bluuebunny/crossref_metadata_2025 huggingface dataset:
Giving support to disease guidelines
Authors: Pilla John
Published: February 2010

The article by Weeramanthri et al (2002) provides an invaluable account of the processes, endeavours andbenefits derived from the development and use of disease guidelines for Indigenous populations. It highlights several important lessons from which others with a similar interest can benefit, including the following:? the importance of obtaining a consensus, and not just an evidence base, for guideline development? guidelines should be judged in relation to what already exists rather than in relation to a hypotheticalstandard of best practice? implementation is far more difficult than development.The term evidence, in this context, is often used to refer to proof of benefit derived from quasi-experimental design studies.However, one should not discount the use of other forms of evidence, particularly (in the absence of evidence from studies with an adequate experimental design) experiential-based evidence.I focus on two related matters in this commentary. The first concerns the extent to which the experiences ofthese two trials are similar to or contrasted by the experiences of the other Indigenous trials. The secondconcerns lessons learned from implementation and usage of disease guidelines as distinct from developmentissues which are the focus of the article by Weeramanthri and colleagues.
Killers in the bush
Authors: Pollard Mike
Published: February 2010

Three senior Chief Executives of acute hospital trusts in the UK recently visited the Northern Territory (NT)and South Australia (SA) to study remote and rural health care in general - and Aboriginal health in particular. As with all other aspects of Aboriginal life, the subject of health status is highly charged and generates heightened emotions and intense political debate across the country but particularly in the NT and SA where many of the remote indigenous people live. Every "mainstream" Australian has an opinion on the trials and tribulations of the indigenous people.The field study was part of the NHS Leadership Centre's Senior Chief Executives' Development Programme. Itcomprised a longitudinal journey across the continent from Darwin (NT) through to Alice Springs to Tanundain the Barossa Valley and then on to Adelaide following the route of the 2,500 kilometre Stuart Highway. Itinvolved visiting rural health services, and meetings with Aboriginal leaders, academics, health practitioners and senior officials of the SA government.A specific research topic was to understand how practitioners working in extreme environments, and delivering long-term programmes of care, can maintain their morale and motivation.
Mongolian experiences with health insurance: are success factors unique?
Authors: Hindle Don , Van LangendOncd Jef , Tsolmongerel Tsilaajav
Published: February 2010

We describe the health insurance model implemented in Mongolia after the Soviet Bloc collapsed in 1990, and note some of its good features. We then discuss the structural weaknesses that became evident over the first ten years of use, and some current proposals for reform. Finally, we consider the factors that appear to have affected success. We argue that the main constraints are much the same as in other countries including Australia - and relate more to confusion and disagreement over broad policy issues than to detailed knowledge of technical aspects or the research evidence.
Health care funding in New South Wales: from health care needs to hospital outputs
Authors: Hindle Don
Published: February 2010

This paper summarises the structure of the State's health care system, and then focuses on the main processes of resource allocation: needs-based funding of 17 Area Health Services, and output-based funding of specific service providers. The general model is widely accepted by informed observers to be fundamentally sound. In particular, the resource distribution formula whereby needs-based allocations are made is a largely valid model that has been progressively refined over fifteen years and is probably as good as any in the world. I conclude that the recent decision to require Area Health Services to use a common framework for out-put-based funding was long overdue, and that many of its features represent best practice. However, I argue that more shouldbe done to refine some of the details and that NSW Health might need to give more consideration to ideas that have been tested and evaluated in other health care systems.
Coding errors and the trauma patient - is nursing case management the solution?
Authors: Curtis Kate , Bollard Lousie , Dickson Cara
Published: February 2010

The aim was to investigate the accuracy of clinical information coding and the financial consequence for trauma patients at a tertiary trauma centre using the resources of trauma nursing case managers. Clinical data for admitted trauma patients in August and September 2000 were compared with data routinely obtained by trauma case managers on their daily rounds. We audited patient injuries, in-hospital complications, investigations, and procedures. Clinical information records requiring alteration were returned to the clinical information manager with additional information and re-entered into the clinical information database.100 trauma patient records (15% of admissions for 2000) were audited. 28% of recoded records had to have their diagnosis related group (DRG)changed, which resulted in the identification of additional funding of over $39,000. We conclude that the implementation of episode funding for acute episodes, such as the complex trauma patient, is placing increased importance on accuracy of coding. The validity of coding is dependent on legible, comprehensive and complete documentation and is improved dramatically by using nursing case manager patient progress summaries.
Waiting time information services: how well do different statistics forecast a patient's wait?
Authors: Cromwell David A. , Griffths David A.
Published: February 2010

