bluuebunny/crossref_metadata_2025 huggingface dataset:
Howard's way: seeking conflict or building commitment?
Authors: Stanton Pauline , Bartram Tim
Published: February 2010

WHILE MANY COMMENTATORS are describing the
Federal Government?s industrial relations reform
package as radical or even revolutionary there is
very little in it that is a complete surprise. Further
reduction in the power of the Australian Industrial
Relations Commission (AIRC), greater simplification
in the making of awards and
agreements, an increase in anti-trade union legislation,
and weakening of unfair dismissal provisions
have been on the government?s wish list for
some time. The move to a national industrial
relations system has also been on the government?s
agenda. The impact of these developments
on the health industry is difficult to predict
beyond saying that it appears to be a recipe for
conflict and division. However, our main focus is
not to discuss the detail and merits of the proposed
changes but instead to ask whether these
policies in any way address the major workforce
issues facing the Australian health care sector in
the twenty first century.
A case study on easing an institutional bottleneck in aged care
Authors: Bergin Anne , Leggat Sandra G , Webb David , Ai Lane Koh
Published: February 2010

This is a case study about a cross-sector Interim
Health Care Strategy (IHCS) developed by a
Victorian metropolitan health service in partnership
with a private residential facility and a
community agency to provide a range of transitional
or interim care initiatives for public hospital
patients awaiting permanent residential care
after completing acute or subacute treatment.
The aims were to improve access to emergency
and acute inpatient services, while meeting the
needs of residential care clients in the metropolitan
suburbs. The components included care
within a residential care facility, communitybased
interim care and a subsequent Extended
Rehabilitation Program. This IHCS has shown
how a cross-sector initiative can improve care
and outcomes of patients awaiting residential
care placement. The case study shows how a
multifaceted strategy that built upon existing relationships
with strong planning, organisational
commitment and a facilitating structure was successful in improving care integration.
Delivering democracy? An analysis of New Zealand's District Health Board elections, 2001 and 2004
Authors: Gauld Robin
Published: February 2010

The district health board (DHB) system is New
Zealand?s present structure for the governance
and delivery of publicly-funded health care. An
aim of the DHB system is to democratise health
care governance, and a key element of DHBs is
elected membership of their governing boards.
This article focuses on the electoral component of
DHBs. It reports on the first DHB elections of 2001
and recent 2004 elections. The article presents
and discusses data regarding candidates, the
electoral process, voter behaviour and election
results. It suggests that the extent to which the
DHB elections are contributing to aims of democratisation is questionable.
Costing the ambulatory episode: implications of total or partial substitution of hospital care
Authors: Wilson Stephen F , Shorten Brett , MI Marks Rhona
Published: February 2010

The Macarthur Health Service introduced an innovative
Acute Ambulatory Care Service (MACS) in
2000. The service was designed to substitute
patient care previously provided in hospital beds
with care in the patient?s home. The financial
implications of complete or partial substitution of
hospital care were explored using local data
sources from the introduction of the service in
2001?2002. These data were analysed using the
NSW Department of Health cost of care methodology.
This study determined that episodes of care
in MACS were less costly than equivalent episodes
of inpatient care for selected diagnoses.
The Macarthur cost of care data confirmed substantial
savings (63%) in cases in certain diagnostic
groups (cellulitis, pneumonia) with complete
substitution, and lower savings (50%) for partial
substitution of care when compared with hospital
admission. Savings are likely to be greater as the
level of substitution increases and are dependent
on the choice of ambulatory sensitive diagnoses.
A principled Australian text
Authors: Uren William J
Published: February 2010

In 1979, the American authors Tom L Beauchamp
and James F Childress published the first
edition of Principles of biomedical ethics. They
espoused the theory of what has come to be
known as ?principlism? as a bridge between the
deontological and ut i l i tarian
approaches to bioethics. They identified
four central values ? autonomy,
beneficence, non-maleficence and
justice ? as the fundamental moral
principles in terms of which to
address ethical dilemmas in biomedical
theory and practice.
A central role for the health call centre
Authors: Bentley Peter J , Turner Valender F , Hodgson Sharon A , Drimatis Rosalia , Hart Jade
Published: February 2010

