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  Subjects -> HEALTH AND SAFETY (Total: 1277 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (506 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (381 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (106 journals)
    - PHYSICAL FITNESS AND HYGIENE (100 journals)
    - WOMEN'S HEALTH (80 journals)

HEALTH AND SAFETY (506 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 19)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 4)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 2)
AJOB Primary Research     Partially Free   (Followers: 2)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 12)
American Journal of Health Education     Hybrid Journal   (Followers: 24)
American Journal of Health Promotion     Hybrid Journal   (Followers: 24)
American Journal of Health Studies     Full-text available via subscription   (Followers: 8)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 170)
American Journal of Public Health Research     Open Access   (Followers: 27)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 7)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 2)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 1)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 5)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 2)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access  
Behavioral Healthcare     Full-text available via subscription   (Followers: 4)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 6)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 9)
BMC Oral Health     Open Access   (Followers: 4)
BMC Pregnancy and Childbirth     Open Access   (Followers: 19)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 15)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 10)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 18)
Case Reports in Women's Health     Open Access   (Followers: 2)
Case Studies in Fire Safety     Open Access   (Followers: 11)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 9)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 1)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 1)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 1)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 13)
East African Journal of Public Health     Full-text available via subscription   (Followers: 2)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 4)
electronic Journal of Health Informatics     Open Access   (Followers: 4)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 4)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 3)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription  
Ethiopian Journal of Health Development     Open Access   (Followers: 9)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 8)
Ethnicity & Health     Hybrid Journal   (Followers: 14)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 1)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 8)
Evidence-based Medicine & Public Health     Open Access   (Followers: 4)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 3)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 10)
Frontiers in Public Health     Open Access   (Followers: 9)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 12)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 4)
Global Health Promotion     Hybrid Journal   (Followers: 14)
Global Journal of Health Science     Open Access   (Followers: 3)
Global Journal of Public Health     Open Access   (Followers: 9)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 14)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 9)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 46)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 11)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 9)
Health Issues     Full-text available via subscription   (Followers: 1)
Health Policy     Hybrid Journal   (Followers: 34)
Health Policy and Technology     Hybrid Journal  
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 19)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 9)
Health Promotion Practice     Hybrid Journal   (Followers: 14)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 46)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 39)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 9)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Sciences and Disease     Open Access   (Followers: 1)
Health Services Insights     Open Access   (Followers: 1)
Health Systems     Hybrid Journal   (Followers: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 10)
Health, Risk & Society     Hybrid Journal   (Followers: 9)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Heart Insight     Full-text available via subscription  
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 9)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 2)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 2)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 6)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 4)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 32)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 7)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 4)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 20)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 13)
International Journal of Health & Allied Sciences     Open Access   (Followers: 1)
International Journal of Health and Rehabilitation Sciences     Open Access   (Followers: 13)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 6)
International Journal of Health Geographics     Open Access   (Followers: 6)
International Journal of Health Policy and Management     Open Access   (Followers: 2)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 12)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Health Services     Full-text available via subscription   (Followers: 9)
International Journal of Health Studies     Open Access   (Followers: 3)
International Journal of Health System and Disaster Management     Open Access   (Followers: 2)
International Journal of Healthcare Delivery Reform Initiatives     Full-text available via subscription   (Followers: 1)
International Journal of Healthcare Information Systems and Informatics     Hybrid Journal   (Followers: 10)
International Journal of Healthcare Management     Hybrid Journal   (Followers: 16)

        1 2 3 | Last

Journal Cover Asia Pacific Journal of Health Management
  [1 followers]  Follow
    
   Full-text available via subscription Subscription journal  (Not entitled to full-text)
   ISSN (Print) 0833-3818
   Published by RMIT Publishing Homepage  [403 journals]
  • Volume 11 Issue 3 - What problem is being solved: 'Preventability' and the
           case of pricing for safety and quality
    • Abstract: Duckett, S
      One of the critical issues facing healthcare systems internationally is to improve safety of care. Unfortunately, safety discussions, both in hospitals and in policy documents, often quickly turn to identifying and acting on 'preventable' mishaps. But preventability is a slippery concept, which this paper discusses.

      A contemporary policy response is to introduce financial incentives in hospitals and/or states to improve safety, proposed for national implementation in Australia from 1 July 2017. This has the potential to change the internal dynamic of hospitals to enhance the focus on safety. The implications for hospitals of this change are also discussed.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - Equitable care for indigenous people: Every health
           service can do it
    • Abstract: Dwyer, J; O'Donnell, K; Willis, E; Kelly, J
      Problem and its context: Indigenous peoples in many countries suffer poorer health and poorer access to good healthcare than their non-Indigenous counterparts. In Australia, enduring barriers to good health and good healthcare remain, in spite of long-standing policy priorities. These barriers include the ongoing reality of colonisation, and silence about its implications. People working in and using the health system need to relate across cultures, but they approach this endeavour with a complex mixture of goodwill, defensiveness, guilt and anxiety.

      Methods: We analysed what is known in Australia about differentials in access to good care, and the underlying factors that entrench them, as well as strategies for developing mainstream competence in care for Aboriginal and Torres Strait Islander patients and communities.

      Analysis and Conclusions: The available evidence of differentials in access and quality that are not explained by clinical or demographic variables is unequivocal. Official policy needs to be implemented at the system and organisation level through operational policies, programs and protocols, and through relationships with Aboriginal healthcare providers and community organisations. The concept of racism anxiety provides a way of making one important barrier visible, and moving beyond it can enable people of goodwill to 'see' where change is needed, and to see themselves as part of the solution. It is time to get beyond the barriers and attend to practical improvements in care, focused on the care system, not simply on the skills and knowledge of individuals within it.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - Night lights
    • Abstract: Briggs, DS
      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - In this issue a point of view: What problem is being
           solved?: Critical issues in health systems management
    • Abstract: Briggs, DS
      This issue represents the 10th year anniversary edition of the Asia Pacific Journal of Health Management (APJHM) that was established by the Australasian College of Health Services Management (ACHSM). Due recognition of those who contributed to the development of the Journal is expressed in the Editorial contributed by Bill Lawrence. To recognise and celebrate this milestone the editorial team agreed to publish a special issue anniversary edition. It was decided to be an invited article only edition around the theme 'What problem is being solved? Critical Issues in health systems management'. This theme is an adaption of a similar challenge issued more than a decade before.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - The journal - a critical development in the
           professional journey of the college
    • Abstract: Lawrence, Bill
      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - Manuscript preparation and submission
    • PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - Library bulletin
    • PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - Health workforce migration in the Asia Pacific:
           Implications for the achievement of sustainable development goals
    • Abstract: Short, SD; Marcus, K; Balasubramanian, M
      The maldistribution of health workers globally and within the Asia Pacific region remains problematic. While globalisation, and the increasing mobility of capital and labour, helps to reduce inequalities between countries, it increases inequality within countries. This study examines health workforce data and densities in the Asia Pacific region through a health workforce migration lens. The main implication relevant to achievement of sustainable development goals is the need for countries to work in a co-ordinated way in this region to increase substantially health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing states, most notably the Maldives, Timor- Leste, Kiribati, Samoa, Solomon Islands, Tuvalu and Vanuatu.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - Federalism and Australia's national health and health
           insurance system
    • Abstract: Podger, A
      While health reform in Australia has been marked by piecemeal, incremental changes, the overall trend to increasing Commonwealth involvement has not been accidental or driven by power-hungry centralists: it has been shaped by broader national and international developments including technological change and the maturing of our nation and its place internationally, and by a widespread desire for a national universal health insurance system. In many respects the Australian health system performs well, but the emerging challenges demand a more integrated, patient-oriented system. This is likely to require a further shift towards the Commonwealth in terms of financial responsibility, as the national insurer. But it also requires close cooperation with the States, who could play a firmer role in service delivery and in supporting regional planning and coordination. The likelihood of sharing overall responsibility for the health system also suggests there is a need to involve the States more fully in processes for setting national policies.

