bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation into the gas diffusion electrodes of polymer electrolyte membrane fuel cell under long-term durability test
Authors: Ide Masahiro , Ikeda Hironosuke
Published: February 2010

When the polymer electrolyte membrane fuel cell is operated for a long period of time, there is a change in the material composition of the membrane electrode assembly (MEA) that coincides with progressive deterioration of the cell. Therefore, it is important to analyze the change in MEA composition. In this study, the durability of a fuel cell was examined during a period of 12 000 h. These test cells were disassembled one after another, approximately every 3000 h, and the change in the constituent was analyzed in detail on the view point of the material and structure. The change in the constituent with MEA in relation with the operating time was also analyzed in detail. The relationship between the changes in the constituent and the operating time was examined and clarified. These changes were in the porosity of the electrode, in the pore distribution of the electrode, and in the surface area of the electrode. Moreover, the change in the thickness of the electrolyte membrane and the change in the material of ionomer on the electrode catalyst were analyzed. In the analysis, transmission electron microscopy, scanning electron microscopy, electron probe microanalysis, and mercury porosimetry were used. As a result, structural changes in the electrodes were quantitatively clarified in relation to an elapsing of operating time.
Taking health seriously:the Senate inquiry into public hospitals
Authors: Hindle Don
Published: February 2010

In July last year, the State and Territory leaders expressed concern over a health system under "unsustainable stress" and suggested that the Federal Government should sponsor a prolongedand detailed inquiry by the Productivity Commission. The Prime Minister rejected thesuggestion, and the Australian Senate therefore decided to conduct its own shorter inquiry.Submissions were invited late last year, and the Senate Community Affairs References Committeeis conducting hearings at the time of writing. The focus here is on my idiosyncratic impressionsof what has happened during the hearings on 11 November 1999 (Canberra), 23 February(Adelaide), 24 February (Darwin), 25 February (Perth), 21 March (Sydney), and 22 March(Brisbane). Transcripts of the hearings are available in Hansard (1999, 2000).
An ethnography of midwifery work patterns during organisational redesign
Authors: Wilson Sue M
Published: February 2010

Despite a substantial increase in midwifery research since the early 1990s, there remains alack of available research into the everyday practice of midwives. In general, hospitals arestriving to reduce costs and increase efficiencies, so many hospital-based midwives are beingexposed to hospital restructuring processes. The primary purpose of my research was to learnabout the work patterns of hospital midwives during organisational redesign. A largeBrisbane hospital, as part of its hospital-wide organisational redesign plan, merged twopostnatal wards to create a new, larger unit. With this amalgamation, the ward midwiveswere exposed to several service delivery changes. Midwifery work patterns during thisorganisational change revealed a milieu characterised by a culture of busyness. The impactof change introduced ritual and personal elements that influenced midwifery work patterns.
Hospital board structure:changing form and changing issues
Authors: Tregoning Susan
Published: February 2010

Economic and social pressures are compelling many hospitals to consider their current board structure in an effort toposition their hospital to meet changing demands. A national profile of the structures of hospital boards has beencompiled from a questionnaire completed by hospital board representatives from both government and non-governmentsectors.Results show that hospital board structures are a hybrid of both philanthropic and corporate models. New structuresmay be required to meet future challenges. In developing new structures, consideration should be given to identifyingthe skills and processes required to undertake board business.
Priority setting in public health and health services research
Authors: Carson Norman , Ansari Zahid , Hart William
Published: February 2010

Models for strategic priority setting in public health and health services research typically lack coherence or omit keyconsiderations. We propose a new model, the Seven 'I's, with seven components: innovation, identification,inequalities, incorporation, importance, influences, and interventions. It tests the 'relevance' of research, while'excellence' will be evaluated using existing criteria for peer review. It should be used to set research priorities primarilyon the basis of expected health benefits, with adjustments for other non-health benefits as necessary.We discuss each component and compare our approach to other models. We argue that our model helps ensure resourceallocation is transparent and accountable, and encourages the link to population health gains. It is flexible, and isapplicable to both commissioned and investigator-driven research. It may be applied to assess existing proposals, or togenerate research ideas.
Implications of decreasing surgical lengths of stay
Authors: Board Neville , Caplan Gideon
Published: February 2010

A recent study at the Prince of Wales Hospital (PoW) compared health outcomes and user satisfactionfor conventional clinical pathways with a shortened pathway incorporating day of surgery admission(DOSA), early discharge and post acute care domiciliary visits for two high volume, elective surgicalprocedures (herniorrhaphy and laparoscopic cholecystectomy). This paper quantifies cost differencesbetween the control and intervention groups for nursing salaries and wages, other ward costs, pathologyand imaging.The study verified and measured the lower resource use that accompanies a significant reduction inlength of stay (LOS). Costs of pre- and post-operative domiciliary visits were calculated and offsetagainst savings generated by the re-engineered clinical pathway. Average costs per separation were atleast $239 (herniorrhaphy) and $265 (laparoscopic cholecystectomy) lower for those on the DOSApathway with domiciliary post acute care.
The Antenatal Ward Care Delivery Map :A Team Model Approach
Authors: Dickinson Christopher , Noud Marina
Published: February 2010