THERE ARE SIGNIFICANT CHALLENGES facing the
health system that stem from the tendency for
decisions to be made by disparate groups focusing
more on the needs of institutions rather than
the needs of patients.1 As a result, patient care is
becoming episodic, with poor communication
leading to inefficiencies, errors and adverse outcomes.
An ideal health system provides ?quality
care that is centred on the patient, communitybased,
coordinated, continuous and cost-effective,
and utilises clinical information systems?.2
(page 229) We believe health call centres (HCCs)
could be instrumental in achieving such aims.
In May 1999, the Western Australian Department
of Health in conjunction with McKesson
Asia Pacific established the Western Australian
Health Call Centre (WAHCC).3 Clinical governance
is overseen by three medical directors and a
specialist nurse, and staff participate in comprehensive,
continuous education and quality
improvement. Since its inception, the WAHCC
has witnessed an increase in demand and serves
about 225 000 callers annually. This amounts to
600 callers per day at a cost (in 2004) of about
$28 per call ? 0.0018% of the health budget.
Seventy per cent of calls are received after hours,
particularly on weekends and public holidays.
The initial program offered by the WAHCC was
HealthDirect. Services have expanded to include
programs and pilot projects listed in the Box .
The impact of the Research Methods Support Structure on research capacity in rural New South Wales
Authors: Fraser John D , Hawkins Antonia , Alexander Christian , Fragar Lyn , Robertson Christine
Published: February 2010

Objective: This paper evaluates a Research
Methods Support Structure (RMSS) to foster
research capacity in the New England region of
rural New South Wales.
Methods: A quasi-experimental design with a
historical control for comparing changes in the
number of research submissions and research
approval rates since the RMSS inception in July
1998 until December 2004.
Results: Comparing the two reporting periods,
the total number of research submissions
increased from 58 to 197, or 9 per year to 30 per
year (odds ratio [OR], 3.33; 95% CI, 1.15?9.90;
?2 = 5.06; P = 0.02); and the total number of ethics
approvals increased from 33 to 145, or 5 per year
to 22 per year (OR, 2.11; 95% CI, 1.10-4.06; ?2 =
5.17; P = 0.02). Submissions were 2.11 times
more likely to receive ethics approval after the
inception of the RMSS, with an increase in overall
approval rates from 57% to 74%. Locally based
rural researchers were 4.89 times more likely to
have their submitted research ultimately approved
after the inception of the research methods support
structure (OR, 4.89; 95% CI, 2.11-11.41; ?2 =
16.06; P < 0.001).
Discussion: This evaluation supports an expansion
of research methods support structures to
increase research capacity in rural Australia.
Using population health surveys to provide information on access to and use of quality primary health care
Authors: Comino Elizabeth J , Hermiz Oshana , Flack Jeff , Harris Elizabeth , Powell Davies Gawaine , Harris Mark F
Published: February 2010

Objective: Currently, primary health care (PHC)
is under-represented in health statistics due to the
lack of a comprehensive PHC data collection. This
research explores the utility of population health
surveys to address questions relating to access to
and use of PHC, using diabetes as an example.
Methods: Drawing on published material relating
to diabetes management, we developed a conceptual
framework of access to and use of quality
PHC. Using this framework we examined three
recent population-based health surveys ? the
2001 National Health Survey, 2002?03 NSW
Health Survey, and AusDiab ? to identify relevant
information collection.
Results: We identified seven domains comprising
aspects of quality PHC for people with diabetes.
For each domain we proposed associated
indicators. In critiquing the three population
health surveys in relation to these indicators, we
identified strengths and weaknesses of the data
collections.
Conclusion: This approach could inform the
development of questions and extension of population
health surveys to provide a better understanding
of access to and use of quality PHC in
Australia. The additional information would complement
other data collections with a communitybased
perspective and contribute to the develop-
ment of PHC policy.
Improving emergency department efficiency by patient streaming to outcomes-based teams
Authors: Kelly Anne-Maree , Bryant Michael , Cox Lisa , Jolley Damien
Published: February 2010

Objective: To describe the process and results of
a process redesign based on task analysis and
lean thinking approaches aimed at improving
emergency department (ED) efficiency.
Methods: Before-and-after study comparing 12-
month periods before and after the process redesign
for total episodes of ambulance bypass,
waiting times (overall and by triage category) and
total ED time (overall and by triage category).
Time data were analysed using non-parametric
methods.
Results: The years were broadly comparable,
with the exception that there was an 8.4%
increase in total hours of care delivered (a marker
of ED workload) in the year after the change.
Episodes of ambulance bypass reduced by 55%
(120 v 54). There were statistically significant
waiting times reductions for triage categories 3
and 5 (median reductions 5 and 11 minutes
respectively). There was an increase in total ED
time for triage category 3 (median increase 7 min)
and a decrease for categories 4 and 5 (median
reduction 14 and 18 min, respectively).
Conclusion: ED process redesign based on task
analysis and lean thinking approaches can result
in improved ED efficiency.
Length of stay benchmarking in the Australian private hospital sector
Authors: Hanning Brian W T
Published: February 2010

Length of stay (LOS) benchmarking is a means of
comparing hospital efficiency. Analysis of private
cases in private facilities using Australian Institute
of Health and Welfare (AIHW) data shows interstate
variation in same-day (SD) cases and overnight
average LOS (ONALOS) on an Australian
Refined Diagnosis Related Groups version 4
(ARDRGv4) standardised basis. ARDRGv4
standardised analysis from 1998?99 to 2003?04
shows a steady increase in private sector SD
cases (~1.4% per annum) and a decrease in
ONALOS (~4.3% per annum). Overall, the data
show significant variation in LOS parameters
between private hospitals.
A service model of short-term case management for elderly people at risk of hospital admission
Authors: Roberts Rosalyn M , Dalton Kate L , Evans Jane V , Wilson Catherine L
Published: February 2010