      This article draws heavily on a lecture presented at the Australian National University in October 2015. It includes an overview of Australia's evolving federal arrangements and the context within which the current Federalism Review is being conducted. It suggests Australia will not return to 'coordinate federalism' with clearly distinct responsibilities, and that greater priority should be given to improving how we manage shared responsibilities.

      There is a long history of Commonwealth involvement in health, and future reform should build on that rather than try to reverse direction. While critical of the proposals from the Commission of Audit and in the 2014 Budget, the lecture welcomed the more pragmatic approaches that seemed to be emerging from the Federalism Review discussion papers and contributions from some Premiers which could promote more sensible measures to improve both the effectiveness and the financial sustainability of Australia's health and health insurance system.

      The Commonwealth's new political leadership in 2015 seemed interested in such measures and in moving away from the Abbott Government's approach. But the legacy of that approach severely damaged the Turnbull Government in the 2016 federal election as it gave traction to Labor's 'Mediscare' campaign. In addition to resetting the federalism debate as it affects health, the Turnbull Government now needs to articulate the principles of Medicare and to clarify the role of the private sector, including private health insurance, in Australia's universal health insurance system. Labor also needs to address more honestly the role of the private sector and develop a more coherent policy itself.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - The language of health reform and health management:
           Critical issues in the management of health systems
    • Abstract: Briggs, DS; Isouard, G
      Health reform has been a constant feature of most health systems for a number of decades and has often focused on structural change. The lexicon of health reform and health management has also become intertwined with managers reporting that reform has become a constant and that rather than influencing that change they are in fact influenced by it and by its impact on their role, professional development and career. There is a challenge for health service managers to return to a leadership role in enabling health reform. In doing so will this challenge us to think differently about management?

      This article addresses the significant body of research into health reform and health management through the lens of language used in reporting the context and the significant impact that it has had on the management role. It describes what directions that role might take, the qualities required in selecting capable managers and questions the current status quo in the education, training and development of this significant sector of the health system workforce.

      It concludes by proposing a way forward that acknowledges that contemporary health reform is shifting the paradigm of healthcare delivery in a way that requires the dominant view of health management to be challenged. This might be achieved by the use of a critical lens on the language of management, a focus on a grounded approach about what managers need to do and an acceptance of variability in that role in adaptive complex contexts.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - Towards more meaningful measures in healthcare
    • Abstract: Leeder, S; Russell, L; Beaton, A
      Most health systems continue to be restructured and modified without much thought to underlying public policy. Patient safety, quality and innovation are monitored through a range of agencies while performance measures are regularly measured and the results published. Primary healthcare in many systems remains fragmented. To achieve value of the whole health system as well as its component parts, the development of an outcomes-based approach to performance measurement is required to guide the delivery of constantly improving health services. This is a critical issue in health systems management.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - Health systems in Australia and four other countries:
           Choices and challenges
    • Abstract: Martins, JM
      The purpose of health systems is the pursuit of healthy lives. The performance of the Australian health system over the last decade is compared with the United Kingdom and its three other offshoots: the United States, Canada and New Zealand. In the first instance, system performance is assessed in terms of threats to healthy lives from risk factors and changes that have taken place during the decade. In view of the emphasis of the five systems on the return to health after trauma and illness, and the human-resource intensity of health services, an appraisal is made of changes in the number of the major health professionals in relation to the growing populations. Then related changes in hospital, medical practitioner and dentist services are assessed. Changes in pharmaceutical drug prescriptions in Australian are also examined. The levels of national expenditures arising from the provision health services are then considered in the context of the costs of administration of the varied organisational modes, use of expensive medical technologies, pharmaceutical drug consumption and remuneration of health professionals. Finally, health outcomes in Australia and the other four countries are assessed in accordance with their human development level, life expectancy, potential years of life lost from different causes, as well as healthy life expectancies. Further, gaps in health and life expectancy of Indigenous people in the United States, Canada, New Zealand and Australia are reviewed, as well as health and survival inequalities among people in different social strata in each country.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - Healthcare system restructuring in New Zealand:
           Problems and proposed solutions
    • Abstract: Gauld, R
      New Zealand's healthcare system is, like most, in a continual process of restructuring and change. While the country has endured several major system-wide changes in recent decades, more recent change has been incremental and evolutionary. Current changes are in response to a set of challenges, which are not unique to New Zealand. This article overviews the New Zealand healthcare system. It then describes a series of problems facing the system and proposed solutions. These include the need for team care, providing services closer to patients' homes, focusing on a population of interest, connecting up the system, and engaging patients more closely in care design and delivery.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - The tyranny of size: Challenges of health
           administration in Pacific Island States
    • Abstract: Taylor, R
      There is great diversity among Pacific Island states (n=22) in geography, history, population size, political status, endemic disease, resources, economic and social development and positions in the demographic and health transitions and their variants. Excluding Papua New Guinea, all Pacific states are less than one million, and half of them (11) are less than 100,000.

      Smallness also means fewer resources available for health, even if percentage allocations are similar to larger countries, and a disproportionate amount may derive from international aid.

      Specialisation is not cost-effective or even possible in clinical, administrative or public health domains in small populations, even if resources or personnel were available, since such staff would lose their skills. In instances where only one to two staff are required, retirement or migration means decimation of the workforce.

      Training doctors within the Pacific Island region provides appropriately trained personnel who are more likely to remain, including those trained in the major specialities. Nursing training should be in-country, although in very small entities, training in neighbouring states is necessary.

      Outmigration is a significant issue, however, opportunities in Pacific Rim countries for medical doctors are contracting, and there is now a more fluid workforce among Pacific health personnel, including those resident in Pacific Rim countries.

      International and regional agencies have a disproportionate influence in small states which can mean that global policies intended for larger polities are often promulgated inappropriately in small Pacific states. Smallness also leads to strong personal relationships between health staff, and contributes to teamwork, but can also create issues in supervision.

