Asia-Pacific Journal of Health Management (ACHSM)
Not a member yet
640 research outputs found
Sort by
Correlations and Organisational Effects of Compensation and Benefits, Job Satisfaction, Career Satisfaction and Job Stress in Public and Private Hospitals in Lucknow, India
Get PDFThe present study compares the organisational effect of compensation and benefits in public and private hospitals. It was observed that private hospital employees were more satisfied with their compensation and benefits as compared to the employees of government hospitals. Furthermore, the employees who were satisfied with their compensation and benefits were also found to be satisfied with their jobs.
Abbreviations: HR – Human Resources
Improving the Health System with Performance Reporting – Real Gains or Unnecessary Work?
Get PDFAim: This paper will discuss current approaches to performance reporting and whether there are real benefits to healthcare organisations or whether it is a time consuming activity that adds little to improving quality healthcare and organisational performance. Most importantly, this paper will argue that performance reporting will not prevent another major healthcare scandal, such as that seen at Bundaberg Hospital or NHS Mid Staffordshire Trust. The paper will also outline learnings for Australia from other health systems where performance reporting is part of management practice.
Approach: While performance reporting is largely designed to increase the efficiency and effectiveness of healthcare organisations, this paper will explore the approach from a practical managerial perspective.
Context: This paper explores performance reporting across a range of Australian healthcare organisational settings to highlight differing approaches to improving performance.
Main findings: Performance reporting can be an effective tool to improve organisational performance. For performance reporting to be successful, managers and clinicians need to work collaboratively to identify areas for performance improvement and useful measures to address these. Additionally, organisations must choose a meaningful suite of measurements that can help drive performance improvement. Real time performance reporting, such as through performance dashboards, provides managers with the opportunity to make timely, incremental improvements. Finally, performance reporting must be done in a way that does not detract from providing safe, quality patient care.
Conclusions: Performance reporting can be a useful management tool for healthcare organisations, however organisations must consider timeliness of performance reporting and select a number of measurements that have impact for their given facilities and avoid the wholesale analysis of data that has little opportunity to improve practice or performance.
Abbreviations: LHN – Local Health Network; NEAT – National Emergency Access Targets; NHPA – National Health Performance Authority
Using Linked Lung Cancer Registry and Hospital Data for Guiding Health Service Improvement
Get PDFObjective: To use linked NSW Cancer Registry and hospital lung cancer (LC) data for raising discussion points on how to improve outcomes.
Design: Historical cohort – cases diagnosed in 2003-2007.
Setting: New South Wales, Australia
Outcome Measures: Relative odds (OR) of localised disease and resection of non-small cases (NSCLC) using multiple logistic regression. Comparisons of risk of NSCLC death using competing risk regression.
Findings: (1) Older patients have fewer resections of localised NSCLC [adjusted OR 95% CLs; 80+Vs <60 years; 0.20 (0.14, 0.28)]. Cases with co-morbidity have fewer resections [adjusted OR, 0.74 (0.61, 0.90)] and have more conservative resections. Question: Is there the best balance between resection and avoiding surgery to accommodate frailty and co-morbidity? (2) Compared with public patients, the health insured: have higher odds of localised LC [adjusted OR, 1.23 (1.12, 1.35] and resection for localised NSCLC [adjusted OR, 2.08 (1.70, 2.54)]; are more likely to have lobectomies than wedge/segmental resections (p<0.001); and have a lower risk of LC death [adjusted SHR, 0.89 (0.85, 0.93)]. Question: Are there opportunities for improving publicpatient outcomes? (3) Patients born in non-English speaking countries have lower odds of localised disease [adjusted OR, 0.88 (0.79, 0.99)]. – Question: Could this difference be decreased by reducing cultural and language barriers? (4) Cancers of pulmonary lobes rather than the main bronchus pose lower risks of LC death. Question: Could outcomes for main bronchus cancers be improved by up-skilling or referral to higher-volume centres? (5) Greater extent of disease is strongly predictive of case fatality – Question: Could LC deaths be reduced by earlier treatment? (6) Use of lobectomies varies – Question: Could survival be increased through greater use of lobectomies for localised NSCLC?
Conclusions: Linked cancer registry and hospital data can increase system-wide understanding of local health-service delivery and prompt discussion points on how to improve outcomes.
