Asia-Pacific Journal of Health Management (ACHSM)
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Remaking Practices in the Redesign of a Primary Healthcare Program
Get PDFObjective: To develop a detailed account of changed practices in everyday work in the redesign of a primary healthcare program.
Design: The research aimed to produce layered and rich descriptions of the complex and multidimensional remaking of health practices. Empirical data was gathered through ethnographic methods including; interviewing, self-reporting, observation and shadowing. The subjects of the research were involved as active participants in the research design, data gathering and analysis.
Setting: HealthOne was a New South Wales government attempt to provide a local and responsive model to improve chronic disease management in primary and community healthcare settings. We report specifically on the HealthOne program implemented in a suburb of Western Sydney.
Main outcome measures: The research did not aim to evaluate the program but to uncover instances of professional learning though identifying changes in professional practice. These were noted and observed by the researchers and research participants or through reflexive conversations with the program planners, healthcare workers and the research team.
Results: Drawing on the work of a number of learning and practice-based theory writers, particularly those using a socio-material approach, we describe how practice change has occurred and how work practiceshave been remade at this site - especially in the role of the General Practice Liaison Nurse (GPLN).
Conclusions: The research demonstrated the potential for new categories and practices of health work to emerge; this was especially seen in the work of the GPLN but also extended to new ways of working through General Practitioners and community health networks.
Abbreviations: GP – General Practitioner; GPLN – General Practice Liaison Nurse. 
Assessing the Competence of Evidence-Informed Decision-Making Amongst Health Service Managers
Get PDFObjective: Evidence-informed decision-making (EIDM) amongst health service managers has been positively linked to better decision outcome, hence more effective healthcare provision. Efforts to improve EIDM practice are required to meet the current challenging healthcare environment. One key step to improve such practices is skill enhancement. The purpose of the study is the measure the competence of mid-level managers in two Victorian hospitals in applying EIDM in their roles.
Design: The competence of 25 mid-level managers in applying EIDM in their roles was assessed via a 360° process using an online management competency assessment tool (MCAP Tool) and case-study objective assessment tool.
Setting: Mid-level managers working in Victorian hospitals were selected.
Main outcome measures: The competence of mid-level managers in applying the competency of EIDM was assessed. This paper discusses the areas of improvement identified in enhancing the competence of EIDM amongst mid-level managers in the group, organisational and individual levels Results: EIDM is an important competency for health service managers. Managers who participated in the assessment are competent in applying EIDM in their roles, but require guidance and improvements. Strengths and weaknesses of managers in applying EIDM in their roles varied between organisations.
Conclusion: This paper suggests that not only improvement of specific aspects of evidenceinformed decision-making amongst health service managers are required, additional more systematic changes at the organisational and individual management level are essential to achieve competent evidence-informed decision-making practices amongst health service managers.
Abbreviations: CCA – Combined Colleagues; CEO – Chief Executive Officer; EIDM – Evidence Informed Decision Making; OA – Objective Assessment; SA – Self Assessment
Health Assistant in Nursing: a Victorian health service pilot
Get PDFObjective: Develop and evaluate pilot of a new role to support nursing care delivery in hospital settings.
Design: A naturalistic, three-stage pre-post, multimethod pilot design used data collected from hospital administrative datasets, and surveys and focus groups with staff participants.
Setting: Three wards at three hospital sites of a large tertiary health service in Victoria, Australia.
Subjects: Staff performing the new role and registered nurses working on participating wards.
Intervention: Pilot of a new Health Assistant in Nursing (HAN) role.
Main outcome measures: Staff outcomes were work satisfaction and workload of registered nurses; quality outcomes included reported patient falls and medication errors; organisational outcomes included service costs and sick leave.
Results: Work satisfaction and workload of registered nurses remained stable after introducing the new role. The frequency of reported patient falls reduced in two of the three wards. Costing outcomes suggested potential for cost benefits attributed to reduced falls in acute wards.
