The Refractive Thinker® Vol XIV: Health Care: The Impact on Leadership, Business, and Education.
The Refractive Thinker® The Refractive Thinker® Press 2018
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Launches on August 16th, 2018. Join contributing scholars as they discuss current research regarding health care and the impact on leadership, business, and education. This volume will continue to shape the conversation regarding the future success of the economy as part of leading the business and educational landscape as society navigates these turbulent waters.


Foreword Vol XIV
The science of medicine has grown and advanced since that time so fast that it is almost impossible to keep up with it. Every day there is a new scientific principle that is presented and what we thought was fact years ago is no longer valid. This book dealing with Refractive Thinking is witness to that fact. What I was taught in medical school and is still being taught has to do with the concept that Pain and Disease are our enemies and our focus is to get rid of them and sometimes in our fight against death we are killing life.

In the early 1970s, a group of physicians who were thinking and practicing “outside of the box” became aware of the reality that something was missing in the way medicine was being practiced. What we realized was that the art of medicine, which is the very essence and spirit of medicine, was considered irrelevant and completely overshadowed by the science of medicine so we started the American Holistic Medical Association. It took us 2 years to decide how to spell holistic and it was only when we realized that the word we were talking about had its root in words like holistic healing and health so of course it had to start with an H.

Although it has come a long way from the medicine that my parents practiced in the jungles of India and those of us who started the AHMA, there is still much work to be done. The future of medicine is bright as the Feminine Face of medicine reemerges and the Art and Science of medicine join together to understand and practice Living Medicine.

(For the complete Foreword, please see the book).
Vol XIV: Ch. 1 The Effects of the Affordable Care Act on Small Business
The Affordable Care Act is arguably one of the most beneficial legacies of former U.S. President Barrack Obama that presented controversies in healthcare and business settings. This paper took a refractive thinking approach to the potential impacts of Obamacare on the healthcare organization with a focus on small business. The Act affects small and large as well as not-for profit and for-profit organizations though in different and unique ways. Key contentious issue with the Obamacare is the provision that requires employers to provide qualified and affordable health benefits to their employees or pay a tax penalty. As clarified herein this prevision is limited to large organizations with 50 plus full-time employees and full-time equivalent (FTE) employees but not to small businesses. The Act is quite lenient to Small-sized businesses. It has established the SHOP which is targeted as small businesses with 1-50 full-time equivalent workers that want to offer dental and health coverage to their workers. This SHOP benefits the corporations with less than 25 FTE employees, and it is a major boost to small businesses and will help increase employee motivation. On the overall the Obamacare has had a massive effect on the hospital financial management. It has effectively lowered the cost of healthcare for business and improved access to healthcare. The Act may be impacting on the employer profitability and employee motivation; and ultimately the value of business negatively.

Vol XIV: Ch 2 Lived Experiences from Nine HIV+ African Women That Contributed to Their HIV Seroconversion and Their Insights for HIV Prevention
African American females contract HIV mainly through heterosexual exposure that deems seroconversion or HIV transmission a behaviorally acquired disease. Therefore, HIV is largely preventable provided if specific prevention strategies and intervention are accessible and implemented prior to risky behavior or unprotected sex with an infected male. Nine HIV positive African American females from ages 39 to 78 shared their deepest perceptions, though many unpleasant, of their lived experiences that resulted in their seroconversion and brought meaning to their highly stigmatized disease and sufferings. In addition, each participant provided information on how they, health care leaders, and HIV/AIDS prevention advocates such as the lead researcher can reach out to prevent future generations from having to live their experiences.
The spiritual underpinnings of the participants’ lived experiences produced the importance of the theme for personal spirituality and clearly defined the need for spirituality and faith based initiatives in reducing HIV transmission. Of all ethnic populations in the industrialized world, African Americans are by far the most spiritually led population (Gallup & Newport, 2006 Nobles, 1996), and an estimate of more than 80% of African Americans report that religious convictions direct and sustain their lives (Gallup & Newport, 2006).
Vol XIV: Ch 3 Salas-Amaro’s Analysis and Evaluation of Management Theories Taxonomy Applied in Business and Healthcare
The Management Theories taxonomy presents, organized, classified, and easy to read outcomes from known theorists that contributed to helping leadership students and management practitioners understand their applications and recognize their deficiencies. The taxonomy provides a list of the theorists, a description of the theory, time in history, attributes, and deficiencies. The taxonomy serves as a scholarly tool to organize literature and further research patterns for business and healthcare.
Vol XIV: Ch 4 PII and PHI’s Privacy in a Dynamic Hyper-Convergent World
Advanced monitoring of Internet activities could help to reduce exposures to threat vectors and increase the ability of secure exchange of personally identifiable information (PII) over the internet in digital-age. A PII refers to personal health information for identification of an individual, “stored or transmitted in any medium, including information related to the Patient’s health, the provision or healthcare, or billing for healthcare,” [in contrast with] “PII and PrHI” (Avancha, Baxi, & Kotz, 2012, pp. 44-45). A breach in individuals’ PII could expose vulnerable subjects to threat actors and risks of harm (Ferrillo, 2015). The top senior executives’ ability to judge content complements host and network-based intrusion detection systems, to monitor the transmission of information across networks, with an emphasis to protect data against a breach. Network firewalls with intrusion detection systems could sense and detect anomalies to build resiliency against threats for securing systems, in addition to educating healthcare organizations’ C-suite in cybersecurity to prepare officers to handle acts of cyber-attack (Duffy, 2015). The future of health information technology (HITECH) in information-age depends on a cyber-secure and aware corporate-wide information exchange due to hyper-connectivity of over 20 billion objects, which connect over the internet. Perfect security is not achievable within the hyperconnected cyber-world and resiliency to risks of threats is the best approach to risk management, in which advanced persistent threats (APT) move through networks to collect sensitive information (Ferrillo, 2015).

