bluuebunny/crossref_metadata_2025 huggingface dataset:
Let's have more equity and justice in rural health services provision
Authors: Gleeson Maureen
Published: February 2010

As we are all well aware there have been great
changes in health care delivery over the past two
decades. The scientific advances that have made
all of this possible command headlines in our
national newspapers almost daily. So too has been
the rate of change in the publication Australian
Health Review. I want to offer my warm congratulations
to the Editorial Committee who, over the
years, have brought AHR to the stage it is at today
? a quality professional journal.
While so much that is great has happened in
our hospitals over the last quarter of a century we
need to be honest and admit not everything has
been optimal. And we must be honest, too, in
admitting there have been some quite remarkable
?power plays? within some of our finest health
facilities and bureaucracies. Patients losing out to
politics has so often been the result of these
unpraiseworthy antics. Does it have to stay this
way? Or can we move on to a better way of
behaving and distributing scarce resources?
Many years of my professional life were spent
within busy teaching hospitals where we did our
part in consuming the lion?s share of the scarce
resources. The last five years in consulting practice
have seen me working a substantial amount
of my time in rural Australia. This has been a
very rewarding personal, as well as professional,
experience for me. It has also been an eyeopening
one ? my city-blinkered view has been
challenged in a variety of ways.
The subsidy of pharmaceuticals in Australia: processes and challenges
Authors: Sansom Lloyd
Published: February 2010

The increasing costs of health care, including new
technologies and pharmaceuticals, pose challenges
for all countries both in the developed and
the developing world. It is essential that the
increased expenditure on pharmaceuticals represents
value for money and is seen as an investment
in health care rather than simply the purchase of
the latest released agent. The system in Australia
uses a cost-effectiveness approach to guide the
decisions as to whether a new drug can be recommended
for subsidy. The need for a greater understanding
and transparency of the processes is
essential in order for a well-informed public debate
to occur about the challenges to the system and its
sustainability. The relevant issues are discussed in
this article to assist that debate.
Patient satisfaction: the Australian patient perspective
Authors: Henderson Amanda , Caplan Gideon , Daniel Ann
Published: February 2010

The literature reveals little Australian academic study of the phenomenon of patient satisfaction and identifies severalproblems in current research practice. A theoretical discussion about the phenomenon of 'patient satisfaction' is for themost part absent, the rigour in the methods applied is often dubious, a definition of patient satisfaction is not agreedand the patient experience is often not the focus of research. To address some of these issues inductive research wasconducted with Australian patients to explore what they considered important for patient satisfaction to exist. A seriesof 52 interviews were conducted with twenty elective surgery patients in an Australian teaching hospital. Patients wereinterviewed on admission to hospital, within one week of discharge from hospital and between six and eight weeksafter discharge. Research with patients identified 16 themes that were important to make a patient's hospital staysatisfactory. Qualitative data have provided a foundation to better understand what 'patient satisfaction' means in itseveryday use. Such an approach is faithful to the concerns and priorities of the patients who are the users of healthcare services.
Data, circumstance and politics: reflections on regional mental health planning
Authors: Fuller Jeff , Edwards Jane
Published: February 2010

We use our experience as consultants to a regional mental health planning project in South Australia to describe threepractical aspects of regional health planning. First, we systematically summarised various data on socio-demographicindicators, health status and health service use along with qualitative opinion about needs and services fromconsultations with over 200 stakeholders. In addition to these data, we found that attention to two other aspects ofplanning, circumstance and politics, were of critical importance, particularly if the plan was to be implemented andas a way of turning thinking into action.
The impact of caring on caregivers' mental health: a review of the literature
Authors: Savage Sally , Bailey Susan
Published: February 2010

This paper provides a brief overview of the literature on the impact of caring on the mental health of informalcaregivers in the areas of aged care, disability and mental health. Factors discussed that may impact on caregivers'mental health include the relationship between the caregiver and care recipient, the nature of the care recipient'sdisability and the stage of the caregiving process. Several moderators of the impact of caring on mental health aredescribed, including socio-economic factors, social support and coping strategies. This information provides a contextwithin which to examine the type of interventions appropriate to assist caregivers in various situations.
Improving human resource management in Chinese healthcare: identifying the obstacles to change
Authors: Pei Likun , Stanton Pauline , Legge David
Published: February 2010

Health sector reform in China has led to increasing responsibility for hospital managers in the management of staff,but constraints continue. New personnel reforms offer new opportunities but face a number of difficulties. Drawingon research in Chinese hospitals in 1997 this paper identifies two major obstacles to improved human resourcemanagement: wage policy and lack of control by local managers over staffing.
Let's ban drivel: commentary on A tale of a few hospitals
Authors: Swan Norman
Published: February 2010