This article presents the model of a short-term
case management program focused on reducing
emergency department presentations and
unplanned hospital admissions for a targeted
group of older people with complex care needs.
As a semi-integrated health care program,
Treatment Response and Assessment for Aged
Care (TRAAC) is implemented by short-term
case managers located in a variety of community
agencies as well as acute and sub-acute
hospital settings. The article discusses the features
of the model including case finding, early
intervention and risk screening, combined with
the rapid mobilisation of specialised geriatric
assessment services. The model has the potential
to contribute to positive results in managing
the complex health needs of this group. Evaluation
outcomes including reductions in hospital
use for the target group, and positive client and
staff perceptions of the service model are discussed
in relation to the unique features of the
intervention program.
Length of stay patterns for patients of an acute care hospital: implications for nutrition and food services
Authors: Vivanti Angela P , Banks Merrilyn D
Published: February 2010

Objective: Shortened hospital average length of
stay (ALOS) has been used to justify rationalisation
of some services, but, by definition, some patients
stay for longer than the average. The objective of this
study was to explore lengths of stay and proportions
of hospital occupied bed-days (OBDs) of those
admitted for longer time periods to inform service
planning.
Methods: The proportion and ALOS of overnight
separations at an Australian tertiary hospital were
assessed for admissions of up to 4 days and 4 days
or more. This was repeated for 7, 14 and 28 days.
The proportion of OBD?s for each time period was
determined.
Results: While the proportion of total hospital
patients staying for 4, 7, 14 and 28 days or more is
relatively small (21.9%, 13.5%, 6.2%, 2.6%, respectively),
they represent a large proportion of OBD?s
(74.9%, 67.2%, 50.8%, 34.2%) with an ALOS of
14.0, 20.3, 33.7, and 54.4 days, respectively. The
majority of long-stay patients were in acute care.
Conclusion: Substantial proportions of OBD?s are
due to patients admitted for time periods far greater
than reflected by ALOS. Hospitals need to rethink
how to optimally accommodate the nutrition and
food requirements of the large patient numbers
admitted for longer time periods, many of whom are
at increased risk of malnutrition.
Valuing variance: the importance of variance analysis in clinical pathways utilisation
Authors: Hyett Kate L , Podosky Mike , Santamaria Nick , Ham Jenni C
Published: February 2010

Variations from the anticipated course of events
in clinical pathways provide valuable information
that could be used to improve clinical practice
and health service planning. Surprisingly, variance
data are rarely collected in health care
organisations using clinical pathways. This
paper describes a project which aimed to
improve reporting and analysis of variance data
in a large regional and a smaller rural hospital
using clinical pathways for a number of surgical,
medical and obstetric procedures. The project
used change management techniques and a
variance analysis software program to inform
clinical practice change.
The development of Version 2áof the AN-SNAP casemix classification system
Authors: Green Janette , Gordon Robert
Published: February 2010

This paper presents the results of a recent review
of the Australian National Sub-acute and Nonacute
Patient (AN-SNAP) classification system.
The AN-SNAP system was developed by the
Centre for Health Service Development, University
of Wollongong in 1997. The review was
conducted between August 2005 and September
2006. Four clinical sub-committees comprising
more than 50 clinicians from sub-acute services
across New South Wales as well as representatives
from Queensland and the Australian Capital
Territory were established to develop a set of
proposals to be considered for incorporation into
Version 2 of the classification.
It is proposed that the final AN-SNAP Version 2
classification will be available for implementation
from 1 July 2007.
An overview of clinical governance policies, practices and initiatives
Authors: Braithwaite Jeffrey , Travaglia Joanne F
Published: February 2010

Objective: To map the emergence of, and define,
clinical governance; to discuss current best practices,
and to explore the implications of these for
boards of directors and executives wishing to
promote a clinical governance approach in their
health services.
Methods: Review and analysis of the published
and grey literature on clinical governance from
1966 to 2006. Medline and CINAHL databases,
key journals and websites were systematically
searched.
Results: Central issues were identified in the
literature as key to effective clinical governance.
These include: ensuring that links are made
between health services? clinical and corporate
governance; the use of clinical governance to
promote quality and safety through a focus on
quality assurance and continuous improvement;
the creation of clinical governance structures to
improve safety and quality and manage risk and
performance; the development of strategies to
ensure the effective exchange of data, knowledge
and expertise; and the sponsoring of a patientcentred
approach to service delivery.
Conclusions: A comprehensive approach to clinical
governance necessarily includes the active
participation of boards and executives in sponsoring
and promoting clinical governance as a quality
and safety strategy. Although this is still a relatively
recent development, the signs are promising.
Review of patient-reported type 2 diabetes service quality
Authors: Tabrizi Jafar S , Wilson Andrew J , Coyne Eleanor T , O'Rourke Peter K
Published: February 2010