Vol XIV: Ch 5 Private Duty Nonmedical Senior Care in the Age of the Affordable Care Act
On March 23, 2010 the concept of health care in the United States changed forever. The advent of the Patient Protection and Affordable Care Act (PPACA), colloquially known as Obamacare, officially sounded the death knell for the fee-for-service era and ushered in a new age of patient centric care based on the concepts of wellness, care coordination, and cost reduction. Of all the ancillary health care sectors impacted by this new mandate, perhaps none experienced a more profound change than the private duty nonmedical senior care industry. Thanks in large part to several key PPACA initiatives including the codification of Accountable Care Organizations (ACOs), the formalization of bundled payments, and the mandate to reduce hospital readmission rates via the Hospital Readmissions Reduction Program (HRRP), the private duty nonmedical senior care industry is experiencing a renaissance the likes of which has rarely been seen in the health care sector. While previously case aside by many in the medical community as mere babysitters and companions, virtually overnight thousands of providers across the country woke up to the reality that nonmedical homecare is a legitimate and cost-effective means of promoting wellness, coordinating care, and reducing readmissions in the ever-expanding senior community in the United States. Refractive thinkers have long thrived on unconventional and disruptive thinking, and when viewed through the refractive lens, the private duty nonmedical senior care sector is the very epitome of evolution and disruption.
Vol XIV: Ch 6 Healthcare Leaders’ Strategies to Improve Nurse Retention
Registered nurse (RN) retention and turnover is a recurring problem for some health care organizations. RN retention strategies focus on preventing skilled RNs from leaving the workplace. Health care leaders must understand what factors influence RN turnover for development of successful strategies to improve RN retention. Most health care organization experience both voluntary and involuntary turnover, which will often have a negative effect on the organization. Turnover of RNs is disruptive and costly for hospitals. As such, improving RN retention is an organizational priority that is essential for sustainability and longevity of the institution. The goal of this chapter was to identify some of the causes of RN turnover and to outline specific RN strategies that current health care leaders are using to improve RN retention in their organization. Stemming the flow of RN turnover and improving RN retention requires supportive leadership, fostering teamwork, and effective communication from health care leaders.
Vol XIV: Ch 7 Practice Makes Perfect: Enhancing a Novel, Low-Cost, Gratitude Heartfulness-Meditation Intervention by Encouraging at-Home Practice
There is a continued trend of mental health problems reported amongst youth and adolescents in the United States. The most detrimental include suicidal ideations and self-harm. Interventions conducted in school are appropriate because of the amount of time adolescents spend in schools.

Increasingly, the secular practice of meditation is studied among youth as a way to increase well-being, or happiness. This is in contrast to the larger body of research examining meditation interventions that addressed more commonly specific physiological and psychological diagnoses. The intervention described in this chapter included the practice of heartfulness-meditation and visualizations on construct of gratitude within the positive psychology paradigm. The author took a refractive thinking approach by combining the two paradigms, and measuring practice outside of the intervention session.

In this chapter, the author examined the frequency of at-home practice of the intervention, conducted among middle-school students. Participants’ life satisfaction, school satisfaction, and gratitude, were measured before and after the intervention. The intervention was conducted in school. Weekly logs captured how often students practiced the exercises on their own. The findings of suggest that students who practiced four or more times weekly benefited the most. The adolescent period is difficult time for most youth, this chapter demonstrates that simply practicing gratitude and meditation together may be the key to increasing happiness and well-being—not only during youth but throughout one’s lifetime.