NORMAN SWANDr Norman Swan is host of The Health Report on ABC Radio National.Before you read on, this is a commentary based on anecdote - not the stuff of high-level evidence. But let me tell you, from the feedback I get from listeners across Australia, Anne Cahill's story is pretty mainstream. You can argue I'm talking rubbish - and I know there are many exceptions, possibly even a growing number of them - but many health service managers would not have a clue about what's going in their hospitals in terms of being service focused because they don't look and they don't measure.
The impact of manual handling training on work place injuries: a 14 year audit
Authors: Massy-Westropp Matthew , Rose Derek
Published: February 2010

Matthew Massy-Westropp is Clinical Senior Occupational Therapist at Metropolitan Domiciliary Care Southern Region. Derek Rose is Research Officer at Metropolitan Domiciliary Care Southern RegionManual handling injuries represented both the highest costs and largest proportion of workers compensation claims for the South Australian Department of Human Services from 1995 to 1999 (Risk Management Services 2000). There is evidence to suggest the manutention method of manual handling training can reduce workplace injuries. A retrospective audit of injuries was conducted at Metropolitan Domiciliary Care Southern Region, a community health service agency, to determine the effects of introducing the manutention method of manual handling to the agency. The workers most likely to sustain a manual handling injury were paramedical aides. For this workgroup, the incidence and severity of injuries were significantly reduced for the period following the introduction of the manutention method of manual handling training.
Australian women's perceptions of a specialist breast nurse model
Authors: Liebert Barbara , Furber Susan
Published: February 2010

Barbara Liebert was formerly at the National Breast Cancer Centre; Dr Susan Furber has a conjoint position at the School of Public Health and Community Medicine, University of NSW.The aim of this study was to evaluate Australian women's perceptions of the specialist breast nurse (SBN) modeldeveloped by the National Breast Cancer Centre. Two hundred and forty women evaluated the care they received from a SBN. The SBN was perceived as a valuable link between women and the multi-disciplinary team, with continuity of care being rated as a major benefit. Over 80% of women reported the SBN to be effective in providing information and emotional support. There is a need to consider the establishment of SBN positions in treatment centres for breast cancer in Australia.
People who are 'socially disadvantaged' and the role of the aged care assessment team: a case example
Authors: McAllister Adrienne
Published: February 2010

Adrienne McAllister is an Occupational Therapist with the Gold Cast Aged Care Assessment Team.The role of Aged Care Assessment TeamsAged Care Assessment Teams (ACAT) were developed as part of the aged care reforms that have been implemented in Australia over the last twenty years (Howe1997). Their role includes completion of comprehensive assessments, clarification of client needs, identification of care options to meet needs and assistance to access to services (CDH&AC 2000). They are described as having a coordinating role for clients with complex care or special needs (McCallum et al 1992, Gray 2001) and it is people with special needs, specifically those with social disadvantage, that are the focus of this paper.
Connecting hospital and community care: the acceptability of a regional data linkage scheme
Authors: Massy-Westropp Matthew , Giles Lynne C , Law Deborah , Phillips Paddy A , Crotty Maria
Published: February 2010

Lack of information on an individual?s premorbid
needs and services in place can impede the
transition from community to acute care. We
report on a trial of an electronic data linking
system between Flinders Medical Centre and
Metropolitan Domiciliary Care. A sample of 82
medical, nursing and allied-health staff across the
organisations completed questionnaires concerning
their level of satisfaction with the trialled
system. Results supported the effectiveness of an
electronic data linking system across the hospital?
community interface. This system was effective in
reducing labour costs, increasing organisational
communication and devising appropriate discharge
plans. Community staff indicated they
were better informed about their client?s medical
and disability status and were able to play an
active role in their client?s treatment. This study
provides more support to the implementation of a
patient electronic data linking system focussed on
older patients, with wider benefits including the
reduction of unnecessarily long admission times
and decreased demand on hospital beds
Combining DRGs and per diem payments in the private sector: the Equitable Payment Model
Authors: W T Hanning Brian
Published: February 2010

The many types of payment models used in the
Australian private sector are reviewed. Their features
are compared and contrasted to those desirable
in an optimal private sector payment model.
The EPMTM (Equitable Payment Model) is discussed
and its consistency with the desirable
features of an optimal private sector payment
model outlined. These include being based on a
robust classification system, nationally benchmarked
length of stay (LOS) results, nationally
benchmarked relative cost and encouraging continual
improvement in efficiency to the benefit of
both health funds and private hospitals. The
advantages in the context of the private sector of
EPMTM being a per diem model, albeit very different
to current per diem models, are discussed.
The advantages of EPMTM for hospitals and health
funds are outlined.
Clinical pathways in 17 European Union countries: a purposive survey
Authors: Hindle Don , Yazbeck Anne-Marie
Published: February 2010

