noted,
the following issues are also contributory.
Admitted Patient Flow
The ED admission process is cumbersome, and patients
experience long delays after decision to admit. The practice of
holding patients leads to ED saturation quickly.
In evaluating the admission process, you determine that while
beds are assigned promptly, but due to difficulties with
Environmental Services cleaning inpatient rooms, delays are
often lengthy. In the last year, the average admission time, from
decision to admit to bed was 187 minutes.
Delays in Discharge: Delays in discharge are often present as
ED nurses are inconsistent in their sense of urgency to
discharge patient’s home. The average time to from discharge
order to departure is close to 1 hour. When the ED is the
busiest, the nursing staff often drag their feet as they know their
bed will be filled again shortly. The worst times are between
1700 and 1900 when the ED patient surge is peaking.

Turnaround Times
Labs:
Labs are often delayed > 1 hour as they are cancelled due to
mislabeling, quantity not sufficient, or hemolyzed specimens.
The ED is not notified of the issues consistently which causes
extensive delays in care. The lab reports difficulty reaching
bedside nurses or team leaders with critical values.
Imaging:
Diagnostic Imaging 240 minutes – Significant delays in final
reads of plain films.
CT results take approximately 120 minutes. No point of care
testing is available for BUN and creatinine prior to CT,
resulting in delay to exam.
Question: Who would be the key stakeholders to invite to your
first ED Steering Committee? What would your first agenda for
this meeting look like?
Staff Turnover
The staff turnover rate is 31% for nurses in the Emergency
Department. Many of the nurses appear to be suffering
compassion burnout and there is bullying among the nurses.
The previous director could not align the staff with
organizational goals. Many resisted any change or new
initiatives. There is a strong “We/They” mentality as the staff
felt administration asked too much of them as nurses.
The cost of recruiting, hiring, onboarding and training is
upwards of 60,000 per nurse. Contract labor is currently
occupying 70 % of the nursing spots and the cost is
astronomical. The hospital is paying 84.00 per hour for contract
nurses and the average full time nurse is compensated at
45.00/hour. The CNO has asked that you find a solution to re-
recruit and retain nurses. You need to find a way to re-engage

staff and the physicians in the importance of urgency in
throughput regardless of volume.
You must round on staff and determine who your high, middle
and low performers are. Evaluate your nurses by examining
professionalism, teamwork, competence, knowledge, and ability
to communicate. Determine how well each nurse adheres to
policies and identify your level of commitment to the
organization.
Some additional thoughts and questions:
You’re head is swimming with all of the data and the issues
facing the ED. A number of questions and observations
formulate in your head:
Question: How are low performers best dealt with?
Ultimately your goal at this organization will be develop a more
patient centric environment. You must find a way to connect the
staff to the “why” in patient care. You must educate the staff on
leading practices to support the patient experience.
Question: What type of data would be meaningful to reconnect
the staff to their purpose?
We know a lack of awareness contributes to the breakdown of
operational efficiency. We notice pre shift huddles lack
standard structure, key metrics, and changes in process are not
shared.
Question: What is the best way to share data on operational
efficiency? How often should these metrics be shared?
Your overall assessment of the culture reveals an apathetic view
of new initiatives leading to a lack of sustainability in
departmental improvement processes.
There is a strong link between engaged, satisfied staff and
patient satisfaction. Both nurses and providers must recognize
the importance of delivering a consistent positive patient
experience in the ED.
Staff must have the full and complete support of management.
Leaders must role model desired behaviors and be consistent in

driving change. Sustainability is vital to the ED’s success.
From the C-Suite down, all must be accountable for creating
that positive patient experience. Communication from the top
down is essential. Leadership must recognize and celebrate
consistency with organizational goals. Until now, a strong
We/They culture has been present. Restoring staff morale is key
to stopping turn-over.
Engaged staff will enable patients to feel as though they are
moving through and efficient process from arrival in the ED to
discharge home.
Conclusions:
You have your work cut out for you and you wonder what to do
first. What can you do now that will make the biggest impact
on both improving patient care quality and safety AND turn
around the ED from a cost center to a profit center so that the
hospital won’t have to close its doors and leave the community
without this valuable resource.
About PICOT
Hi everyone, in your week 1 TD I like to work with each of you
to help develop a very tight and solid PICOT and research
question. Remember that you can't post in this TD until May
3rd, but it will be helpful to think about this early. I posted
some other announcements with some materials to help you with
that and I hope you'll take advantage of those. I'm thinking
back to previous courses and where I've had to help students the
most and I thought I'd provide some additional direction.
What would help me (and you) the most is if you would format
your initial post like this:
1. Brief overview of your project idea
1. You'll all be working from the same Chamberlain Hospital
ER case scenario so some of your project ideas may be similar
2. State your PICOT listing each of the elements point by point:
1. P - What is your population of interest (Among _______,

