bluuebunny/crossref_metadata_2025 huggingface dataset:
Book review: Community Nursing in Australia
Authors: Day Gary
Published: February 2010

THIS BOOK AIMS to be a comprehensive insight
into community nursing in Australia. The text
largely achieves this claim and in doing so has
provided one of the first texts of its type contextualised
specifically at Australian community
nursing issues.
The book comprises 24 well organised and
clear chapters around the three primary elements:
the organisation of community nursing in Australia;
the rapidly changing environment of community
health delivery; and the specific practice
elements of community nursing care. The chapters
are well set out and include a focussed
conclusion that really distils the essential elements.
The text makes appropriate use of case
studies, and scenarios add to the quality of the
overall product.
One area that could have been given more
prominence would have been a specific chapter
on issues concerning the community nursing care
of Australia?s Indigenous population, as well as a
chapter on community nursing approaches to
stigmatised and marginalised groups. While reference
is made to these groups within other chapters,
it may have been more powerful had
chapters been specifically
written on these groups.
Despite this, there is a lot to
like about this Australiancentred
nursing text. In addition
to what you would routinely
expect to find in a text
on community nursing, the
book includes chapters on
risk management; organisation
culture and organisational
change; the changing professional role of
community nursing; and the changing focus of
research.
Overall, the book is easy to read and provides
an excellent overview of community nursing in
Australia. Additionally, as outlined earlier in this
review, the text takes the reader further than what
you would expect from a book of this nature. The
book would suit a wide variety of readers, from
those wanting a greater understanding of the
complexities of nursing in the community to
nurses working in a range of community health
settings.
Editorial: Models of Care
Authors: Yarmo-Roberts Deborah
Published: February 2010

TWO ARTICLES ARE FEATURED in this AHR issue?s
Models of Care section. The first article by May and
colleagues entitled ?Integrated models or mayhem?
Lessons learnt from three integrated primary health
care entities in regional New South Wales? reviews
integrated general practices and conceptualises a
model to explain how integrated service might best
function. (page 595)
The second article by Coombe and colleagues is
?Community-governed health services in Cape
York: does the evidence point to a model of service
delivery?? (page 605) The article reviews the literature
on community governance models and community-
controlled health service delivery models
and their application to service delivery in Cape
York.
Integrated models or mayhem? Lessons learnt from three integrated primary health care entities in regional New South Wales
Authors: May Jenny , Cooper Rodney , Magin Parker , Critchley Anthony
Published: February 2010

While ?integration? may be a policy imperative at
present, the reality of integrating services whilst
managing the business of service delivery and
best patient outcomes is both challenging and
unfamiliar territory for most general practitioners.
Recent policy changes in general practice have
challenged traditional financial and governance
models. This paper reviews three integrated general
practice entities, all under the auspice of the
University of Newcastle, for commonalities and
concerns. A model was conceptualised and key
factors identified and discussed. These factors
included careful selection of partners, elucidation
of the level of integration and the need for a lead
champion to promote the changed environment.
The financial and clinical governance systems
needed to be clearly delineated, including the type
and priority of service delivery intended. Integration
is not a blanket solution but may be useful for
patients with chronic and complex health problems.
Being resource-intense, it may not be available
or appropriate for all. The practical realities of
workforce however, and the political and funding
environment are likely to dictate how GP practices
in the future embrace integration.
Strengthening the link between policy formulation and implementation of Indigenous health policy directions
Authors: Matthews Anna , Jackson Pulver Lisa R , Ring Ian T
Published: February 2010

This study aimed to understand the problems
within the Indigenous health policy process in
Australia and how weaknesses in the process
impact on policy implementation. Using semistructured
questions, 23 key stakeholders in the
policy-making process were interviewed. Three
main themes dominated; a need for increased
Indigenous involvement in policy formulation at
the senior Australian Government level, increased
participation of Indigenous community-controlled
health organisations in the policy-making process
and, most importantly, ensuring that policies have
the necessary resources for their implementation.
The emergence of these specific themes demonstrated
weaknesses in policy process from the
formulation stage onward. Tackling these would,
according to our informants, significantly enhance
the effectiveness of the policy process and contribute
to further improvement of the health of
Indigenous Australians.
The national Indigenous health performance measurement system
Authors: Anderson Ian P , Anderson Marcia , Smylie Janet
Published: February 2010

This article reviews the development of the
national Indigenous performance measurement
system over the last decade. Data were collected
from the published and unpublished literature and
review of government websites, facilitated by key
informant interviews which provided information
about the policy context. A number of innovations
have occurred over the last decade, including the
development of a conceptual framework to underpin
a system-wide approach to performance
measurement that is aligned with nationally
agreed strategic goals. The development of
mechanisms to oversee Indigenous health strategy
and health data development create formal
mechanisms that potentially link data development
and performance measurement priorities.
Innovation in the development of processes to
support health system performance improvement
is evident, but this needs to be prioritised, particularly
with respect to those components of the
health system that are not Indigenous-specific.
Eye health programs within remote Aboriginal communities in Australia: a review of the literature
Authors: Durkin Shane R
Published: February 2010