Vol XIV: Ch 8 Chapter 8: Nonprofit and For-profit Healthcare Organization Satisfaction Based on Compensation Packages
Healthcare in the nonprofit and for-profit realm has traditionally had a vast discrepancy in what many perceive is the quality of healthcare. For-profits have often enjoyed the perception of being the best among healthcare providers based on quality of care and the ability to attract top medical professionals in their fields; in contrast, nonprofits healthcare organizations are perceived as healthcare providers who provide indigent care, can only attract volunteers, and often provide a lower quality of care. In side-by-side comparisons, there were no noted differences in the actual quality of care; however, the perception remains the same. Additional research also indicates that a higher patient care ratio equates to higher satisfaction with healthcare and quality of services. This however does not support the findings that nonprofit healthcare providers have a higher staff to patient ratio. This paper takes a refractive thinking approach to a review of literature crucial to understanding the comparison of staffing compensation, staffing use, and organizational paradigms of nonprofit and for-profit healthcare providers (HCP).
Vol XIV: Ch 9 Understanding Employee Turnover in the Healthcare Industry
Employee turnover has an adverse effect on the survival of healthcare organizations because increased turnover leads to decreased productivity, lower profitability, and reduced sustainability. Employees are the most valuable resource an organization has and are responsible for managing the knowledge used during the daily operations of the business. Losing key employees leads to loss of knowledge and has an immediate impact on healthcare leaders’ ability to accomplish their organizations’ missions and visions. By implementing effective employee turnover reduction strategies, healthcare leaders can increase the organization’s competitive edge, improve knowledge retention, increase productivity and sustainability, and retain key employees. Leaders who care about the survival and profitability of their organization must not ignore that without the right people in the right positions gaining a competitive edge to increase performance and productivity is very difficult. In this chapter of the Refractive Thinker, I present an overview of the current status of employee turnover in the healthcare industry. I also shared the finding from 10 qualitative interviews I conducted with 10 healthcare leaders from a hospital in El Paso, Texas. The findings from the data analysis revealed that healthcare leaders could reduce employee turnover by practicing supportive leadership, using fair distributive justice, and being effective managers of employee schedules.
Vol XIV: Ch 10 Highly Effective Award-Winning Healthcare Organizations
When appropriately applied, the Malcolm Baldrige National Quality Award Health Care Framework transforms health systems by means of implementation of continuous improvement. Systemic holistic thinking during the implementation allows the gamete of the organization to be viewed from a refractive perspective allowing for improved organizational alignment, targeted strategies, and improved stakeholder outcomes.
Vol XIV: Ch 11 Effectiveness of Web-based Animated Andragogical Agents: Facilitating Critical Thinking of Nursing Students

A bumper sticker sold by Amazon read: Critical Thinking: The Other National Deficit. Critical thinking has been described as an essential skill for registered nurses. Anyone who has been a patient understands that a nurse needs to be able to stand at the bedside and determine the best course of action for the patient. Various strategies have been designed to assist with developing critical thinking skills in nursing students. Unfolding case studies have provided one approach. Animated andragogical agents or virtual characters provide a possible tool for facilitating critical thinking by asking questions to engage the student further in the process of thinking about a case study. The animated andragogical agent are able to speak to the students as an instructor would when asking students questions about their patients in the clinical setting. This mixed method experimental between the groups study addresses the effectiveness of an animated web-based andragogical agent in facilitating critical thinking in students in their final semester of an associate degree nursing program.
Vol XIV: Ch 12 Reducing Early Readmissions One Patient at a Time with a Population Health Management Approach
This research study will demonstrate if the degree of glucose control upon admission, the interaction of a specialized diabetes clinicians during admission, and initiating insulin as a new medication upon discharge had an impact on diabetes patients being readmitted within 30 days of previous discharge from an acute care facility. The Chronic Care Model was the conceptual framework used by the researcher since the disease state of diabetes is a chronic condition that requires ongoing assessment and medication adjustment. The population of this study was all diabetes patients, aged 18 or older, and admitted during a 12-month period. The sample size was 16,539 patients. This quantitative, correlational study used chi-square test of independence to analyze the data. While the results of the second research question were not statistically significant, there were significant findings regarding the relationships between both hyperglycemia upon admission and initiation of insulin as a new medication upon discharge from the initial admission. Although some of the results from this study were statistically significant, they may not be clinically significant and warrant future research. The findings of this study may assist health care leaders to better associate certain factors with diabetes patients who may be at highest risk for early readmission.