A planning model for needs analysis for subacute care

The purpose of this study is to produce a model to be used by state regulating agencies to assess demand for subacute care. In accomplishing this goal, the study refines the definition of subacute care, demonstrates a method for bed need assessment, and measures the effectiveness of this new level of care. This was the largest study of subacute care to date. Research focused on 19 subacute units in 16 states, each of which provides high-intensity rehabilitative and/or restorative care carried out in a high-tech unit. Each of the facilities was based in a nursing home, but utilized separate staff, equipment, and services. Because these facilities are under local control, it was possible to study regional differences in subacute care demand.^ Using this data, a model for predicting demand for subacute care services was created, building on earlier models submitted by John Whitman for the American Hospital Association and Robin E. MacStravic. The Broderick model uses the "bootstrapping" method and takes advantage of high technology: computers and software, databases in business and government, publicly available databases from providers or commercial vendors, professional organizations, and other information sources. Using newly available sources of information, this new model addresses the problems and needs of health care planners as they approach the challenges of the 21st century. ^

Organizational response to employment under the ADA of workers with psychiatric disabilities: Four case studies

Title 1 of the Americans with Disabilities Act (ADA) requires all employers, public and private, with more than fifteen employees to provide reasonable accommodation to qualified individuals with disabilities if the accommodation would, within limits, allow the individual to perform the essential functions of the job. Seven years after Congress enacted the law and five years after the initial provisions became effective, little information is available about the experience of organizations faced with requests for workplace accommodation.^ The question addressed in this study is: How are organizations responding to the ADA mandate to fit individuals with psychiatric disabilities in the workplace? The data sources are three organizations that allowed access to this sensitive information, and a fourth that had two disability discrimination charges filed against it.^ A brute-force case method approach applied to the four organizations yields the following information: Attorneys are hesitant to allow inquiry into company policy owing to fear of litigation; workers are not disclosing and requesting accommodation; tacit accommodation of long-standing employees appears to be a regular practice; knowledge of the intent of the ADA makes a difference in terms of equality of treatment; and insensitivity to employee privacy results in an adversarial situation.^ Implications are relevant to the need to improve lines of communication between human resource, EEO, supervisory, and legal staff; consequences of failure to address accommodations on an explicit level; need for better understanding of the availability and use of outside resources for achieving accommodation; and improvement of self-advocacy and disclosure by the employees with disabilities. ^

Problems faced by beginning principals

The job of a principal is becoming more demanding and more critical each year. Principals are asked to undertake huge challenges and to succeed regardless of what obstacles lie ahead. The purpose of this study was to identify which Administrative Task Areas and Specific Task Areas caused the most difficulties for first- and second-year principals.^ A survey was taken of first- and second-year principals in Dade County, Florida. These beginning principals rated their level of proficiency for each administrative task area and each specific task within those areas. Participants rated their perceptions on a scale from one to four. The data were analyzed based on frequency distributions, percentages, means, and standard deviations.^ Beginning principals perceived themselves as least proficient in the administrative task areas of management and personnel duties. They believed their strongest areas were curriculum and instruction and school-community relations. Within these areas, the specific administrative task areas identified as most problematic were identifying proper procedures for construction in the schools, visiting classrooms to help teachers improve instruction, awareness of issues related to school law, establishing accounting procedures for the school's internal funds, and procedures for dismissing incompetent staff members.^ Many beginning principals surveyed volunteered to make recommendations for future beginning principals. Of these recommendations, the most popular responses addressed obtaining more experience with the budget and internal funds prior to becoming a principal. In addition, there was a strong need for more training dealing with school personnel and the importance of networking with a veteran principal.^ The principal training programs for five of the largest school districts in Florida were reviewed. These programs were found to incorporate a vast amount of the recommendations included in the literature. Florida is moving in the right direction toward excellence in the public schools. ^

Local officials' preferences of performance measurements: A study of local police services

The purpose of this study is to identify the determinants of local officials' preferences of performance measures under the assumption that public officials' consensus on performance measures can enhance the accountability in public service delivery. This research consists of two steps: multiple case studies and a survey. The author conducted the case studies in five general-purpose municipalities in Florida, interviewing 25 local officials, attending community meetings, and reviewing relevant local documents. Based on the case studies and the relevant literature, a survey was developed and sent to 445 local officials in 67 general-purpose municipalities in Dade, Broward, and Palm Beach Counties, Florida. The findings of the case studies and the survey suggest that local officials' preferences of performance measures are influenced by their perception of utilities of performance measures and their desire to measure the achievement of organizational goals. The author concludes that a consensus among local officials for outcome-oriented performance measures is easier to achieve if a prospective performance measurement system is designed for reporting and management purposes rather than for budgeting purposes. ^