Objective: To review the literature regarding the
most sustainable and culturally appropriate ways
in which to implement eye health care programs
within remote Aboriginal communities in Australia
from a primary health care perspective.
Data sources: The search included letters, editorials
and papers (published and unpublished)
from January 1955 to April 2006.
Study selection: The search revealed 1 106 758
papers, books and other related material. The
relevancy of this material was determined by
abstract and 378 relevant articles were reviewed
in their entirety. After reading the relevant articles
and the interview transcripts the themes that
emerged from each source were extracted.
Conclusions: The ten areas to consider include:
clinical practice and access, sustainability,
regional-based programs, information technology
systems, health worker training, self-determination,
cultural and language barriers, funding body
responsibilities, embedding specialist programs in
primary care services, and other considerations.
Further research needs to be undertaken within
Aboriginal communities in the area of primary eye
health care and barriers to the acceptance of
treatment. This may be undertaken using more
interactive research methods such as cooperative
and narrative inquiry.
Pay for performance programs in Australia: a need for guiding principles
Authors: Scott Ian A
Published: February 2010

Pay-for-performance (P4P) programs which
reward clinical providers with incentive payments
based on one or more measures of quality of care
are now common in the United States and the
United Kingdom and it is likely they will attract
increasing interest in Australia. However, empirical
evidence demonstrating effectiveness of such
programs is limited and many existing programs
have not had rigorous outcome evaluation. To
maximise success, future P4P programs should
incorporate the lessons and insights obtained
from previous experience. Based on a review of
published trials, program evaluations and position
statements, the following principles that may guide
future program design and implementation were
synthesised: 1) formulate a rationale and a business
case for P4P; 2) use established evidencebased
performance measures; 3) use rigorous
and verifiable methods of data collection and
analysis; 4) define performance targets using
absolute and relative thresholds; 5) use rewards
that are sufficient, equitable and transparent; 6)
address appropriateness of provider responses
and avoid perverse incentives; 7) implement communication
and feedback strategies; 8) use existing
organisational structures to implement P4P
programs; 9) attribute credit for performance to
participants in ways that foster population-based
perspectives; and 10) invest in outcomes and
health service research. Recommendations flowing
from these principles relevant to Australian
settings are provided.
How are language barriers bridged in acute hospital care? The tale of two methods of data collection
Authors: Garrett Pamela W , Forero Roberto , Dickson Hugh G , Klinken Whelan Anna
Published: February 2010

Access to care for patients remains a concern for
all parties in the provision of hospital services. It is
the subject of patient complaints, large investments
of funds and vigorous debate in the community,
hospitals and the political arena. This is a
common problem in developed nations. There has
been little achievement in information technology
solutions to this significant problem in Australia.
This paper presents a case study of the development
and implementation of an organisational
access display system intended to provide realtime,
or near to real-time information and feedback
on access for staff on the floor. This is
believed to be one of the first times such a
development has been reported in the Australian
literature, albeit limited to the context of a single
organisation.
Cholesterol-lowering therapy and the Australian Pharmaceutical Benefits Scheme: a population study
Authors: Adams Robert J , Appleton Sarah , Wilson David H , Taylor Anne W , Chittleborough Catherine , Gill Tiffany , Ruffin Richard E
Published: February 2010

Objective: The Australian Pharmaceutical Benefits
Scheme (PBS) expanded the criteria for eligibility
for subsidised lipid-lowering therapy (LLT) in
2006. The aim of this study was to determine the
use of LLT in a representative Australian population
in relation to cardiovascular disease (CVD) risk,
and the effectiveness of the therapy in meeting
target levels.
Design: Cross-sectional biomedical study with
telephone interviews, questionnaires, clinical
measurements, and PBS dispensing data.
Subjects: Representative population sample of
4060 urban adults aged 18 years attending for
the biomedical examination in 2001.
Results: Of the 406 who qualified for PBS-subsidised
LLT at that time, only 88 (21.5%) were
actually on LLT. National Heart Foundation of Australia
(NHF) recommended low-density lipoprotein
cholesterol (LDL-C) levels of < 2.5 mmol/L were
recorded in only 13% (528) of the population, and
in 46.8% of those on LLT. Of those on LLT, 76% had
total cholesterol < 5.5 mmol/L, but over 80% had
total cholesterol levels above NHF-recommended
levels of 4.0 mmol/L. Of the 842 classified at the
highest CVD risk, only 26% were using LLT. Those
aged > 60 years and on low incomes were significantly
more likely to use LLT. The new PBS criteria
will expand eligibility to include nearly 20% of
adults.
Conclusions: The majority of people at high risk
of CVD were not receiving LLT, and LLT is not being
used to its full effectiveness. People with low
incomes or on government benefits or pensions
were not less likely to use LLT than others under
the PBS scheme. Whether higher copayments for
those on low incomes who do not qualify for
concessional payments is a significant barrier to
LLT use needs further research.
The AusPSIs: the Australian version of the Agency of Healthcare Research and Quality patient safety indicators
Authors: McConchie Steven , Shepheard Jennie , Waters Simon , McMillan Alison J , Sundararajan Vijaya
Published: February 2010