This study investigates how accurately the waiting times of patients about to join a waiting list are predicted by the types of statistics disseminated via web-based waiting time information services. Data were collected at a public hospital in Sydney, Australia, on elective surgery activity and waiting list behaviour from July 1995 to June 1998.The data covered 46 surgeons in 10 surgical specialties. The accuracy of the tested statistics varied greatly, being affected more by the characteristics and behaviour of a surgeon's waiting list than by how the statistics were derived. For those surgeons whose waiting times were often over six months, commonly used statistics can be very poor at forecasting patient waiting times.
Audit of longterm mortality and morbidity outcomes for carotid endarterectomy
Authors: Middleton Sandy , Donnelly Neil , Harris John , Lusby Robert , Ward Jeanette
Published: February 2010

There have been no Australian studies of longterm mortality status and cause of death after carotid endarterectomy (CEA) or, for survivors, quality-of-life. We first determined rate and cause of death for a cohort of patients four years after CEA. Surviving patients were surveyed to ascertain health status, using MOS SF-36. Of 238 patients who underwent CEA in our health service in 1995, 44 (18.5%) had died within four years. The majority of deaths (61.4%) were attributable to vascular causes. Of the surviving 162 patients (survey response fraction 90%), 10 (6.2%) subsequently had suffered a non-fatal stroke in the four years following their CEA. With respect to health status, Physical Functioning scores differed significantly by age (t=2.65, df=149, P=0.01) as did Role Physical scores (t=2.10, df=142, P=0.04). We conclude that patients undergoing CEA are at high risk of dying from vascular causes, inviting concerted efforts in discharge planning to co-ordinate optimal vascular risk factor management.
Factors associated with young adults' obtaining general practitioner services
Authors: Parslow Ruth , Jorm Anthony , Christensen Helen , Jacomb Partricia
Published: February 2010

This paper explores factors associated with the use of general practitioner services by young adults aged 20 to 24 years. The analyses examined sociodemographic and health data obtained for a community survey of respondents who lived in Canberra or Queanbeyan in 1999 and 2000 and linked this information to Medicare records of general practitioner visits over the following six months. In line with the Andersen model of health behaviour, predictor variables were classified as measures of physical and mental health needs for such services or as factors that predispose or enable the individual to obtain those services.Those who obtained general practitioner care were more likely to be female, to have been or be undertaking higher education and to be living with children. They were also identified by their having poorer physical health, more chronic diseases, higher levels of suicidal ideation and by their regularly using marijuana. General practitioners need to be aware of the potential mental health and substance use problems experienced by consumers in this age group. Strategies are also needed to encourage young men to seek general practitioner services when they are ill.
Linking acute care to a strategy for improving Aboriginal health
Authors: Anderson Ian , Clarke Angela , Renhard Russell , Otim Michael , Andrews Shawana
Published: February 2010

In this paper we consider the extent to which strategies to improve access to acute care services have been integrated with national strategies to improve Aboriginal health outcomes. To do this we review the primary and secondary sources and provide an overview of current national strategy in Aboriginal health and identify where policy and strategic issues relevant to acute care have been developed. In particular we consider the extent to which national policy processes have focussed on the interface between the primary and acute sectors. It is our contention that nationally integrated strategies to improve access to the acute care sector require the development of an Aboriginal health focus in hospital based quality assurance processes and a comprehensive engagement with Aboriginal issues across the acute care sector.
Characteristics of general practitioners that provided health assessments, care plans or case conferences, as part of the Enhanced Primary Care program
Authors: Wilkinson David , McElroy Heather , Beilby Justin , Mott Kathy , Price Kay , Morey Sue , Best John
Published: February 2010

We aimed to describe the characteristics of general practitioners (GPs) who provided health assessments (HA), care plans (CP) or case conferences (CC) as part of the Enhanced Primary Care (EPC) program between November 1999 and October 2001.While the gender distribution of EPC-active GPs is similar to that of non-EPC-active GPs, EPC-active GPs tend to be younger (72% vs 58% aged 35-54 years). Among EPC-active GPs, males account for about 66% of providers and about 80%of services. There is a very wide range in the number of EPC services provided per GP. In all, 1591 (14%)have rendered a single service while 919 (8.1%)have rendered over 100 services each (accounting for almost half of all EPC activity in Australia). The number of GPs providing any EPC service each month gradually increased to around 5000 in October 2001.Most patients (80-90%)that received multiple EPC services did so from the same GP. Across Divisions of General Practice the proportion of practices registered for the Practice Incentive Program (PIP) that have provided EPC services ranges from 100 to 0%. In the first year at least 50% of all practices in 84 Divisions rendered at least one EPC service while in the second year 108 did. Across Australia 58% of PIP practices rendered at least one service in the first year and 76% did in the second year. A little over half the GP workforce rendered at least one EPC service in the first year of the program, but there was a very wide range in the number of services provided per GP. Most GPs provide very few and a small number provide very many. There is wide variation in the proportion of practices providing EPC services, but this is increasing.
A case study in strategic change: Developing a strategic research program to address cardiovascular disease and related disorders in Aboriginal and Torres Strait Islander peoples
Authors: Field Pat , Wakerman John
Published: February 2010