An examination of attitude toward change as a predictor of policy/program implementation

Policy/program implementation, e.g., the process of fulfilling policy/program directives, is fundamentally tied to change. Implementation studies have examined the process, identifying many critical organizational variables although individuals perform the activities.^ Many of the studies are predicated on the rational, goal oriented model of organizations and examine implementation, presenting only the goal-oriented view. Organizational change and its resistance, however, are not fully explained by the rational model of organizations. There are other schools of thought providing different views of organizations from which explanation may emerge. Bolman and Deal (1984, 1991a, 1994) provide a different perspective for examining organizations Bolman and Deal argue organizations should be viewed through four different frames or lenses. Framing and reframing organizational action captures the complexity of action and provides better understanding of organizational processes. Understanding of implementation of policies/programs also will benefit from the use of the four-frame approach.^ The goal of this research is to provide a better understanding of the implementation process by examining individual attitudes toward change, the dependent variable of this research, and studying the relationship between the dependent variable and frame. The research was conducted in two phases. In Phase One, a survey was sent to 306 school administrators and teachers in magnet programs in Dade County, Florida. The survey instrument was composed of 55 questions including six from Bolman and Deal's Leadership Orientation Survey (1988) and 38 questions about organizational change. In Phase Two, more in-depth analysis of four school was conducted, to further explore the relationship between frame and attitude toward change.^ The results revealed that frame was a factor in explaining differences in personal Attitude Toward Change and Comfort Level with Change. Individuals using the symbolic frame had more positive attitudes toward change and were also more comfortable with change. The results of Phase Two of the research partially supported this finding in that the most fully implemented program was the product of an administrator who had chosen the symbolic frame. ^

Determinants of resource development strategies in nonprofit organizations: An analysis of children, youth and family services

This study is an exploratory analysis of an operational measure for resource development strategies, and an exploratory analysis of internal organizational contingencies influencing choices of these strategies in charitable nonprofit organizations. The study provides conceptual guidance for advancing understanding about resource development in the nonprofit sector. The statistical findings are, however, inconclusive without further rigorous examination. A three category typology based on organization technology is initially presented to define the strategies. Three dimensions of internal organizational contingencies explored represent organization identity, professional staff, and boards of directors. Based on relevant literature and key informant interviews, an original survey was administered by mail to a national sample of nonprofit organizations. The survey collected data on indicators of the proposed strategy types and selected contingencies. Factor analysis extracted two of the initial categories in the typology. The Building Resource Development Infrastructure Strategy encompasses information technology, personnel, legal structures, and policies facilitating fund development. The Building Resource Development Infrastructure Strategy encompasses the mission, service niche, and type of service delivery forming the basis for seeking financial support. Linear regressions with each strategy type as the dependent variable identified distinct and common contingencies which may partly explain choices of strategies. Discriminant analysis suggests the potential predictive accuracy of the contingencies. Follow-up case studies with survey respondents provide additional criteria for operationalizing future measures of resource development strategies, and support and expand the analysis on contingencies. The typology offers a beginning framework for defining alternative approaches to resource development, and for exploring organization capacity specific to each approach. Contingencies that may be integral components of organization capacity are funding, leadership frame, background and experience, staff and volunteer effort, board member support, and relationships in the external environment. Based on these findings, management questions are offered for nonprofit organization stakeholders to consider in planning for resource development. Lessons learned in designing and conducting this study are also provided to enhance future related research. ^

Performance accountability in the federal-state transportation program: Factors affecting successful implementation

Governmental accountability is the requirement of government entities to be accountable to the citizenry in order to justify the raising and expenditure of public resources. The concept of service efforts and accomplishments measurement for government programs was introduced by the Governmental Accounting Standards Board (GASB) in Service Efforts and Accomplishments Reporting: Its Time Has Come (1990). This research tested the feasibility of implementing the concept for the Federal-aid highway construction program and identified factors affecting implementation with a case study of the District of Columbia. Changes in condition and performance ratings for specific highway segments in 15 projects, before and after construction expenditures, were evaluated using data provided by the Federal Highway Administration. The results of the evaluation indicated difficulty in drawing conclusions on the state program performance, as a whole. The state program reflects problems within the Federally administered program that severely limit implementation of outcome-oriented performance measurement. Major problems identified with data acquisition are: data reliability, availability, compatibility and consistency among states. Other significant factors affecting implementation are institutional barriers and political barriers. Institutional issues in the Federal Highway Administration include the lack of integration of the fiscal project specific database with the Highway Performance Monitoring System database. The Federal Highway Administration has the ability to resolve both of the data problems, however interviews with key Federal informants indicate this will not occur without external directives and changes to the Federal “stewardship” approach to program administration. ^ The findings indicate many issues must be resolved for successful implementation of outcome-oriented performance measures in the Federal-aid construction program. The issues are organizational and political in nature, however in the current environment resolution is possible. Additional research is desirable and would be useful in overcoming the obstacles to successful implementation. ^