Conclusions: This pilot identified the new HAN role has capacity to contribute to improved patient quality and safety outcomes without compromising nurse job satisfaction and workload. Potential cost benefits of thenew role warrant further consideration in the acute care sector.
Abbreviations: CPO – Constant Patient Observer; CSN – Clinical Support Nurse; HAN – Health Assistant in Nursing. NWSQ – Nursing Workplace Satisfactio
Building a Culture of Health
Get PDFCommentary and published research on the value of healthcare has become more evident in recent times. There has been a noticeable shift from the focus on efficiency of health systems and practice to a greater focus on what effectively works, or more so, what doesn’t work. Health delivery systems struggle with increased demand on existing services and other health priorities remain underserviced. What do we need to do to better examine and understand what delivers value to people, communities, the health system and at the same time improves health outcomes? .......
Healthcare Workforce in Indonesia
Get PDFIntroduction: Imbalanced distribution of healthcare providers between urban and rural areas is one of the difficulties facing health service provision in Indonesia. Several regulations have been made by the governmentto solve the problem. The objective of this paper is to describe the provision of human resources for healthcare services in Indonesia.
Methodology: A review of medical related electronic databases, CINAHL and Ovid MEDLINE, was undertaken from their commencement date until the end of January 2017. The grey literature from the Indonesian government, the World Health Organisation and the World Bank websites was also searched.
Results: There were 92 articles identified from the CINAHL and 222 articles from the Ovid MEDLINE databases. Five articles were included from the two databases and five documents from grey literature with ten articles to be reviewed.
Discussion: Nurses and midwives account for the largest proportion of healthcare providers in Indonesia. The ratio of healthcare providers in Indonesia is lower than the average of South-East Asian and other lower middle income countries. More than half of the healthcare providers in Indonesia provide care in community health centres. Several regulations have been proclaimed to improve the imbalanced proportion of healthcare providers across the country.
Conclusion: Indonesia continues to develop strategies towards successful distribution of healthcare providers across the country. A study investigating the impact of the programs reducing the imbalanced distribution of healthcare providers on health outcomes is essential for Indonesia
Health Workers’ Perspectives on Infrastructure to Support Maternal Health Services in Rural Areas of Vietnam
Get PDFBackground: One common governance issue faced by developing countries is the establishment and maintenance of infrastructure to support the delivery of primary health services. This qualitative study explores the perspective of maternal health workers on how infrastructure impacts the provision of maternity services in rural areas in Vietnam.
Methods: Forty-one health workers and health managers at the commune, district and provincial levels of the Vietnamese public health system were interviewed. Questions focused on the impact of various organisational factors, including the impact of infrastructure on the performance of the health workforce, which provides publicly funded primary care. All interviews were recorded, transcribed and coded for thematic analysis.
Findings: Participants noted that infrastructure directly affected their ability to perform certain tasks and could both directly and indirectly negatively impact their motivation. In general, participants noted a lack of investment in infrastructure for the provision of primary care services in rural areas. They identified that there were deficits in the availability of utilities and the adequacy of facilities.
Conclusion: This research contributes to understanding the barriers to the provision of primary care in developing countries and in particular. The current inadequacy of facility buildings and inadequacy of clean water supply are issues for health workers in meeting the technical requirements of the standards as set out in the National Guidelines on reproductive health, and lead to safety concerns for the quality of maternal health services provided in commune health centres and District Health Centres.
Abbreviations: CHC – Commune Health Centres; DHC – District Health Centre; HW – Health Worker
Identifying and Ranking Areas of Relative Need for New Public Dental Clinics Using a State-of-the-Art Data Simulation Approach
Get PDFBackground: Lower socioeconomic groups and country residents are more likely to experience dental disease. Previous research has found that it is generally more cost effective to provide subsidised dental care through publically employed dentists when compared to subcontracting the work out to the private sector.
Objective: The primary objective of this study was to identify and rank areas of relative need for new public dental care facilities across Australia. The secondary objective was to gauge how many of these areas arelocated in the vicinity of an existing public hospital (medical) with a view to utilise existing infrastructure for future service rollout.
