Date of Award

Spring 5-18-2023

Degree Type


Degree Name

PhD Health Sciences


Health and Medical Sciences


Deborah A. DeLuca, JD

Committee Member

Genevieve Zipp, EdD

Committee Member

Terence F. Cahill, EdD

Committee Member

Glen Beamer, PhD


high velocity environment, competency, decision-making, sustainability, regulatory, compliance, Patient Protection Affordable Care Act


Background and Purpose of the Study: Healthcare organizations face challenges in efficiently accommodating increased participant demands with limited resources and capacity. The modern reimbursement environment prioritized the maximization of operational efficiency and the reduction of unnecessary cost (i.e., waste) while maintaining or improving quality. As healthcare organizations adapt, significant pressures are placed on leaders to make difficult operational and budgetary decisions (Hamrock, Eric, et al., 2013).

As healthcare goes through this transformation within its high velocity environment defined as environments in which there is rapid and discontinuous change in demand, competitors, technology and /or regulations, such that information is often inaccurate, unavailable, or obsolete (Bourgeois and Eisenhardt, 1988). It leaves to question, “How do healthcare executives make decisions? In addition, what competencies are now required in this high velocity environment to make such decisions which will yield positive outcomes, being sustainability of their Institutions.

The purpose of this study is threefold; the first is to create a measurement tool which identifies the healthcare competencies required by healthcare leaders in a high velocity environment to achieve sustainability, using the Delphi Technique. Secondly, to then assess the reliability and construct validity of the new tool in the population of interest using Cronbach’s Alpha and Exploratory Factor Analysis and third, to use the new tool in the population to identify, understand and measure the projected health care leadership competencies required by healthcare leaders to make effective decisions in a high velocity yielding organizational stability.

Method: This study utilized a mixed methods of both quantitative and qualitative methodology with a descriptive, exploratory, cross-sectional, and correlational research design to look at decision making by healthcare leaders with five competencies being leadership, knowledge of healthcare environment, communication and relationship management, professionalism, and business skills and knowledge.

Optional open-ended questions were asked with every survey question to provide some contextual meaning, hence enabling the Primary Investigator to identify themes. A sample size of 231 healthcare leaders were attained for this study.

Results: The High Velocity Decision Making survey tool reliability had a Cronbach alpha of 0.834, being a “good” internal consistency, George and Mallery (2010). The exploratory factor analysis yields a KMO value of 0.875 being “meritorious” Tabacchrick and Fiddel (2001).

Conclusion: The research shows that there is no correlation between the acquisition of the constructs to sustainability in the organization and there are no significant differences between the middle managers/leaders and senior/executive leaders decision making in a high velocity environment. However, there is a positive correlation between the constructs and decision making in a high velocity environment and there is a significant contribution of the constructs between both middle management and senior leaders decision making in a high velocity environment, while the competency of knowledge of the environment had the highest impact on decision-making in a high velocity environment.