Reformed county government structure and service delivery performance: An integrated study of Florida counties

The most fundamental and challenging function of government is the effective and efficient delivery of services to local taxpayers and businesses. Counties, once known as the “dark continent” of American government, have recently become a major player in the provision of services. Population growth and suburbanization have increased service demands while the counties' role as service provider to incorporated residents has also expanded due to additional federal and state mandates. County governments are under unprecedented pressure and scrutiny to meet citizens' and elected officials' demands for high quality, and equitable delivery of services at the lowest possible cost while contending with anti-tax sentiments, greatly decreased state and federal support, and exceptionally costly and complex health and public safety problems. ^ This study tested the reform government theory proposition that reformed structures of county government positively correlate with efficient service delivery. A county government reformed index was developed for this dissertation comprised of form of government, home-rule status, method of election, number of government jurisdictions, and number of elected officials. The county government reform index and a measure of relative structural fragmentation were used to assess their impact on two measures of service output: mean county road pavement condition and county road maintenance expenditures. The study's multi-level design triangulated results from different data sources and methods of analysis. Data were collected from semi-structured interviews of county officials, secondary archival sources, and a survey of 544 elected and appointed officials from Florida's 67 counties. The results of the three sources of data converged in finding that reformed Florida counties are more likely than unreformed counties to provide better road service and to spend less on road expenditures. The same results were found for unfragmented Florida counties. Because both the county government reform index and the fragmentation variables were specified acknowledging the reform theory as well as elements from the public-choice model, the results help explain contradicting findings in the urban service research. ^ Therefore, as suggested by the corroborated findings of this dissertation, reformed as well as unfragmented counties are better providers of road maintenance service and do so in a less costly manner. These findings hold although the variables were specified to capture theoretical arguments from the consolidated as well as the public-choice theories suggesting a way to advance the debate from the consolidated-fragmented dichotomy of urban governance. ^

Fiscal and organizational determinants of transportation outcomes: A quantitative and qualitative analysis of sustainability factors

Federal transportation legislation in effect since 1991 was examined to determine outcomes in two areas: (1) The effect of organizational and fiscal structures on the implementation of multimodal transportation infrastructure, and (2) The effect of multimodal transportation infrastructure on sustainability. Triangulation of methods was employed through qualitative analysis (including key informant interviews, focus groups and case studies), as well as quantitative analysis (including one-sample t-tests, regression analysis and factor analysis). ^ Four hypotheses were directly tested: (1) Regions with consolidated government structures will build more multimodal transportation miles: The results of the qualitative analysis do not lend support while the results of the quantitative findings support this hypothesis, possibly due to differences in the definitions of agencies/jurisdictions between the two methods. (2) Regions in which more locally dedicated or flexed funding is applied to the transportation system will build a greater number of multimodal transportation miles: Both quantitative and qualitative research clearly support this hypothesis. (3) Cooperation and coordination, or, conversely, competition will determine the number of multimodal transportation miles: Participants tended to agree that cooperation, coordination and leadership are imperative to achieving transportation goals and objectives, including targeted multimodal miles, but also stressed the importance of political and financial elements in determining what ultimately will be funded and implemented. (4) The modal outcomes of transportation systems will affect the overall health of a region in terms of sustainability/quality of life indicators: Both the qualitative and the quantitative analyses provide evidence that they do. ^ This study finds that federal legislation has had an effect on the modal outcomes of transportation infrastructure and that there are links between these modal outcomes and the sustainability of a region. It is recommended that agencies further consider consolidation and strengthen cooperation efforts and that fiscal regulations are modified to reflect the problems cited in qualitative analysis. Limitations of this legislation especially include the inability to measure sustainability; several measures are recommended. ^