      Small health services are not just scaled-down versions of large health services; they are qualitatively different. Smallness is usually intractable, and its effects require creative and particularistic solutions involving other more endowed Pacific states and Pacific Rim countries.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - Launching Hong Kong's healthcare financing reform: Why
           continued inaction?
    • Abstract: Lieu, G
      Hong Kong has sought without progress in the past 25 years to introduce reform proposals to enhance the long-term financial sustainability of its healthcare system. Through a systematic review of the consultation documents released over the years, this paper examines what might have been done right or wrong and pinpoints lessons learned for healthcare leaders, executives and reformers facing looming opportunities for reform. The findings suggest that the phased-approach of introducing reform options, involving step-by-step public consultations, to engaging the community to give their views on the healthcare financing reform options has not been effective. Other factors, including changes in the stewardship of the reform initiatives and the top-down elitist-led preparations of pre-launch work, added to the resultant inaction of not taking any of the reform proposals forward for launch and to produce reform. The study proposes that a broadly participatory approach, involving a wider base of members of the community in an inclusive guiding coalition charged to drive the reform from pre-launch to implementation, be undertaken. This coalition should start afresh and, based on renewed evidence-based assessments of the need and urgency of reform, proceed accordingly to formulate, if indicated, an overarching healthcare financing reform agenda that motivates people with conflicting interests to take mutually beneficial actions or that gives stakeholders the right incentives to work effectively together.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 3 - From global to local: Strengthening district health
           systems management as entry point to achieve health-related sustainable
           development goals
    • Abstract: Tejativaddhana, P; Briggs, DS; Thonglor, R
      Thailand has performed admirably in its health reform over the last few decades. Healthcare is provided at a relatively low cost and healthcare needs have transitioned to begin to address diseases and mortality of developed countries. The challenges now faced by Thailand are similar to most developed countries reflecting adult mortality and risk factors of an uppermiddle income population and the need to modify institutional structures to reflect these changing circumstances.

      The approach to these challenges has focused on the 'implementation of knowledge based health development' and critically identifies 'the triangle that moves the mountain' (health reform) as a movement that mobilises; the creation of relevant knowledge, social movement and political involvement' to address 'inter-connected, complex and extremely difficult to solve' problems. The move to District Health Systems as the access point to healthcare and the service delivery structure demands competent qualified leadership and management. It requires an understanding of the differences in managing professionally dominated complex adaptive systems compared to traditional approaches of managing within bureaucratic structures.

      This can be best described as managing connected, integrated care focused both on individuals as patients and communities with a strong emphasis on primary healthcare, prevention and evidence-based practice. It also requires an understanding of how distributed networks of practice (DNOP) provide the potential for researchers, practitioners and other agencies and communities to collaborate, learn and improve healthcare across geographic, jurisdictional and organisational boundaries.

      This approach provides recognition of the need to build the capacity and capability of health professionals in the management and leadership of health systems and Thailand is moving towards this goal in implementing specific health systems management curriculum which focuses on action-based research and learning together at the District health level augurs well for continued ability to address current health challenges and to achieve SDGs.

      PubDate: Thu, 29 Dec 2016 21:16:19 GMT
       
  • Volume 11 Issue 2 - To the editor
    • Abstract: Day, GE
      PubDate: Tue, 18 Oct 2016 22:31:47 GMT
       
  • Volume 11 Issue 2 - In this issue
    • PubDate: Tue, 18 Oct 2016 22:31:47 GMT
       
  • Volume 11 Issue 2 - Developing and implementing a framework for system
           level measures: Lessons from New Zealand
    • Abstract: Doolan-Noble, F; Lyndon, M; Hill, A; Gray, J; Gauld, R
      Background: Measuring performance is now the norm in health systems. System Level Measures (SLMs), implemented at New Zealand's Counties Manukau Health (CMH) are designed to support quality improvement activities undertaken across the health system using only a small set of measures. While the healthcare and performance measurement literature contains information regarding the facilitators and barriers to quality improvement initiatives, there is an absence of studies into whether these factors are germane to the establishment and implementation of a SLM framework.

      Methods: A purposive sample of thirteen senior managers and clinicians involved in the construction and implementation of SLMs were invited to participate. Semi-structured telephone interviews were completed and recordings transcribed verbatim. Transcriptions were thematically analysed using a general inductive approach.

      Findings: In total, ten interviews took place. Six facilitative themes were identified including: dispersed and focused leadership; communication; data; alignment of the measures with organisational strategic data; alignment of the measures with organisational strategic plans and values; stakeholder engagement; and a dedicated project team. Conversely, five themes were identified that hindered the process. These were: reaching consensus; perfection versus pragmatism; duplication and process burden; achieving buy-in and workload.

      Discussion: The factors that facilitate and hinder establishing and implementing a framework of SLMs are common to other quality improvement approaches. However, this study demonstrated that these factors were also germane to SLMs. These findings are of particular relevance as researchers and policy makers elsewhere increasingly aim to adopt measurement arrangements for health systems that address equity, safety, quality, access and cost.

      PubDate: Tue, 18 Oct 2016 22:31:47 GMT
       
  • Volume 11 Issue 2 - Implementation of shared decision-making in Australia
    • Abstract: Ervin, K; Blackberry, I; Haines, H
      Shared decision-making (SDM) is the process of clinicians and patients participating jointly in making healthcare decisions, having discussed evidence-based treatment options and the potential risks and benefits of each option, taking into consideration the patient's individual preferences and values. SDM is ubiquitous in Australian healthcare policy. While there is good evidence for utilising SDM, clinicians' knowledge of SDM, the current uptake, effectiveness and acceptability of SDM in Australia is largely unknown. The challenges perceived by clinicians to implementing SDM in clinical practice and potential moral, legal and ethical dilemmas require further debate and consideration.

      PubDate: Tue, 18 Oct 2016 22:31:47 GMT
       
  • Volume 11 Issue 2 - Co-creating and developing health management theory
           and practice: A global opportunity?
    • Abstract: Briggs, DS
      PubDate: Tue, 18 Oct 2016 22:31:47 GMT
       
  • Volume 11 Issue 2 - A review of the ACHS clinical indicator program after
           20 years
    • Abstract: Collopy, B; Dennis, C; O'Connor, L; Nathan, M
      The Clinical Indicator Program, which was introduced into the Australian Council on Healthcare Standards' accreditation program two decades ago, has grown from one set addressed by 115 healthcare organisations to 22 sets with data received from over 800 healthcare organisations, resulting in a national database which is unique in its clinical diversity, reflecting every major medical discipline involved in hospital practice. The process for Clinical Indicator selection and review remains with the providers of the care, but the selection criteria are better defined and the evidence base strengthened. Early responses to their introduction were encouraging as improvements in patient management and outcomes were sought and achieved following review of comparative data, and some examples of these are provided. Clinical Indicator revision remains an important and major task and the original Hospital- Wide set of Clinical Indicators is now in its 12th version. The development and use of Clinical Indicators is increasing world-wide, and in Australia there are other organisations, including the Australian Commission on Safety and Quality in Healthcare, looking at Clinical Indicators to further understand the performance of healthcare organisations.

      As clinical care changes, the challenges for the Australian Council on Healthcare Standards are to ensure the Clinical Indicators continue to reflect current practice, to retain clinician support, and also to ensure that the existence of its extensive and long-standing national clinical database is more widely known and utilised.