We undertook a survey of clinical pathways
across the 25 European Union countries. Fiftyone
questionnaires were completed by largely
self-selected experts from 17 countries. Respondents
reported that pathways were important and
were becoming increasingly widely used
(although the rate of progress was highly variable).
One important constraint was reported to be
a cultural aversion among doctors that arises at
least in part from the implication that pathways
require multidisciplinary teamwork which will prejudice
medical autonomy. In other words, pathways
challenge clinical professional sub-cultures. Other
constraints included lack of encouragement by
external parties, such as purchasers, with limited
financial support for pathway development and
implementation and service purchasing that did
not reward care providers who use pathways.
The obvious implication of the survey is that more
needs to be done to achieve a common understanding
of pathways. In spite of the large quantity
of published papers, survey respondents reported
that there are many health professionals who have
only a superficial understanding at best.
From the Editors
Authors: Leggatt Sandra G , Dwyer Judith
Published: February 2010

AS FORESHADOWED IN OUR LAST ISSUE, an Editorial
Board has been established by the Australian
Healthcare Association, with the task of setting
policy directions and safeguarding the independence
of the journal (see page 256 for the list of the
founding members). We look forward to working
with the new Board and extend a warm welcome
to the members.
Geriatric interventions: the evidence base for comprehensive health care services for older people
Authors: Cordato Nicholas J , Saha Sabari , Price Michael A
Published: February 2010

Specialist geriatric services apply a comprehensive,
multidisciplinary evaluation and management
approach to the multidimensional and
usually interrelated medical, functional and
psychosocial problems faced by at-risk frail elderly
people. This paper examines currently available
data on geriatric interventions and finds ample
evidence supporting both the efficacy and the
cost-effectiveness of these specialist interventions
when utilised in appropriately targeted patients. It
is proposed that substantial investment in these
programs is required to meet the future demands
of Australia?s ageing population.
Future investment
Authors: Tenkate Thomas
Published: February 2010

SUSTAINABILITY IS ONE OF those
buzz words that is often used,
but I suspect is poorly understood.
In the last few decades of
the 20th century, scientific support
began to demonstrate overwhelming
evidence for global
climate change and major environmental
impacts that have the
real possibility of resulting in significant impacts on
the health and well-being of current and future
generations. Unfortunately, up until now, public
health practitioners have not seemed to play as
pivotal a role in the process as is necessary. Given
this background, the text Sustainability and health
provides some welcome answers to the question
?What is the role for public health practitioners in
the sustainability governance process??
Private care and public waiting
Authors: Hanning Brian W T , Duckett Stephen J
Published: February 2010

Letters to the Editor
Information sharing in health care: a patient's perspective
Authors: Stevens Stella
Published: February 2010

When it comes to getting ideas for improvement,
no vantage point in health care is
better than the horizontal position.1
THERE ARE FEW INDUSTRY SECTORS more in need
of better solutions to information sharing and
knowledge management than health care. The
issues surrounding information management in
the health care sector are pressing and complex.
This paper explores my subjective experience of
information sharing as a patient within a
medium-sized Australian public hospital and
illustrates the potential impact on safety and
quality.
I am a health services researcher. My case was
not urgent or complex, I am not disadvantaged or
seriously ill, and the hospital?s waiting list for the
procedure was short. The outcome of the surgery
was good and my satisfaction high. The case is,
however, extremely pertinent to the current
debate around information sharing in health care.
Assessing patient satisfaction: implications for South Australian public hospitals
Authors: Hordacre Ann-Louise , Taylor Anne , Pirone Christy , Adams Robert J
Published: February 2010

This paper reports on the results from 2620 South
Australians who participated in the 2003 Patient
Evaluation of Hospital Services. Patients were
found to be generally satisfied with the care,
services and amenities provided, with a statewide
overall score of 86.3. Satisfaction was lowest in
the patients? assessment of their involvement in
their own care and treatment. Three demographic
factors (younger age, female sex or tertiary education)
predicted lower levels of satisfaction in the
multivariate analysis, whereas living with others,
non-emergency admission or admission to
smaller hospitals were found to predict higher
satisfaction. Despite administrative and organisational
difficulties, and limited current evidence of
increased quality or satisfaction, it is considered
important to continue satisfaction research with
the goal of encouraging the development of action
plans for improvement of care, services and
amenities.
Enhancing evidence-based practice in population health: staff views, barriers and strategies for change
Authors: Adily Armita , Ward Jeanette E
Published: February 2010