A history of a policy-level curriculum change in California

With the publication of A Nation at Risk (1983) educational reform has had a prominent place on the agenda of virtually every one of the sovereign states. As in many other states California focused much of its reform effort on the teaching of reading. In a political battle over the reading curriculum, California went from the English/Language Arts Framework of 1987, widely viewed as giving the state's imprimatur to whole language (an approach rooted in the learner's experience), to the English/Language Arts Frameworks (a more traditional or basic approach) of 1998 that called for the inclusion of phonemic awareness as the building block of reading instruction in all elementary schools. This study examined the historical record to determine the major forces behind this curriculum change. The results of this study are helpful to those who wish to better understand the relationship between political forces and curriculum change in the current age of educational reform. ^ This study utilized qualitative research methods and is presented as humanistic historical research (Landes & Tilly, 1971). The organizational framework for the study is taken from the work of M. Frances Klein (1991) which identifies seven different levels of curriculum decision-making. In this analysis particular attention was paid to the interaction of academic, formal, and societal levels, as the problem under consideration casts curriculum decision-making in the political realm. Three sources of information were used to provide the historical record. They include articles from popular newspapers and magazines, government documents, and interviews with individuals directly involved in the political process. ^ The results of this study demonstrate the power of societal forces over formal authority in making curriculum policy decisions. ^

Making the grade: The perceived impact of Florida's A+ Plan on the learning environment of one elementary school

The purpose of this study was to ascertain the perceptions of educators at one elementary school regarding the changes in the teaching and learning environment and their related effects following the implementation of Florida's A+ high-stakes accountability system. This study also assessed whether these changes were identified by participants as meaningful and enduring, in terms of the definition by Lieberman and Miller (1999). Twenty-one educators, including 17 teachers and four administrators, at Blue Ribbon Elementary school were interviewed. Data were inductively coded and categorized into four major themes: (a) teaching and learning environment consistency, (b) changes in the teaching and learning environment since the implementation of A+, (c) effects of the changes, and (d) significant and enduring change. Findings fell into three categories (a) identified changes since A+ implementation, (b) effects of changes, and (c) what participants believed was significant and long term change, which included those characteristics of the school that had been identified as consistent in the teaching and learning environment. Statements of the participants explained their perceptions about what instructional decisions where made in response to the A+ Plan including the modification of curriculum, the addition or omission of subject matter taught, and the positive or negative impact these decisions had on the teaching and learning environment. It was found that study participants felt all changes and their effects were a direct result of the A+ Plan and viewed many of the changes as being neither significant nor long term Analysis of the educators' perceptions of the changes they experienced revealed the overall feeling that the changes were not indicative of what was necessary to make a school successful. For the participants, the changes lacked the characteristics that they had described as vital in what constituted success. This led to the conclusion that, by Lieberman and Miller's definition, the majority of changes and effects that were implemented at the school as a result of the mandated A+ Plan, were not meaningful and enduring for effective school reform. ^

School desegregation in Broward County, Florida, 1970--1998: A historical study of power

This is a historical case study on school desegregation and power in Broward County, Florida from 1970 to 1998. The purpose of this study is to describe, explain and analyze types of power used by the School Board of Broward County, Florida and community activists, in their efforts to influence desegregation decisions from 1970 to 1998. In addition, this study explains who benefited and who won from the School Board's desegregation decisions and who governed those decisions? ^ A historical case study approach was used as the method for conducting this study. Data sources included 11 interviews of individuals who were involved in school desegregation issues as either School Board officials or community activists and 10 archival data sources. ^ The theoretical models of Russell, Galbraith, Wartenberg and Domhoff were used to determine the different types of power techniques used by School Board officials and community activists and to answer the questions: who benefited and who won from the School Board's desegregation decisions and who governed those policies and practices? ^ The primary beneficiaries of school desegregation policies and practices in Broward County were: white, affluent communities and the builders, developers, realtors and other businesses in the western suburban communities. All of the data sources indicated that the black community did not benefit from the School Board's desegregation policies. ^ The primary power techniques used by School Board officials to influence desegregation policies and practices was “power over opinions” and compensation. These power techniques were manifested by the School Board publicly disputing the allegations raised by community activists and by compensating those who supported and promoted the School Board's desegregation policies and practices. ^ The power techniques primarily used by community activists were coercive force and “power over opinions.” They effectively used these power techniques to change the School Board's policies and practices they felt were detrimental to black children and the black community. ^ Based on the analysis of the qualitative data, it can be concluded that black children did not benefit from school desegregation in Broward County, Florida and the community continues to suffer residual effects from past desegregation policies and practices. ^