Many countries are seeking ways to measure the
safety and performance of their health systems.
The ability to track improvement and monitor
safety event rates at a population level is provided
by routinely collected administrative data in conjunction
with a set of well-developed indicators
such as the patient safety indicators from the
Agency for Healthcare Research and Quality
(AHRQ) in the United States of America. These
indicators are currently in the International Classification
of Diseases Ninth Revision, Clinical Modification
(ICD-9-CM) whereas Australia has coded
its data in ICD-10-Australian Modification (ICD-10-
AM) since 1998. We describe the process recently
undertaken to translate and revise the patient
safety indicators (PSIs) so they can be of use with
ICD-10-AM.
The initial translation (electronic mapping, review
and revision by expert coder, programming of
codes and testing on data from 1996?1998 [ICD
9-CM] to 1998?2006 [ICD-10-AM, through 4 editions])
found that differences between ICD-9-CM
and ICD-10-AM datasets presented some challenges.
After this phase, which was faithful to
AHRQ?s case definitions, the indicators were
refined for use with the condition onset flag,
resulting in the AusPSIs.
Health care leadership, quality and safety
Authors: Duckett Stephen
Published: February 2010

THIS ISSUE OF Australian Health Review started as
part of a Festschrift to celebrate the work and
leadership of Professor Mike Ward, currently Commissioner
of the Health Quality and Complaints
Commission in Queensland but previously inaugural
Senior Director of the Clinical Practice
Improvement Centre in Queensland Health and a
Professor of Medicine at the University of Queensland,
as well as Commissioner of the Australian
Commission on Safety and Quality in Health Care.
During his time at Queensland Health and in
clinical practice, Mike made an outstanding contribution
to health care in Queensland, recognised by
the award of the Public Service Medal. Initially
trained as a gastroenterologist, Professor Ward?s
interest broadened to include organisational issues
such as communication among teams, and how to
measure and improve quality of care. He was
particularly interested in methods of displaying
data to highlight the underlying patterns in the
information presented. Mike, not surprisingly for
someone who occupied a professorial role, was
also interested in the development of health professionals
and played a key role in the creation and
shaping of Queensland Health?s world renowned
Skills Development Centre.
Patient safety — a balanced measurement framework
Authors: Wakefield John G , Jorm Christine M
Published: February 2010

Evidence of the unacceptably high incidence of
patient harm associated with health care has
resulted in patient safety becoming a major reform
agenda. Despite significant investment by governments
on strategies to reduce patient harm, confusion
still exists on how to measure patient safety.
While the goal of patient safety is harm prevention,
most of the measurement focus has been on
counting incident reports. The (ab)use of reported
incident data to measure both technical safety
performance (injury rates) and evaluate the effectiveness
of safety improvement initiatives continues
to confuse and mislead consumers, funders
and providers of health care.
This paper proposes a simple measurement
framework for patient safety which balances the
elements of: learning, action, performance,
patient experience, and staff attitudes and behaviour.
Application of this framework to current priority
areas should be used as a basis for patient
safety improvement at clinical unit, hospital, state
and national levels.
Using research to make health care safer
Authors: Jorm Christine M , White Sarah J
Published: February 2010

There is a fine balance that needs to be maintained
between research and improvement in
safety and quality in health care ? when do we
need more research and when can we just get on
with it? The moral imperative to improve care may
have been a distractor, preventing adequate attention
to research. Three research areas are proposed
as current priorities for patient safety:
getting evidence into practice, measurement of
safety, and the evaluation of complex interventions.
A focus on these areas should ensure that
research becomes more central to the process of
making health care safer.
Statistical process control part 2: using statistical process control to measure process improvement in patient flow
Authors: Chetter Tamara G
Published: February 2010