Study objective: To determine barriers and enablers
for evidence-based practice (EBP) in population
health and potential strategies for change.
Design: Self-administered survey of 104 professional
staff (response rate, 73%) in the Division of
Population Health, South Western Sydney Area
Health Service in NSW serving a disadvantaged
urban population.
Main results: Most respondents (80%) ?strongly
agreed? or ?agreed? that EBP would improve the
effectiveness of their efforts in a disadvantaged
region. However, more than half of respondents
(56%) ?strongly agreed? or ?agreed? that there is
lack of evidence for interventions in population
health. Eighty two per cent of respondents
?strongly agreed? or ?agreed? that training in EBP
is important for all population health workers.
Those who used evidence also needed a greater
capacity to discriminate ?good? from ?bad?
research (85% in agreement). Contradictory policy
was cited by one third of respondents as
acting against EBP.
Using pilot studies to inform health services
Authors: Stewart Williams Jenny A , Lowe Julia M , Candlish Paula M
Published: February 2010

A pilot study was conducted at the John Hunter
Hospital, Newcastle, Australia in 1998?99 to inform a
randomised controlled trial (RCT) for a cardiac rehabilitation
intervention for patients with congestive
heart failure (CHF). Although the RCT did not proceed,
the pilot study results raised a number of
issues. In this paper, the pilot is used to demonstrate
how estimates of population benefit need to take into
account patient eligibility, consent and adherence,
and also how non-clinical data can inform the planning and development of health service interventions.
Measuring capacity
Authors: Devereux John A
Published: February 2010

EVERY SO OFTEN a book is published
that deals with an area of such
importance in such a clear and comprehensive
way that you wonder
why the book has not been written
before. Mental capacity is such a
book. Using a breathtaking breadth
of vision, the book draws on the
research of lawyers, ethicists, psychiatrists
and neuropsychologists to
present a fascinating account of the problems of defining
and measuring capacity. The book wisely commences
by examining general principles of capacity,
before focusing on individual concerns relating to
advance health care planning. It comprises a good mix
of prescriptive information combined with case studies
to illustrate particular points. The text is meticulously
referenced and written in a lucid style.
Given the excellence of the work, criticisms are few in
number, and minor in magnitude. On occasion, there is
some unnecessary repetition of material in different
chapters. For the reader who is not reading the entire
book, just selected chapters, this may not be a bad thing.
I was also frustrated at the brevity of the concluding
chapter ? some good points emerged in this chapter
which could usefully have been further developed.
Overall, this is a first class book and will be a rich
source of material for researchers and practitioners alike.
Exploring the need for hepatology nurses and allied health professionals in Victorian liver clinics
Authors: Ehsani Jonathon P , Vu Trang , Karvelas Maria
Published: February 2010

Objective: To examine the need for hepatology
nurses and allied health professionals in Victorian
liver clinics to meet the increasing demand from
people seeking treatment for hepatitis C infection.
Design: We reviewed the literature, analysed
data from nine Victorian liver clinics, and conducted
a qualitative rapid assessment with key
stakeholders including hepatology nurses.
Participants: Fourteen key stakeholders including
clinicians and directors of liver clinics were
invited to take part in interviews; two declined to
participate. All ten members of the Victorian
Hepatology Nurses Group were invited to participate
in a focus group discussion, and six
attended.
Results: Participants reported that hepatology
nurses played a critical role in improving treatment
uptake and compliance, in particular, in educating,
counselling and managing treatment for people
with hepatitis C infection. Psychiatric and social
work staff assisted patients to overcome side
effects associated with treatment. Interpreters
increased access for those from culturally and
linguistically diverse communities.
Conclusions: Hepatology nurses and allied
health professionals are central to enhancing
treatment outcomes for people who are infected
with hepatitis C. Further research is necessary to
estimate the number of nurses and allied health
professionals required to meet the current and
future needs of people receiving treatment for
hepatitis C infection.
Developing inter-agency collaboration for older patients needing rehabilitation
Authors: Bloor Geoffrey
Published: February 2010

Inter-agency collaboration is becoming increasingly
important in delivering services to elderly people.
Collaboration is not easy and careful attention
needs to be paid to developing and sustaining the
necessary working relations. This paper presents
an analysis of what worked in a successful rehabilitation
program involving collaboration among a
number of acute public hospitals and aged care
service providers.
The feasibility of implementing an electronic prescribing decision support system: a case study of an Australian public hospital
Authors: Bomba David , Land Tim
Published: February 2010

Medication errors are common in public hospitals,
with the majority at the prescribing stage of the
medication pathway. Electronic prescribing decision
support (EPDS) is a rules-based computer
system that can be used by clinicians to warn
against such errors to improve patient safety and
support staff workflows. Despite its apparent
advantages, this technology has not been widely
adopted in Australian public hospitals for inpatient
prescribing. A case study using Sauer?s (1993)
Triangle of Dependencies Model was conducted
in 2003 into the feasibility of implementing an
EPDS system at an Australian public hospital in
New South Wales. It was found not feasible to
implement an EPDS at the hospital studied due to
the legacy patient administration system, low
availability of information technology on the wards,
differing stakeholder views, legislation, and the
Independent Pricing and Regulatory Tribunal of
NSW report recommendations. A statewide standard
was preferred, with an agreed specification
framework identifying basic core data items and
functions that an EPDS must meet which can then
be used by area health services to: (i) choose a
solution which best meets their contextual needs;
and (ii) engage vendors to tender for building an
open source (non-proprietary) system based on
the specification framework.
Online referral and OPD booking from the GP desktop
Authors: Nicholson Caroline , Jackson Claire L , Wright Bernadette , Mainwaring Paul , Holliday Dimity , Lankowski Andrew , Kardash Christine
Published: February 2010