Against small arms: An analysis of an international network

Small Arms and Light Weapons (SALW) proliferation was undertaken by the Non-Governmental Organizations (NGOs) as the next important issue in international relations after the success of the International Campaign to Ban Landmines (ICBL). This dissertation focuses on the reasons why the issue of SALW resulted in an Action Program rather than an international convention. Thus, this result was considered as unsuccessful by the advocates of regulating the illicit trade in SALW. The study provides a social movement theoretical approach, using framing, political opportunity and network analysis to explain why the advocates of regulating the illicit trade in SALW did no succeed in their goals. The UN is taken as the arena in which NGOs, States and International Governmental Organizations (IGOs) discussed the illicit trade in SALW. ^ The findings of the study indicate that the political opportunity for the issue of SALW was not ideal. The network of NGOs, States and IGOs was not strong. The NGOs advocating regulation of SALW were divided over the approach of the issue and were part of different coalitions with differing objectives. Despite initial widespread interest among States, only a couple of States were fully committed to the issue till the end. The regional IGOs approached the issue based on their regional priorities and were less interested in an international covenant. The advocates of regulating illicit trade in SALW attempted to frame SALW as a humanitarian issue rather than as a security issue. Thus they were not able to use frame alignment to convince states to treat SALW as a humanitarian issue. In conclusion it can be said that all three items, framing, political opportunity and the network, play a role in the lack of success of advocates for regulating the illicit trade in SALW. ^

The drivers of perception: Identifying the driving factors of resident perceptions of municipal service quality in cities of South Florida

The idea of comparative performance assessment is crucial. Recent study findings show that in South Florida the use by most municipalities of external benchmarks for performance comparison is virtually non-existent. On one level this study sought to identify the factors impacting resident perceptions of municipal service quality. On a different and more practical level, this study sought to identify a core set of measures that could serve for multi jurisdictional comparisons of performance. ^ This study empirically tested three groups of hypotheses. Data were collected via custom designed survey instruments from multiple jurisdictions, representing diverse socioeconomic backgrounds, and across two counties. A second layer of analysis was conducted on municipal budget documents for the presence of performance measures. A third layer of analysis was conducted via face-to-face interviews with residents at the point of service delivery. Research questions were analyzed using descriptive and inferential statistic methodologies. ^ Results of survey data yielded inconsistent findings. In absolute aggregated terms, the use of sociological determinants to guide inquiry failed to yield conclusive answers regarding the factors impacting resident perceptions of municipal service quality. At disaggregated community levels, however, definite differences emerged but these had weak predictive ability. More useful were the findings of performance measures reporting via municipal budget documents and analyses of interviews with residents at the point of service delivery. Regardless of socio-economic profile, neighborhood characteristics, level of civic engagement or type of community, the same aspects were important to citizens when making assessments of service quality. For parks and recreation, respondents most frequently cited maintenance, facility amenities, and program offerings as important while for garbage collection services timely and consistent service delivery mattered most. Surprisingly municipalities participating in the study track performance data on items indicated as important by citizen assessments but regular feed back from residents or reporting to the same is rarely done. ^ The implications of these findings suggest that endeavors, such as the one undertaken in this study, can assist in determining a core set of measures for cross jurisdictional comparisons of municipal service quality, improving municipal delivery of services, and to communicate with the public. ^

Measuring effectiveness in international financial crime prevention: Can we agree on a performance metric?

The attempts at carrying out terrorist attacks have become more prevalent. As a result, an increasing number of countries have become particularly vigilant against the means by which terrorists raise funds to finance their draconian acts against human life and property. Among the many counter-terrorism agencies in operation, governments have set up financial intelligence units (FIUs) within their borders for the purpose of tracking down terrorists’ funds. By investigating reported suspicious transactions, FIUs attempt to weed out financial criminals who use these illegal funds to finance terrorist activity. The prominent role played by FIUs means that their performance is always under the spotlight. By interviewing experts and conducting surveys of those associated with the fight against financial crime, this study investigated perceptions of FIU performance on a comparative basis between American and non-American FIUs. The target group of experts included financial institution personnel, civilian agents, law enforcement personnel, academicians, and consultants. Questions for the interview and surveys were based on the Kaplan and Norton’s Balanced Scorecard (BSC) methodology. One of the objectives of this study was to help determine the suitability of the BSC to this arena. While FIUs in this study have concentrated on performance by measuring outputs such as the number of suspicious transaction reports investigated, this study calls for a focus on outcomes involving all the parties responsible for financial criminal investigations. It is only through such an integrated approach that these various entities will be able to improve performance in solving financial crime. Experts in financial intelligence strongly believed that the quality and timeliness of intelligence was more important than keeping track of the number of suspicious transaction reports. Finally, this study concluded that the BSC could be appropriately applied to the arena of financial crime prevention even though the emphasis is markedly different from that in the private sector. While priority in the private sector is given to financial outcomes, in this arena employee growth and internal processes were perceived as most important in achieving a satisfactory outcome.