      PubDate: Tue, 18 Oct 2016 22:31:47 GMT
       
  • Volume 11 Issue 2 - Making hospital governance healthier for nurses
    • Abstract: Clark, K; Beatty, S
      The current research examined front line nurse expectations of non-metropolitan public hospital governance. In doing so, it explored the relevance of two dominant, competing Agency and Stewardship governance theories to these organisations.

      Two studies were conducted with the first establishing an inventory of notional nurse preferences for governance and the second testing these with a random sample of front-line non-metropolitan hospital nurses across one Australian State, with the aim of identifying valid and reliable measures.

      The study data suggest nurses working in nonmetropolitan public hospitals expect governance practices to reflect: respect for and engagement with clinical perspectives; utilisation of evidence-based planning; and effective engagement with local communities. Scales with good consistency and criterion and construct validity measuring these three components were identified.

      The study provides evidence that nurses expect and value a style of hospital governance that is consistent with Stewardship Theory. The results also suggest that governance is an important enough issue for nurses that it significantly affects their turnover intentions. This has important implications for healthcare leaders concerned about the sustainability of public hospitals.

      PubDate: Tue, 18 Oct 2016 22:31:47 GMT
       
  • Volume 11 Issue 2 - Financing healthcare in Indonesia
    • Abstract: Plummer, V; Boyle, M
      Introduction: There have been two major transitions for healthcare in Indonesia: the implementation of government decentralisation and universal health insurance. A universal public health insurance called Badan Penyelenggara Jaminan Sosial (BPJS) was launched in January 2014 and aims to cover all Indonesian people.

      Objective: The objective of this paper is to discuss the funding of healthcare in Indonesia through a comparison with other South East Asian countries.

      Methodology: A search for relevant literature was undertaken using electronic databases, Ovid Medline, ProQuest Central, and Scopus from their commencement date until December 2015. The grey literature from the Indonesian government, the WHO's and World Bank's website, has been included.

      Results: There were nine articles from Ovid Medline, eight from ProQuest Central, and 12 from Scopus that met the criteria. Seventeen articles were duplicates leaving 12 articles to be reviewed. Nine documents have been identified from grey literature.

      Discussion: Most people in Indonesia sought health services from the private sector and were out-ofpocket financially or did not receive the required care. The private sector delivered 62.1% of health services compared to 37.9% by the government. Despite some inappropriate use of previous health insurance, the BPJS is expected to have improved management and will cover all citizens by the end of 2019.

      Conclusion: Indonesia has undergone a series of changes to health system funding and health insurance. There are lessons that can be learnt from other countries, such as Thailand, Cambodia, and Vietnam, so that Indonesia can improve its health funding.

      PubDate: Tue, 18 Oct 2016 22:31:47 GMT
       
  • Volume 11 Issue 2 - Assessing the adoption of a home health provisioning
           system in India: An analysis of doctors' knowledge, attitudes and
           perceptions
    • Abstract: Agarwal, N; Sebastian, MP; Agarwal, S
      Background: Unlike developed countries, home healthcare provision systems (HHPS) are not widely prevalent in developing countries like India. Our objective was to study the knowledge, attitudes and perceptions of doctors in India about the adoption of HHPS.

      Methods: Our survey included 180 doctors across India, working in local hospitals. Using online and paperbased questionnaires, we used bar charts and pie charts to represent the frequency distributions. We also conducted multivariate logistic regression analysis to understand the importance of the selected factors upon the dependent variables of interest such as willingness to work during non-office hours, desire for increased remuneration, and willingness to enrol in HHPS.

      Results: The desire for an increase in remuneration made doctors more willing to enrol in HHPS. Possible reasons for doctors to enrol included the ability to answer follow-up queries through email or video chat and HHPS being integrated with the local healthcare system in the hospital. Young male doctors were most likely willing to provide services through HHPS during nonoffice hours as compared to females. A large majority of doctors indicated hospital visits to be important for follow-up queries, but several doctors indicated that simple patient queries could be addressed by nonpersonal interactions like video chat or email.

      Conclusions: The desire for extra remuneration could be the primary reason for the willingness of doctors to work during non-office hours and thus enrol in HHPS. The majority of doctors considered hospital visits to be important, but several doctors also indicated that nonpersonal interactions using text messages, telephone, email and video chat might serve as important methods to respond to simple follow-up queries from patients.

      PubDate: Tue, 18 Oct 2016 22:31:47 GMT
       
  • Volume 11 Issue 2 - Addressing health insurance deductions through an
           interventional study: The case of a large Central Hospital
    • Abstract: Kharazmi, E; Salehi, A; Hashemi, N; Ghaderi, S; Hatam, N
      Objective: A large proportion of hospitals' private income is provided by insurance organisations. Hospitals in Iran face various problems in terms of insurance deductions from insurance organisations resulting from inefficient performance by both the hospitals and the insurers. These problems necessitate more specific cost control in this area. This research assesses the causes of insurance deductions by using the Failure Mode Effects Analysis (FMEA) technique, and addresses the issues resulting in deductions by providing some interventions through the Pareto technique.

      Design: The 10-step pattern of FMEA was implemented for assessing the main causes of insurance deduction in this study.

      Setting: Data was collected from deduced amounts by three main/largest contracting party insurance organisations (e.g. the Social Security Insurance Organisation, Medical Services Insurance Organisation and Armed Forces Medical Services Insurance Organisation of Namazi Hospital, a large healthcare provider in the South of Iran, in 2014.

      Findings: Sixty-five potential failure causes were identified, of which 26 were related to the anaesthesia unit, 23 were related to the surgery room unit and 16 were related to the hospitalisation unit. Deductions in the anaesthesia and hospitalisation units and the surgery room were reduced after intervention programs by 14.42%, 57.76%, and 51.52%, respectively.

      Conclusions: Using the FMEA technique in a large healthcare provider in Iran resulted in identifying the main causes of insurance deductions and provided intervention programs in order to increase the efficiency and productivity of healthcare services.

      PubDate: Tue, 18 Oct 2016 22:31:47 GMT
       
  • Volume 11 Issue 2 - Correlations and organisational effects of
           compensation and benefits, job satisfaction, career satisfaction and job
           stress in public and private hospitals in Lucknow, India
    • Abstract: Saxena, N; Rai, H
      The present study compares the organisational effect of compensation and benefits in public and private hospitals. It was observed that private hospital employees were more satisfied with their compensation and benefits as compared to the employees of government hospitals. Furthermore, the employees who were satisfied with their compensation and benefits were also found to be satisfied with their jobs.

      PubDate: Tue, 18 Oct 2016 22:31:47 GMT
       
  • Volume 11 Issue 1 - Balancing Yin and Yang: The development of a framework
           using Participatory action research for the translation and implementation
           (part 1) of new practices
    • Abstract: Fitzgerald, A; Ogrin, R; Hayes, K; Curry, J; Eljiz, K; Radford, K
      Context: Despite the demonstrable benefits of many healthcare innovations, embedding research findings into practice has been slow and sporadic. Many implementation frameworks exist, however most have been criticised for not having a strong theoretical underpinning. This study addresses this gap by reviewing the current models to propose a new, theoretically driven framework for change management and translation.