A critical review was conducted of the literature
from 1960 to June 2005 on service quality in type
2 diabetes. The review demonstrated that improving
service quality may improve the outcomes for
people with type 2 diabetes. The potential service
quality factors from the perspective of people with
type 2 diabetes were: timeliness, confidentiality,
continuity, dignity, communication, access, education, cost, amenities and autonomy.
Care management for older people with mental health problems: from evidence to practice
Authors: Tucker Sue , Hughes Jane , Sutcliffe Caroline , Challis David
Published: February 2010

Aim: To explore the implications of providing
intensive care management in a typical old age
mental health service in North West England.
Methods: The time spent by core groups of
specialist mental health and social services staff
on a range of activities deemed central to the
provision of intensive care management was
explored by means of a diary exercise. The
difference between what is actually being done
and what evidence suggests is needed was
examined.
Results: More than 1500 hours of activity were
appraised. Assessment and care managementrelated
tasks accounted for more than 40% and
30% of social work and nursing staff?s time,
respectively. However, several fundamental features
of intensive care management were lacking,
including health staff?s adoption of the care manager
role, arrangements to facilitate appropriate
information sharing and sufficient time for practitioners
to provide the necessary careful assessment
of needs, liaison with other agencies, and
close and regular contact with the elderly person
and their care network.
Re-visioning cultural competence in community health services in Victoria
Authors: Renzaho Andre
Published: February 2010

There are few studies exploring the need to
develop and manage culturally competent health
services for refugees and migrants from diverse
backgrounds. Using data from 50 interviews with
service providers from 26 agencies, and focus
group discussion with nine different ethnic groups,
this paper examines how the Victorian state government
funding and service agreements negatively
impact on the quest to achieve cultural
competence. The study found that service providers
have adopted ?one approach fits all? models of
service delivery. The pressure and competition for
resources to address culturally and linguistically
diverse communities? needs allows little opportunity
for partnership and collaboration between
providers, leading to insufficient sharing of information
and duplication of services, poor referrals,
incomplete assessment of needs, poor compliance
with medical treatment, underutilisation of
available services and poor continuity of care.
This paper outlines a model for cultural consultation
and developing needs-led rather than serviceled programs.
A piece of the puzzle — the role of ethnic health staff in hospitals
Authors: Matthews Clair , Klinken Whelan Anna , Johnson Maree , Noble Cathy
Published: February 2010

The role of ethnic health staff in hospitals has not
been clearly articulated for managers and practitioners.
This paper describes findings from a
study based on ethnic and allied health staff
interviews and observations of ethnic health staff
interactions. Care was provided to language
concordant patients directly and by assisting
practitioners to work within the patient?s cultural
paradigms and family schema. The scope of
practice involved: engaging patients in a therapeutic
relationship, patient assessment, linking
assessment with care options, facilitating communication
between patients and practitioners,
education, smoothing hospital experiences,
referral and interpreting. Ethnic health staff displayed
a range of specialised skills that managers
need to harness within multidisciplinary
teams to reach patients from diverse backgrounds.
Measuring person-centred care in a sub-acute health care setting
Authors: Davis Sandra , Byers Suzanne , Walsh Fay
Published: February 2010

Objective: A more appropriate tool to measure
the client experience of person-centred care is
required to complement other existing measures
of quality. A tool developed in the United Kingdom
was trialled to determine its utility with a frail older
Australian population.
Design: A random sample of clients recently
discharged from a sub-acute setting over a 6-
month period in 2005 were sent a questionnaire
and invited to respond, a reply-paid envelope
being provided for the return of the questionnaire.
The questionnaire comprised the 20-item tool and
space to provide additional qualitative comments.
Setting: The inpatient wards of a sub-acute
facility in Melbourne.
Participants: From the random sample of 144
discharged clients, 78 responded to the questionnaire.
Main outcome measure: 20-item Patient-Centred
Inpatient Scale (P-CIS) developed by Coyle
and Williams (2001).
Results: Overall, there was a fundamental core
of person-centredness as demonstrated by a ratio
score of 0.68. Personalisation and respect dimensions
are the main strengths of person-centred
care in the health care setting in which the P-CIS
was trialled, with personalisation scoring 0.75 and
respect scoring 0.77. The miscellaneous components
scored 0.69. The findings show that areas
of the client experience warranting priority quality
improvement effort are specific to the dimensions
of empowerment (0.58), information (0.58) and
approachability/availability (0.43).
Conclusions: The P-CIS demonstrates the
potential to be a contributing component that
informs the monitoring and improvement of quality
person-centred care in Australian inpatient health
care settings.
"If it wasn't for OTDs, there would be no AMS": overseas-trained doctors working in rural and remote Aboriginal health settings
Authors: Gilles Marisa T , Wakerman John , Durey Angela
Published: February 2010