Abbreviations: APDC – Australian Patient Data Collection; CHeReL – Centre for Health Record Linkage; EOD – Extent of Disease; LC – Lung Cancer; NSCLC – Non-Small Cell Cancers; NSWCR – New South Wales Cancer Registry; OR – Relative Odds; SEIFA – Socio-Economic Index for Areas; SES – Socio- Economic Status
Equitable Care for Indigenous People: every health service can do it
Get PDFProblem and its context: Indigenous peoples in many countries suffer poorer health and poorer access to good healthcare than their non-Indigenous counterparts. In Australia, enduring barriers to good health and good healthcare remain, in spite of long-standing policy priorities. These barriers include the ongoing reality of colonisation, and silence about its implications. People working in and using the health system need to relate across cultures, but they approach this endeavour witha complex mixture of goodwill, defensiveness, guilt and anxiety.
Methods: We analysed what is known in Australia about differentials in access to good care, and the underlying factors that entrench them, as well as strategies for developing mainstream competence in care for Aboriginal and Torres Strait Islander patients and communities.
Analysis and Conclusions: The available evidence of differentials in access and quality that are not explained by clinical or demographic variables is unequivocal. Official policy needs to be implemented at the system and organisation level through operational policies, programs and protocols, and through relationships with Aboriginal healthcare providers and community organisations. The concept of racism anxiety provides a way of making one important barrier visible, and moving beyond it can enable people of goodwill to ‘see’ where change is needed, and to see themselves as part of the solution. It is time to get beyond the barriers and attend to practical improvements in care, focused on the care system, not simply on the skills and knowledge of individuals within it.
Abbreviations: ACCHO – Aboriginal Community Controlled Health Organisation; CC – Cultural Competence
What Problem is Being Solved? ‘Preventability’ and the Case of Pricing for Safety and Quality
Get PDFOne of the critical issues facing healthcare systems internationally is to improve safety of care. Unfortunately, safety discussions, both in hospitals and in policy documents, often quickly turn to identifying and acting on ‘preventable’ mishaps. But preventability is a slippery concept, which this paper discusses. A contemporary policy response is to introduce financial incentives in hospitals and/or states to improve safety, proposed for national implementation in Australia from 1 July 2017. This has the potential to change the internal dynamic of hospitals to enhance the focus on safety. The implications for hospitals of this change are also discussed.
Abbreviations: COAG – Council of Australian Governments
Development of a Consumer Engagement Framework
Get PDFObjective: The purpose of this project was to develop a Consumer Engagement Model to plan for effective baby boomer engagement to inform policy makers in the healthcare system. This is the first stage of that process.
Design: Initial model development for healthcare systems based on literature review and author group experience in evidence-based practice and research, and consumer advocacy and engagement.
Setting and population: South Australian health and community service systems, and healthcare professionals that work with baby boomers.
Findings: To develop an evidence-based Consumer Engagement Plan, it is recommended that policy makers undertake the four steps outlined in this document to design a question, determine consumer and community segments and scope of engagement, determine the breadth and depth of engagement and address the implications, assess risk and develop strategic partnerships to ensure the Plan is evidencebased,reasonable and achievable.
Conclusions: We believe this process provides a framework for planning consumer engagement and for implementation, monitoring, evaluation and review of consumer engagement for policy excellence. We propose to undertake a validation of the model thus populating the model with examples of practice-based strategies and revising the model accordingly.
Abbreviations: EBP – Evidence-Based Practice; IAP2 – International Association of Public Participation; PIO – Patient Intervention and Outcome
The Tyranny of Size: challenges of health administration in Pacific Island States
Get PDFThere is great diversity among Pacific Island states (n=22) in geography, history, population size, political status, endemic disease, resources, economic and social development and positions in the demographic and health transitions and their variants. Excluding Papua New Guinea, all Pacific states are less than one million, and half of them (11) are less than 100,000.
Smallness also means fewer resources available for health, even if percentage allocations are similar to larger countries, and a disproportionate amount may derive from international aid.
Specialisation is not cost-effective or even possible in clinical, administrative or public health domains in small populations, even if resources or personnel were available, since such staff would lose their skills. In instances where only one to two staff are required, retirement or migration means decimation of the workforce.
Training doctors within the Pacific Island region provides appropriately trained personnel who are more likely to remain, including those trained in the major specialities. Nursing training should be in-country, although in very small entities, training in neighbouring states is necessary.