The Brisbane Inner South E-referral Project
(BISEP) developed an application which allowed
general practitioners, from their desktop, to successfully
search for and book an available hospital
outpatient appointment for patients with suspected
cancer, send the referral electronically, and
inform the patient of both the appointment and
referral during the consultation. The hospital
changed their outpatient department processes to
allow such functionality for local GPs with patients
with suspected cancer, working from a mutually
agreed set of best practice referral criteria. A
group of 19 GPs participated in an 11-week pilot
implementation of the application, and were
enthusiastic about continuing and expanding the
approach. Patient satisfaction measures post
intervention indicated that they perceived no
major disadvantage in this form of outpatient
department referral.
Australian Health Review call for papers
Authors: Leggat Sandra G
Published: February 2010

Technology in health care: are we
delivering on the promise?
Australian Health Review invites contributions for
an upcoming issue on information management
and information and communication technology
in health care.
Submission deadline: 15 May 2007
Despite a reputation for less spending on information
and communication technologies (ICT),
the health care sector has an imperative to ensure
the ?right? information has been made available
and accessible to the ?right? person at the ?right?
time. While there is increasing evidence that the
strategic application of ICT in innovative ways
can improve the effectiveness of health care delivery,
we don?t often discuss the substantial changes
to the way health care organisations operate that
are required for best practice information management.
In an upcoming issue, Australian Health
Review is looking to publish feature articles,
research papers, case studies and commentaries
related to information management and information
and communication technologies in health
care. We are particularly interested in papers that
report on the successes, or failures, of initiatives
in Australia and New Zealand that have brought
together the research, the technology and the
clinical, managerial and organisational expertise.
Submissions related to international initiatives
with lessons for Australia and New Zealand will
also be welcomed.
Submissions can be short commentaries of
1000 to 2000 words, or more comprehensive
reviews of 2000 to 4000 words. Please consult the
AHR Guidelines for Authors for information on
formatting and submission. The deadline for submission
is 15 May 2007.
Using a multi-state model to enhance understanding of geriatric patient care
Authors: Faddy Malcolm J , McClean Sally I
Published: February 2010

Objectives: To use multi-state Markov chain
modelling to analyse data on geriatric patient
care, and to make comparisons between male
and female patients.
Methods: Estimation, from observed data, of
covariate (age of patient and date of admission to
hospital or community care) dependent parameters
of statistical models for time in care and
subsequent events.
Results: Differential effects of these covariates
shown on the parameters of the models for female
and male patients, where these parameters can
be interpreted as affecting different features of the
distributions of time in care.
Conclusions: Multi-state modelling is an appropriate
means of analysing data on geriatric patient
care and can reveal underlying patterns of differential
effects, some of which may not be apparent
from more routine data processing.
Engaging men in the health system: observations from service providers
Authors: Monaem Abdul , Woods Micheal , Macdonald John , Hughes Rodney , Orchard Michael
Published: February 2010

Men?s health is a significant public health issue in
Australia. Increasingly, health indices show poor
health outcomes for them. Literature suggests
limitations in the health services dealing with their
needs. If we are to improve boys? and men?s
health, we should look at the efficacy of these
services and address their limitations. This study
provides data from a survey about the types of
services available for boys and men. The service
provider respondents expressed major concerns
and identified ways of improving services.
Interdisciplinary versus multidisciplinary care teams: do we understand the difference?
Authors: Jessup Rebecca L
Published: February 2010

AS A MANAGER OF allied health staff in a major
metropolitan health care service, I am responsible
for recruitment to a variety of different disciplines.
One of the questions I regularly ask at
interview centres around the applicant?s understanding
of interdisciplinary teams in the health
care environment. Anecdotally, I would estimate
that only around one in ten individuals can
provide an accurate definition of the role of an
interdisciplinary team. The remainder default to a
description of multidisciplinary teams, and some
even utilise the terms interchangeably.
Living on the edge: issues that undermine the capacity of residential aged care providers to support student nurses on clinical placement
Authors: Robinson Andrew L , Andrews-Hall Sharon , Fassett Matthew
Published: February 2010