      Methods: This study is reported in two parts. In part 1, a systematically-based literature review was undertaken. Following this, part 2 included conducting focus groups with academics to verify the model and provide feedback on the new framework.

      Findings: The gaps in current implementation frameworks identified include deficiencies in the areas of individual and social behaviour, participatory action, operationalisation and evaluation of the frameworks. The Quality Implementation Framework (QIF) [3] was used to provide the basis to develop a robust extended model, which addressed those areas that were identified as deficient in the current frameworks. By combining the best parts of extant models with a translation and implementation foci, we developed the PARTI model that is underpinned by commitment to change (Ying) and change fidelity (Yang) at each of its four stages, which included a behavioural questionnaire and implementation checklist. PARTI stands for Participatory Action Research, Translation and Implementation.

      Conclusions: The implementation of change in healthcare delivery is difficult and demanding, and healthcare managers look to change frameworks for guidance. The PARTI model has been developed to provide a systematic approach to implementing changed practices that is repeatable, reliable and scalable.

      PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 11 Issue 1 - Improving the health system with performance reporting
           - real gains or unnecessary work?
    • Abstract: Day, GE; South, L
      Aim: This paper will discuss current approaches to performance reporting and whether there are real benefits to healthcare organisations or whether it is a time consuming activity that adds little to improving quality healthcare and organisational performance. Most importantly, this paper will argue that performance reporting will not prevent another major healthcare scandal, such as that seen at Bundaberg Hospital or NHS Mid Staffordshire Trust. The paper will also outline learnings for Australia from other health systems where performance reporting is part of management practice.

      Approach: While performance reporting is largely designed to increase the efficiency and effectiveness of healthcare organisations, this paper will explore the approach from a practical managerial perspective.

      Context: This paper explores performance reporting across a range of Australian healthcare organisational settings to highlight differing approaches to improving performance.

      Main findings: Performance reporting can be an effective tool to improve organisational performance. For performance reporting to be successful, managers and clinicians need to work collaboratively to identify areas for performance improvement and useful measures to address these. Additionally, organisations must choose a meaningful suite of measurements that can help drive performance improvement. Real time performance reporting, such as through performance dashboards, provides managers with the opportunity to make timely, incremental improvements. Finally, performance reporting must be done in a way that does not detract from providing safe, quality patient care.

      Conclusions: Performance reporting can be a useful management tool for healthcare organisations, however organisations must consider timeliness of performance reporting and select a number of measurements that have impact for their given facilities and avoid the wholesale analysis of data that has little opportunity to improve practice or performance.

      PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 11 Issue 1 - In this issue
    • PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 11 Issue 1 - Responding to the call for innovation: How do we
           develop health professionals' skills and operationalise innovation?
    • Abstract: Briggs, DS
      PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 11 Issue 1 - Development of a consumer engagement framework
    • Abstract: Lizarondo, L; Kennedy, K; Kay, D
      Objective: The purpose of this project was to develop a Consumer Engagement Model to plan for effective baby boomer engagement to inform policy makers in the healthcare system. This is the first stage of that process.

      Design: Initial model development for healthcare systems based on literature review and author group experience in evidence-based practice and research, and consumer advocacy and engagement.

      Setting and population: South Australian health and community service systems, and healthcare professionals that work with baby boomers.

      Findings: To develop an evidence-based Consumer Engagement Plan, it is recommended that policy makers undertake the four steps outlined in this document to design a question, determine consumer and community segments and scope of engagement, determine the breadth and depth of engagement and address the implications, assess risk and develop strategic partnerships to ensure the Plan is evidencebased, reasonable and achievable.

      Conclusions: We believe this process provides a framework for planning consumer engagement and for implementation, monitoring, evaluation and review of consumer engagement for policy excellence. We propose to undertake a validation of the model thus populating the model with examples of practice-based strategies and revising the model accordingly.

      PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 11 Issue 1 - Library bulletin
    • PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 11 Issue 1 - The importance of the physical environment for child
           and adolescent mental health services
    • Abstract: Rogers, SL; Edwards, SJ; Hudman, P; Perera, R
      Objective: This study examined the relationships between appraisals of the physical environment with the subjective experience of consumers, and work satisfaction of clinicians, in Child and Adolescent Mental Health Services (CAMHS).

      Design, setting, and outcome measures: A survey of clinicians, parent/guardians, and child/adolescents was conducted across eight community CAMHS in Western Australia. Respondents evaluated the waiting room and therapy rooms on a number of environmental attributes, and factor analysis was carried out to confirm that these ratings loaded on an overall appraisal of the physical environment measure. This measure was then correlated with self-reported subjective experience of consumers, and overall work satisfaction of staff members.

      Results: Clinicians were found to be much more critical of the physical environment compared with consumers. Moderate associations were found between appraisal of the physical environment and subjective experience of consumers. A strong positive association was found between clinician appraisal of the physical environment and overall work satisfaction.

      Conclusions: The present study adds to the limited existing research arguing for the important role that the physical environment can have upon both consumer and staff experience in mental health settings. The present study provides empirical evidence to justify steps being taken to enhance the physical environment in mental health clinics. The inter-relationship between physical environment attributes suggests there is potential for managers to improve the overall perception of clinic space via relatively small actions (e.g., adding a nice piece of artwork).

      PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 11 Issue 1 - Employability skills in health services management:
           Perceptions of recent graduates
    • Abstract: Messum, DG; Wilkes, LM; Jackson, D; Peters, K
      Background: Employer skill requirements of graduates are monitored by Graduate Careers Australia, but health services management (HSM) specific employability skills (ES) perceived by graduates to be important on the job and their perceptions of skills they need to improve are not well reported. Academics need this feedback to improve course employment outcomes by helping current students identify and articulate appropriate competencies to potential employers. Also teaching of industry requirements can help improve job matching for employers.

      Method: Recent graduates working in HSM in New South Wales, Australia were surveyed to rate ES for importance and rate their own skill levels on the same items. The gap between these two ratings was identified for 44 ES.

      Results: ES important to recent graduates in rank order were: verbal communication skills, integrity and ethical conduct, time management, teamwork, priority setting, ability to work independently, organisational skills, written communication, being flexible and open minded and networking. Highest self-ratings were found for integrity and ethical conduct, ability to work independently, being flexible and open minded, tertiary qualifications, interpersonal skills, written communication skills, time management, life-long learning, priority setting and administration skills. Generally graduates rated their skills lower than their ratings of importance.

      Conclusions: Recent graduates can provide valuable feedback to universities about ES required for HSM positions and identify their own skill gaps for development at work or through study. Generic skills rather than job-specific skills are what they rate as most important. Closer engagement of universities and employers is recommended especially through placements.

      PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 11 Issue 1 - Using linked lung cancer registry and hospital data
           for guiding health service improvement
    • Abstract: Roder, D; You, H; Baker, D; Walton, R; McCaughan, B; Aranda, S; Currow, D
      Objective: To use linked NSW Cancer Registry and hospital lung cancer (LC) data for raising discussion points on how to improve outcomes. Design: Historical cohort - cases diagnosed in 2003-2007.