.....)(I know that some PICOT conventions allow for P to stand
for other things but for our projects it works best to use P to
describe the population that will be affected by your
intervention)
2. I - Succinctly state your intervention...what are you
proposing to do differently than what is currently being done
that is a change in practice and that you think will result in
achieving your outcome
3. C - State what you are comparing your intervention to. This
might simply be the current state or it may be a specific
program or data set.
4. O - What is your desired outcome? Please state this in very
measurable terms. One example of this would be to state
something like "Decrease/increase (some form of direction)
falls from X (baseline) to Y (goal)"
5. T - Include a time element. At what point in time to you
expect to have made enough progress toward your goal to do
some measurement?
3. Finally transform your PICOT statements into a fluid
sentence that states your research question or project proposal.
What I'll be doing with each of you is helping you either narrow
your focus or address some part of your PICOT to make it more
measurable. If you work hard now it will help guide the
development of your project more smoothly. I hope this makes
week 1 easier for you! I look forward to starting to review your
project ideas!
Week 1: PICOT Worksheet
Guidelines and RubricPurpose:
Clear identification of the problem or opportunity is the first
step in evidence-based nursing. In a previous course, you
identified a practice problem of interest and developed a PICOT
question. This assignment is a review of PICOT with the
opportunity to revise or refine it. You will post your PICOT in
the Week 1 discussion for your classmates to review and

provide feedback.
Due Date:Sunday 11:59 PM MT at the end of Week 1Total
Points Possible: 50 points Requirements:
Description of the Assignment
Use the PICOT worksheet found in Course Resources to
complete the Week 1 Assignment PICOT Worksheet.
Step 1: State your PICOT question. This should be the PICOT
question that you previously developed in NR505 and which
you should have continued to build upon in the Nurse
Executive–track courses. If your PICOT question has changed
since NR505, please note the changes in this section so it’s
clear to the instructor what was original and what has been
updated.
Step 2: Clearly define your PICOT question. List each element:
P (patient, population, or problem), I (intervention), C
(comparison with other treatment or current practice), O
(desired outcome), and T (time frame). Is the potential solution
something for which you (as nurse or student) can find a
solution through evidence-based research? Look in your book
for guidelines to developing your PICOT question and read the
required articles.
Step 3: Describe the issue or problem that will be the focus of
your CGE evidence-based practice change project. What have
you noticed in your work or school environment that isn’t
achieving the desired patient or learning outcomes? What needs
to change in nursing, and what can you change with the support
of evidence in the literature?
Step 4: How was the practice issue identified? How did you
come to know this was a problem in your clinical practice?
Review the listed concerns and check all that apply.
Step 5: What terms did you use to make sure that your search
was wide enough to obtain required information but narrow
enough to keep it focused? How will you narrow your search if
needed?
Criteria for Content
1. Access the PICOT worksheet found in the Course Resources

area.
2. Follow the instructions on the PICOT worksheet and
complete the form.
3. Submit the completed PICOT worksheet form.
Example 1:
What is the PICO(T) question?
Will influenza immunization compliance rates increase if flu
clinics are provided in a flu PODs and immunization clinics at
convenient times covering all shifts?
Define each element of the question below.
P (patient, population, or problem): Require hospital employees
and volunteers to have the influenza immunization annually.
I (intervention): Offer multiple flu PODs and immunization
clinics to hospital employees and volunteers, making it
convenient to receive the required immunization. Offer them at
a variety of times, available to all shifts.
C (comparison with other treatment or current practice):
Compare analytics showing employees and volunteers who
received a flu shot prior to 2016—when flu PODs and
immunization clinics were not offered—to 2016, when flu PODs
and immunization clinics are offered to accommodate shifts.
Track the number of employees and volunteers coming at each
hour time frame.
O (desired outcome): Increase of compliance (number of
employees and volunteers receiving the annual mandatory flu
shot).
Example 2:
What is the PICO(T) question?
For nondiabetic patients on corticosteroid therapy, does
monitoring for headache, fatigue, nausea, vomiting, and blurred
vision hourly promote improvement of pulmonary complications
versus making no observations for signs of hyperglycemia?
Define each element of the question below.
P (patient, population, or problem): Nondiabetic patients on
corticosteroid therapy
I (intervention): Monitoring for headache, fatigue, nausea,

vomiting, and blurred vision
C (comparison with other treatment or current practice): No
observations for signs of hyperglycemia
O (desired outcome): Improvement of pulmonary complications
T (time frame): 90 days
**Academic Integrity Reminder**
Chamberlain College of Nursing values honesty and integrity.
All students should be aware of the Academic Integrity policy
and follow it in all discussions and assignments.
By submitting this assignment, I pledge on my honor that all
content contained within is my original work except as quoted
and cited appropriately. I have not received any unauthorized
assistance on this assignment.Directions and Assignment
Criteria
Assignment Criteria
Points
%
Description
Presentation of a suitable PICOT question
20
40%
Student presents a complete PICOT question in the proper
format that addresses a practice change issue of interest to the
nurse executive
Identification of PICOT elements and measurable outcomes
10
20%
Student provides appropriate and correctly worded statements
for each of the PICOT elements
Description of the practice problem; need for change; practice
area; identification of practice issue; clear scope
10
20%
Practice issue or problem is thoroughly described. The need for
change is evident. The practice area is identified. Identification
of the practice issue is clear. The scope of the problem is

