Asia-Pacific Journal of Health Management (ACHSM)
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To Remain, Migrate Abroad or Resettle: A complex dynamic process affecting Pakistani physicians’ career decisions
Get PDFObjective: This study investigated Pakistani physicians’ decision-making concerning their decisions to stay in Pakistan, migrate abroad, or resettle back into their country after working abroad.
Methods: This qualitative study employed a phenomenological research design. Thirteen Pakistani physicians characterised as ‘stayers’, ‘leavers’ and ‘resettlers’ were interviewed via telephone to explore their lived experience in 2008-2009.
Results: Results show a dynamic nature of the physicians’ career decision-making depending on their constant weighing of complex personal, family, professional and societal factors. Stayers, leavers and resettlers are not mutually exclusive groups but rather individual physicians’ can move between these groups at different stages of career and life. Physicians vary in their decision making. Stayers and resettlers place more emphasis on personal and family reasons and societal factors providing there is a permanent job for them. Leavers focus on health system problems and recent societal problems of personal and societal insecurity.
Conclusions: The findings of this study indicates that physician migration, retention and resettlement is a complex issue and there are multiple personal, social, political and economic factors that affect their decisions to stay, move abroad or resettle back into their countries. Therefore, it is recommended that future research focusing on health workers retention, migration and resettlement issues look at it from a holistic perspective rather than focusing only on the economic and professional imperatives. The findings of this study have international implications for health care managers dealing with a highly mobile international medical workforce. Strategies considering different stages of the physician career/ life cycle need to highlight the importance of identity, belonging and place as doctors weigh this with career goals
Rural Health Services: Data, technology and the social capital of local health professionals, time to invest!
Get PDFRecent editorials have had some focus on health policy and health reform and included commentary about the variability of output from public policy research institutes, based on their respective philosophical and ideological position. Recently, a group Global Access Partners (GAP) published a report entitled ‘Australia’s Health 2040: GAP Taskforce Report’. [1] This organisation is said to be an independent non-profit institute, established in 1997 and is a member of the TCG Group, described as a diverse and growing network of Australian-owned companies. [1,2]....
Aging and Diversity of Medical Needs: Cost of illness of cerebrovascular disease in each prefecture of Japan
Get PDFBackground: Aging in Japan is advancing most rapidly in the world, and is expected to increase demand of medical services more in near future. Aging is uneven and progress of the aging varies from regions resulting in great differences in medical needs. In order to supply the needs for medical services, Japanese government developed “Regional Medical Vision”, which estimates the near future requirements for medical resources. However, this is a plan for redistribution of medical resources taking into only future changes of population composition based on current situation. In fact, each region has diversity of medical needs, and it is difficult to use average medical needs even if they are adjusted by population structures. In consideration of such situation, we tried to estimate the social burden of major diseases of each region in order to estimate the medical needs. We picked up cerebrovascular diseases (CVD, ICD10 code: I60 - I69) and dementia (ICD10code: F01, F03, G30), and calculated their social burden of all 47 prefectures in Japan that have great authority for health policy.
Method: Modifying the COI method developed by Rice D, we newly defined and estimated C-COI of CVD (ICD10 code: I60 - I69) and dementia (ICD10code: F01, F03, G30). C-COI consists of five parts; direct cost (medical), morbidity cost, mortality cost, direct cost (long term care (LTC)) and informal care cost (family’s burden). Direct cost (medical) is medical cost of each disease. Morbidity cost is opportunity cost for inpatient care and outpatient care. Mortality cost is measured as the loss of human capital (human capital method). These three costs are known as components of original cost of illness by Rice D. Direct cost (LTC) is long term care insurance benefits. Family’s burden is “unpaid care cost” by family, relatives and friends in-home and in-community (opportunity cost). We calculated such costs at 2013/2014 using Japanese official statistics.
Results: The total C-COI of CVD in Japan was about 6,177 billion JPY, the maximum was 621 billion JPY in Tokyo and the minimum was 33 billion JPY in Tottori (Tokyo/Tottori=18.8), whereas the total C-COI of dementia was 3,778 billion JPY, the maximum was 341 billion JPY in Tokyo and the minimum was 22 billion JPY in Tottori (Tokyo/Tottori=15.5). The C-COI per capita of CVD in Japan was about 48 thousand JPY, the maximum was 66 thousand JPY in Kagoshima and the minimum was 38 billion JPY in Saitama (Kagoshima/Saitama=1.7), whereas the total C-COI of dementia was 3,778 billion JPY, the maximum was 46 thousand JPY in Shimane and the minimum was 22 thousand JPY in Chiba (Shimane/Chiba=2.1).