This paper presents an analysis of a strategic change process. It identifies and reviews the critical factors that impact on,and need to be considered in order to successfully initiate and implement change. The problem was the narrow focus and priorities of a well-established research program. We undertook a stringent process to refocus the program to the areas of greatest need. The paper provides information on the process undertaken to achieve the change and other factors that impacted. The outcome has been considered successful in the first instance. However the long-term picture may not be as positive. Reviewing and presenting the process and influential factors provides the reader with the opportunity to compare this scenario with their own experience and thereby develop their own change strategies.
Detection and documentation of DRG-relevant comorbidities using laboratory tests
Authors: Wilke Michael H , Schenker Mike , Hoffmann George
Published: February 2010

Germany will soon begin per case payment by DRG, and preparations are in progress in most hospitals and insurance companies. The Academic Teaching Hospital Munich-Schwabing in Munich decided to explore coding strategies by considering the impact of diagnoses that could be detected by pathology An Australian database was analysed. We detected "discriminating'diagnoses - that is, diagnoses that could be found in level A or B DRGs, and not in the respective lower severity DRG. After isolating 584 diagnoses, they were rated by a laboratory specialist, to determine whether they could be proved by pathology tests. 187 diagnoses were selected in this way. In the next step, theoretical cases were generated and grouped. 157 diagnoses were found to produce a switch to a higher DRG. The diagnoses, the DRGs and the respective laboratory tests were then arranged in a small MS-Excel program to allow comfortable browsing. The overall success rate of 84% shows that laboratory medicine can contribute to correct coding for DRGs.
Unassigned Geriatric Evaluation and Management Program: preventing sub-acute hospital admissions
Authors: Heaney Clare , Lim Kwang , Lydall-Smith Sharryn , Dorevitch Michael
Published: February 2010

The purpose of this study was to describe and evaluate the Unassigned Geriatric Evaluation and Management (UGEM) program recently developed at Bundoora Extended Care Centre (BECC). The UGEM program resembles a bed substitution service and aims to prevent hospital admissions by providing community case management services to clients who would otherwise require inpatient admission.Data was collected on 36 clients who had received UGEM services. Twenty-six clients/carers also took part in a follow-up telephone satisfaction interview.Overall, the evaluation indicates that the UGEM program is a flexible, valuable and effective service. Most UGEM clients could be maintained at home with services, and this suggests that the program succeeds in assisting many clients to avoid hospitalisation in crisis situations. Further, clients and carers displayed a very high level of satisfaction with the service. The ongoing funding of such programs is crucial in order to maintain the reduction in hospital admissions and hence the high costs associated with inpatient care.
Funding of Northern Territory public hospitals
Authors: Fisher Dale , Ruben Allen
Published: February 2010

The Northern Territory is Australia's third largest jurisdiction by land mass but it is the smallest by population. By proportion it accommodates the largest number of Aboriginal people who suffer the greatest burden of disease with highmorbidity, mortality, admission rates and lengths of stay. Output based funding by DRG is based on the 'typical' Australian population which is not that of the Northern Territory. The NT has had to significantly modify its approach to funding to meet the needs of its population. The current funding method based on detailed analyses of clinical data with small numbers may be inappropriate where simpler methods tailored to the NT population could suffice.
Developing a positive organisational culture using a management development strategy
Authors: Williams Harry
Published: February 2010

This paper evaluates a management development program, which was piloted at Albury Base Hospital during 2001 for nurse managers. The program uses quantitative assessments of participants using a lifestyle inventory tool and enables managers to identify opportunities and strategies to assist them to become more effective managers. The program also helps identify management 'blind spots" and increased awareness of the effect of management's behaviour on team efficiency. The program was evaluated as being relevant to managers from any health discipline and was a means by which workplace culture and behaviour could be improved.
The association between musculoskeletal disorders and obesity
Authors: Kortt Michael , Baldry Jonathan
Published: February 2010

The aim of this study was to examine the association between musculoskeletal disorders and the level of obesity (as defined by the body mass index) for a sample of the Australian population aged 20-64.A logistic regression model was used to estimate the association between musculoskeletal disorders and obesity, controlling for a range of socio-demographic characteristics. Individual-level data on obesity, musculoskeletal disorders, and various socio-demographic characteristics were extracted from the Australian Bureau of Statistics (ABS) 1995 National Health Survey (NHS). Individuals with musculoskeletal disorders were identified using ICD-9 codes 710-739 from a sample of 28,376 individuals from the non-institutionalised population. Estimates from the logistic regression equation indicate that there is a statistically significant positive relationship between the probability of having a musculoskeletal disorder and the level of obesity. Socio-demographic variables such as age, sex, origin, income level, employment status and geographic location also had a statistically significant relationship. This information can be used by public health practitioners and educators to identify those at risk and to design health strategies that target at-risk patients.
The Baycrest SARS experience: the human side
Authors: Goldhar Jodeme , Adie Clare , Webb Nancy , Harrison Laurie
Published: February 2010

