Date of Conferral


Date of Award



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


Business Administration


Dr. Kenneth Gossett


A 1999 evaluation of case studies performed by staff from the Institute of Medicine found that between 40,000 and 98,000 patients died from preventable errors, while 43,598 individuals died in car accidents that year. A 2011 report increased that estimate nearly 10 times. Widespread preventable patient harm still occurs despite an increase in healthcare regulations. High-reliability organization theory has contributed to improved safety and may potentially reverse this trend. This explorative single case study explored how the perceptions and experiences of nursing and respiratory staff affected the successful transition of a healthcare organization into a reliability-seeking organization. Fourteen participants from a subacute nursing facility in the western United States were selected using purposeful criterion sampling. Data were collected through participant interviews, document review, and group observation. Data were then analyzed through open coding of frequently used words or themes, and through memoing and selected coding. Key themes uncovered in the study were the need for extensive education and training, communication, and teamwork to improve patient safety. The findings of the study contribute to social change by enhancing awareness of safety and quality issues that staff should focus on in a health care setting. Study data are useful to business leaders seeking to improve staff morale, to reduce costly errors in care, and to enhance leadership from the bottom-up to promote a culture of safe patient care.