Conclusion: We substantiated a method to calculate the social burden of medical care and LTC care for each prefecture using C-COI methods. In both diseases, a large difference was found in total costs per capita and components ratio between prefectures. The situations of social burden of diseases has diversity among prefectures. When estimating the future medical needs of each region, it is necessary to take each regional condition into account
The Pursuit of Purposeful Partnerships-Making A Health Matrix Successful
Get PDFObjective: To analyse a matrix model of management to optimize the partnerships, collaboration and interaction between vertical management structures (services and geographical clusters) and horizontal clinical structures (Clinical Networks and Streams) in a large Local Health District [LHD] in New South Wales, Australia.
Approach: An ‘Action Research’ approach utilising a maturity tool, the Collaboration Rubric®, an evidence-based model for Network analysis. The rubric describes four types of collaboration and defines the three essential drivers that allow successful collaborations.
Outcomes: Benchmarking comparisons indicate that this LHD is operating at a level well above base level for the three drivers that enable collaboration [capacity, authority and shared value]. The professional relationship between Clinical Networks/ Streams and Operational Managers, is the main barrier to improving collaboration. The Operational Managers have clear positional authority related to the organisational structure and are accountable to their Executive for good governance and financial management. Clinical leaders hold substantial influential power derived from their professional authority.
The following actions have been identified to improve collaboration.
Ensure all leaders actively “manage for collaboration“
Executive fosters joint innovation projects characterised by collaborative practice between the Clinical Networks/Streams and Operational Managers.
Ensure leadership accountabilities are held as close as possible to any projects (locally) involving reform or innovation
Clinical Network/Streams’ operational plans are jointly agreed with local management and signed off by Executive
LHD recruit leadership with skills in managing for collaboration
Conclusions: This evaluation supports the use an Action Research approach using the Collaboration Rubric® as a useful tool to define not only the type of collaboration required but the key drivers that must be addressed to facilitate improved [horizontal and vertical] partnerships leading to better outcomes. This local health district will build improved collaboration utilising the insights gained from this analysis
In this Issue
Get PDFThis issue is a Special Issue in that it predominantly features a series of articles that have arisen from the CPCE Health Conference 2019. The special issue commences with an editorial where Professor Yuen emphasises the ongoing collaboration with this Journal, the ACHSM and the Hong College of health Services Executives and with the CPCE. His leadership and contribution are appreciated.
The first article of the Special Issue is by Hasegawa, Matsumoto, and Hirata of Toho University Tokyo Japan who present an article entitled ‘Aging and Diversity of Medical Needs: Cost of Illness of Cerebrovascular Disease in Each Prefecture of Japan. This is followed by the contribution from Ng, Fong and Kwong of Hong Kong on the ‘Transition of hospital acute-centric to long term care in an ageing population in Hong Kong - is it an issue of service gap’. In the next article, Chu and Chong of Hong Kong address the ‘Oncology Pharmacist’s role and the impact on multidisciplinary patient-centred practice of oncology clinic in public hospitals in Hong Kong. Two interesting articles follow from Kwan, Yick and Wong of the Institute of Textiles and Clothing, Hong Kong Polytechnic University of Hong Kong who provide a research article on the ‘Impact of Co- creation Footwear Workshops on Older Women in Elderly Centres in Hong Kong’ and the following article from Yick, Yip and Ng, again from the Institute of Textiles and Clothing and from the Division of Science and Technology of the Hong Kong College of the same University. The latter article examines the importance of thermal comfort in foot wear design for the elderly and is entitled ‘Thermal equations for predicting foot skin temperature’. In conclusion, Kwong and Fong provide a review article on a contemporary issue of ‘promotion of appropriate use of electronic devices among Hong Kong adolescents.
We thank Professor Yuen and his authors for this important contribution to our understanding of humane, wholistic and integrated care from diverse international health systems.
In support of this effort of our colleagues above, we have added some more articles ready for publication. This includes an editorial on Health Reform that was prompted by my plenary session contribution at the CPCE Hong Kong Conference. We also continue the international emphasis of this issue with a contribution from Sharma of Maharishi Markandeshwar University, Northern India with a research article on the ‘Extrinsic Rewards, Occupational Commitment, Career Entrenchment and Career Satisfaction of Dentists’. Our next article is by Mak and colleagues in a research article entitled ‘What is the Professional Identity of Allied Health Managers?’ Isouard and Martin provide a further contribution about the Australian workforce in an article entitled ‘Managers of aged care residential services: 2006-2016.’ Way and colleagues conclude this issue with an analysis of management practice in one local health district in Australia entitled ‘The pursuit of purposeful partnerships-making a health matrix successful’
A Practical Toolkit of Strategies for Building Research Capacity in Allied Health
Get PDFObjectives: The objectives of this project were firstly to develop a practical toolkit of evidence-informed strategies for building research capacity in allied health, and secondly to disseminate and apply this toolkit to inform tailored research capacity building plans for allied health teams.
Design: This project used a plan, do, study, act (PDSA) service quality improvement methodology to develop, disseminate and apply a toolkit which was based on the results of a recent systematic review of allied health research capacity building frameworks and a narrative review of other interventions and theoretical recommendations.