This paper reports in part on the Building Connections
in Aged Care Project about developing quality
clinical placements for undergraduate nursing
students in residential aged care in Tasmania,
Australia. Informed by an action research
approach, and using multi-methods data collection,
the three-stage project explored issues
impacting on students? experiences of placement,
implemented strategies to address identified
issues, and tested the sustainability of achievements
gained. This research highlights the vulnerability
of residential aged care facilities to
changing conditions and shows how problematic
circumstances related to staffing and workloads
can readily undermine their capacity to provide
supportive teaching and learning environments for
students.
Clinical characteristics of people with mental health problems who frequently attend an Australian emergency department
Authors: Brunero Scott , Fairbrother Greg , Lee Soung , Davis Martin
Published: February 2010

The objective of this study is to determine the
clinical characteristics of people with mental
health problems who frequently attend an
Australian emergency department (ED). A retrospective
clinical audit of presenter characteristics
was conducted in a 550-bed tertiary
referral metropolitan hospital with data reflecting
12 months of consecutive ED presentations
between September 2002 and August 2003. A
sample of 868 individuals accounted for 1076
presentations. Patients attending more than
once accounted for 12.5% of the total sample.
Significant variables associated with frequent
attendance included: younger age; English
speaking background; and mood and anxiety
disorders. Lone arrival of a patient to the ED
showed marginal significance. The significant
associates of frequent attendance found in this
study may be used to identify patients earlier to
a multidisciplinary case review process and
individual management planning involving clinicians, carers and patients.
The Australian Healthcare and Hospitals Association celebrates 60 years. Excerpts from an historical review by Selby Steele
Authors: Steele Selby K
Published: February 2010

DUE TO rising costs and neglect in forward
planning the financial position of Australian
hospitals has never been worse. An additional
reason for their present difficult situation is
the political difference of policy between the
various Governments, Federal and State.
From an editorial in The Australian Modern
Hospital, 1949.
n=1: Some challenges and opportunities for integrating patient care
Authors: Dart Jared
Published: February 2010

I AM A JUNIOR DOCTOR working in a Brisbane
hospital. I recently completed a PhD investigating
the use of eHealth strategies to improve
community access to relevant health information,
with a particular focus on low socioeconomic
communities and their needs.1 Like many
products of the postgraduate medical course, I
came to medicine after studying other disciplines
? economics and government as part of a
Bachelor of Arts, and medical sciences as part of
a Bachelor of Science. I?ve long had an interest in
policy, and after several years of communitybased
field work in a community with an average
household income of $25 000, and two
years of hospital-based clinical experience, I
have come to realise that the health system fails
to integrate services to provide a systematic
approach to dealing with patients? needs.
In this n=1 I outline some of the deficiencies I
encounter in everyday clinical practice, from
admission to discharge, and beyond, to community-
based care. Let me make it clear at the
outset that I believe these deficits do not arise
from a lack of compassion or care on the behalf
of dedicated clinicians and hospital support
staff, but rather from a system failure. Indeed, in
my own experience, most health care workers
give too much, to the detriment of their own
health and quality of life. Some of my comments
are supported by ?systematic research? (fieldbased
observation and survey data), while others
come from my own daily encounters.
The diversity of emergency code telephone numbers in Australian hospitals: the feasibility of an Australian standard emergency code
Authors: Williams Ged F , Livingston Patricia M
Published: February 2010

This study explored the diversity of emergency
code telephone numbers currently in use in
Australian hospitals and examined the feasibility
of a standard emergency code telephone number
for all Australian hospitals, based on the United
Kingdom experience. An email and telephone
convenience survey of Australian hospitals from
six states and two territories was conducted. Of
the 108 hospitals surveyed, seven did not use a
telephone number system and used a button/
pager system to call an emergency. Of the 101
hospitals surveyed that used a telephone number
system, 40 different emergency telephone numbers
were in place, and in nine hospitals the
telephone number used for Code Blue (medical
emergency) was different to the telephone
number used for other emergency codes. With
increasing mobility of staff across hospitals, uniformity
of emergency code telephone numbers is
required to reduce confusion, potential danger
and improve staff response in emergency situations.
A single Australian standard emergency
telephone number for all Australian hospitals is
advocated.
A new approach to clinical governance in Queensland
Authors: Duckett Stephen J
Published: February 2010

Clinical governance approaches in Queensland
health were trenchantly criticised in 2005 by two
external reviews. In designing the new approach
to clinical governance it was recognised that
clinical governance should not be seen as only
being about traditional safety and quality policies.
A range of levers and policy instruments have
been used in Queensland health to effect a new
approach to clinical governance.
Quali-quantitative analysis: a new model for evaluation of unusual cases in hospital performance?
Authors: Bell Erica
Published: February 2010

