The document summarizes an action research project that aims to explore leadership effectiveness issues created by healthcare reform. The project will qualitatively analyze case studies of leadership at Michael E. DeBakey VA Medical Center to assess the current leadership model and provide a new model incorporating shared leadership. If successful, the new model could enhance patient and employee outcomes at the medical center and beyond by improving workforce engagement in a dynamic healthcare environment.

1. Section #2
To be completed by Learner
2.1 Project
Write approximately one paragraph that describes the action
research project and the basis for it being addressed.
The action research project seeks to explore pertinent leadership
effectiveness issue created by the healthcare reform process in
healthcare institutions across the United States. The reform
process has created a dynamic environment that is in constant
flux. Essentially, healthcare reform institutionalization has
proven to be very beneficial when it comes to reducing the
rising cost of healthcare. Additionally, it helps ensure that
effective delivery of primary care is achieved so as to diminish
the prevalence of chronic illnesses such as diabetes and cardiac-
related health problems. The shift towards preventive care for
the reduction of chronic illnesses requires more engagement
between the patients and the doctors and closer follow-ups of
patient outcomes. This requires effective leadership when it
comes to the creation a workforce that is responsive to long-
term patient needs. This means the healthcare professionals
such as the physicians and nurses need effective leadership in
hospital management so as to ensure they are motivated and
engaged in the change process through teamwork and
partnerships within hierarchical structures. Nonetheless, the
purpose of this action research is assess Micheal E. DeBakey
VA Medical Center of Houston’s leadership so as to provide a
leadership model that includes the most appropriate leadership
qualities that can be adopted by the organization to create a
dynamic healthcare environment. Essentially, the action
research project will involve a qualitative analysis of case
studies related to leadership mechanisms within the institution

2. and how they influence employee and patient outcomes. Based
on the findings of the studies conducted, the possibility of using
the proposed leadership model to improve outcomes will also be
gauged. Comment by Nita Stika: What example would you use
to demonstrate how this is true? Comment by Nita Stika:
Management, observation or as Dr. Z suggests. Comment by
Nita Stika: To assess Comment by Nita Stika: Current
administrative structure so as to construct a leadership model
that includes the most compatible qualities to be adopted?
Comment by Nita Stika: Again, a forgone conclusion,
could.
Reference
Thompson, J.M. (2007). Health Services Administration.
Sudbury, MA: Jones and Bartlett.
Dageling, P. and Carr, A. (2004). Leadership for the
systemization of health care: the unaddressed issue in health
care reform. Journal of Health Organization and Management,
18(6), 399 – 414.
2.2 Contribution to Society
Using citations, answer the following questions in order:
1. How does your project improve a current practice?
2void . If your action research project is successful, how could
your project impact your field of interest?
3. What are the practical implications of your project? For
example, what will be the impact of this project on your sample,
your site location, or your workplace?
Leadership is a dominant issue in healthcare reform, not only in
the United States but also in other countries where health

3. reforms are being implemented. Dageling and Carr (2004)
conducted a study on the improvement in performance in reform
implementation in Australia and England, and they found out
that the absence of appropriate leadership models that include
subcultures within the leadership framework contribute to a
disconnect between expectations and outcomes. Through an in-
depth investigation of case studies on healthcare reform in
various settings, the researcher will suggest appropriate
leadership models that fail to take into account the importance
of social constructs that end up producing less than optimal
results. For similar reasons, the action research process hopes to
change the hierarchical model of leadership in implementation
in most healthcare institutions through the shared leadership
model that takes into account horizontal social dynamics in
leadership effectiveness. This is similar to Dageling and Carr’s
(2004) suggestion that leadership should pass authority to the
subcultures that exist within an organization’s management
hierarchy. Comment by Nita Stika: Watch abosolutes.
1. If the action research project is successful, it could provide
an excellent framework for the leadership of Michael E.
DeBakey VA Medical Center and other healthcare organizations
to enhance the delivery high quality care outcomes to patients
and favorable working environment for employees.
2. Successful completion of the research will contribute a lot to
the identification and determination of the best solutions to
some healthcare malpractices. These malpractices include
corrupt insurance claims and misdiagnosis, which could lead to
increased effectiveness of service delivery to patients when
addressed effectively. Comment by Nita Stika: should
3. The research will provide an action plan for the organization
to develop actionable strategies that can be employed to
enhance employ recruitment and development. This way,
Michael E. DeBakey VA Medical Center will be able to recruit
physicians who practice the tenets of affordable, high quality
care, particularly in line the Affordable Care Act. Comment by
Nita Stika: intends to strives to, watch absolutes or avoid