Toronto, in the province of Ontario, Canada was one of the cities severely impacted by Severe Acute RespiratorySyndrome (SARS). SARS required the health care system to respond quickly and efficiently. This paper describes thesituation and response at a large public academic aged care centre.
Commentary on the King Edward Inquiry: lessons we fail to learn
Authors: Siddins Mark
Published: February 2010

Commentary on the King Edward Inquiry by Mark Siddins, a urologist and transplant surgeon at the Repatriation General Hospital in Adelaide,South Australia.
Commentary on the King Edward Inquiry: coming soon to a theatre near you
Authors: Hindle Don
Published: February 2010

Commentary on the King Edward Inquiry by Don Hindle, visiting professor in the Medical Faculty, University of New South Wales
Should Australia's hospitals be reviewing the use of research in patient care by nurses, managers and allied health professionals? - A systematic review of recent evidence
Authors: Peach Hedley
Published: February 2010

Recently published studies were systematically reviewed to determine whether use of research in clinical practice bynurses, managers and allied health professionals in hospitals is currently sub-optimal, the factors influencing this andpossible remedial strategies. The better studies confirmed that use of appropriate research is currently sub-optimal. Thenature of the research and access to it is partly responsible for this. However, adoption of research findings is alsocurrently hindered by factors inherent in hospitals and by the skills and attitudes of potential users of the research.Numerous remedial strategies have been suggested and hospitals could take responsibility for implementing many ofthem. However, most have yet to be evaluated. Studies into the use of research findings by nurses, managers and alliedhealth professionals in Australian hospitals and trials of remedial strategies are recommended.
A comparison of health insurance in Slovenia and Croatia
Authors: Hindle Don
Published: February 2010

Before Croatia and Slovenia became independent in 1991, they had similar health systems.They have generally taken the same reform path since then,but have also travelled in opposite directions on occasions. Of particular relevance here, both countries established quasi-government agencies to administer a new national scheme of compulsory health insurance in 1993. However, Slovenia's compulsory scheme involved much larger copayments, and a parallel voluntary insurance scheme was created mainly to cover them. In 2002, Croatia increased copayments and introduced a voluntary insurance scheme almost identical to that of Slovenia's. To complete the circle, Slovenia has announced it intends to abandon the use of voluntary insurance for copayments, and reduce the level of copayments for its compulsory scheme.This paper describes and compares the two insurance systems,and I argue that there has been considerable success in difficult circumstances.However,the experiences reinforce aspects of design that seem to be generally relevant: the need to make use of consumers' informed opinions, to recognise and then redress a lack of experience of optional approaches among many of those making decisions about health insurance, to define and apply a rigorous evaluation framework that includes estimating people's total costs for health care, to emphasise the long term, to identify and ensure there is transparency of vested interests, and to use the financial power of the dominant government insurer to encourage and reward improvements in clinical practice.
Health care leadership in an age of change
Authors: Farrell Maureen
Published: February 2010

This study examined the leadership practices of a sample of network and hospital administrators in metropolitan Victoria, Australia. It was undertaken in the mid-1990s when the State Liberal-National (Coalition) Government in Victoria established Melbourne's metropolitan health care networks. I argue that leadership,and the process of leading, contributes significantly to the success of the hospital in a time of turmoil and change.The sample was taken from the seven health care networks and consisted of 15 network and hospital administrators. Bolman and Deal's frames of leadership - structural, human resource, political and symbolic - were used as a framework to categorize the leadership practices of the administrators. The findings suggest a preference for the structural frame - an anticipated result, since the hospital environment is more conducive to a style of leadership that emphasizes rationality and objectivity. The human resource frame was the second preferred frame,followed by the political and symbolic. These findings suggest that network and hospital administrators focus more on intellectual than spiritual development, and perhaps this tendency needs to be addressed when educating present and future hospital leaders.
Casualisation of the nursing workforce in Australia: driving forces and implications
Authors: Creegan Reta , Duffield Christine , Forrester Kim
Published: February 2010