Setting: Eight allied health professional teams in a publicly funded tertiary health service were supported to develop tailored research capacity building plans based on their specific needs, goals and context.
Main outcome measures: The outcomes of this project were evaluated using process measures including whether a research capacity building plan was developed and to what extent short-term goals were achieved within three months.
Results: A practical toolkit was developed which consolidates existing evidence-informed strategies and organises these around three components including ‘supporting clinicians in research’, ‘working together’ and ‘valuing research for excellence’ and 17 sub-components. Several barriers and facilitators to applying the toolkit to teams were identified and this paper suggests some recommendations and future directions for addressing these.
Conclusions: This toolkit may be a useful resource to inform the development of team-based research capacity building plans for allied health. The application of the toolkit may be enhanced by a needs assessment and facilitation from a researcher. 
Impact of Co-creation Footwear Workshops on Older Women in Elderly Centers in Hong Kong
Get PDFBackground: The use of appropriate footwear could reduce the risk of falls among the geriatric population. However, the elderly are generally reluctant to accept new footwear designs particularly with the incorporation of fabrication materials and functional design features that are perceived to be less comfortable. Co-creation activities that encourage user involvement during the product design process and development can therefore address this issue and provide unique benefits and better value for users, increase acceptance, and even lead to positive perception as well as positive psychological impacts, thereby increasing the practical use of newly designed footwear.
Objective: This study aims to investigate the impact of hands-on footwear workshops on perceived functionality of geriatric footwear for older women.
Method: Footwear co-design workshops for older women were carried out in two elderly centers in Hong Kong. Twenty-one healthy females between 64 and 80 years old (mean: 71; SD: 4.2), were recruited. Subjects were invited to decorate the prescribed geriatric footwear prototype and discuss their ideas on footwear design in a group of three. They were surveyed after completing the footwear decoration.
Main outcome measures: The perceptions of the subjects on the geriatric footwear and related design features were analysed.
Results: The questionnaire survey shows positive results in the psychological value of the workshops for older women. The participants express high levels of satisfaction with the co-design process and a strong sense of achievement with the newly designed geriatric footwear. The acceptance and awareness of the functions of the footwear are greatly enhanced.
Conclusions: The co-design approach has positive psychological impacts on the elderly and their acceptance of the final product. This approach also better meets the aesthetic needs of the users
What Is the Professional Identity of Allied Health Managers?
Get PDFObjective: This paper explores the professional identity (PI) of Allied Health Managers (AHMs) and how their identity is typically constructed.
Methods: A qualitative research methodology utilising semi-structured interviews was employed for this research. Thematic analysis was used to extract relevant data from the transcripts.
Settings: The study was undertaken in five acute hospitals within one of the largest metropolitan Local Health Districts in New South Wales, Australia. A total of sixteen AHMs and deputy AHMs were interviewed.
Results: Three key themes identified were: PI of AHM, motivation of becoming a manager, and construction of their identity. Factors motivating AHMs to follow a management pathway were identified as being a natural progression and having interest in high-level decision-making. Despite AHMs sharing similar role conflict as the medical managers, they adapted to hybrid manager roles with minimal resentment. They also adopted to the hybrid manager role with a positive, realistic and flexible perspective.
Conclusion: Despite facing role conflict as a hybrid-professional-manager, AHMs manage the transition from clinicians to managers with a positive approach. This indicates that AHMs may require certain skills or characteristics to successfully construct their PI
What Are the Client, Organisational and Employee-Related Outcomes of High Quality Leadership in the Allied Health Professions? A scoping review.
Get PDFBackground: Leadership is viewed as the panacea the complex problems in modern health care where chronic disease, contracting budgets and rising consumer expectation are challenging care provision. As the second largest workforce in Australia, Allied Health Professionals (AHP) are core contributors to health teams however they are largely absent from leadership positions and there is little evidence of their impact on client outcomes. Aim: A scoping review was carried out to synthesise evidence on the client, organisational and employee-related outcomes of high quality leadership in Allied Health. Method: A search of grey literature, peer and non-peer reviewed literature was undertaken using Embase, Emcare, SCOPUS and Psychinfo from 2010-2017. Data were sourced from journals, government reports, conference presentations and other grey literature. The reference list of key articles were hand searched for relevant research. Results: A total of 5880 articles were identified and after screening 35 articles were included for in depth review. Leadership contributed towards positive outcomes in all three domains and had influence across professional groups and services. Leaders are highly valued and respected by their teams. Allied Health leaders did not feature in any of the articles and AHP were the focus of only seven studies. The majority of articles were conference papers or case reviews that provided little robust data making it difficult to draw substantive conclusions on the outcome of AHP leadership. Conclusion: There was a lack of robust data specific to AHP leaders. Future research should attempt to gather evidence of the outcomes of AHP leadership through qualitative and quantitative means to substantiate the anecdotal evidence for high quality AHP leaders. 
ACHSM Library Bulletin - July 2019
No full textIt provides that recent multidisciplinary articles related to healthcare management topics