Quality of care is a vital element for achieving high productivity levels within healthcare organizations, and is defined as the degree to which the probability of achieving the expected health outcomes is increased and in line with updated professional knowledge and skills within health services [6]. The Institute of Medicine OM has described six characteristics of high-quality care that must be: (1) safe, (2) effective, (3) reliable, (4) patient-centred, (5) efficient, and (6) equitable. Measuring health outcomes is a core component of assessing quality of care. Quality measures are: structure, process, outcome, and patient satisfaction [6]. According to the National Quality Measures Clearing House (USA), a clinical outcome refers to the health state of a patient resulting from healthcare. Measures on patient outcomes and satisfaction constitute: shorter patient length of stay, hospital mortality level, health care-associated infections, failure to rescue ratio, restraint use, medication errors, inadequate pain management, pressure ulcers rate, patient fall rate, falls with injury, medical errors, and urinary tract infections [7].
Among the main findings, correlation of leadership with quality care and a wide range of patient outcomes (e.g., 30-day mortality, safety, injuries, satisfaction, physical restraint use, pain, etc.) were stressed in most of the identified articles [9,24,27,28]. Therefore, leadership is considered a core element for a well-coordinated and integrated provision of care, both from the patients and healthcare professionals. It is essential regardless of where care is delivered (e.g., clinics or inpatient units, long-term care units, or home care facilities), especially for those who are directly involved with patients for long periods of time [34].
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Ferguson: When I started, there were no agents, and although games were televised, the media did not elevate players to the level of film stars and constantly look for new stories about them. Stadiums have improved, pitches are in perfect condition now, and sports science has a strong influence on how we prepare for the season. Owners from Russia, the Middle East, and other regions have poured a lot of money into the game and are putting pressure on managers. And players have led more-sheltered lives, so they are much more fragile than players were 25 years ago.
One way to increase access to midwives and ensure high-quality maternity care is through the integration of midwifery care with primary health care. A study, conducted by the Birth Place Lab in the Division of Midwifery at the University of British Columbia, found that for states with integrated midwifery care throughout health care systems, families were more likely to have full access to high-quality maternity care.143 The study conceptualized integration as the ability of midwives to work fully in the scope of their practice autonomously and without unnecessary restrictions, within both traditional (hospitals) and nontraditional health settings (birthing centers and home births).144 This work was done collaboratively with other health care professionals. Washington state, New Mexico, and Oregon were ranked highest for integration.145 The states that were cited as being hostile to midwives were concentrated in the South and also had large African American populations.146 In addition to coverage expansions and easing restrictive laws and regulations on the practice of midwifery, policymakers should do more to fully integrate both midwifery care and doula services in health systems, which could be particularly impactful in states with large African American populations or within states with high rates of maternal and infant mortality. Better integration could be achieved by ensuring the availability of skilled doulas and midwives in hospitals and birthing centers, with a focus on doulas and midwives of color, and ensuring close coordination and collaborative working partnerships with nurses and OB-GYNs.