THE FIRST ARTICLE in this series, ?Statistical process
control part 1: a primer for using statistical
process control in health care process improvement?
1 (in this issue of the Journal), introduced
the basic concepts of statistical process control
(SPC) and its main tool, the control chart. While
this set of techniques was originally developed in
the manufacturing sector, there is growing realisation
in recent years that SPC (and also other
quality improvement techniques, such as Six
Sigma and lean thinking) can be successfully
applied to health care quality improvement.2 The
reason for this is that SPC is a potent and
powerful, yet simple tool for tracking, and detecting
any variation in, process performance over
time; which creates the opportunity for health
professionals to promptly respond to any
improvement or deterioration in the process.
Perhaps the most valuable feature of SPC techniques
however, is the ability to place a change in
the outcome of a process in close temporal proximity
to the redesign and improvement of the
process. This means SPC can reliably evaluate the
effectiveness of quality improvement initiatives
implemented at the front line of health service
delivery, despite the complexities of the hospital
system and the challenges this often poses for
health services research (for example, the inability
to use robust research designs).
The purpose of this companion article is to
therefore demonstrate the practical application of
SPC in a health care organisation. Specifically, the
technique of control charting was used to track
the impact of patient flow process improvement
interventions in a public hospital, in the hope
that this will exemplify to health care professionals
the value and simplicity in applying SPC as
part of their daily work.
Dementia risk reduction in primary care: what Australian initiatives can teach us
Authors: Travers Catherine M , Martin-Khan Melinda G , Lie David C
Published: February 2010

Only limited research has been undertaken to
identify factors that impede or facilitate the implementation
of evidence-based health promotion,
prevention and early intervention (PPEI) activities
within primary practice. We examined recent Australian
initiatives that encouraged primary care
practitioners to implement PPEI activities to
reduce the risk of chronic disease, particularly
those that have focused on lifestyle risk factors.
The aim was to identify barriers and facilitators to
the uptake of these activities to inform the Australian
National Dementia Prevention Strategy. Barriers
that were consistently reported across
evaluations and that appear to be of most concern
to Australian general practitioners include the
issues of financial remuneration and time constraints
secondary to heavy work commitments.
Factors that were effective in overcoming barriers
included the integration of interventions within
existing activities, the specification of a clear,
funded role for practice nurses and the support of
the Australian General Practice Network. It was
concluded that these factors should be considered
if PPEI activities for dementia are to be successfully incorporated within primary care.
Medical model for hospital in the home: effects on patient management
Authors: Tran Anh , McD Taylor David
Published: February 2010

Objective: To evaluate the effects of a change to
a medical model for hospital in the home (HITH).
Design and setting: This was a retrospective
pre- and post-intervention study in the Royal
Melbourne Hospital HITH between 28 March 2002
and 29 March 2006. The intervention was daily
review, by medical staff, of all patients in their
homes. 159 patients with cellulitis or deep venous
thrombosis (DVT) admitted to HITH in the preintervention
period were matched with patients
admitted in the post-intervention period.
Main outcome measures: HITH length of stay
(LOS), scheduled and unscheduled hospital
review rates (during the HITH admission), and
hospital admission rates.
Results: Post-intervention, median LOS
decreased (6 v 5 days [P= 0.03]). There were also
significant reductions in scheduled and unscheduled
review rates (40.9 v 1.3 reviews/100 patients
[P< 0.001] and 15.7 v 4.4 reviews/100 patients
[P= 0.001], respectively) and hospital admission
rates (10.7 v 3.8 admissions/100 patients [P=
0.02]). Although there was no difference in
adverse event rates between the two periods (3.1
v 2.5/100 patients [P= 0.50]), there was a significantly
greater complication rate post-intervention
(57.2 v 92.4/100 patients [P< 0.001]).
Conclusion: The medical model resulted in significant
improvements in process measures and clinical
endpoints among patients with cellulitis and DVT.
How far can systematic reviews inform policy development for “wicked” rural health service problems?
Authors: Humphreys John S , Kuipers Pim , Kinsman Leigh A D , Wells Robert , Jones Judith , Wakermann John
Published: February 2010

Policy makers and researchers increasingly look to systematic reviews as a means of connecting research and evidence more effectively with policy. Based on Australian research into rural and remote primary health care services, we note some concerns regarding the suitability of systematic review methods when applied to such settings. It suggests that rural and other health services are highly complex and researching them is akin to dealing with ?wicked? problems. It proposes that the notion of ?wicked? problems may inform our understanding of the issues and our choice of appropriate methods to inform health service policy. Key issues including the complexity of health services, methodological limitations of traditional reviews, the nature of materials under review, and the importance of the service context are highlighted. These indicate the need for broader approaches to capturing relevant evidence. Sustained, collaborative synthesis in which complexity, ambiguity and context is acknowledged is proposed as a way of addressing the wicked nature of these issues.
Global warming and Australian public health: reasons to be concerned
Authors: Bi Peng , Saniotis Arthur
Published: February 2010

Studies in global warming and climate change indicate that human populations will be deleteriously affected in the future. Studies forecast that Australia will experience increasing heat waves and droughts. Heat stress caused by frequent heat waves will have a marked effect on older Australians due to physiological and pharmacological factors. In this paper we present an overview of some of the foreseeable issues which older Australians will face from a public health perspective.
Science, research and social change in Indigenous health — evolving ways of knowing
Authors: Harvey Peter W
Published: February 2010

History tells us of the overwhelming destructive influence of exotic culture, politics and knowledge forms upon the worldview and wellbeing of Indigenous Australians. The power of dominant culture to oppress, control and dominate traditional Indigenous ways of knowing and being has been identified as a being a crucial influence on the health status, future hopes and aspirations of Indigenous Australians. Fundamental to this assertion is that the alienating effect of the belief in and application of the scientific method in relation to learning and knowing is a phenomenon that is incompatible with the law and cultural ways of traditional Indigenous people.