Outmigration is a significant issue, however, opportunities in Pacific Rim countries for medical doctors are contracting, and there is now a more fluid workforce among Pacific health personnel, including those resident in Pacific Rim countries.
International and regional agencies have a disproportionate influence in small states which can mean that global policies intended for larger polities are often promulgated inappropriately in small Pacific states.Smallness also leads to strong personal relationships between health staff, and contributes to teamwork, but can also create issues in supervision.
Small health services are not just scaled-down versions of large health services; they are qualitatively different. Smallness is usually intractable, and its effects require creative and particularistic solutions involving other more endowed Pacific states and Pacific Rim countries.
Abbreviations: NCD – Non-Communicable Disease; NGOs – Non Government Organisations; ODA – Overseas Development Assistance; TFR – Total Fertility Rate
Assessing the Adoption of a Home Health Provisioning System in India: an analysis of doctors’ knowledge, attitudes and perceptions
Get PDFBackground: Unlike developed countries, home healthcare provision systems (HHPS) are not widely prevalent in developing countries like India. Our objective was to study the knowledge, attitudes and perceptions of doctors in India about the adoption of HHPS.
Methods: Our survey included 180 doctors across India, working in local hospitals. Using online and paperbased questionnaires, we used bar charts and pie charts to represent the frequency distributions. We also conducted multivariate logistic regression analysis to understand the importance of the selected factors upon the dependent variables of interest such as willingness to work during non-office hours, desire for increased remuneration, and willingness to enrol in HHPS.
Results: The desire for an increase in remuneration made doctors more willing to enrol in HHPS. Possible reasons for doctors to enrol included the ability to answer follow-up queries through email or video chat and HHPS being integrated with the local healthcare system in the hospital. Young male doctors were most likely willing to provide services through HHPS during nonoffice hours as compared to females. A large majority of doctors indicated hospital visits to be important for follow-up queries, but several doctors indicated that simple patient queries could be addressed by nonpersonal interactions like video chat or email.
Conclusions: The desire for extra remuneration could be the primary reason for the willingness of doctors to work during non-office hours and thus enrol in HHPS. The majority of doctors considered hospital visits to be important, but several doctors also indicated that nonpersonal interactions using text messages, telephone, email and video chat might serve as important methods to respond to simple follow-up queries from patients.
Abbreviations: EMR – Electronic Medical Record; HHPS – Home Help Provisioning Systems; ICT – Information and Communication Technology; ISO – International Organisation for Standardisation
Are Clinical Registries Actually Used? The Level of Medical Staff Participation in Clinical Registries, and Reporting within a Major Tertiary Teaching Hospital
Get PDFClinical Registries are established to provide a clinically credible means for monitoring and benchmarking healthcare processes and outcomes, to identify areas for improvement, and drive strategies for improving patient care. Clinical Registries are used to assess changes in clinical practice, appropriateness of care and health outcomes over time. The American Heart Association Policy Statement in April 2011 called for expanding the application for existing and future Clinical Registries, with well-designed Clinical Registry programs. Concurrently, in Australia, and similarly within the United States and United Kingdom, there has been an increased focus on performance measurement for quality and patient safety. Within Victoria, the Victorian Clinical Governance Policy Framework outlines clinical effectiveness as one of the four domains of Clinical Governance
As Clinical Registries evaluate effectiveness and safety of patient care by measuring patient outcomes compared with peers, the use of Clinical Registries data to improve a health service’s quality of care seems intuitive. A mixed methods approach was utilised, involving (1) semi-structured interviews and (2) documentation audit in this study conducted at Austin Health, a major tertiary teaching hospital in North-Eastern metropolitan Melbourne, affiliated with the University of Melbourne and various research institutes within Austin LifeSciences.
Although many studies have highlighted the benefits of data collected via individual Clinical Registries, [5,6] the level of voluntary medical staff participation in Clinical Registries at a health service level is yet to be established. The aim of this study was to document the level of medical staff involvement for Clinical Registries within a major tertiary teaching hospital, and the level of reporting into Quality Committees within the organisation.
This study demonstrates that along with a very high level of medical staff participation in Clinical Registries, there is a lack of systematic reporting of Registries data into quality committees beyond unit level, and utilisation of such data to reflect upon practice and drive quality improvement.
Abbreviations: CREPS – Centre for Excellence in Patient Safety; CSU – Clinical Services Unit; HOU – Heads of Unit; VASM – Victorian Audit of Surgical Mortality