      Setting: New South Wales, Australia.

      Outcome Measures: Relative odds (OR) of localised disease and resection of non-small cases (NSCLC) using multiple logistic regression. Comparisons of risk of NSCLC death using competing risk regression.

      Findings: (1) Older patients have fewer resections of localised NSCLC [adjusted OR 95% CLs; 80+Vs
      PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 11 Issue 1 - Are clinical registries actually used?: The level of
           medical staff participation in clinical registries and reporting within a
           major tertiary teaching hospital
    • Abstract: Dwyer, A; McNeil, J
      Clinical Registries are established to provide a clinically credible means for monitoring and benchmarking healthcare processes and outcomes, to identify areas for improvement, and drive strategies for improving patient care. Clinical Registries are used to assess changes in clinical practice, appropriateness of care and health outcomes over time. The American Heart Association Policy Statement in April 2011 called for expanding the application for existing and future Clinical Registries, with well-designed Clinical Registry programs. Concurrently, in Australia, and similarly within the United States and United Kingdom, there has been an increased focus on performance measurement for quality and patient safety. Within Victoria, the Victorian Clinical Governance Policy Framework outlines clinical effectiveness as one of the four domains of Clinical Governance.

      As Clinical Registries evaluate effectiveness and safety of patient care by measuring patient outcomes compared with peers, the use of Clinical Registries data to improve a health service's quality of care seems intuitive. A mixed methods approach was utilised, involving (1) semi-structured interviews and (2) documentation audit in this study conducted at Austin Health, a major tertiary teaching hospital in North- Eastern metropolitan Melbourne, affiliated with the University of Melbourne and various research institutes within Austin LifeSciences.

      Although many studies have highlighted the benefits of data collected via individual Clinical Registries, the level of voluntary medical staff participation in Clinical Registries at a health service level is yet to be established. The aim of this study was to document the level of medical staff involvement for Clinical Registries within a major tertiary teaching hospital, and the level of reporting into Quality Committees within the organisation.

      This study demonstrates that along with a very high level of medical staff participation in Clinical Registries, there is a lack of systematic reporting of Registries data into quality committees beyond unit level, and utilisation of such data to reflect upon practice and drive quality improvement.

      PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 11 Issue 1 - Best practice pathology collection in Australia
    • Abstract: Pilbeam, V; Ridoutt, L; Badrick, T
      Objectives: The specific objectives of the study were to (a) identify current best practice in pathology specimen collection and assess the extent to which Australian pathology services currently satisfy best practice standards; and (b) identify training and other strategies that would mitigate any gaps between current and best practice.

      Methods: A total of 22 case studies were undertaken with pathology collector employers from public, not for profit and private pathology organisations and across urban and rural locations and eight focus groups with pathology collection services consumers were conducted in December 2012 in four different cities.

      Results: The preferred minimum qualification of the majority of case study employers for pathology collectors is the nationally recognised Certificate III in Pathology. This qualification maps well to an accepted international best practice guideline for pathology collection competency standards but has some noted deficiencies identified which need to be rectified. These particularly include competencies related to communicating with consumers. The preferred way of training for this qualification is largely through structured and supervised on the job learning experiences supported by theoretical classroom instruction delivered in-house or in off the job settings. The study found a need to ensure a greater proportion of the pathology collection workforce is appropriately qualified.

      Conclusion: The most effective pathway to best practice pathology collection requires strong policies that define how pathology samples are to be collected, stored and transported and a pathology collection workforce that is competent and presents to consumers with a credible qualification and in a professional manner.

      PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 11 Issue 1 - Factors affecting hospital choice decisions: An
           exploratory study of healthcare consumers in Northern India
    • Abstract: Kamra, V; Singh, H; De, KK
      This study examines the factors affecting hospital choice decisions by patients for tertiary level healthcare services and the relationships of these factors with respondent demographics. It also categorises the decision makers involved in the selection of hospitals. Data were collected from in-patients of multispecialty hospitals located in northern India with the help of a structured questionnaire. Factor analysis, ANOVA and t-test techniques have been employed to analyse the data. The study has revealed that the factors that affect hospital choice decisions of patients are basic amenities, reputation and quality, building and infrastructure, ease and affordability, personal substances (experiences), responsiveness of services, recommendations and suggestions, clinical support, privacy and information sharing, and range of services. The study has also revealed that various categories of respondent demographics, namely, age, gender, residence, education and monthly family income are significantly different statistically (P < .05) with respect to the identified factors. It has been found that most of the time family members, doctors or a combination of family members and doctors make the decisions to choose the hospital. It has also been found that friends/ relatives and patients themselves choose the hospital in some cases.

      PubDate: Thu, 5 May 2016 22:24:52 GMT
       
  • Volume 10 Issue 3 - Manuscript preparation and submission
    • PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - Library bulletin
    • PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - Back to the future: Using the ethical climate
           questionnaire to understand ethical behaviour in not for profits
    • Abstract: Dark, DL; Rix, M
      The ethical climate of an organisation can be described as the lens by which employees determine what comprises 'correct' behaviour within that organisation. As an outcome of the organisation's culture, many factors influence an ethical climate's design and configuration, including the organisation's history, its structure and management systems, the external environment and the individuals working within it. In order to work out the best ethical structure or ethical framework to support ethical behaviour, ethical climate must first be understood. The ethical climate questionnaire, (ECQ) a tool developed more than 25 years ago, has been applied and refined in empirical research with a focus on private and public organisations, but what about not-for-profit organisations?

      Through a focused literature review, this paper finds that the volume of empirical studies involving the ECQ in not-for-profit organisations is quite limited. Sample size, composition of the populations sampled and corresponding diversity in the intent or focus of these studies also limits broader application of their findings.

      However, the admittedly limited research findings so far suggest that ethical climates in not-for-profits are different to those found in organisations from the private and public sectors, and cannot be established using a compliance or rule-based approach to instilling ethics and integrity in organisations. Recent regulatory reform in the not-for-profit sector, increased community expectations, and the fact that services are often provided to vulnerable populations suggest a focus on the systems that support and demonstrate ethical decision-making is long overdue.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - Analysis of management practice strategic planning: A
           comprehensive approach
    • Abstract: Schneider, S
      Objective: To describe a comprehensive approach to crafting a strategic plan for a health service organisation which incorporates the pillars of: corporate governance; service master planning; facilities master planning; business planning; clinical governance; and organisational culture to provide the framework for its development and subsequent implementation.

      Background: As a senior heath executive spanning 25 years, the author experienced first hand the negative consequences of a health service not developing and maintaining a comprehensive contemporary strategic plan through key stakeholder engagement. Throughout subsequent appointments the author refined his approach to strategic planning and draws on these experiences to write this article.

      Discussion: Each of the pillars is briefly discussed for the purposes of providing a definition and a considered rationale for inclusion in a comprehensive strategic plan. As each pillar is discussed, a number of elements are identified which are considered essential inclusions in this planning framework. Five key additional considerations that must be made during the development or crafting and implementation of a health service organisation's comprehensive strategic plan are also identified and discussed. These are: multi-site organisation; functional integration; resource requirements; implementation; and monitoring the strategy.

