Asia-Pacific Journal of Health Management (ACHSM)
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The importance of the Physical Environment for Child and Adolescent Mental Health Services
Get PDFObjective: 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 thencorrelated 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).
Abbreviations: CAMHS – Child and Adolescent Mental Health Services
Factors Affecting Hospital Choice Decisions: an exploratory study of healthcare consumers in Northern India
Get PDFThis 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
Making Hospital Governance Healthier for Nurses
Get PDFThe 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 withlocal 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.
Abbreviations: NPM – New Public Management; PCA – Principal Components Analysis
The Language of Health Reform and Health Management: critical issues in the management of health systems
Get PDFHealth 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.
Abbreviations: DNOP – Distributed Networks of Practice; MDG – Millennium Development Goals; PHC – Primary Healthcare; PHN – Primary Health Network; SDG – Sustainable Development Goals; SEDOH – Social Economic Determinants of Health; SHAPE – Society for Health Administration Programs in Education
A Review of the ACHS Clinical Indicator Program after 20 years
Get PDFThe 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.
Abbreviations: ACHS: Australian Council of Healthcare Standards; ACIR – Australasian Clinical Indicator Report; ANZICS – Australian and New Zealand Intensive Care Society; APD – Adult Patient Database; CI – Clinical Indicators; HCO – HealthCare Organisation; PIRT – Performance Indicator Reporting Tool; RACMA - Royal Australian College of Medical Administrators
Responding to the call for Innovation: How do we develop health professional’s skills and operationalise innovation?
Get PDFIn a recent online open forum of the Association of University Programs in Health Administration (AUPHA) two of our American colleagues were discussing the need for a greater focus in health management curricula on ‘transformation’. [1] They indicated that some time ago the American College of Healthcare Executives identified key skill areas for healthcare leaders as ‘operational, people, and transformation’, suggesting that good progress and focus on the first two had been achieved while more focus on the third was required. The discussion suggested that ‘the area of transformation’ needed to ‘specifically include skills in intrapreneurship and also innovation’. ...
Developing and Implementing a Framework for System Level Measures: lessons from New Zealand
Get PDFBackground: 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.
Abbreviations: CMH – Counties Manukau Health; DHB – District Health Board; IHI – Institute for Healthcare Improvement; QI – Quality Improvement; SLM – System Level Measure
Towards More Meaningful Measures in Healthcare
Get PDFMost 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.
Abbreviations: KPI – Key Performance Indicator; SLM – System Level Measures
Federalism and Australia’s National Health and Health Insurance System
Get PDFWhile 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 Australianhealth 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 thereis 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.
Abbreviations: COAG – Council of Australian Governments; NHHRC – National Health and Hospitals Reform Commission; PHI – Private Health Insurance; VFI – Vertical Fiscal Imbalance
Health Systems in Australia and Four Other Countries: choices and challenges
Get PDFThe 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.
Abbreviations: GDP – Gross Domestic Product; HDI – Human Development Index