The establishment of the Centre of Clinical Research Excellence (CCRE) is predicated upon and responds to a deep need in our community today to synthesise the ideological and epistemological premises of an increasing range of cultures and world views. It recognises that clinical research, for example, is important to the health of Aboriginal and Torres Strait Islander peoples, but also that the way such research is designed and carried out is also crucial to its potential to effect change in and improve the state of Indigenous health in Australia.

This paper examines knowledge principles and processes associated with research in Indigenous communities, explores emerging research trends in science and proposes an epistemological framework for synthesis of traditional approaches with those of the scientific paradigm.
As good as anyone: antenatal shared care at an inner Sydney hospital
Authors: Webster Pam , Ulmer Barbara , Mann Jeff
Published: February 2010

An exploratory survey design was used to assess satisfaction with antenatal careover a two-month period of women giving birth in an inner Sydney teachinghospital. Patients received obstetric services from private obstetricians, midwives, thehospital outpatient clinic, or ?shared care? between general practitioners and theoutpatient clinic or birth centre. Insurance status and demographic information werecollected across all groups. Shared care patients gave reasons why they chose thatmodel of antenatal service.Ten per cent of women in the sample received shared care. Shared care patientswere equally as satisfied as those in other modes of care in all but one factor?promptness of service (in which private obstetricians received higher ratings). Theyalso judged shared care to have the advantages of being convenient, personal, andculturally appropriate. Significantly more patients in the shared care group were bornoverseas and they were less likely to hold private insurance.This paper discusses the results of the current study in the context of theAustralian literature, explores some issues surrounding satisfaction research, andsuggests further research arising from this work.
A comparison of costs in Australian public teaching, public non-teaching and private hospitals
Authors: Lawson James S
Published: February 2010

This paper compares costs for caring for patients according to common diagnosis groupsin Australian public teaching, public non-teaching and private hospitals. Generally,the costs for general surgical procedures are highest in public teaching hospitals, followedby public non-teaching hospitals, and are lowest in private hospitals. However, theprivate sector is more expensive than the public sector for obstetric activities. The reasonsfor the differences appear to be the much higher ?overheads? in the public sector thanin the private sector, and the longer hospital stay for obstetric patients in privatehospitals. Managers of individual hospitals should examine the data in detail todetermine if alternative approaches are appropriate.Introduction
Women's subjective experience of hysterectomy
Authors: Ferroni Paola , Deeble John
Published: February 2010

This paper presents data on the experience of hysterectomy from a sample of 656women aged between 30 and 50 years recruited from patients of a random sampleof 50 general practices in Perth. Respondents were identified as women who:? had undergone hysterectomy for reasons other than cancer? were affected by gynaecological conditions? had neither gynaecological problems nor had undergone hysterectomy.Respondents voluntarily completed a self-administered questionnaire which covereddemographic information, general health, gynaecological problems and hysterectomy,sexual activities and family relationships. Formal measures of depression and self-esteemwere included.The main concern was with the psychological and social outcomes ofhysterectomy rather than its physical results. The findings showed that of 107women who had undergone hysterectomy, only two had negative comments aboutthe outcome. There were significant effects on both work and sexual relationshipsfor women in the gynaecological condition group, with 52- per cent reporting adverseeffects on work and 46- per cent believing that their sexuality was affected. Fewwomen regarded the uterus as ?essential to femininity or womanhood? and very fewsaw it as affecting sexuality. Women in the hysterectomy group reported that theirsatisfaction with sexual activity had improved, whereas those with gynaecologicalconditions believed that it had deteriorated. Depression and self-esteem scores weresignificantly worse for women with gynaecological conditions.
Aboriginal health: A discussion ofsome current issues
Authors: Lynne Johnstone P
Published: February 2010

This paper explores some health status differences between the Aboriginal and totalAustralian populations, and investigates trends in Aboriginal mortality and morbiditywithin the context of some of the socioeconomic, lifestyle and environmentalinfluences. It identifies that Aboriginal people continue to suffer from a number ofhealth problems at significantly higher rates than the rest of the population, anddiscusses some of the effects of early fertility and alcohol misuse on health status.Drawing on some findings of the 1994 National Aboriginal and Torres Strait IslanderSurvey, the paper concludes with the proposition that it is impossible to consider theeconomic implications of sub-standard Aboriginal health without also considering thesocial issues, and that programs aimed at improving this situation must be demand-driven,economically responsible responses to identified problems in specific regions.
Health personnel: Perceived differences in professional relationships and work role
Authors: Adamson Barbara J , Harris Lynne
Published: February 2010