This paper aims to provide hospital administrators
and others making decisions about hospital
error funding, as well as researchers, with information
about what good hospital error research
looks like. It offers a selective review of how the
error literature has approached hospital error,
which is used to develop five criteria for sound
hospital error research. It also explores the
potential for better hospital error research of
quali-quantitative analysis (QQA), an innovative
social sciences research method. In a context in
which other methodologies all have their shortcomings,
QQA appears to go some way toward
meeting the five criteria for sound hospital error
research. Ideally, QQA would be used in combination
with other approaches to answer the kinds
of questions that are important to hospital administrators
when they are faced with high-stakes
error evaluation situations.
Ensuring the delivery of quality health care
Authors: Ranmuthugala Geetha
Published: February 2010

Letters to the Editor
Reforming funding for chronic illness: Medicare–CDM
Authors: Swerissen Hal , Taylor Michael J
Published: February 2010

Chronic diseases are a major challenge for the
Australian health care system in terms of both the
provision of quality care and expenditure, and
these challenges will only increase in the future.
Various programs have been instituted under the
Medicare system to provide increased funding for
chronic care, but essentially these programs still
follow the traditional fee-for-service model. This
paper proposes a realignment and extension of
current Medicare chronic disease management
programs into a framework that provides general
practitioners and other health professionals with
the necessary ?tools? for high quality care planning
and ongoing management, and incorporating
international models of outcome-linked funding.
The integration of social support services with the
Medicare system is also a necessary step in
providing high quality care for patients with complex needs requiring additional support.
Community health information sources — a survey in three disparate communities
Authors: Dart Jared , Gallois Cindy , Yellowlees Peter
Published: February 2010

Objective: To determine the current utilisation,
importance, trust and future preference for contemporary
sources of health information in three different
socioeconomic groups.
Design: A pilot study including key informant interviews
and direct observation was conducted in a low
socioeconomic community. From this work a survey
questionnaire was designed and implemented
across three different communities.
Participants and setting: Semi-structured key
informant interviews and focus groups capturing 52
respondents. Paper-based surveys were left in community
organisations and local health practices in a
low socioeconomic (LSE) community on the outskirts
of Ipswich, Queensland, a mid-high socioeconomic
(MSE) community in the western suburbs of
Brisbane, and at a local university.
Main outcome measures: Rank of current and
preferred future sources of health information,
importance and trustworthiness of health information
sources.
Results: Across all three communities the local
doctor was the most currently used, important,
trusted and preferred future source of health information.
The most striking difference between the
three communities related to the current use and
preferred future use of the internet. The internet was
a more currently used source of health information
and more important source in the university population
than the LSE or MSE populations. It was also a
less preferred source of future health information in
the LSE population than the MSE or university
populations. Importantly, currently used sources of
health information did not reflect community members?
preferred sources of health information.
Conclusions: People in different socioeconomic
communities obtain health information from various
sources. This may reflect access issues, education
and awareness of the internet as a source of health
information, less health information seeking as well
as a reluctance by the e-health community to
address the specific needs of this group.
Ken Donald and Muscular Christianity
Authors: Loane Mark
Published: February 2010

?MUSCULAR CHRISTIANITY? was a system which
relied upon sport to allow people to grow in a
moral and spiritual way along with their physical
development. It was thought that
. . . in the playing field boys acquire virtues
which no books can give them; not merely
daring and endurance, but, better still temper,
self restraint, fairness, honor, unenvious
approbation of another?s success, and all that
?give and take? of life which stand a man in
good stead when he goes forth into the
world, and without which, indeed, his success
is always maimed and partial [Kingsley
cited from Haley, in Watson et al].1
This system of thought held that
a man?s body is given him to be trained and
brought into subjection and then used for
the protection of the weak, the advancement
of all righteous causes [Hughes, cited in
Watson et al].1
The body . . . [is] . . . a vehicle by which
through gesture the soul could speak
[Blooomfield, cited in Watson et al].1
In the 1800s there was a strong alignment of
Muscular Christianity and the game of Rugby:
If the Muscular Christians and their disciples
in the public schools, given sufficient wit,
had been asked to invent a game that
exhausted boys before they could fall victims
to vice and idleness, which at the same time
instilled the manly virtues of absorbing and
inflicting pain in about equal proportions,
which elevated the team above the individual,
which bred courage, loyalty and discipline,
which as yet had no taint of
professionalism and which, as an added
bonus, occupied 30 boys at a time instead of
a mere twenty two, it is probably something
like rugby that they would have devised.
[Dobbs, cited in Watson et al]1
The idea of Muscular Christianity came from
the Greek ideals of athleticism that comprise the
development of an excellent mind contained
within an excellent body. Plato stated that one
must avoid exercising either the mind or body
without the other to preserve an equal and
healthy balance between the two.
Residents' satisfaction with multi-purpose services
Authors: Anderson Judith K , Rae John B , Grenade Linda E , Boldy Duncan P
Published: February 2010