This article provides an overview of the extent of casualisation of the nursing workforce in Australia,focusing on the impact for those managing the system. The implications for nurse managers in particular are considerable in an industry where service demand is difficult to control and where individual nurses are thought to be increasingly choosing to work casually. While little is known of the reasons behind nurses exercising their preference for casual work arrangements,some reasons postulated include visa status (overseas trained nurses on holiday/working visas); permanent employees taking on additional shifts to increase their income levels; and those who elect to work under casual contracts for lifestyle reasons. Unknown is the demography of the casual nursing workforce, how these groups are distributed within the workforce,and how many contracts of employment they have across the health service - either through privately managed nursing agencies or hospital managed casual pools. A more detailed knowledge of the forces driving the decisions of this group is essential if health care organisations are to equip themselves to manage this changing workforce and maintain a standard of patient care that is acceptable to the community.
Gender differences in senior management decision making in the New England Area Health Service
Authors: Anderson Donna M
Published: February 2010

Data from a questionnaire administered to senior
managers in the New England Area Health Service
(NEAHS) was used to examine gender differences
in decision-making processes. The study
found that female managers were more likely to
report that they included staff in decision-making
processes. The small size of the population
restricted the statistical analysis; more meaningful
findings may result if the study were to be
repeated using a larger population of senior
managers.
The Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S) assesses new surgeries
Authors: Maddern Guy
Published: February 2010

The Australian Safety and Efficacy Register of
New Interventional Procedures ? Surgical
(ASERNIP-S) is a programme of the Royal Australasian
College of Surgeons (RACS). We provide
assessments of new and emerging surgical
techniques, establish and facilitate clinical and
research audits or trials, and produce clinical
practice guidelines. We use horizon scanning to
identify new techniques. ASERNIP-S conducts
systematic literature reviews and accelerated systematic
literature reviews on the safety and effectiveness
of new surgical techniques before they
are widely accepted into the health care system.
The RACS recently endorsed two new ASERNIPS
systematic reviews and three accelerated systematic reviews.
"Tough but fair"? The active management of the New Zealand drug benefits scheme by an independent Crown agency
Authors: Davis Peter
Published: February 2010

For just over a decade, New Zealand has relied on
an independent Crown agency to manage the
public drug benefits scheme. It was established
after a period of industry litigation and unsustainable
budgetary increases. The agency has successfully
contained prices, saving the equivalent
to its originally allocated budget every year,
despite a 50% increase in volumes. It shares
features with similar agencies elsewhere in the
world, particularly in its independence and its
operational methodology. Opposition from the
industry and ambivalence in the medical community
remain matters of concern. The fate of such
agencies is inextricably linked to wider regulatory
and policy settings in the health sector.
India's pharmaceutical industry: hype or high tech take-off?
Authors: Malhotra Prabodh , Lofgren Hans
Published: February 2010

India has built a large pharmaceutical industry
through an array of measures in support of
domestic firms. The absence of product patents
enabled Indian companies to become world leading
producers of generic versions of patented
drugs. Low costs and a strong engineering tradition
continue to sustain competitive strength. The
implementation of the World Trade Organization
patent regime in 2005 is driving a transformation
of the industry. Key elements of the present
shake-up include the return of ?big pharma? companies
on a large scale and the emergence of
several Indian firms that aim to become fullyfledged
research-based multinationals. This article
provides a description of the development and
structure of the Indian pharmaceutical industry
and explores questions and challenges arising
from its integration into global markets.
The international vaccine scene
Authors: Robinson Priscilla
Published: February 2010

INFECTIOUS AND COMMUNICABLE DISEASES account
for a large burden of disease worldwide, causing the
death of roughly a million people each month
(WHO 2004). This book is about some of the ways
in which this enormous problem is being
addressed.
The book comprises a collection of papers from
the global Conference on vaccines, prevention, and
public health and is as much about public health
thinking in communicable disease control as it is
specifically about vaccines. Its contributors are
practitioners in the field of immunisation and communicable
disease control from all over the world.
The book is clearly set out in eight sections, with
both an introductory summary, Setting the stage, and
an Epilogue summary section. The specific sections
cover The present, with summaries of measles,
rubella and poliovirus control measures, as well as
the case of yellow fever which is used as a warning
about what can happen if we take our eyes off the
public-health-control ball. This is followed by The
cutting edge, covering the newest vaccines for Haemophilus
influenzae, varicella (chicken pox), hepatitis
A, and the two major bacterial infections ?
meningococcal and pneumococcal diseases. The
future section covers prospects for vaccines to control
a variety of infections, including the enteric
diseases rotavirus, Shigella and typhoid; two major
causes of cancer, Helicobacter pylori (gastric cancers
and ulcers) and human papillomavirus (cervical
cancer); hepatitis C; and two common causes of
viral respiratory disease, influenza and respiratory
syncytial virus (RSV). RSV is a good example of a
common disease which carries a large burden of
morbidity (Chin 2002) all over the world, especially
among children, and yet few people have
heard of it.
Patents, pills and politics: the Australia–United States Free Trade Agreement and the Pharmaceutical Benefits Scheme
Authors: Harvey Ken
Published: February 2010

