Asia-Pacific Journal of Health Management (ACHSM)
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The Desirability of Zero Tolerance for Procrastination
Get PDFI choose the desirability of zero tolerance for procrastination as my topic because I have seen so many opportunities lost in health and medicine because of delays in taking action. Procrastination ranks alongside shortage of cash as an explanation of things not being done. It is, quintessentially, bad management
Introduction of the Community Rehabilitation Northern Queensland Service
Get PDFObjective: To analyse trends in length of hospital stay before and after the implementation of the Community Rehabilitation Northern Queensland Service (CRNQ) in Townsville, Australia.
Design: Retrospective analysis of collected administrative data provided by the data custodian Townsville Hospital Health Service District.
Setting: All patients discharged from the Townsville hospital between 1 July 2008 and 30 June 2013 for whom the Australian Refined Diagnosis Related Groups were stroke (B70), degenerative nervous system disorders (B67) or rehabilitation (Z60).
Main outcome measures: Average length of stay and total number of inpatient episodes coded stroke, degenerative nervous system disorders or rehabilitation.
Results: Length of stay for the selected diagnosis related groups was consistently ranging from 23 days to 25 days for the period 2008-2012. In the first year of full operational capacity of CRNQ (2012-13), there was an average reduction of six days in length of stay. The major reductions in length of stay occurred in patients admitted for rehabilitation care.
Conclusions: This study adds additional evidence that earlier discharge can be facilitated for patients with neurological conditions living outside metropolitan areas when appropriate rehabilitation services are available in the community.
Abbreviations: AR-DRG – Australian Refined Diagnosis Related Groups; CRNQ – Community Rehabilitation Northern Queensland Service
A Recipe for Success: localism and bounded rationality in lobbying for radiation therapy services in North West Tasmania
Get PDFObjective: Describes where bounded rationality and localism are evident in the debate over the introduction of radiation therapy services in North West Tasmania and how this affected the delivery of the message fromeach side.
Design: Semi-structured interviews with stakeholders and patients/family over an eight month period in 2016 are contrasted with viewpoints identified via document analysis.Setting: North West Tasmania.
Main Outcome Measures: The mechanisms for policy change and the policy beliefs of each side are examined with the intention of understanding how bounded rationality and a sense of localism can combine to effectpolicy change.
Results: In the instance of radiation therapy services in North West Tasmania, a policy debate was originally waged between medical professionals and policy makers opposed to a local service on one side and a handful of policy actors advocating for a local service on the other. Those in favour of a local radiation therapy service harnessed a sense of localism to project the perception of widespread community support for the proposal and secured funding commitments during the 2010 Federal Election campaign.
Conclusions: There is evidence of bounded rationality from both the stakeholder and patient groups, as well as a strong sentiment of localism expressed by patients and community advocates. Through understanding this particular case, health service managers can determine how to better time and target messages to the general public and to policy makers during periods of proposed changes to health services
Attracting Future Health Workforces in Geographically Remote Regions: perspectives from current remote health professionals
Get PDFObjective: The aim of this study was to identify what has previously attracted health professionals to work in geographically remote regions, to identify the incentives that managers are currently using to attract health professionals to remote regions, and to determine whether they are comparable.
Design: This article examines the data from two separate, yet complementary, research studies. The first study used qualitative methods to investigate why health professionals choose to work in geographically remote regions through current remote health workforces. The second study investigated whether information communicated through recruitment advertising contained information congruent with the themes that attracted the current remote health professionals through a content analysis of recruitment advertisements. The findings from these two studies are then compared and contrasted and Psychological Contract Theory is used to examine the implications for health service managers.
Setting: This study was conducted in northern Australia, a remote tropical setting with geographically challenging working conditions.
Results: The findings revealed that recruitment advertisements contained information comparable with the themes that had attracted health professionals to work in remote regions. Most importantly, they highlight opportunities to better align recruitment practices, and provide insight into how unrealistic expectations lead to psychological contract breaches.
Conclusions: This study found that while recruitment advertisements are using appropriate content to attract health professionals to remote regions, there is considerable scope for improvement so that attraction translates into improved retention
Effects of Clinical Placements on Paramedic Students’ Learning Outcomes
Get PDFBackground: Clinical placements are of major importance in students’ learning processes through creating supportive environments and fostering independence into paramedic professional roles. The study aimed to explore whether clinical experiences in out-of-hospital emergency services affected students’ learning outcomes and satisfaction.
Methods: A retrospective study was carried out using preceptors’ evaluations (n=160) and students’ feedback forms (n=21). Descriptive and non-parametric inferential statistics were used to analyse quantitative items, and open-ended questions were analysed using content analysis.
Results: Findings showed that more than 70% of students were satisfied with the quality of preceptors and the fieldwork atmosphere. Preceptors reported that students’ clinical skills across all categories improved significantly in the last two weeks of training. Qualitative data indicated that students displayed appropriate behaviour and professional socialisation and were keen to learn, and demonstrated competence in paramedicskills.
