Date of Award

Spring 5-2017

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Center for Science and Math Education


Center for Science and Math Education

Committee Chair

Sherry S. Herron

Committee Chair Department

Center for Science and Math Education

Committee Member 2

Mary F. Lux

Committee Member 2 Department

Medical Laboratory Science

Committee Member 3

Margot J. Hall

Committee Member 3 Department

Medical Laboratory Science

Committee Member 4

Richard S. Mohn

Committee Member 4 Department

Educational Research and Administration

Committee Member 5

Matthew L. Safley


The healthcare system in the United States has undergone substantial changes in support of the Patient Protection and Affordable Care Act (PPACA). On March 23, 2010, the implementation of the new healthcare law brought universal healthcare access to all Americans, while attempting to increase quality and decrease medical costs. The new law promotes more of a quality-focused, outcome-based model rather than a pay-for-fee service model; thus, moving the paradigm from infrequent to preemptive healthcare. The PPACA postulates as the only way to achieve cost savings while increasing quality and access. Never before has there been such an extensive change to the healthcare system since the inception of the Medicare system in 1965. In 2014, approximately 49 million uninsured Americans entered the healthcare system prompting increased demands of providers in navigating the new law; therefore, encouraging institutions to adopt best practices regarding health care reform. The purpose of this study is to begin assessing those best practices in clinical laboratories, by creating an accurate instrument, based on the theory of the iron triangle of health care. William Kissick first proposed the theoretical framework in 1994, when he conceptualized that healthcare 1) as a tightly linked, self-equilibrating system of three constructs: cost, quality, and access 2) when the increase occurs in one or two of the constructs, an effect to the third construct will occur. As a reformer to healthcare in the laboratory, the PPACA maybe a disrupter to the theory, therefore this study addresses the effects of PPACA. One-Hundredth Sixty Clinical Laboratory Improvement Amendment (CLIA) affiliated laboratory managers from 50 states provided data to validate the Clinical Laboratory Manager Inventory survey (CLMI). The data from the survey were analyzed using IBM SPSS 23 and AMOS 23 software with the statistical methodology Structural Equation Modeling (SEM). The results of the study showed the CLMI explained 75% of the variance associated with PPACA effects on the laboratory, indicating that it is an accurate instrument and that PPACA acts as a disrupter to theory. This finding allows the laboratory community to have a plausible instrument to assess the impact of PPACA on subsequent research.