There is tension between the need of the pharmaceutical
innovator for intellectual property protection
and the need of society for equitable and
affordable access to innovative drugs. The recent
Australia?United States Free Trade Agreement
provides a nice illustration of this interplay
between patents, pills and politics. This article
provides a brief history of patent law as applied
to pharmaceuticals, describes how the Pharmaceutical
Benefits Scheme got caught up in AUSFTA
negotiations, analyses the clauses that are
likely to impact upon the PBS and describes the
political process that reviewed and ultimately
amended the AUSFTA.
Correction: Patents, pills and politics: the Australia-United States Free Trade Agreement and the Pharmaceutical Benefits Scheme
Authors: Harvey Ken
Published: February 2010

Re: ?Patents, pills and politics: the Australia?
United States Free Trade Agreement and the
Pharmaceutical Benefits Scheme?, by Ken
Harvey, (Aust Health Rev 2004, vol. 28, no.
2, pp. 218-226).
Under the heading ?A brief history of
patent law relevant to pharmaceuticals?, in
the second paragraph, the second sentence
was: ?Before TRIPS, many developing countries
provided no patent protection on pharmaceutical
products, or they recognised
patents on products but not process?. The
corrected version should be ?. . .process but
not products?.
A case study in mainstreaming flexible learning in health - perspectives from the bush
Authors: Hartley Ross , Mills Melissa , Cupitt Margaret
Published: February 2010

Our mission is to inculcate an ethos of online learning and communicating, moving it from the margins tomainstream. A skilled health workforce is crucial to better practices. Face-to-face teaching still dominates learningacross NSW Health, despite remarkable developments worldwide in using technology for learning. Health is slow toembrace this renaissance due partly to lack of exposure among educators and learners, and the fact of course thatlearning is not its core business. The three staff comprising New England Area Health Service (NEAHS) LearningServices extensively researched NEAHS staff attitudes to flexible learning (2001) and Information Technology skills(2003). Amalgamating these data, with that from the first ever across-NSW Health online course we ran (2002)determined the appropriateness of our decision to instigate an external web-based discussion facility, previously notavailable in health,for supporting learning and for communicating within NEAHS and indeed across Area HealthServices (AHS).
You can't get there from here: building bridges across research and practice communities
Authors: Dwyer Judith , Leggat Sandra G
Published: February 2010

IN THIS ISSUE, Ried and Fuller (page 6) describe an
approach taken by the Primary Health Care
Research Evaluation and Development (PHCRED)
program in South Australia to support novice
authors. This paper reminds us of the acute need to
support developing researchers, given the low levels
of support for health services research in Australia.1
But where is the accompanying paper that focuses
our attention on developing the research insight of
managers, leaders, policymakers and practitioners?
There has been much talk of the critical need to link
the disparate research and decision-making communities,
but little action.
Consistently we find evidence that evidence is not
available or is not used. In a study of economic
evaluations only 27% were thought to have influenced
either health care decision makers or policy.2
Review of purchasing decisions by NHS districts
found that only 42% had evidence to support the
decision made.3 In Australia there is a dearth of
health services research focusing on major system or
broad policy issues.1
Care coordination in the Emergency Department: improving outcomes for older patients
Authors: Corbett Helen M , Lim Wen K , Davis Sandra J , Elkins Ann M
Published: February 2010

This study aimed to evaluate the effectiveness of
the care coordination (CC) program operating in
the Emergency Department (ED) of The Northern
Hospital in improving outcomes for older people
and reducing ED admissions and re-presentations.
This was achieved by comparing admissions from
ED to wards pre and post commencement of the
CC program, and measuring patient health-related
quality of life pre and post CC intervention. Patient
readmission rates and staff and patient satisfaction
with the service were also investigated. Results
indicate a statistically significant reduction in the
proportion of patients admitted from the ED to a
ward since the inception of the program, a significant
difference in the mean-related quality of life
scores before and after intervention by care coordination,
and staff and patient satisfaction with the
service. The readmission data collected in the
present evaluation will serve as a baseline measure for future evaluations.
A description of handover processes in an Australian public hospital
Authors: T Bomba David , Prakash Robert
Published: February 2010

Handover of patient care has been an ongoing
problem within the health care sector. The process
remains highly variable and there is a threat
to patient safety. Despite the general belief that
handover transitions in patient care have become
routine, not enough attention or research has
been directed at improving this period of care. For
this reason there is a need to provide an analysis
of the communication processes during handover.
A study was conducted of the handover process
among doctors during shift changes within a hospital
setting. The results suggested a need for
process change. Results revealed a handover
process which was unstructured, informal and
error prone, with the majority of doctors noting that
there was no standard or formal procedure for
handover. The research found that the majority of
hospital doctors recognised the potential benefits
of formalising and computerising this process.
Relations with the health care workforce, industrially and otherwise
Authors: Dwyer Judith , Leggat Sandra G
Published: February 2010