In 2011, Community Care of North Carolina partnered with the North Carolina Divisions of Medical Assistance and Public Health to launch the Pregnancy Medical Home (PMH) program in an effort to increase access to care and improve health outcomes for Medicaid recipients.201 Under PMH, participating providers must perform risk screenings for each Medicaid patient seeing a participating provider for her pregnancy to determine if they are at risk for premature birth. Moreover, PMHs must refer at-risk patients to pregnancy care managers to develop individualized plans to prevent poor birth outcomes. In return, participating providers receive additional payments: $50 per initial risk screening, $150 per postpartum visit, and enhanced Medicaid reimbursement for vaginal deliveries.202 As of 2017, there were 380 PMHs across 94 of the 100 counties in the state. About 80 percent of pregnant women complete risk screenings, and the state has seen a decline in elective deliveries (C-sections and induced labor) before 39 weeks.203
The shortage of mental health professionals throughout the United States poses a significant challenge related to the availability and accessibility of mental health care. A 2016 report by HRSA revealed that, by 2025, there will be significant shortages of psychiatrists, psychologists, social workers, and other mental health professionals.236 The lack of availability of mental health care is already leading to long wait times, causing patients to delay or forgo care altogether.237 Moreover, the few available providers are geographically clustered in certain parts of the country, leaving many counties with no local behavioral health providers.238 Rural areas are the most underserved, with some rural communities having virtually no access to mental health services. Regional differences are also stark. Almost 70 percent of counties in the New England region had access to a psychiatrist, while only 6 percent of counties in the West North Central region, including Oklahoma, Missouri, and North Dakota, had similar access.239
These changes are certainly important short-term interventions, but federal policymakers must also make longer-term investments to build a more robust, well-trained behavioral health care workforce that can provide culturally appropriate care. Proposals to accomplish this include expanding federal and state loan repayment programs for mental health professionals to practice in underserved areas and expanding the numbers of midlevel and paraprofessional providers added to the workforce. For example, federal policymakers should increase funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) Minority Fellowship Program.254 SAMHSA, an agency within the HHS, aims to reduce the impact of substance abuse and mental health in America, and its Minority Fellowship Program is a grant initiative that provides funding to organizations to build out a pool of mental health practitioners that can serve communities of color. In addition, programs run by nonprofit, community-based organizations such as Mamatoto Village are also vital to addressing mental health conditions amongst pregnant and postpartum women, particularly women of color, because they are rooted in the community and are committed to crafting solutions that meet a woman where she is.255 By increasing funding for these programs, not only can mental health professionals attain proper training, but more mental health professionals of color can also enter the workforce, which is key to ensuring the development and implementation of culturally sensitive mental health treatment.
After graduating from Hermon High School in 1987,[12] White started college twice, once at Quincy College and once at UMass Boston, but dropped out during his first semester each time.[13] During this time, he had various jobs, such as laying asphalt, working as a bouncer at an Irish bar, and being a bellhop at the Boston Harbor Hotel. White had begun boxing at age 17, and befriended former Golden Gloves champion Peter Welch. Through this relationship, White decided he wanted to enter the fight business, and he started a boxing gym in Boston with Welch. White initially intended to become a professional boxer himself, but was put off the idea after seeing a punch drunk boxer and worrying that he would suffer the same neurodegeneration.[14] White then worked as a boxercise coach.[15]
In Las Vegas, White continued running boxercise gyms and also began training jiu-jitsu under John Lewis, alongside Lorenzo Fertitta and his older brother Frank Fertitta III.[17] It was in Lewis' practises where White met Tito Ortiz and Chuck Liddell and ultimately became their manager.[18][17]
While working as a manager for Ortiz and Liddell, White met Bob Meyrowitz, the owner of Semaphore Entertainment Group, the parent company of the Ultimate Fighting Championship. When White learned that Meyrowitz was looking to sell the UFC, he contacted childhood friend Lorenzo Fertitta (an executive and co-founder of Station Casinos, and former commissioner of the Nevada State Athletic Commission), to ask if he would be interested in acquiring the company. In January 2001, Lorenzo and his older brother Frank acquired the UFC for $2 million, which subsequently became a subsidiary of Zuffa. White was installed as the company's president.[19]
A "tree protection plan" is a plan that modifies the area of no disturbance around a tree proposed for preservation while protecting and preserving the tree during construction. A tree protection plan is prepared by an arborist certified by the International Society of Arborculturists (ISA) or equivalent professional organization that includes:
Prior to construction, at least one of the erosion and sedimentation control measures described in paragraphs (a) through (e) of this Section shall be selected. A plan describing how the selected erosion and sedimentation control measure will be implemented and justifying its selection on the basis of the particular conditions of the site shall be prepared by a professional engineer or landscape architect and submitted to the City Planning Commission. 2ff7e9595c