Asia-Pacific Journal of Health Management (ACHSM)
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The Journal – a Critical Development in the Professional Journey of the College
Get PDFIn the professional journey of the College in February 2006 I was a participant in early meetings of a Federal Councilendorsed Steering Committee to develop the College’s own professional journal. The thinking behind this initiative centred on thefundamental belief that a professional body should have, under its auspices, a peer reviewed professional journal with a focus on its particular body of knowledge....
Factors Affecting Motivation and Retention of Village Health Workers and Recommended Strategies: a systematic review from 11 developing countries
Get PDFIntroduction: Motivation and retention of village health workers (VHWs) are crucial for the continuity, sustainability, and success of health programs. VHWs are the first point of contact for rural communities, providing health services to improve access and health coverage which, for a variety of logistical reasons, cannot be reached by the district health care system. Thus VHWs are critical for ultimately ensuring universal health coverage. However, systematic review revealed that there are numerous factors that affects their motivation and retention, leading to high dropout rates and hampering the delivery of health services to the community. This review intends to examine contextual factors affecting motivation and retention of VHWs in their roles and identify recommendations and strategies to motivate and retain them in the systems.
Method: Five electronic databases and two search engines were accessed. Nineteen studies met the inclusion criteria for the final review. An in-depth reading of all the articles was undertaken to gather and compile the relevant themes. Content analysis was done based on the list of specific categories that are relevant to motivation and retention.
Result: Findings from the systematic review revealed different levels of factor affecting motivation and retention of village health workers. It was finally contextualized and categorized into four main domains such as individual, family, social or community and organizational or systems levels. Financial incentives under the organizational factors was highlighted for the demotivation and the discontentment for the VHWs.
Conclusion: Financial factors under the organization were often key in the studies reviewed. However, there were also many other factors, sometimes surprising or unintuitive, influencing the motivation and retention of village health workers
Adverse Events Sustained by Children in The Intensive Care Unit: Guiding local quality improvement
Get PDFObjective: To determine the frequency, nature and consequence of adverse events sustained by children admitted to a combined general and cardiac paediatric intensive care unit (PICU).
Design: Retrospective analysis of data collected between January 1st 2008 and December 31st 2017 from PICU.
Setting: The Royal Children’s Hospital, a paediatric tertiary referral centre in Melbourne, Victoria, Australia. The PICU has thirty beds.
Results: During the study period, PICU received 15208 admissions, of which 73% sustained at least one adverse event with a frequency of 67 adverse events per 100 PICU-days and 3 per admission. One adverse event was sustained for every 35 hours of care. The risk of an adverse event was highest in children less than a month of age, or if mechanically ventilated, a high Pediatric Index of Mortality (PIM2) score, longer PICU length of stay, had a pre-existing disability or a high risk adjustment for congenital heart surgery (RACHS) score. Those patients who sustained an adverse event, as compared to those who did not, were mechanically ventilated for longer (80 hrs Vs. 7 hrs, p=<0.001), had a longer PICU length of stay (131 hrs Vs. 35 hrs, p=<0.001), had a longer hospital length of stay (484 hrs Vs. 206 hrs, p=<0.001) and had a higher mortality rate (3% vs. 0.1%, p=<0.001).
Conclusion: Whilst admission to PICU is an essential aspect of care for many patients, the risk of adverse events is high and is associated with significant clinical consequences. Monitoring of adverse events as part of quality improvement enables targeted intervention to improve patient safety
The Common Barriers and Facilitators for a Healthcare Organization Becoming a High Reliability Organization
Get PDFBackground: Implementing high reliability organization principles can enhance quality and safety in healthcare. Evidence-based instructions on how to effectively change the organizational culture in healthcare setting are required.
Objectives: A systematic review investigating methods, facilitators, and barriers to assist healthcare organizations in becoming a high reliability organization.
Method: Literature searches were performed in PubMed, MEDLINE, CINAHL-Complete, EMBASE, and Scopus for articles published between January 2012 and October 2017. The included articles were case reports, case studies, and protocol development studies on implementing high reliability organization principles. The articles were appraised using a modified Critical Appraisal Skills Programme tool. Thematic synthesis was conducted using manual coding.
Results: Of the 14 eligible articles nine were case studies, four were case reports, and one was a framework development report. The study populations varied from whole healthcare systems to a single department of a hospital. The most common methods were supportive leadership, staff education, and analysing the safety events and sharing the knowledge. Cost was one of the barriers. Remuneration came in reduction of safety events and costs avoided.
Conclusion Implementing high reliability organization principles in healthcare settings is slow and challenging, but doing so improves quality, resilience, and safety, thus increasing productivity
Publish or Perish: Perspectives from the APJHM for health managers
Get PDFThe term ‘publish or perish’ is familiar to most of us engaged in some way in academia and reflects the mantra that to have a successful career as a teacher, researcher and all-round academic wanting to be recognised as an expert in your discipline requires you to be well and regularly published. This directive also has added implications to not publish in ‘any journal’ but in ones that have high impact factors. This suggests that they have recognised quality articles that have been peer reviewed, have rigour in the editorial process and, therefore are difficult to obtain publication in, particularly for students and emerging researchers. Progression of careers are dependant on this mantra and, we all want to ensure that the quality of our research, our science is of the best standard....
