Date of Conferral



Doctor of Business Administration (D.B.A.)




Peter Anthony


Healthcare spending in the United States has continued to rise with annual healthcare cost of $3.8 trillion in 2014. While costs and the population continue to rise, resources continue to dwindle. Consequently, Congress has imposed various price controls and healthcare reform measures over the past 20 years, including the recent Patient Protection and Affordable Care Act (PPACA), which aims to decrease spending while enhancing quality and safety of care delivery. As a result of the implementation of the PPACA, 34 million additional Americans may be eligible for healthcare in a system already needing additional resources, increased access to care, and strategies to offset increasing operational and fiscal challenges. The purpose of this descriptive study was to explore what strategies and changes 10 executive leaders of the nonprofit hospitals in Maryland used to address the operational and fiscal challenges of the PPACA. The conceptual framework for this study was built upon the general systems theory. The data were collected through semistructured interviews, cataloged and coded, analyzed using a modified van Kaam method, and reviewed by participants as part of member checking process. The findings revealed 3 emergent themes: investment in IT resources to support an EMR system, strategies to address healthcare workforce challenges, and strategies for sustainability for managed care outpatient services and patient safety and quality of care. The findings impact social change by presenting policies and processes that medical professionals can use to support local and national health care reform.