Aim: To establish a system for measuring resident
satisfaction in multi-purpose services,
benchmarking and performance improvement.
Setting: Six multi-purpose services in rural New
South Wales were involved in the project.
Design: Residents were surveyed and the
results benchmarked. Benchmarking included a
comparison of results along with an exploration
of work processes across participating sites. This
preceded quality improvement activities conducted
by individual multi-purpose services. Resident
surveys were repeated and staff and
managers interviewed.
Outcomes: Benchmarking was a useful method
for identifying performance leaders and enabling
the dissemination of better practice. The majority
of staff members were comfortable with the
PDSA (Plan, Do, Study, Act) quality improvement
cycle to guide their improvement efforts. The
ability of staff to complete quality improvement
cycles was related to the management styles of
their supervisors. Resident satisfaction was
related to the understanding and confidence of
staff.
Conclusion: A resident satisfaction survey can
provide the direction for effective quality improvement
activities. Benchmarking results with other
sites not only empowers staff members at those
sites recognised as leaders, but can also stimulate
dissemination of leading practice. Management
styles which empower staff enhance their
ability to implement quality improvement
projects.
An overview of clinical governance policies, practices and initiatives
Authors: Robinson Maureen E , Travaglia Joanne F , Braithwaite Jeffery
Published: February 2010

TO THE EDITOR: Braithwaite and Travaglia make
some telling points in their article ?An overview of
clinical governance policies, practices and initiatives?.
1 However, while they have identified many
of the key components of clinical governance, they
have underplayed the role that collaborations and
partnerships have in ensuring the quality of clinical
care. Braithwaite and Travaglia suggest that corporate
governance is about what happens in the
board room and clinical governance is what happens
at the clinical level of the organisation.
The governors (in some cases this is the Boards;
sometimes, the executive group) and the clinicians
are equally responsible for the quality of clinical
care that is provided in the organisation. They have
different roles and use different strategies, but for
many initiatives they must combine forces. We
should not see governance in hierarchical but in
partnership terms.
Educating social workers for the demographic imperative
Authors: McCormack John T
Published: February 2010

Our health system aims to restore, maintain and
improve the independent function of all Australians
and so our health workforce needs to have
the knowledge, skills and abilities to achieve this
task. As older people are already significant users
of the health system, and will increase in the
future due to population ageing, our workforce
should be trained to deal with the age-related
health and social needs required to achieve independent
living for older Australians. Social workers,
like other allied health disciplines, play a key
role in hospitals and community health settings in
maintaining older peoples? health and wellbeing in
the community, as well as carer support. This
article reports on a pilot research program to look
at the skills and competencies of social workers
needed to provide a quality service in aged care,
as well as the expansion of an educational program
aimed at developing a gero-rich curriculum
which enhances the gerontological competencies
of social work students.
Vouchers for chronic disease care
Authors: Watts Jennifer J , Segal Leonie
Published: February 2010

This paper explores the economic implications of
vouchers for chronic disease management with
respect to achieving objectives of equity and
efficiency. Vouchers as a payment policy instrument
for health care services have a set of
properties that suggest they may address both
demand-side and supply-side issues, and contribute
to equity and efficiency. They provide a means
whereby health care services can be targeted at
selected groups, enabling consumer choice of
provider, and encouraging competition in the supply
of health services. This analysis suggests that,
when structured appropriately, vouchers can support
consumers to choose services that will meet
their health care needs and encourage competition
among providers. Although they may not be
appropriate across the entire health care system,
there are features of vouchers that make them a
potentially attractive option, especially for the
management of chronic disease.
Understanding the use of respite services among informal carers
Authors: Vecchio Nerina
Published: February 2010

Objective: To examine the use of respite services
among carers of non-institutionalised individuals aged
15 and over with either profound or severe disabilities.
Methods: Based on data collected from the Australian
Survey of Disability, Ageing and Carers in 2003,
the investigation evaluated the statistical significance
of a number of carer and recipient characteristics on
the likelihood of the use of respite services. Further
analysis assisted in identifying the support most
desired by the majority of carers (88.6%, n=243690)
who have never used respite.
Results: The results revealed that social and cultural
factors played a critical role in the receipt of respite
services. Family relationships were important. Just
under one-fifth of all primary carers most preferred
more financial assistance in their role as caregiver.
After controlling for confounding variables it was found
that, compared with other forms of assistance, the
desire for an improvement in the primary carers? own
health was more likely among non-respite users. This
may reflect the carers? preference to improve their
own capacity to service the recipient rather than rely
on others outside the household.
Conclusions: Since the recipients under investigation
typically possess core communication restrictions
and highly individualised needs, it is speculated that
carers perceive family members as better able to
interpret and meet the sporadic and individualised
care demands of recipients.
Implications: Given the low usage of respite services
among primary informal carers, policy makers
and health organisations need to dispel the ?one size
fits all? approach to support services for households.