Australian-trained doctors are often reluctant to
work in rural and remote areas and overseastrained
doctors (OTDs) are recruited to practise in
many rural Aboriginal medical services. This paper
focuses on recent research carried out in Australia
to analyse factors affecting OTDs? professional,
cultural and social integration and examine their
training and support needs. Ten case studies were
conducted throughout Australia with OTDs, which
also included interviews with spouses/partners,
professional colleagues, co-workers, and Aboriginal
and Torres Strait Islander community members
associated with the health service.
Key themes emerging from the data across all
informants included the need to better address
recruitment, orientation and cross-cultural issues;
the importance of effective communication and
building community and institutional relationships,
both with the local health service and the broader
medical establishment.
Few urban–rural differences in older carers' access to community services
Authors: Lucke Jayne , Russell Anne , Tooth Leigh , Lee Christina , Watson Melanie , Byrne Gerard , Wilson Andrew , Dobson Annette
Published: February 2010

To examine perceived adequacy of access to
information and services, and perceived quality of
health and community services, among older
female carers across rural and urban areas primary
data were collected as part of the ongoing
Australian Longitudinal Study on Women?s Health
(ALSWH). In all, 306 women in their 70s who had
family caregiving roles responded to a nested
substudy of the ALSWH. There were few reported
differences between urban and rural older carers
in their access to health and community services
for the people they cared for. In fact, those in rural
areas fared slightly better than those in urban
areas in awareness of service availability and
perceived quality of service. Many older carers in
both rural and urban areas do not access health
and community services even when appropriate
services are available. A better understanding is
needed of how support can be delivered to complement older carers? existing arrangements.
A decade of data linkage in Western Australia: strategic design, applications and benefits of the WA data linkage system
Authors: Holman C D'Arcy J , Bass John  A , Rosman Diana L , Smith Merran B , Semmens James B , Glasson Emma J , Brook Emma L , Trutwein Brooke , Rouse Ian L , Watson Charles R , de Klerk Nicholas H , Stanley Fiona J
Published: February 2010

Objectives: The report describes the strategic
design, steps to full implementation and outcomes
achieved by the Western Australian Data Linkage
System (WADLS), instigated in 1995 to link up to
40 years of data from over 30 collections for an
historical population of 3.7 million. Staged development
has seen its expansion, initially from a
linkage key to local health data sets, to encompass
links to national and local health and welfare
data sets, genealogical links and spatial references
for mapping applications.
Applications: The WADLS has supported over
400 studies with over 250 journal publications and
35 graduate research degrees. Applications have
occurred in health services utilisation and outcomes,
aetiologic research, disease surveillance
and needs analysis, and in methodologic
research.
Benefits: Longitudinal studies have become
cheaper and more complete; deletion of duplicate
records and correction of data artifacts have
enhanced the quality of information assets; data
linkage has conserved patient privacy; community
machinery necessary for organised responses to
health and social problems has been exercised;
and the commercial return on research infrastructure
investment has exceeded 1000%. Most
importantly, there have been unbiased contributions
to medical knowledge and identifiable
advances in population health arising from the
research.
High prices for generics in Australia — more competition might help
Authors: Bulfone Liliana
Published: February 2010

It is commonly believed that dispensed prices of
medicines in Australia are substantially lower than
those in other developed countries, particularly the
US. This article reports the results of an analysis
comparing dispensed prices for the most commonly
prescribed and the highest cost items in Australia
with dispensed prices in the US. Although a large
majority of items are less expensive in Australia than
in the US, Australian prices are higher for a substantial
number of products, particularly generic drugs.
This article examines various policies affecting the
pricing of generics in Australia. It is postulated that
the main cause for higher prices for a substantial
number of generic products is the lack of price
competition. This results from government policy
which ensures that a price reduction by one company
is communicated immediately to all competitors
in that market along with an invitation to match
the reduced price. The dominant strategy for all
suppliers is to only reduce their price in response to
a reduction in price by a competitor. The result is a
lack of differentiation in pricing across brands of a
medicine on the Schedule of Pharmaceutical Benefits.
The government could improve the structure of
the generics market and encourage greater competition
by ceasing to disclose competitor firms? offers
to other competitors. The government could conduct
pricing reviews of each generic product relatively
infrequently (eg, only once annually or every 18
months). At the time of the pricing review, the
government would request confidential offers on
price for a generic from all players in the market.
Brands should then all be listed under the Pharmaceutical
Benefits Scheme (PBS) at the offered price.
Prices offered by the individual supplier would apply
until the next pricing review. The PBS would continue
to subsidise up to the price of the lowest priced
brand, with brand premiums applying to all brands
priced higher than the benchmark price. Such an
approach would provide opportunity for players in
the market to capture market share by being the
lowest priced brand.
Biopharmaceutical innovation and industrial developments in South Korea, Singapore and Taiwan
Authors: Hsieh Chee-Ruey , Lofgren Hans
Published: February 2010