      Conclusion: The crafting of a contemporary strategic plan with six inherent pillars through key stakeholder engagement is fundamental for any organisation's long-term survival. Multi-site and functional integration challenges, resource implications, implementation needs and monitoring requirements are crucial in ensuring the successful implementation of such a strategic plan.

      Through the development and successful implementation of such a plan, a health service organisation will have significantly greater confidence that the risks it confronts in the future are mitigated. A health service's board and its executive would have every justification to be optimistic of their ability to future proof the organisation when adopting the strategic planning approach discussed in this article.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - A taxonomic approach to understanding managerial
           ethical decision-making approaches of clinically and non-clinically
           trained healthcare managers in Australia
    • Abstract: Casali, GL; Day, GE
      Objective: To understand differences in the managerial ethical decision-making styles of Australian healthcare managers through the exploratory use of the Managerial Ethical Profiles (MEP) Scale.

      Background: Healthcare managers (doctors, nurses, allied health practitioners and non-clinically trained professionals) are faced with a raft of variables when making decisions within the workplace. In the absence of clear protocols and policies healthcare managers rely on a range of personal experiences, personal ethical philosophies, personal factors and organisational factors to arrive at a decision. Understanding the dominant approaches to managerial ethical decisionmaking, particularly for clinically trained healthcare managers, is a fundamental step in both increasing awareness of the importance of how managers make decisions, but also as a basis for ongoing development of healthcare managers.

      Design: Cross-sectional.

      Methods: The study adopts a taxonomic approach that simultaneously considers multiple ethical factors that potentially influence managerial ethical decisionmaking. These factors are used as inputs into cluster analysis to identify distinct patterns of influence on managerial ethical decision-making.

      Results: Data analysis from the participants (n=441) showed a similar spread of the five managerial ethical profiles (Knights, Guardian Angels, Duty Followers, Defenders and Chameleons) across clinically trained and non-clinically trained healthcare managers. There was no substantial statistical difference between the two manager types (clinical and non-clinical) across the five profiles. Conclusion: This paper demonstrated that managers that came from clinical backgrounds have similar ethical decision-making profiles to non-clinically trained managers. This is an important finding in terms of manager development and how organisations understand the various approaches of managerial decision-making across the different ethical profiles.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - The observer effect: Can being watched enhance
           compliance with hand hygiene behaviour?: A randomised trial
    • Abstract: Bolton, PGM; Rivas, K; Prachar, V; Jones, MP
      Bateson and Shelby provide evidence that cues of being watched can be a powerful mechanism inducing those observed to change behaviour. We designed and conducted a randomised controlled trial to assess the impact of visual cues of being watched on hand hygiene compliance. This did not demonstrate improved hand hygiene compliance associated with cues of being watched: compliance for wards with a 'cleanse your hands' poster was 87.3% and for wards without the poster it was 84.9%. This difference failed to reach statistical significance (OR=1.73, 95% CI 0.71- to 4.24, p=0.23).

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - The ethics of managing and leading health services: A
           view from the United Kingdom
    • Abstract: Armit, K; Oldham, M
      The financial challenges facing the NHS in England show no signs of abating. The well-publicised events of Mid Staffordshire NHS Foundation Trust between 2005-2009 show what can happen when leaders and managers focus on finances at the expense of the health and wellbeing of staff and patients. Leading and managing health services in a financially pressured environment is considerably challenging but those responsible for doing so need to learn from the lessons from Mid Staffordshire and be highly aware of, understand and fulfill the ethical responsibilities expected of them. Expectations of ethical behaviours are well articulated through the NHS Constitution and various professional codes of conduct and standards. Critically, if we want individual leaders and managers, no matter what their professional background, to behave ethically, all the players in the system - professional bodies, regulators, politicians need to create and support the culture and climate in which this can be achieved.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - Ethics of managing and leading health
    • PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - The ethics of managing health services: Why does it
           matter?
    • Abstract: Day, Gary E; Casali, Gian Luca
      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - Leading ethical decision-making: Clinical ethics
           services in Australia
    • Abstract: Jones, J; Milligan, E
      Decision-making in healthcare demands consideration of not only the clinical, operational or financial aspects of care but increasingly complex ethical issues. Meeting the physical and emotional needs of patients ethically, while acknowledging the distress and conflicting expectations and needs of staff, can be extremely difficult for all involved. It is vital that staff be provided with a 'safe space' to speak of the ethical challenges they are encountering if we are to take staff safety as seriously as we take patient safety. A Clinical Ethics Service (CES) established in accordance with the recently released National Health and Medical Research Council (NHMRC) consensus statement and the 'NHMRC Clinical Ethics Resource Manual' can provide such a space.

      This paper explores the who, what and why questions embedded in ethical decision-making. The work of a CES will be outlined. Drawing of the Roger L Martin's concept of heroic leadership, stakeholder roles and moral orientations will also be explored. In addition, the often unspoken attitudes towards certain patients, 'likeable' and 'unlikable' for instance, which threaten to influence views of 'worthiness' of care will also be explored.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - Do health inquiries lead to health system change?:
           What have we learnt from recent inquiries and will the same mistakes
           happen again?
    • Abstract: Day, GE; Casali, GL
      Since 2001 there have been numerous Commissions of Inquiry into health system failures across the world. While the Inquiries were established to examine poor patient outcomes, each has identified a range of leadership and management shortcomings that have contributed to a poor standard of patient care. While there is an acknowledgement that different heath systems have different contexts, this paper highlights a number of themes that are common across Inquiries. It will discuss a number of common system failures in Inquiries spanning from 2001 to 2013 and pose questions as to why these types of failures are likely to re-occur, as well as possible learnings for health service management and leadership to address a number of these common themes.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - Do our leaders have the technical expertise to lead
           health sector reform?
    • Abstract: Arya, D
      The healthcare delivery paradigm has changed. This requires health care leaders implementing reform to think differently. It requires organising ourselves differently and even behaving differently. It is incumbent on health professionals with technical skills, experience and expertise to remain cognisant of the changing landscape, culture and community, understand patient and community expectations and lead development of a new vision, strategy and clinical systems and processes.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - Raising the bar for health leadership in Australia
    • Abstract: Sebastian, A
      An insider's view of two national conversations leading to an agreed and approved health leadership framework for Australia, this perspective highlights the national aspirations for developing leadership for a people focused health system that is equitable, effective and sustainable. Admired in Canada and in many places around Australia, development of the tools and programs to accompany Health LEADS Australia faltered in the transfer of custodianship from Health Workforce Australia to the Department of Health. On hold too, is a national approach to health leadership built into early career education and professional development. Despite this, authors and stakeholders in State and Territory Health Departments and independent health agencies are using Health LEADS Australia in ways that continue to highlight its potential for raising the bar of health leadership in Australia.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - Editor's note
    • Abstract: Briggs, DS
      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - On the use/misuse of health research gatekeeping
           powers in Australia: An underconsidered problem?
    • Abstract: Murgatroyd, P; Karimi, L; Robinson, P; Rada, J
      Significant investments have been made internationally, including in Australia, to enhance evidence generation and implementation in healthcare. Nevertheless, large knowledge gaps persist, and changes in clinical settings are slow to appear. This impacts service efficiency and efficacy, and ultimately the health and wellbeing of individuals and communities.