Conclusion: A supportive atmosphere and positive student–preceptor relationships are key attributes for clinical placements if students are to accomplish learning outcomes in out-ofhospital environments
The Influence of Politics on Accountability of Health Professionals in Bangladesh: An Analysis of the Quality of Health Service Delivery
Get PDFThis study explored the role and responsibility of elected officials including political actors and addressed the factors of politics, decentralisation, bureaucratic management, and political commitment to understanding accountability in health service delivery. This study used qualitative case studies for which a total of 68 in-depth interviews and five focus group discussions were conducted in two areas of rural and urban Bangladesh. The findings show that political actors have poor commitment to improving accountability and healthcare delivery. The elected officials are not interested in organising regular meetings and they are even reluctant to organise a health service committee to make health officials accountable. The opposition political parties have no participation in health service organisations as the existing political culture does not allow it. Moreover, elected officials have a limited administrative authority because of an inadequate decentralised health system that leads to poor accountability and inadequate healthcare delivery. Further, bureaucrats want to capture power and are unwilling to decentralise the health system. The policy recommendation includes the decentralisation of healthcare provision and increased participation of elected representatives in a decentralised system.
Abbreviations: ADP – Annual Development Plan; MP – Member of Parliament; NGO – Non Government Organisation; UHC – Upazilia Health Complex; UP – Upazilia Parishad
Beyond the Numbers: on the road to achieving public value in community support organisations
Get PDFObjective: To explore public value as a management tool for measuring outcomes, in Community Support Organisations (CSOs) and determine if further research is warranted.
Design: A literature review on public value and outcome measurement in the community service sector was conducted to evaluate how public value best fits with CSOs.
Setting: Public value has not previously been applied to measuring outcomes in CSOs and could provide beneficial information to assist in obtaining government funding as fiscal resources decline.
Main outcome measures: The following question was considered; Can a public value framework be used as a management tool by CSOs to measure the value of their service? A flow chart applying a public value framework to outcome measurement of CSOs was developed.
Results: Key elements identified were indicators, measures and outcomes. Stakeholders included; government, community sector, CSOs and consumer. A public value framework has the potential to be used for measuring outcomes in the community sector however realworld application is still required.
Conclusion: This study provided preliminary application for a larger study and has provided evidence of a public value framework having the potential to be applied as an outcome measurement tool for CSOs.
Abbreviations: CSO – Community Support Organisatio
Flexible, Capable, Adaptable: A Dynamic Allied Health Workforce
Get PDFObjective: The Allied Health Executive at a major Metropolitan Health Service was experiencing an increasing number of flexible work requests and was keen to ensure that local and legislative requirements were met, our highly skilled and specialist staff were supported to remain in the workforce as their life outside work changed and the operational demands of a bed-based service delivery model were not negatively impacted.
Design: A root cause analysis was completed identifying three main contributing factors for the current, adhoc approach to flexible work requests. Current and past flexible work participants were surveyed, along with their managers and the Nurse Unit Managers of the clinical work areas. A literature review and environmental scan regarding frameworks for decision making for and supporting flexible work requests was undertaken.
Findings: There was a lack of consistent information as to how to establish and manage a flexible work request. There had been an historical view that flexible work requests were difficult to operationalise and there were missed experiences with flexible work arrangements for the people involved, their managers and their colleagues.
Outcome measures: The combined data was then utilised to develop a framework to support decision-making around whether a role could operate as a flexible work arrangement. A framework on how to best support the staff considering and entering into these arrangements to ensure all the benefits of a flexible work arrangement are realised and many of the challenges minimised was also developed.
Conclusion: Flexible work arrangements should be considered in appropriate circumstances, and will have the best opportunity for success when supported by a consistent, evidenced-based framework.
Abbreviations: EFT – Equivalent Full Time; RCA – Root Cause Analysis
The Cost of Waiting on an Orthopaedic Waiting List: a scoping review
Get PDFBackground: Approximately 30% Australians suffer from arthritis and other musculoskeletal disorders. From 2003-2033 there is a predicted 223% increase in expenditure on health management of musculoskeletal disorders. There is evidence of increasing prevalence of orthopaedic complaints, in longer waiting lists for specialist consultations in public hospital outpatient clinics. Little is known about the costs and ramifications of waiting for orthopaedic consultations.
Aim: Establish what is known about the direct and indirect costs of being placed on a waiting list for an orthopaedic consultation.
Method: Patient and Outcome search strategy of Medline, Embase, Pubmed, NHS Economic evaluation database (NHS-EED) from each database inception date. Handsearching of reference lists of included papers alsooccurred. A realist synthesis framework underpinned the review, using a ubiquitous patient journey to map available literature on the impact of waiting. Hierarchy of evidence was reported using NHMRC criteria andarticles critically appraised using either the PEDRo or CASP criteria (relevant to the design). A purpose-built data extraction instrument was developed.
Results: We identified 786 studies, of which 139 were relevant, including a systematic review (Hoogeboom et al) with 15 included articles which were added to the list of eligible papers (and the review itself deleted), leaving 153 included articles; 17 were relevant to the review. Fourteen papers reported on quality of life and four reported on costs, two of these papers reported on both and all were of low to moderate quality. The research was not based on a comprehensive understanding of the stages of waiting, and there were inconclusive outcomes for quality of life and cost.
Conclusion: There is scant evidence of the impact on quality of life and costs of waiting for orthopaedic outpatient appointments. Future research should aim for improved methodological quality and use patientfocused quality of life measures, and validated measures of cost.
Abbreviations: NHMRC – National Health and Medical Research Council; PROMS – Patient Related Outcome Measures; QoL – Quality of Life; WOMAC – Western Ontario and McMaster Universities Osteoarthritis Index; YLD – Years Lived With Disabilit