This study questions the validity of the assumption that the workplace culture andexperiences of health personnel are largely similar. The study compares nurses,occupational therapists, physiotherapists and speech therapists concerning theirperceptions of professional issues within their own profession, and their perceptionsof professional issues within the medical profession. Respondents completed aquestionnaire containing 55 items referring to their own profession, and 55 itemsreferring to the medical profession. Six scales were derived from the large surveyinstrument addressing issues regarding status/cohesiveness of the profession, professionalrelationships, and the role of the patient in health delivery in the respondent?sprofession, and in the medical profession. Nurses emerged as different to other healthpersonnel on most dimensions. Few differences emerged among allied healthprofessionals. Physiotherapists were more positive than occupational therapists aboutthe status/cohesiveness of their profession, and regarded the contribution of the patientto health delivery as less important. Speech therapists did not differ significantly fromoccupational therapists on any dimension.
Issues affecting refurbishment and re-use of pacemakers
Authors: Jackson Margaret
Published: February 2010

This paper discusses the problems associated with the refurbishing and re-use ofmedical devices which are sold by manufacturers as ?single use items? by focusingin particular on the re-use of pacemakers. Re-use of single-use devices such aspacemakers does occur in Australia, and in many other parts of the world, but therehas been little public awareness of this fact. The paper explains and discussesmedical, legal and ethical issues which arise through the re-use of pacemakers. Italso discusses the recommendations of the 1995 ?Draft report of the NHMRCExpert Panel on Re-Use of Medical Devices Labelled as Single Use?.
Development of a casemix classification system for inpatient rehabilitation services
Authors: Webster Fiona
Published: February 2010

This study examines the feasibility of classifying rehabilitation patients according torelative cost and proposes an option for a casemix classification and payment systemfor rehabilitation services in Victoria. The classification system proposed has16- mutually exclusive groups based on patient diagnosis, change in functional status,admission functional status and age, using patient length of stay as a proxy for cost.Data relating to five hospitals were collected over three months during 1994, resultingin 483 inpatient episodes from a variety of impairment groups. The data wereanalysed using an analysis of variance model (PC Group), with the resulting modelaccounting for 30- per cent of the variance in length of stay. The study also considersthe implications of incentives to contain cost and concludes by suggesting that sucha payment system would be feasible to implement following further research to validateand refine the system.
The need for acute hospitals to provide counselling following motor vehicle accidents
Authors: Watts Rod , Horne David , Sandells Jenny
Published: February 2010

This paper examines the need for a systematic way of detecting individuals likely toencounter moderate to severe psychological sequelae after being injured in a motorvehicle accident. It presents the findings of assessments of consecutive adult admissionsduring a six-month period to the Accident and Emergency Department of RoyalMelbourne Hospital, a major acute hospital in Melbourne, within two days of beinginjured in a motor vehicle accident. Seventy of the 250 subjects surveyed completedthe General Health Questionnaire 12 and the Impact of Event Scale questionnaire,with 77- per cent found likely to have had a psychiatric disorder. Seventy-four per centhad at least moderate levels of intrusion or avoidance phenomena. Forty-four per centhad severe levels of one or the other. Prevalence of these psychological sequelae wasgreater than that found in several recent studies on the effects of motor vehicleaccidents.A small number (11?15- per cent) sought or received professional counselling withinthe first three months. This group did not differ, according to levels of intrusion,avoidance, or scores on the GHQ 12, to subjects who did not seek or receive suchassistance. Results identify the necessity of investigating and implementing methodsof detecting and treating the many who apparently sustain significant psychologicalsequelae following injury in a motor vehicle accident.
Clinicians as managers: Organisational change at the Illawarra Regional Hospital
Authors: Lee Lynette
Published: February 2010

In 1990 a decision was made to merge the Port Kembla (160 beds) andWollongong (290 beds) Hospitals into the Illawarra Regional Hospital and tochange the traditional functional management structure to one of product lineinstitute management, with medical officers as part-time clinical directors. Thistransformation in health care management had been occurring in other sections ofthe Illawarra Area Health Service, with medical directors of programs and with alliedhealth and nursing heads of departments throughout the system.A survey was conducted among 22 clinician managers for their impressionsof the ?new? management organisation. The respondents felt that the change hadbeen a positive one and that it had particularly improved communication andaccountability among clinicians.
Human resource management in hospitals: A contested arena for jurisdiction
Authors: Patrickson Margaret , Maddern Janny
Published: February 2010