4. drawning conclusion before you have the data or information to
do so.
Reference
Dageling, P. and Carr, A. (2004). Leadership for the
systemization of health care: the unaddressed issue in health
care reform. Journal of Health Organization and Management,
18(6), 399 – 414.
2.3 Need and Evidence to Make Change
Provide current information on your needs assessment or
analysis for change. Include the cost-benefit analysis if
indicated by design.
The American Hospital Association (2013) highlights the need
for change in human resource planning through workforce
planning. This is the process of estimating current and future
workforce needs and developing a workforce plan to reduce the
gap between the current and future needs. Workforce planning
is necessary because the healthcare system is increasingly
dynamic and subject to change. Institutions need to ensure there
are adaptive systems for the change process. The cost would be
increase the need for workforce deployment and engagement to
deal with the change process, which can be accomplished
through effective communication and training. The benefit is
the improved adaptation to the dynamic healthcare system and
speedy implementation of healthcare reforms that facilitate the
delivery of quality of care to patients.
Reference
American Hospital Association. (2013). Developing an
Effective Health Care Workforce Planning Model. Retrieved
July 16, 2015, from

5. http://www.aha.org/content/13/13wpmwhitepaperfinal.pdf
2.4 Theoretical Foundation
Describe the theory or theories that serve as the backbone of
your project. Provide references for each theory.
Shared leadership is the theoretical approach adopted for
improving leadership effectiveness in the healthcare system.
This model of leadership includes a systems thinking of the
organization as an organism that is influenced by internal and
external factors (Thompson, 2007; Luckett & Grossenbacher,
2003) that charts its course towards patient and employee
outcomes such as improved employee and patient satisfaction,
as well as high quality care based on reduced number of
readmissions. Other important aspects of the proposed
leadership model that makes it relevant to the dynamic
healthcare environment include transformational leadership
(Atkinson, 2011), improvement of human resource management
(Robbins & Davidhizar, 2007), and the creation of teamwork in
horizontal hierarchies in organizational subcultures (Wood,
2005).
References
Atkinson, S. (2011). Are you a transformational leader?
Nursing Management, (September,
2011).DOI:10.1097/01.NUMA.0000403279.
04379.6a
Luckett, S. & Grossenbacher, K. (2003). A critical systems
intervention to improve the Implementation of a District Health
System in Kwa Zulu-Natal. Systems Research andBehavioral
Science 20,147–162.
Wood, M. S. (2005). Determinants of shared leadership in
management teams. International Journal of Leadership
Studies, 1(1), 64-85.

6. 2.5 Researcher Positionality:
· Insider
· Insider w/collaboration
· Reciprocal collaboration
· Outsider, collaboration w/ insiders
Define your role, position, and how positionality will impact
your research study.
The researcher position is more like a combination of both
outsider and insider collaboration to improve the knowledge
base as well as widen the scope of the action. In order, to
accomplish this goal, the researcher will collaborate with the
human resource, physicians, and the staff at Michael E.
DeBakey VA Medical Center. This position will allow for
objectivity since the researcher will not have any conflict of
interest between the research needs and the organizational
influence. Collaboration with insiders intends to enhance the
acquisition of crucial information, including the formal and
informal organizational mechanisms that can help in obtaining a
clear picture of the leadership structures and practices in the
organization. Comment by Nita Stika: Intends to Comment by
Nita Stika: Should, be careful of drawing conclusions for all
interested parties before the research has been done.
2.6 Research Questions and Project Goals/Objectives
List the research questions or project goals. These should align
with the need for organizational structure or activities/
outcomes of the project.
Research questions:
· How can the outcomes as a result of the changes in the health
care environment be sustainable? Comment by Nita Stika:
Grammar could the outcome from the resulting changes….
· How conducive is the hierarchical leadership model at the
hospital with regards to the best practices in human resource
and patient care? Comment by Nita Stika: How conducive is

7. the hospital’s hierarchical leadership model with regard
to….watch grammar and word alignment.
· How do employees rate their level of satisfaction at the
selected organization? (This will be measured based on the
responses obtained from an interview with the members of staff
at Michael E. DeBakey VA Medical Center).
· How do business considerations take precedence over the
quality of care for patients?
This is the other committee member and the mentor comments
Section #2
To be completed by Learner
2.1 Project
Write approximately one paragraph that describes the action
research project and the basis for it being addressed.
The action research project seeks to explore pertinent leadership
effectiveness issues created by the healthcare reform process in
healthcare institutions across the United States. The reform
process has created a dynamic environment that is in constant
flux. Essentially, healthcare reform institutionalization has
proven to be very beneficial when it comes to reducing the
rising cost of healthcare. Additionally, it helps ensure that
effective delivery of primary care is achieved so as to diminish
the prevalence of chronic illnesses such as diabetes and cardiac-
related health problems. The shift towards preventive care for
the reduction of chronic illnesses requires more engagement
between the patients and the doctors and closer follow-ups of
patient outcomes. This requires effective leadership when it
comes to the creating a workforce that is responsive to long-
term patient needs. This means healthcare professionals, such as
physicians and nurses, need effective leadership in hospital