IN THIS ISSUE we present three commentaries
addressing the likely impact on the health care
system of the industrial relations reforms proposed
by the national government. Whether you
believe that the reforms will control wages,
increase flexibility and improve productivity, or
that they are more likely to cost jobs and create an
un-Australian two-tiered system of employment
protection, there is no doubt of the importance of
these changes.
Information systems in the new world: an emerging national approach
Authors: Grain Heather
Published: February 2010

AUSTRALIA IS ONE OF MANY countries around
the world wanting to take advantage of clinical
decision support systems to reduce misadventure,
improve quality of care and enhance
health outcomes. Policy and infrastructure
developments that could remove many of the
barriers to the implementation of these systems
are being considered by the Australian Health
Ministers? Advisory Council (AHMAC) over the
next few months.
These initiatives include processes for national
identification of health care recipients; common
approaches to consent to information sharing and
access control in the electronic health care environment;
secure messaging infrastructure; a
national medicines directory and agreement on
national terminology.1 These considerations are
taking place in a context of jurisdictional cost
sharing, with mutual benefits being sought.
Detailed business cases have been developed, and
supporting policy and practical pathways forward
are actively sought. This joint policy and infrastructure
development approach will seek to
build consistent, shared formats and risk management,
as well as shared financial responsibility.
This approach is seen as more likely to lead to
system change and implementation, where previously
almost every advancement has succeeded in
identifying more obstacles.
The kind of objectives outlined above are a
major underpinning of HealthConnect and
state-based health information system initiatives
across the country. These initiatives are
extremely expensive, require significant infrastructure
investment to achieve the benefits
they promise, and none can be successfully
implemented solely by information technology
or information system professionals. It is vital
that health care managers at all levels and
domains of health care appreciate the success
factors when making decisions about the introduction
and management of these systems.
The information world itself is changing for us
all. These changes don?t just affect the information
managers or the information technology
(IT) enthusiasts found in many clinical areas of
our health care organisations. As in other areas
of our lives, IT has invasive effects on the clinical
workplace, administration and government
offices. Managers in health care are often frustrated
by what is seen as a failure of IT to deliver
on its promise of better decision support systems,
sharing of clinical information between
organisations and faster access to patient information
and clinical knowledge. Nevertheless,
these systems are already changing the method
of collecting and using clinical information in
the workplace, and are having an impact on the
skills needed by all health professionals, including
the health administrator.
Board self-evaluation: the Bayside Health experience
Authors: Duncan-Marr Alison , Duckett Stephen J
Published: February 2010

Board evaluation is a critical component of good
governance in any organisation. This paper
describes the board self-evaluation process used
by Bayside Health, a public health service in
Melbourne.
The question of how governing boards can
assess their performance has received increasing
attention over the past decade. In particular,
the increasing demand for accountability to
shareholders and regulators experienced by corporate
sector Boards has resulted in greater
scrutiny of board performance, with the market
and the balance sheet providing some basis for
assessment.1-3
Performance evaluation of governing boards in the
public sector has been more challenging. Performance
evaluation is complex in a sector that is not
simply driven by the bottom line, where the stakeholders
involve both government and the broader
community, and where access to, and the quality
and safety of the services provided, are often the
major public criteria by which performance may be
judged. While some practices from the corporate
sector can be applied successfully in the public
sector, this is not always the case, and public
sector boards such as the Board of Directors of
Bayside Health have been developing ways to
evaluate and improve their performance.
Slaves to economists? A Canadian's view of the Australian health care system
Authors: Deber Raisa B
Published: February 2010

AN EXPERT IS DEFINED as someone from out of
town ? with slides. In health care, such experts
also have a tendency to make cross-national
comparisons on the basis of a short visit, a few
conversations, and a desire to indicate ?lessons
learned?.1 In that time-honoured tradition, on the
basis of a visit to Melbourne to address the
Victorian Healthcare Association, coupled with
visits to several local hospitals, this Canadian
identified several potential problems arising from
Australia?s approach to the public?private mix of
hospital services.
As Keynes noted, ?The ideas of economists and
political philosophers, both when they are right and
when they are wrong, are more powerful than is
commonly understood. Indeed the world is ruled
by little else. Practical men, who believe themselves
to be quite exempt from any intellectual influence,
are usually the slaves of some defunct economist.?2
Over the past decades, many health care reformers
have urged change ? with varying degrees of
success ? based on a set of ideas that markets are
always right, that competition is both necessary and
sufficient for efficiency, and that private is superior to
public. One consequence has been a push for a
greater role for private delivery of health care services.
This is currently hotly contested in Canada,
with Australia providing either an exemplary example
or a cautionary tale, depending upon ideological
proclivities.
I was therefore interested in learning more from
Australians as to areas of success or failure of the
public?private mix in Australia, and this paper
highlights my observations.
Antibiotic guidelines in NSW hospitals
Authors: Maxwell David J , Easton Kylie L , Brien Jo-anne E , Kaye Karen I
Published: February 2010