South Korea, Singapore and Taiwan are well
known as export-oriented developmental states
which for decades employed industrial policy to
target particular industries for government support.
In the past fifteen years, these three countries
all identified the biopharmaceutical industry
as a strategic sector. This article explores,
through economic analysis, the rationale for this
decision and the strategies chosen for linking into
the global bio-economy with the objective of
catching up in biopharmaceuticals. The paper
identifies three comparative advantages enjoyed
by these countries in the biopharma sector: (1)
public investments in basic research; (2) private
investments in phase 1 clinical trials; and (3) a
potentially significant contract research industry
managing latter-stage clinical trials. Governments
employ a range of industrial policies, consistent
with these comparative advantages, to promote
the biopharmaceutical industry, including public
investment in biomedical hubs, research funding
and research and development (R&D) tax credits.
We argue that the most important feature of the
biopharmaceutical industry in these countries is
the dominant role of the public sector. That these
countries have made progress in innovative capabilities
is illustrated by input measures such as
R&D expenditure as share of gross domestic
product, number of patents granted and clinical
trials, and volume of foreign direct investment. In
contrast, output indicators such as approval of
new chemical entities suggest that the process of
catching up has only just commenced. Pharmaceutical
innovation is at the stage of mainly
generating inputs to integrated processes controlled
by the globally incumbent firms.
Doctor and pharmacist — back to the apothecary!
Authors: Liaw Siaw-Teng , Peterson Gregory
Published: February 2010

The Australian National Medicines Policy embodies
four tenets: availability, quality, safety and
efficacy of medicines; timely access to affordable
medicines; quality use of medicines (QUM); and a
responsible and viable medicines industry. The
promotion of QUM requires a multidisciplinary
approach, including contributions from government,
the pharmaceutical industry, health professionals,
consumers and academia. However,
there are significant tensions and unintended
effects associated with the multidisciplinary
approach, especially with the relationships
between prescribers and dispensers of medicines.
The general practitioner and the pharmacist share
a common ancestor ? the apothecary. The separation
of dispensing from prescribing, which
began in medieval Europe and 19th century England,
reframed and confined the patient?doctor
relationship to one of diagnosis, prescription and
non-drug management. The role of pharmacists
was limited to dispensing, though the present
trend is for their responsibilities to be widened.
Historical antecedents, the contribution of an
increasing number of actors to the costs of health
care, universal health insurance and an evolving
regulatory framework, are among the factors influencing
doctor?pharmacist relations.
The prescribing and dispensing of medicines must
be guided by an ethical clinical governance structure
encompassing health professionals, regulators,
the pharmaceutical industry and consumers.
There must be close monitoring of safety and
effectiveness, and promotion of quality use of
medicines and improved patient outcomes. Ongoing
training and professional development, within
and across professional boundaries, is essential
to support harmonious and cost-effective interprofessional
practice. The approach must be
?apothecarial? with complementary roles and
responsibilities for the prescriber and dispenser
within the patient?clinician therapeutic relationship, and not adversarial.
Practising inspired leadership: the use of applied theatre "prophetical" in the Executive Leadership Development Program for Queensland Health
Authors: Haseman Brad C , Crethar Meagan P , Phillips Jan N , Stafford Paul J
Published: February 2010

QUEENSLAND HEALTH as an organisation has
been under a great deal of pressure in recent
times. On 26 April 2005, the Queensland Government
announced an independent review of
Queensland Health?s administrative, workforce
and performance management systems. The
review was established in response to public
concern over the safety and quality of the public
health system following events that took place at
Bundaberg Hospital, particularly the appointment
and practices of Dr Jayant Patel. Associated
with the Patel case were issues of bullying and
intimidatory behaviour at the workplace.
In response to the recommendations of the
review, Queensland Health embarked upon a
major reform program. One of the strategies for
driving reform highlighted by the Queensland
Health Systems Review final report, September 2005
was leadership development. Strong leadership
was identified as vitally important to both drive
the reform process and improve workplace culture.
Should patient safety be more patient centred?
Authors: Jorm Christine M , Dunbar Nicola , Sudano Leena , Travaglia Joanne F
Published: February 2010