8. management so as to ensure they are motivated and engaged in
the change process through teamwork and partnerships within
hierarchical structures. The purpose of this action research is to
assess Micheal E. DeBakey VA Medical Center of Houston’s
leadership so as to provide a leadership model that includes the
most appropriate leadership qualities that can be adopted by the
organization to create a dynamic healthcare environment. This
action research project will involve a qualitative analysis of
case studies related to leadership mechanisms within the
institution and how they influence employee and patient
outcomes. Based on the findings of the studies conducted, the
possibility of using the proposed leadership model to improve
outcomes will also be gauged. Comment by Heather: You might
want to give an example of some concrete issues (example,
accountability, medical documentation, malpractice, etc)
Comment by Heather: I get the point of this sentence, but
it reads a little confusing. Comment by Heather: Change to
either monitoring or surveillance. Follow-up is to informal.
Comment by Heather: This point is much better received
now!! Comment by Heather: How will you be providing this
leadership model? Will you be creating a new model through
your action research? Is there a model that already exist that
you will be incorporating through your study? Comment by
Zerwekh, Tyler: This sounds like you have a proposed model
already in mind?
Reference
Thompson, J.M. (2007). Health Services Administration.
Sudbury, MA: Jones and Bartlett.
Dageling, P. and Carr, A. (2004). Leadership for the
systemization of health care: the unaddressed issue in health
care reform. Journal of Health Organization and Management,
18(6), 399 – 414.
2.2 Contribution to Society

9. Using citations, answer the following questions in order:
1. How does your project improve a current practice?
2void . If your action research project is successful, how could
your project impact your field of interest?
3. What are the practical implications of your project? For
example, what will be the impact of this project on your sample,
your site location, or your workplace?
Leadership is a dominant issue in healthcare reform, not only in
the United States but also in other countries where health
reforms are being implemented. Dageling and Carr (2004)
conducted a study on the improvement in performance in reform
implementation in Australia and England, and their findings
revealed the absence of appropriate leadership models that
include subcultures within the leadership framework contribute
to a disconnect between expectations and outcomes. Through an
in-depth investigation of case studies on healthcare reform in
various settings, the researcher will suggest appropriate
leadership models that fail to take into account the importance
of social constructs that end up producing less than optimal
results. For similar reasons, the action research process hopes to
change the hierarchical model of leadership in implementation
in most healthcare institutions through the shared leadership
model that takes into account horizontal social dynamics in
leadership effectiveness. This is similar to Dageling and Carr’s
(2004) suggestion that leadership should pass authority to the
subcultures that exist within an organization’s management
hierarchy. Comment by Heather: As I read this section, I cannot
help but to think that you are already making an assumption that
the VA Medical Center you will be using as your site is already
in need of improvement and lacks in leadership for employee
and patient outcomes. You cannot make this assumption. Your

10. study may find that the current leadership model leads to
satisfactory patient outcomes. Be careful of how you state
things as to avoid creating inferences not based on your
research findings. Comment by Zerwekh, Tyler: Completely
agree with Heather; it’s a leading statement
4. If the action research project is successful, it could provide
an excellent framework for the leadership of Michael E.
DeBakey VA Medical Center and other healthcare organizations
to enhance the delivery high quality care outcomes to patients
and favorable working environment for employees.
5. Successful completion of the research will contribute a lot to
the identification and determination of the best solutions to
some healthcare malpractices. These malpractices include
corrupt insurance claims and misdiagnosis, which could lead to
increased effectiveness of service delivery to patients when
addressed effectively.
6. The research will provide an action plan for the organization
to develop actionable strategies that can be employed to
enhance employ recruitment and development. This way,
Michael E. DeBakey VA Medical Center will be able to recruit
physicians who practice the tenets of affordable, high quality
care, particularly in line the Affordable Care Act. Comment by
Zerwekh, Tyler: Same as the previous page; statement is
leading. Consider revising….possibly using wording like….:
“….if the data supports the hypothesis, then necessary strategies
could be implemented by the organization to……”
Reference
Dageling, P. and Carr, A. (2004). Leadership for the
systemization of health care: the unaddressed issue in health
care reform. Journal of Health Organization and Management,
18(6), 399 – 414.