Methods: Usual resident population, employment status and socioeconomic distribution data was downloaded from the Australian Bureau of Statistics website at Statistical Area 1 level. A mathematical weighing formula was applied to those variables, which subsequently allowed for ranking of the results based on magnitude of the product values. The findings were considered in terms of proximity to existing public health infrastructure.
Results: A total of 49 SA1 areas were identified and preselected as potential sites for new public dental clinics across Australia. Eighty per cent of the identified areas of relative need were located outside metropolitanareas. Fifty per cent of those were found to be in close proximity to an existing public hospital (medical).
Conclusion: Offering subsidised dental care through existing public hospitals may be an option. Such an approach has a potential to improve access to subsidised dental care in regional centres while minimising capitalexpenditure on infrastructure.
Abbreviations: ABS – Australian Bureau of Statistics; ASGS – Australian Statistical Geography Standard; SEIFA – Socio-Economic Indexes for Area
Entry Points to the Health System: a review of the emerging community models for management of non-life threatening urgent conditions relevant to Australia
Get PDFProblem: The number of presentations to Emergency Departments (EDs) is increasing at levels above population growth rates and these increases are becoming unsustainable.
Objective: To review evidence for emerging entry points to the health system for patients with non-life threatening urgent conditions (NLTUC) in order to consider more effective healthcare services in Australia.
Methods: An in-depth review of the Emerald, Medline, CINAHL, Web of Science, Proquest Business and Medical databases from January 2005 to April 2016 matching ‘acute care’ or ‘urgent care’ with general practice andother health providers found thirteen entry point models with five currently relevant to Australia.
Results: Studies examining five emerging entry points were found including urgent care community pharmacy, new prehospital practitioner community care, advanced nurse enhancement of primary care, designated urgent care clinics and integrated primary care centers. Evidence for these emerging models of community healthcare is presented including emerging initiatives, cost implications, subsequent admission to hospital, satisfaction, mortality, care, treatment time, subsequent referrals, testing and health outcomes.
Conclusion: These emerging models of community healthcare need to be trialed and studied in the Australian context to evaluate whether they provide patients with NLTUC with a safe cost-effective option with similar outcomes to EDs. Implementation of these models can be examined further to determine their effectiveness in potentially reducing the increasing rate of presentation to EDs.
Abbreviations: APCN – Advanced Primary Care Nurse; ECP – Emergency Care Practitioners; ED – Emergency Department; GP – General Practitioner; IPCC – Integrated Primary Care Centre; PP – Paramedic Practitioners; NLTUC – Non-Life Threatening Urgent Conditions; UCC – Urgent Care Clinics; UCCP – Urgent Care Community Pharmacy
Leadership in Allied Health: A Review of the Literature
Get PDFBackground: It is well established that effective clinical leadership improves the quality of healthcare service provision and promotes leadership outcomes. [1,2] Leadership capacity and capability of allied health professionals is needed for successful clinical service provision, [3] but less is known about allied health leadership than about other clinical groups.
Aims: The literature review aimed to identify research about leadership and leadership development of allied health practitioners in healthcare settings.
Methods: A database review was undertaken using SCOPUS, CINAHL, Medline and Business Elite databases from December 2014-September 2015. Three leadership journals were also hand searched. A total of 1665 articles were identified. These were scanned and 129 articles were retrieved with 70 articles shortlisted for indepth review.
Results: After application of inclusion and exclusion criteria, seven journal articles were included in the literature review. Review of the studies identified two areas of primary focus: leadership styles and outcomesand leadership development programs.
Conclusions: Findings showed that there are currently a limited number of robust published reports in relation to leadership and allied health practitioners. Implications for Practice: Well-designed research studies to further evaluate leadership skills of allied health practitioners as well as to determine the effectiveness of leadership programs in developing transformational leaders are required.
Abbreviations: CASP – Clinical Appraisal Skills Program; NHMRC – National Health and Medical Research Council