identified.
Identification of manageable search terms
5
10%
Student identifies search terms that are appropriate for the
PICOT question and are manageable for the scope of the project
Appropriate literature review scope identified
5
10%
Scope of the literature review is appropriate for the project and
is neither too broad nor too narrow
Total
50
100 %
Chamberlain College of Nursing NR505 Advanced Research
Methods: Evidenced Based Practice
Chamberlain College of Nursing NR631 Nurse Executive
Concluding Graduate Experience 1
NR505: W2 Assignment Refinement of Nsg. Issue Rev-
7/31/2017 (AR)
NR631: Week 1 Assignment PICOT Worksheet 11/27/2017
(RD)
3
Grading Rubric
Assignment Criteria
Exceptional
(100%)
Outstanding or highest level of performance
Exceeds
(88%)
Very good or high level of performance

Meets
(80%)
Competent or satisfactory level of performance
Needs Improvement
(38%)
Poor or failing level of performance
Developing
(0)
Unsatisfactory level of performance
Content
Possible Points = 50 Points
Presentation of a suitable PICOT question
20 Points
18 Points
16 Points
8 Points
0 Points
Outstanding question or nursing problem identified that is an
independent nursing decision
Very good question or nursing problem is identified that is an
Competent question or nursing problem is identified that is an
Question or nursing problem is identified but is not an
PICOT question missing
Identification of PICOT elements and measurable outcomes
10 Points
9 Points
8 Points
4 Points
0 Points
PICOT elements correctly identified. Outcomes are measurable.
One PICOT element not correctly identified. Outcomes are

measurable.
Two PICOT elements not correctly identified. Outcomes are not
measurable.
Three or more PICOT elements not correctly identified.
Outcomes are not measurable.
PICOT elements missing
Description of the practice problem; need for change; practice
area; identification of the practice issue; clear scope
10 Points
9 Points
8 Points
4 Points
0 Points
Practice issue or problem is thoroughly described. The need for
change is evident. The ractice area is identified. Identification
identified.
Practice issue or problem is partially described. The need for
change is evident. The practice area is identified. Identification
identified.
Practice issue or problem is vaguely described. The need for
change is not obvious. The practice area is identified.
Identification of the practice issue is clear. The scope of the
problem is identified.
Practice issue or problem is vaguely described. The need for
change is not obvious. The practice area is not identified.
Identification of the practice issue is not clear. The scope of the
problem is not identified.
Not answered
Identification of manageable search terms
5 Points
4 Points
3 Points
2 Points

0 Points
Thoroughly describes manageable search terms
Good description of manageable search terms
Partially describes manageable search terms
Minimally describes manageable search terms
Search terms are absent
Appropriate literature review scope identified
5 Points
4 Points
3 Points
2 Points
0 Points
Thoroughly describes how to narrow search
Good description how to narrow search
Partially describes how to narrow search
Minimally describes how to narrow search
No description given
Total _____ of 50 Points
NR631: W1 Assignment PICOT Worksheet 11/27/2017 (RD)
5
Chamberlain College of Nursing NR631 PICOT Worksheet
PICOT Worksheet—Week 1
Name:
Date:
Your Instructor’s Name:
Purpose: To identify a problem or concern that nursing can
change and develop a PICOT question to guide the change
project
Directions: Use the form below to complete the Week 1

Assignment PICOT Evidence Worksheet. This includes filling
in the table with information about your research question and
your PICOT elements, and the second part is filling in the
evidence worksheet.
Step 1: Select the key PICO terms for searching the evidence.
Clearly define your PICOT question. List each element: P
(patient, population, or problem), I (intervention), C
(comparison with other treatment or current practice), O
(desired outcome), and T (time frame). Is the potential solution
something for which you (as nurse or student) can find a
solution through evidence-based research? Look in your book
for guidelines to developing your PICOT question and read the
required articles.
Step 2: Identify the problem. What have you noticed in your
work or school environment that isn’t achieving the desired
patient or learning outcomes? What needs to change in nursing,
and what can you change with the support of evidence in the
literature? Describe the problem or practice issue you want to
research. What is your practice area: clinical, education, or
administration? (This is not where you will list your PICOT
question.)
Step 3: How was the practice issues identified? How did you
come to know this was a problem in your clinical practice?
Review the listed concerns and check all that apply.
Step 4: What terms did you use in order to make sure that your
search was wide enough to obtain required information but
narrow enough to keep it focused? How will you narrow your
search if needed?
PICOT Question
What is the PICOT question?
Define each element of the question below:
P (patient, population, or problem):
I (Intervention):
C (comparison with other treatment or current practice):

O (desired outcome):
T (time frame):
What is the practice issue or problem? What is the scope of the
issue? What is the need for change?
How was the practice issue identified? (check all that apply)
___ Safety or risk management concerns
___ Unsatisfactory patient outcomes
___ Wide variations in practice
___ Significant financial concerns
___ Difference between hospital and community practice
___ Clinical practice issue a concern
___ Procedure or process a time waster
___ Clinical practice issue with no scientific base
___ Other:
Search terms: How can you narrow the search?
NR631 PICOT Worksheet 11/27/17
1

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