      However, despite this situation, surprisingly negative attitudes to research exist within healthcare. This paper describes a number of cases where research has been blocked at various levels by Australian health organisations, managers and clinicians for reasons of corporate and individual self-interest, rather than ethical or resource-related concerns. We call this tendency nimbyism in healthcare research and suggest it often operates through the misuse of gatekeeping powers at the nexus between potential research participants and would-be researchers. We identify three levels where research nimbyism can operate: 1) institutional control of research activities 2) dissemination of findings 3) vested interests of individuals in the status quo. We propose that nimbyism may not be an unusual phenomenon.

      Ethical aspects of research gatekeeping, including societal and individual aspects, are considered together with possible motivations. We ask whether patterned, covert and unauthorised misuse of gatekeeping powers is an under-considered problem affecting evidencebased practice and the right to research participation and call for more research into this phenomenon.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - The challenges of a relational leadership and the
           implications for efficacious decision- making in healthcare
    • Abstract: Harden, H; Fulop, L
      Objective: To demonstrate how decision-making can be made more efficacious in healthcare contexts, such as cancer care networks, by adopting relational leadership practices.

      Design: Empirical material was collected through video-recordings over a 12-month period of fifty-three meetings of seven cancer networks in Australia. Using an interpretive approach, analysis was conducted on the meeting conversations of service improvement subcommittees of the networks. Only one sub-committee was described as 'narrative rich' meaning, personal narratives or stories were evident in their conversations. The sub-committee is characterised as displaying elements of multi-ontology sense making. Drawing on the Cynefin framework, conversations were classified as simple, complicated, complex or crisis-based depending on the nature of their decisions and the contextual constraints. This allowed conversations to be tagged as examples of either single or multi-ontology sense making.

      Setting: Cancer networks in Australia tasked with the dilemma of enhancing multi-disciplinary cancer care.

      Main outcome: Relational leadership practices can generate narrative rich conversations in decisionmaking through enabling multi-ontology sense making.

      Results: Sufficient evidence was found to demonstrate that narrative rich conversations offered potentially new and innovative ideas for service improvement but lacking relational leadership practices, networks simply produced interventions that amounted to 'more of the same.'

      Conclusions: The ability to skilfully relate helps create contexts in which multi-ontology sense making can flourish. Skilful relating, as a leadership practice, is essential to making healthcare professionals more innovative and creative in how they deal with organisational dilemmas, allowing them to engage in robust, informed and inclusive decision-making processes.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - Understanding the need for the introduction of the
           multi-purpose service model in rural Australia
    • Abstract: Malone, L; Anderson, JK
      Aim: This article provides a commentary on the implementation of the Multi Purpose Service (MPS) healthcare program and the underlying principles that govern the administration of MPS within the Australian public health system.

      Background: Existing funding models for acute care services do not apply to MPS, which increases the pressure on small rural areas with decreasing populations to maintain health care services.

      Evaluation: A database search yielded 147 articles and 23 were identified as being relevant to the topic.

      Key Issues: Key issues were identified from the evaluation of the literature and included: poor health in rural communities; the need for collaboration between governments; unique design of an MPS; and the need to consider community and staff perspectives.

      Conclusions: In the absence of any other sustainable model of health care delivery being developed or implemented within Australian rural and regional areas, the MPS model of care is the most practical use of financial and human resources to provide healthcare services for these small communities.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - General supplement
    • PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - Developing an instrument for a state-wide palliative
           care satisfaction survey in Australia
    • Abstract: O'Connor, M
      In the State of Victoria, Australia, there was an identified need for a validated instrument to measure the satisfaction of people receiving palliative care. The process of gaining sector-wide cooperation to collect satisfaction data across many settings and models of care had been a challenge for many years. This was finally achieved in 2007, particularly when driven by the requirement that funding was contingent on meeting the Victorian Government's key performance indicators in relation to satisfaction. What has emerged is the ability to report to government and the sector, to compare and contrast service satisfaction and these data being used to enable improved care provision.

      This paper outlines the process of developing and validating the Palliative Care Satisfaction Instrument (VPCSI). Continued annual use of the instrument enables ongoing collection of benchmark data for subgroups, confirmation of core components and other psychometric consolidation measures.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - A study on patient satisfaction at Khanh Hoa
           Provincial general hospital
    • Abstract: Le, Phung Tan; Fitzgerald, G
      Patient satisfaction has been considered an indispensable measure in the process of evaluating hospital performance. A patient satisfaction survey can help explore possible gaps in hospital service to improve its quality.

      The study was conducted based on a random sample of 985 in-patients who were already discharged within three months. A 26-item patient satisfaction scale was used to evaluate respondents' satisfaction with the hospital service. Univariate and multiple analyses were used to examine the relationship between satisfaction and patients' socio demographic characteristics. T test, ANOVA, and regression model were used for analysis.

      The results showed a proportion of 68 per cent satisfaction with the hospital's service. The most dissatisfied dimension was Responsiveness that relates to waiting time for doctors' and nurses' responses and administrative procedures. There were no significant differences in satisfaction regarding patients' gender, religion and health insurance status. Older people were likely to be more satisfied than younger ones. Patients who were living in remote areas were likely to be more satisfied with the hospital service.

      Further studies should be conducted to confirm the five-factor structure of the scale. More attention should be paid to the dimensions of Assurance, Reliability and Empathy to improve hospital service quality.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
  • Volume 10 Issue 3 - It's time: The poor culture regarding safety and
           quality in Australian hospitals must be addressed!
    • Abstract: Davis, E; Beale, N
      This review article demonstrates the causal relationship between a poor safety and quality culture in Australian and overseas hospitals and the occurrence of adverse patient events (AEs). The evidence of serious adverse events occurring in these hospitals is unquestionable.

      Awareness of the importance of that poor safety and quality culture in hospitals and its linkage with AEs is not as widespread as is warranted, but there is mounting evidence of its rapidly increasing recognition. The concept of technical and non-technical competence in workers in different industries is also well developed, with an increasing consensus that the non-technical aspects of healthcare delivery are responsible for a majority of the adverse events, rather than issues of technical competence.

      The need to provide patient safety education, particularly in a multi-professional setting has been established through the World Health Organisation's (WHO) Patient Safety Curriculum Guide: Multi- Professional Edition in 2011. This document also stresses the importance of multi-disciplinary care teams. A corollary of this is the need to extend this education to more senior members of healthcare teams, who did not experience these concepts in their education.

      Following completion of the education of those senior members in the issues of a safety and quality culture, all members of those professions must then have periodic mandatory reviews of these lessons incorporated into their continuing professional development (CPD) activities.

      One manifestation of that poor safety and quality culture is bullying, which is extensive in hospitals and which is rapidly being recognised in the Australian environment.

      PubDate: Wed, 20 Jan 2016 23:24:41 GMT
       
 
 
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