The Center for Total Health: Healthcare Reform in Cook County, Illinois

The Center for Total Health: Healthcare Reform in Cook County, Illinois by James L. Miles, Sr. DMin, Virginia Union University, 2002 MDiv, Virginia Union University, 1996 BS, Park University, 1989 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University December 2015 Abstract The Patient Protection and Affordable Care Act (PPACA) of 2010 requires hospital systems in the United States to shift the culture of patient care from a focus on sick-care to a focus on prevention and wellness care. Little is known about how hospital systems will make this culture shift while retaining quality patient care. The purpose of this case study of a pioneering hospital-based PPACA-compliant initiative was to answer the research question of how Wallace’s revitalization movement theory (RMT)—a rapid culture change model—could serve as a transferable evaluation framework for PPACA prevention and wellness care compliance in hospital-based programs. Kingdon’s policy streams theory provided a conceptual framework. Data analysis included iterative, thematic coding of interviews with 3 primary stakeholders responsible for developing the policy, planning, and program implementation strategies of the Center for Total Health (CTH). Nineteen extensive primary source documents were included in the analysis as well. Findings supported the utility of the RMT structure and definitions in the identification of culture change dynamics in CTH. Additionally, this structure served as a scaffolding for grouping individual and institutional rapid culture change dynamics into stages that could be evaluated in terms of PPACA compliance. These stages effectively identified a Kingdon policy window in which PPACA mandates could be expected to result in culture change in multiple streams of public policy development, not only in wellness and sickness prevention, but also in local, state, and national health cost-saving initiatives in food-as-medicine, community identity, public health support networks. It could also reduce chronic disease and the rising institutional care delivery costs.The Patient Protection and Affordable Care Act (PPACA) of 2010 requires hospital systems in the United States to shift the culture of patient care from a focus on sick-care to a focus on prevention and wellness care. Little is known about how hospital systems will make this culture shift while retaining quality patient care. The purpose of this case study of a pioneering hospital-based PPACA-compliant initiative was to answer the research question of how Wallace’s revitalization movement theory (RMT)—a rapid culture change model—could serve as a transferable evaluation framework for PPACA prevention and wellness care compliance in hospital-based programs. Kingdon’s policy streams theory provided a conceptual framework. Data analysis included iterative, thematic coding of interviews with 3 primary stakeholders responsible for developing the policy, planning, and program implementation strategies of the Center for Total Health (CTH). Nineteen extensive primary source documents were included in the analysis as well. Findings supported the utility of the RMT structure and definitions in the identification of culture change dynamics in CTH. Additionally, this structure served as a scaffolding for grouping individual and institutional rapid culture change dynamics into stages that could be evaluated in terms of PPACA compliance. These stages effectively identified a Kingdon policy window in which PPACA mandates could be expected to result in culture change in multiple streams of public policy development, not only in wellness and sickness prevention, but also in local, state, and national health cost-saving initiatives in food-as-medicine, community identity, public health support networks. It could also reduce chronic disease and the rising institutional care delivery costs. The Center for Total Health: Healthcare Reform in Cook County Illinois by James L. Miles, Sr. DMin, Virginia Union University, 2002 MDiv, Virginia Union University, 1996 BS, Park University, 1989 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University December 2015 Dedication With a grateful heart, I dedicate this dissertation to my parents, Harold and Evelyn, and to my children, Princess and JL. Acknowledgments First and foremost I thank Dr. Bethe Hagens, my dissertation Chair, for her amazing guidance, corrections, and support without which I would not have reached this academic milestone. A special thanks to Dr. Eliesh Lane who presented finely tuned public policy perspectives that strengthened my dissertation research and writing. To Dr. Terry Mason, I am eternally grateful for the, life transforming, invitation to participate in his vision for a revitalized 21st century food is medicine movement. There were others among Walden University faculty leadership, my family, friends, students, and colleagues who shared just the right encouragement, at the right times, solidifying my resolve to complete this academic goal. To all, I say thank you for believing in me and my potential to make a difference with this scholarship.