In a patient-centred health system the views,
experiences and rights of the patient drive the way
that care is delivered. There is now an increasing
emphasis on patient-centredness as an essential
characteristic of safe and high quality care, but to
date the involvement of patients in patient safety
activities has been limited. The views and priorities
of patients are not always valued in safety and
quality work, and their perspectives are rarely
included in activities such as incident investigation.
We propose six areas of action to make
patient safety more patient centred and hypothesise
that the replacement of industrial safety models
with a patient-centred model of safety culture
will improve clinicians? ability to engage with safety
initiatives.
Perceptions of multidisciplinary case conferencing in residential aged care facilities
Authors: Halcomb Elizabeth J , Griffiths Rhonda , Sheperd Bernadette M
Published: February 2010

Objective:

To explore the understanding about and perceptions of, multidisciplinary case conferencing in residential aged care from the perspective of residential facility staff, residents, carers and general practitioners.
Methods:

Focus groups and in-depth interviews were conducted with nurses, residents, carers, allied health workers and general practitioners from two residential aged care facilities during February?March 2008. Conversations were analysed using thematic analysis techniques.
Results:

Thematic analyses highlighted four key themes. Most notably, respondents identified a degree of confusion regarding the purpose of case conferencing and its role in resident health care. The ad hoc development of the conferencing model led to unclear role descriptions for participants that contributed to role confusion and the lack of a collaborative culture. Underpinning much of the discussion was the need for a framework to support the organisation of the conference process.
Conclusions:

While the process of multidisciplinary case conferencing in residential aged care has significant potential to improve resident care and health outcomes, the development of an explicit framework is required to support the effective conduct of these meetings. Key stakeholders need to be engaged to develop a team approach to conducting case conferences that facilitates the active participation of providers, residents and their carers.
The impact of the Coronial Communiqué on changing patient safety: a subscriber survey
Authors: Ehsani Johnathon P , Ibrahim Joseph E
Published: February 2010

To determine whether the Coronial Communiqu� prompted subscribers to initiate changes to clinical practice for patient safety an anonymous, online cross-sectional population survey questionnaire was provided to all registered subscribers to the Communiqu�. The main outcome measure was self-reported review and change to practice. From 1325 subscribers invited to participate, 697 complete and valid responses were received (52.6%). Most of the respondents (588; 84.4%) reported the Communiqu� provided ideas for improving patient safety, 429 (61.5%) reviewed their practice, and 290 (41.6%) changed their practice. The characteristic most associated with a change in practice was if the subscriber was in clinical practice. This association was evident for ideas (odds ratio [OR], 3.42; 95% CI, 2.24?5.23), review (OR, 2.63; 95% CI, 1.91?3.61) and change to improve practice (OR, 2.40; 95% CI, 1.73?3.32).
Health service structures,management and professional practice: Beyond clinical management
Authors: Southon Gray
Published: February 2010

At the heart of the operation of the health system is the relationship betweenmanagers and the various professionals who provide clinical services. While thereis an inherent conflict between these two groups, this conflict has been avoided inthe past by the managers playing a supporting rather than a controlling role.However, the current demands of cost-control are placing managers and professionalsinto direct conflict; a situation that many organisations are addressing by puttingclinicians into management roles. This measure has had initial success in somesituations, but it is argued that this success will be limited because clinicaldepartments are not able to address many of the broader issues that affect theperformance of health services. This paper proposes an alternative approach that willenable these broader issues to be effectively addressed, and also reduce the structuralconflict.
Differences in patient throughput between community health centre and private general practitioners
Authors: Montalto Michael , Dunt David , Richardson Jeff
Published: February 2010

This study sought to compare the rate of patient throughput by community healthcentre general practitioners (GPs) and their private practice fee-for-servicecounterparts.The study group comprised 44 community health centre GPs (out of an identified51) in 16 community health centres; the control group comprised 268 GPs.Community health centre GPs were found to have significantly fewer consultationsand significantly smaller rebates than their private practice counterparts. Thedifference of means for consultation numbers and rebates was 30.3- per cent. Thepattern was reversed in the case of rural community health centre GPs (who retainfee-for-service arrangements).Figures are uncorrected for patient status, and data relate to Medicare billing practicesrather than observed activity or outcome. However, at face value they would indicatethat if Australian general practice moved to a community health centre model, withpredominantly salaried GPs, then patient throughput in general practice could beexpected to drop. Whether these results reflect the impact of incentives on throughputand, if so, whether this indicates a difference in the quality or accessibility of theservice provided to patients is not certain.
Computerised data collection for a cancer centre:A Queensland perspective
Authors: Franklin Ian , Walker Quenten , Tripcony Lee
Published: February 2010

The Queensland Radium Institute has had a computerised database for 15 years butthere was little uniformity in the data collected and there was considerable scope forimprovement. In 1991 the institute decided to upgrade and standardise its datacollection system. The improvements will allow easier access to the data for researchand audit purposes. The process was effective and the implementation straightforwardbecause of effective planning and training. This paper outlines the process used in thereview and implementation of the new database system and describes the data setsin some detail.
Classifying sub-acute and non-acute patients: Results of the New South Wales Casemix Area Network study
Authors: Eagar Kathy , Cromwell David
Published: February 2010