During the past 10 years, financial pressures on health service providers have led toa quest for more efficient service delivery and many consequential changes to theorganisation and utilisation of staff. This study investigated the organisationalresponses to such pressures by four major South Australian hospitals and the level ofinvolvement of hospital human resource staff in the staffing issues associated withstrategic planning. With one exception, there was little contribution from qualifiedhuman resource professionals to staffing decisions involving medical and nursingpersonnel and little value was placed on their potential input by other professionalgroups. If, as suggested by writers on strategic human resource management, humanresource practice is moving toward a more strategic approach, then there is a largecredibility gap for human resource staff to overcome within the South Australianhealth service.
Benchmarking and supplier networking ? best practice approaches
Authors: Waixel Bernie , Laidlaw Jeanette
Published: February 2010

This article examines the approach adopted by a health service to benchmark outsidethe health industry and to network with its own suppliers in its quest for bestpractice. The Maryborough District Health Service was selected for funding underthe Commonwealth Government?s Best Practice in the Health Sector Program. Thisrural health service is setting a fine example of how generic benchmarking can beused to increase efficiency and improve outcomes in an environment of change,increasing demands and contracting resources. The organisation has networked withits suppliers with a view to ensuring that, as a customer, it has access to the bestquality goods and services. The objective is to improve the services and quality ofpatient care provided by the health service and to minimise its cost structures.
The effect of the proposed national data protection regime on the health sector in Australia
Authors: Jackson Margaret
Published: February 2010

The Commonwealth Government and a number of State governments are proposingto introduce legislation based on the Information Privacy Principles contained in thePrivacy Act 1988 (Cwlth). This will allow individuals access to any personalinformation held on them by any organisation or person, including privatepractitioners, private health facilities and State government agencies. This articlediscusses this proposed legislation and its implications for the health sector.Although in the public health area patients can already gain access to their medicalrecords through the use of the various Freedom of Information Acts and, in the caseof Commonwealth government agencies, the Privacy Act 1988 (Cwlth), the proposeddata protection legislation will provide more than access rights to individuals. Theeffect of the proposed legislation on the private sector, where no obligation exists onthe part of the doctor to grant a patient access to his or her records, will be substantial.
To market, to market: Corporatisation, privatisation and hospital costs
Authors: White Kevin , Collyer Fran
Published: February 2010

The Australian political arena echoes with calls for the privatisation of health careinstitutions, the contracting-out of health care services and the introduction of variousmarketing strategies into hospital management. These calls are justified by assertingthat the market, rather than the public sector, can provide better services, greaterproductivity and increased efficiency. The National Health Strategy (1991, p 17)provides a good example. Noting that Australia is copying American investment trendsfor hospital ?chains? rather than for independent small establishments, the strategydismisses any concern over changes in ownership, pointing instead to a ?process ofrationalisation? that is to be ?welcomed?. Using evidence from the United States,United Kingdom and Australian hospital sectors, this paper examines claims for thegreater efficiency of market processes.
Bioethics:A balancing of concerns in context
Authors: Anne Berglund Catherine
Published: February 2010

Ethics is a philosophical approach which is increasingly being used to identifyacceptable behaviour in a health context. Bioethics has emerged as a term for ethicsin health and medical contexts. Bioethics is about the application of reasoning to ahealth context. It relies on the people in each context to reflect on ethics concerns, andto make acceptable decisions on how to behave. This paper canvasses current concernsin bioethics, and demonstrates the essential features of context, and players in thecontext, in ethical discussion.
Adult intensive care in an environment of resource restriction: How should the unit director respond?
Authors: Henderson Alan
Published: February 2010

Adult intensive care touches the lives of very few while consuming a disproportionatelyhigh level of resources. To survive in the future environment of resource restrictionand accountability, the unit director must rapidly acquire a wide range of professionalmanagement skills. The intensive care unit director must be able to demonstrate tocolleagues, health managers and the community that the large amount of resourcesprovided to intensive care, and the remarkable freedom given to intensivists to usethose resources, are justified in terms of compassionate evidenced-based care, efficiency,efficacy and appropriateness. While many outcomes may be subjected to audit,intensive care units must publish minimal performance data indexed to severity ofillness and including their mortality, hospital mortality and length of stay and anoverall indicator of patient acuity to identify patients at low risk who need not beadmitted to an expensive intensive care bed.
A national clinical indicator database: Issues of reliability and validity
Authors: Booth Joanne L , Collopy Brian T
Published: February 2010