Service Navigators in the Workforce: an ethical framework for practice
Get PDFAim and Context: This paper explores the current growth of service navigators in complex health and human services and details the development of the Service Navigation Relational Autonomy Framework as a guide to assist practitioners and managers implementing this role.
Approach: The framework was developed using a research into action process. The three-stage process included knowledge inquiry: bringing together existing knowledge in practice fields and research; knowledge synthesis:debate and exchange of practitioner insights and messages from research; and knowledge framework: framework creation based on the key elements of evidence-informed best practice. Main findings: The framework centres on four practice domains: reinforcing ethical practices; fostering self-determination; supporting transitions and wellbeing; and mobilising service systems. It incorporates the concept of relational autonomy as a foundation for navigator practice by recognising the nature of relationships and power dynamics in the provision of care, and the central importance of self-determination. Conclusions: A navigation framework is critical for practice guidance and to ensure service navigators and organisations have the capacity to meet the needs of service users and their families. The framework presented in this paper seeks to encourage debate about service navigation, its implementation, and its future in health and human service organisations
A Comparison of Three Payment Systems for Public Paediatric Dental Services
Get PDFObjective: This study investigated the delivery of paediatric (0-17 years) government dental services in New South Wales (NSW), Australia through public dental clinics and the commissioned payments models of Fee-for-Service and Capped-Fee.
Method: De-identified patient data from government provided dental care and the commissioned services was sourced from NSW Oral Health Data Warehouse for evaluation and interpretation using descriptive analysis during the period 1 January 2012 to 31 December 2013.
Result: The breakdown of dental care provided the associated cost analysis for the study’s cohort that resulted in both years, more than 50 percent dental services offered to paediatric patients were preventive care in all payment systems. The most common preventive items offered were fluoride treatment, dietary advice, oral health education and fissure sealants.
Conclusion: There was little difference in the mix of dental care provided between study years and age groups through the three payment systems in NSW. The difference between the government services and those provided via the Fee-for-Service and Capitation payment systems was negligible.
This has important implications for the delivery of dental care to public dental care, particularly when patients may not live close to a public dental clinic and also with the interest nationally in giving patients greater choice
Co-creating and Developing Health Management Theory and Practice: a global opportunity?
Get PDFIn recent years much has been made of the need to effectively translate knowledge developed through research into health systems practice. [1] Literature suggests that the acceptance of research findings would be more likely if the research were achieved and disseminated into practice where it occurs in a more collaborative alignment of researchers and practitioners....
The Sociology of Healthcare Safety and Quality
Get PDFBook review of "Sociology of Health and Illness Monograph" series 
Mainstreaming Human Immunodeficiency Virus (HIV) Insurance in India: Opportunities and Challenges
Get PDFMillions of Indians fall into poverty because of the private high Out of Pocket pattern of health financing, due to the absence of insurance coverage. Conditions like HIV and AIDS also influence poverty due to a lifelongtreatment requirement. Access to insurance coverage (commercial or voluntary) has been denied to People Living with HIV (PLHIV) through various clauses. However lately, there have been certain experiments on inclusion of HIV into new or existing schemes. This paper provides a systematic review of coverage, managerial and financial systems of selected cases of HIV insurance pilots in India with an objective to explore its sustainability and ability to be replicated.
A cross-sectional descriptive analysis of existing literature and in-depth case studies of relevant health insurance schemes were used for the review. Data was compiled using qualitative data collection tools such as in-depth interviews with officials. The schemes were analysed using two frameworks viz. managerial ability and coverage ability. The managerial ability was analysed through a Strength-Weakness-Opportunity-Threat(SWOT) analysis. The coverage ability was analysed through three dimensions viz. a) breadth b) depth and c) height. In India, there are two types of insurance policies vis-à-vis HIV coverage. These were categorised as HIV-specific and HIV-sensitive policies.
Of the seven pilot schemes reviewed, the small-scale health insurance schemes show limited success owing to smaller pool and limited managerial capabilities. The large schemes offer avenues for mainstreaming butpose issues of governance as well as marketing among PLHIVs. The findings of the research identify a specific set of issues and challenges for sustainability and replication from three perspectives viz. a) market, b) cost recovery and sustainability and c) equitable coverage.
Abbreviations: AIDS – Acquired Immune Deficient Syndrome; ART - Anti-retroviral Therapy; BPL – Below Poverty Line; FF-HIP – Freedom Foundation Health Insurance Policy; HIV – Human Immunodeficiency Virus; IRDA – Insurance Regulatory and Development Authority; NGO – Non Government Organisation; PLHIV – People Living with HIV; OI – Opportunistic Infections; OOP – Out of Pocket; RSBY – Rashtriya Swasthya Bima Yojana; STI – Sexually Transmitted Infection; SWOT – Strengths, Weaknesses, Opportunities, Threats; UHC – Universal Health Coverage; UNDP – United Nations Development Program