THIS PAPER REPORTS THE RESULTS of a preliminary
survey which investigated antibiotic guideline use
and the strategies used to implement and evaluate
guideline use in NSW hospitals. We were interested
in assessing the extent to which well established
guidelines of proven value are being used in a
sample of hospitals, as one way to measure implementation
of the principles of clinical governance.
From the Book Review Editor
Authors: Day Gary E
Published: February 2010

THE PLEASING ASPECT of
this book is that it goes
much broader than the
title implies. The opening
statement sums up
the text nicely: ?Every
management decision
has financial implications
? every financial
decision has management
implications!? The
book looks broadly at
health management and its link to financial viability.
Subject areas include excellent chapters
and sections on leadership and organisational
strategy, ethics in nursing administration, information
systems, budgeting principles and strategies,
finance and accounting issues, and
determining and evaluating staff. The editors
have included useful definition boxes, case studies
and web links.
Mental health care: commitment to action?
Authors: Dwyer Judith , Leggat Sandra G
Published: February 2010

THE COUNCIL OF AUSTRALIAN GOVERNMENTS
(the peak intergovernmental forum in Australia,
comprising the Prime Minister, State Premiers,
Territory Chief Ministers and the President of the
Australian Local Government Association)
focused on mental health care at its meeting in
February. They agreed that more money is
needed, and asked their public servants to prepare
an action plan urgently.1 The action plan is
expected to contain a stronger focus on mental
health promotion and early intervention, and
perhaps a more flexible approach to the housing
and care needs of people who can?t ?manage on
their own?. A stronger role for the non-government
sector is anticipated, as well as increased
access to psychologists and other health professionals
in primary care, and efforts to improve
access for people with mental illness to employment,
community activities, rehabilitation and
respite care.
It's time for action: do something to help
Authors: Kennett Jeff
Published: February 2010

IN 1997, while I was the Premier of Victoria, I was
challenged by my daughter to do something to
stop young country men dying on our roads.
Further investigation of the two deaths that
caused my daughter to cry out her challenge
found that, while both young men?s deaths were
recorded as road fatalities, both men were
depressed and had used their motor vehicles to
take their own lives.
Hence began a journey that led me to consider
better suicide prevention programs ? until I
realised suicide prevention programs were too
late in the process.
Talking about mental illness was rejected by
most of the community, but the word depression
had a much wider acceptance. My advocacy for a
national body to destigmatise depression took
shape in July 2000 when I became the Inaugural
Chairman of The National Depression Initiative,
which became beyondblue.
Stakeholder concerns about Australia's mental health care system
Authors: Townsend Clare E , Pirkis Jane E , Pham An T N , Harris Meredith G , Whiteford Harvey A
Published: February 2010

There is growing community and professional
concern that the Australian mental health care
system requires substantial reform. In response to
these concerns, a Senate Select Committee on
Mental Health has been commissioned to conduct
an inquiry into the provision of mental health
services. The current study involved a content
analysis of 725 submissions received by the Committee,
and highlighted significant areas for
reform. People with mental illness face difficulties
in accessing mental health care, the care they do
receive is of varying quality and poorly coordinated,
and necessary services from other sectors,
such as housing, are lacking. These problems
may be exacerbated for particular groups with
complex needs or heightened levels of vulnerability.
The system requires reorienting towards the
consumers and carers it is designed to serve, and
needs stronger governance, higher levels of
accountability and improved monitoring of quality.
These findings are discussed in the context of the
recent acknowledgement of mental health as an
issue by the Council of Australian Governments
(COAG), which has called for an action plan to be
prepared for its consideration by June 2006.
Private hospital insurance status among a state-wide injured population
Authors: Clay Fiona J , Ozanne-Smith Joan
Published: February 2010

Injury is a leading cause of inpatient hospital
episodes. Over a 4-year period (1997?2000) the
Australian Government introduced measures to
support the private health insurance industry by
providing incentives for people to take up private
health insurance (PHI) in order to take the pressure
off public hospitals. This study examined the
levels of PHI for moderately and severely injured
people in Victoria as a way of determining the
effectiveness of government incentives. The
method involved an analysis of all Victorian public
and private hospital injury admissions between
July 2000 and June 2003. We found that people
with injuries, either unintentional or intentional,
had lower levels of PHI than state norms. While
numbers of injured patients occupying private
hospital beds initially increased, levels then
dropped below the levels before the introduction of
the incentives. The burden of injury is substantial
and suggests that incentives need to be targeted
towards at-risk groups.