The introduction of performance (clinical) indicators into the accreditation processby the Australian Council on Healthcare Standards is in keeping with global trendsand has enabled the establishment of a National Aggregate Database reflectingstandards of care in acute health care organisations. The database contains bothquantitative and qualitative information on the processes and outcomes of patientcare and changes in practice induced through indicator monitoring. Of fundamentalimportance to the integrity of the database are the issues of indicator validity,responsiveness and reliability. This paper considers these issues, drawing parallels, asappropriate, to other performance indicator programs and studies.
The quiet revolution: Reporting of health outcomes in general medical journals
Authors: Seymour Janelle , Newell David , Shiell Alan
Published: February 2010

This study reviews the extent of evaluation of health outcomes in three general medicaljournals over the past decade by examining papers published in the original researchsection of the New England Journal of Medicine (NEJM), The Lancet, and theMedical Journal of Australia (MJA) in 1982 and 1992. Evaluations were identifiedand classified according to the type of comparison group and the type of outcomemeasures employed. They were divided into three categories: those employing acomparison group; those employing a before-and-after study design (or owncomparison group); and those with no comparison group. The categories of outcomemeasures were mortality, clinical or intermediate measures of health state, and finaloutcome measures (quality of life). Results show that the proportion of papersevaluating a health services intervention remained stable over the period. However,the MJA published considerably fewer evaluations than the other journals. In theNEJM and The Lancet, 75- per cent of evaluations incorporated comparison groups,in the MJA, less than 40- per cent. Overall, the proportion of papers reporting finaloutcome measures increased significantly between 1982 and 1992 (p = 0.04) butthe change in each journal individually did not reach statistical significance. Thisstudy indicates that the reporting of health outcomes evaluations has remainedconstant but there has been some change in the use of comparison groups and finaloutcome measures over time.
Hospital leadership for quality:Theory and practice:II. Quality performance evaluation
Authors: Saunders Ian W , Preston Arthur P , Rice John
Published: February 2010

Hospitals need excellent leadership to be efficient in the use of scarce stakeholderresources and to be effective in the competitive provision of services to multiplecustomers. This paper is the second report on a study conducted with the cooperationof the executive team at a large government-funded hospital in Brisbane, Australia.The overall study focused on linking the leadership concepts and attributes of themembers of the executive with an overall evaluation of quality practice in the hospital.The first paper reported the leadership results. This paper reports the quality practiceand its links with leadership. The study revealed use of data, understanding ofprocesses and the formation of supplier partnerships as the areas of hospital activitymost limiting the ability to improve. Little impact of leadership attributes was found,contrary to studies conducted elsewhere. This may be due to the strong influence ofdifferent professional groups within the hospital, since domains of leadership influencelargely coincided with these groups.
Spirituality and discourse: A postmodern approach to hospice research
Authors: McGrath Pam
Published: February 2010

In modern western society, because of the dominance of secular modernist ideas ofrationalism and positivistic science, notions of spirituality have been at bestmarginalised, at worst excluded from our discourse on health care. Research intospirituality has been limited by modernist epistemological assumptions concerning?objective? proof and measurement. This discussion seeks to help reverse such a directionby offering an example of research on an Australian hospice service (Karuna HospiceService) which is inclusive of the notion of spirituality. This research indicates thata spiritual discourse was not only important in the genesis of this organisation, butis also a significant factor in energising and guiding the ongoing democratic, holistic,compassionate praxis of this hospice service.
A literature review of rehabilitative intervention for chronic obstructive pulmonary disease patients
Authors: Schoo Adrian M
Published: February 2010

Pulmonary rehabilitation programs contribute to physical and psychological well-being and improved quality of life. Pulmonary rehabilitation reduces fear and depression, and increases self-esteem; it improves feelings of well-being and lowers levels of mooddisturbance, but does not seem to change lung function and perfusion. Patients with chronic conditions are reported to have problems complying with rehabilitation programs, especially when these programs require lifestyle modification.Community-based programs are therefore attractive for reasons such as addressing thespecific needs of the population, cost-benefit and flexibility in delivery.
Trusting the surgeon: A tornado from Bristol
Authors: Hindle Don
Published: February 2010

The latest edition of the Medical Journal of Australia presents an article by Stephen Bolsin, a British anaesthetist now working in Australia (Bolsin 1998). He describes how, as early as 1987, there was talk behind closed doors in the United Kingdom Department of Health about worrying results of paediatriccardiac surgery at a large public hospital in southern England, the Bristol Royal Infirmary. In 1988 Bolsin began work there. He had not heard the whispers, butsoon became concerned. He noted the long surgery times overall, and the long duration of the period during which the heart was off-line (and hence deprivedof oxygen). He suspected this could be associated with higher death rates and injuries (like brain damage).
Health policy and its impact on poverty
Authors: Podger Andrew
Published: February 2010

Poverty may be defined narrowly as a lack of income, but is more usefully viewed asa multidimensional concept. I discuss some associations between poverty and health,identify groups with special needs, and describe some aspects of the government?s health policy which are relevant to those needs. Finally, I note the importance of ensuringthere is a more integrated approach in future.