11. 2.3 Need and Evidence to Make Change
Provide current information on your needs assessment or
analysis for change. Include the cost-benefit analysis if
indicated by design.
The American Hospital Association (2013) highlights the need
for change in human resource planning through workforce
planning. This is the process of estimating current and future
workforce needs and developing a workforce plan to reduce the
gap between the current and future needs. Workforce planning
is necessary because the healthcare system is increasingly
dynamic and subject to change. Institutions need to ensure there
are adaptive systems for the change process. The cost would be
increase the need for workforce deployment and engagement to
deal with the change process, which can be accomplished
through effective communication and training. The benefit is
the improved adaptation to the dynamic healthcare system and
speedy implementation of healthcare reforms that facilitate the
delivery of quality of care to patients. Comment by Zerwekh,
Tyler: Awkward sentence. Consider revising Comment by
Zerwekh, Tyler: Wouldn’t also standardize a leadership model
being utilized the organization? This standardized model assist
in training, retention of staff, accreditation, etc.
Reference
American Hospital Association. (2013). Developing an
Effective Health Care Workforce Planning Model. Retrieved
July 16, 2015, from
http://www.aha.org/content/13/13wpmwhitepaperfinal.pdf
2.4 Theoretical Foundation
Describe the theory or theories that serve as the backbone of
your project. Provide references for each theory.

12. Shared leadership is the theoretical approach adopted for
improving leadership effectiveness in the healthcare system.
This model of leadership includes a systems thinking approach
of the organization as an organism that is influenced by internal
and external factors (Thompson, 2007; Luckett &
Grossenbacher, 2003) that charts its course towards patient and
employee outcomes such as improved employee and patient
satisfaction, as well as high quality care based on reduced
number of readmissions. Other important aspects of the
proposed leadership model that makes it relevant to the dynamic
healthcare environment include transformational leadership
(Atkinson, 2011), improvement of human resource management
(Robbins & Davidhizar, 2007), and the creation of teamwork in
horizontal hierarchies in organizational subcultures (Wood,
2005).
References
Atkinson, S. (2011). Are you a transformational leader?
Nursing Management, (September,
2011).DOI:10.1097/01.NUMA.0000403279.
04379.6a
Luckett, S. & Grossenbacher, K. (2003). A critical systems
intervention to improve the Implementation of a District Health
System in Kwa Zulu-Natal. Systems Research andBehavioral
Science 20,147–162.
Wood, M. S. (2005). Determinants of shared leadership in
management teams. International Journal of Leadership
Studies, 1(1), 64-85.
2.5 Researcher Positionality:
· Insider
· Insider w/collaboration
· Reciprocal collaboration
· Outsider, collaboration w/ insiders
Define your role, position, and how positionality will impact

13. your research study.
The researcher position is more like a combination of both
outsider and insider collaboration to improve the knowledge
base as well as widen the scope of the action. In order to
accomplish this goal the researcher will collaborate with the
human resources department, physicians, and the staff at
Michael E. DeBakey VA Medical Center. This position will
allow for objectivity since the researcher will not have any
conflict of interest between the research needs and the
organizational influence. Collaboration with insiders will allow
for the acquisition of crucial information, including the formal
and informal organizational mechanisms that can help in
obtaining a clear picture of the leadership structures and
practices in the organization. Comment by Heather: But does
collaboration make you an insider? Do you work for the VA?
Comment by Zerwekh, Tyler: Agreed with Heather….if
you are employed by them there could be a conflict of interest
at THAT SITE (you work at). You may want to consider
analyzing another VA hospital or other hospital in the TMC.
2.6 Research Questions and Project Goals/Objectives
List the research questions or project goals. These should align
with the need for organizational structure or activities/
outcomes of the project.
Research questions:
· How can the outcomes as a result of the changes in the health
care environment be sustainable? Comment by Zerwekh,
Tyler: This is a very broad research question. Are you looking
at the physical environment? Social environment? Financial
environment? I think if you make this question a little more
specific it would help better frame your intended data
collection.
· How conducive is the hierarchical leadership model at the
hospital with regards to the best practices in human resource
and patient care? Comment by Heather: I think you could

14. separate this into two individual research questions. 1) How
conducive is the hierarchical leadership model used in the
hospital with regards to best practices in HR? 2) How does the
hierarchical leadership model impact physicians’ delivery of
patient care?
· How do employees rate their level of satisfaction at the
selected organization? (This will be measured based on the
responses obtained from an interview with the members of staff
at Michael E. DeBakey VA Medical Center). Comment by
Heather: Again, how does this impact patient care? Need to be
able to make an association between employee satisfaction and
clinical outcomes for patients.
· How do business considerations take precedence over the
quality of care for patients?