In 1994 the New South Wales Casemix Area Network initiated a study to developa classification and funding model for sub-acute and non-acute care. Thirty-fiverehabilitation, geriatric, psychogeriatric and palliative care services were recruited intothe study throughout eight area health services. The aim of the first phase, summarisedhere, was to capture and analyse a sufficiently large quantity of data to select thosevariables most likely to predict resource utilisation, for subsequent use in a detailedcosting study.It is known that acute care diagnosis related groups are not predictive of costs in sub-acutecare. This phase of the project confirmed that, in New South Wales, the mostpredictive variables were case type, functional status measures, impairment type forrehabilitation, phase for palliative care and severity of symptoms for palliative care.The resultant Phase 1 casemix classification, which has built on recent United Statesexperience and studies in other Australian States, has been termed the New SouthWales Sub-Acute and Non-Acute Patient (SNAP) Version 1 classification.
Health outcomes as an organisation-wide quality initiative
Authors: Healy Bronwyn , Kelleher Dianne , Bennie Alex
Published: February 2010

Since the burgeoning of the ?health outcomes? movement there has been an ever-increasingbody of literature on health outcomes policy debates, directions, frameworksand tools for implementing health outcome-directed initiatives. There is a significantgap in the literature, however, in regard to translating a comprehensive healthoutcomes policy into practice at a local level. This paper addresses that gap. It describesthe local implementation of a comprehensive health outcomes approach which worksacross the continuum of care. It identifies those organisation-wide structures andprocesses that support successful progress, thereby providing a useful guide to otherorganisations wishing to institutionalise the health outcomes approach.
Staff perceptions of discharge planning: A challenge for quality improvement
Authors: Grimmer Karen , Hedges Gaynor , Moss John
Published: February 2010

One hundred staff in three acute care public hospitals were asked about their perceptions of successes and failures of their discharge planning activities. The intention was to highlight ways in which the quality of discharge planning could be improved within the acute hospital setting. Generally staff described failures more commonly than successes, with a number of key failures being identified, including problems associated with vacating beds, lack of appropriate staff, patients and carer education about discharge activities, general process issues, problems associated with community service provision and patients who are difficult to discharge. Staff identified the lack of feedback on the outcome of their efforts as a source of frustration and a barrier to improving discharge planning activities. The challenges for improving the quality of discharge planning in the acute hospital setting would appear to be in establishing appropriate structures and processes that promote interaction between staff,patients and community providers, and provide incentives for behavioural change.
The expanded role of acute care nurses: The issue of liability
Authors: Chaboyer Wendy , Forrester Kim , Harris Denise
Published: February 2010

For a variety of reasons the activities performed by health care professionals are ever increasing, however the legislative process regulating these specialised workers is not keeping up with the practice realities. While competency statements and credentialling mechanisms are developing, they are not uniformly in place for specialists. Therefore activities completed by these practitioners may be legally controversial. This study documents a variety of tasks completed independently by nurses employed in three acute care hospitals that legally require medical orders and then examines the legal implications of this role extension. Credentialling is one mechanism by which nurses and other health care professionals can ensure they possess the levels of knowledge and skill required to perform the advanced activities required of them and consequently avoid negative legal repercussions.
Meeting the information needs of an evidence-based world
Authors: Reid Beth
Published: February 2010

There are many new and exciting health information developments in Australia today.However, there are also many gaps and problems in the information available to support evidence-based decision-making. For example, computerisation in health lags behind other industries. However, these problems should not prevent us using the available data to manage individual care and the health care system more effectively. It is fruitless to wait for atechnological solution to all our problems. Educational and staff changes are needed to prepare health professionals and patients to use information to make evidence-based decisions and bring health care into the information age.
Perceptron learning rule derived from spike-frequency adaptation and spike-time-dependent plasticity
Authors: D’Souza Prashanth , Liu Shih-Chii , Hahnloser Richard H. R.
Published: February 2010

It is widely believed that sensory and motor processing in the brain is based on simple computational primitives rooted in cellular and synaptic physiology. However, many gaps remain in our understanding of the connections between neural computations and biophysical properties of neurons. Here, we show that synaptic spike-time-dependent plasticity (STDP) combined with spike-frequency adaptation (SFA) in a single neuron together approximate the well-known perceptron learning rule. Our calculations and integrate-and-fire simulations reveal that delayed inputs to a neuron endowed with STDP and SFA precisely instruct neural responses to earlier arriving inputs. We demonstrate this mechanism on a developmental example of auditory map formation guided by visual inputs, as observed in the external nucleus of the inferior colliculus (ICX) of barn owls. The interplay of SFA and STDP in model ICX neurons precisely transfers the tuning curve from the visual modality onto the auditory modality, demonstrating a useful computation for multimodal and sensory-guided processing.