We begin by defining the concept of a 'CareMap', before briefly examining the context in which CareMaps emerged,as well as both their potential applications and the benefits arising from their implementation in health care services.We identify and discuss the history of, and critical aspects involved in, the development of the Antenatal Ward CareDelivery Map for the Mater Mothers' Hospital, Brisbane. We will address the multiple applications of, and specificbenefits arising from, the formulation and implementation of the Antenatal Ward Care Delivery Map. Additionally,the relationship between the Care Delivery Map and other projects aimed at enhancing and maintaining highquality service delivery for patients across the continuum of care, will be explored. We examine the benefits of utilisingthe Care Delivery Map in professional education for clinical staff, as well as for health care consumers and theirfamilies. In conclusion, future projects enabled through the development of the Care Delivery Map are identified, aswell as areas requiring further research.
Evaluation of a (pilot) stage-tailored brief smoking cessation intervention among hospital patients
Authors: Rissel Chris , Salmon Allison , Hughes Ann-Maree
Published: February 2010

Despite the significant benefits of advising all smokers to quit, hospital patients who smoke do not systematicallyreceive this advice. This study sought to determine the prevalence of smoking, attitudes of patients towards notsmoking while in hospital, and the feasibility and effectiveness of a brief smoking cessation intervention in a pre-admissionclinic context. Over 230 smokers received a brief smoking cessation intervention, while a control group(n=114) received only a free Quit Kit. The age-standardised smoking prevalence was 19%; a further 3% of patientswere recent quitters. Most smokers do not expect or experience problems with not smoking while in hospital. Briefsmoking cessation advice tailored to stage-of-change by a health worker in a hospital pre-admission clinic significantlyincreased the quit rates for females.
An assessment of the effects of casemix funding on hospital utilisation: A Northern Territory perspective
Authors: Xiao Jianguo , Lee Andy , Ram Vemuri Siva
Published: February 2010

This article is concerned with the methodological issues of assessing the effects of casemixfunding on hospital utilisation. Time-series analysis and intervention analysis are proposedto ascertain the effects. It was found there had been a decline in average length of stay andnumber of bed-days, an increase in weighted separations for teaching and non-teachinghospitals, and no apparent increase of costliness in terms of a comprehensive casemix index.No evidence of decline in quality of care can be established in terms of readmission rates.The long-term effects of casemix funding, and specific issues in terms of the funding modelused, patients and cost shifting between hospital services and community health services,remain to be studied.
Organ transplant AN-DRGs: Modifying the exceptions hierarchy in casemix classification
Authors: Antioch Kathryn , Zhang Xichuan
Published: February 2010

The study described in this article sought to develop AN-DRG Version- 3 classificationrevisions for organ transplantation through statistical analyses of recommendations formulatedby the Australian Casemix Clinical Committee. Two separate analyses of variance wereundertaken for AN-DRG Version- 2 and for the proposed Version- 3 AN-DRGs, using averagelength of stay as the dependent variable. The committee made four key recommendationswhich were accepted and incorporated into AN-DRG Versions 3 and 3.1. This article focuseson the classification revisions for organ transplantation.
Information technology adoption in health care: when organisations and technology collide
Authors: England Ian , Stewart Don , Walker Sue
Published: February 2010

The implementation of advanced information systems is enabling great social and organisational changes. However,health care has been one of the slowest sectors to adopt and implement information technology (IT). This paperinvestigates why this is so, reviewing innovation diffusion theory and its application to both health organisations andinformation technology. Innovation diffusion theory identifies variables that influence the 'innovativeness' oforganisations and the rate at which a technology diffuses. When analysed, these variables show why ITimplementation has progressed at a slower rate in health compared with other industry sectors. The complexity ofhealth organisations and their fragmented internal structure constrain their ability to adopt organisation wide IT.This is further impacted upon by the relative immaturity of strategic health IT which is complicated and unable toshow quantifiable benefits. Both organisational and technological factors lead to the slow adoption of strategic IT. Onthe other hand, localised IT solutions and those providing measurable cost reductions have diffused well.
The organisational context for teamwork: Comparing health care and business literature
Authors: Mickan Sharon , Rodger Sylvia
Published: February 2010

Teams are a significant tool for promoting and managing change. There are shared definitionsof teamwork in the literature, and agreement on general benefits and limitations of workingin teams. However, the historical development of teamwork differs between health care andthe business environments of manufacturing and service industries. The impact of theorganisational context on teamwork appears to differ most, when literature from the twoenvironments is compared. As a result, there are specific issues that are unique to thedevelopment and implementation of health care teams. This article summarises the uniqueteam structures and the issue of professionalisation in health care teams, while recommendingthat team members acknowledge their professional differences and focus foremost on meetingpatient needs.
Australia's pharmaceutical benefits system: flawed but improving, and better than anywhere else
Authors: Dalton Andrew
Published: February 2010

The composition and role of the Pharmaceutical Benefits Advisory Committee (PBAC) has been the subject ofacrimonious debate through the media in recent months, with accusations of government subjugation to strongindustry lobby groups at the future expense of the Australian taxpayer. An understanding of the issues at thismore political level is helped by appreciation of the rationale for the current process of listing drugs forreimbursement on the Pharmaceutical Benefits Scheme (PBS). I will try to give the non-economist reader anoverview of the system and share some perceptions of the strengths and weaknesses of what is fundamentally agood system.
Developing the Esperanto of quality
Authors: Majoor Jennifer W , Ibrahim Joseph E
Published: February 2010

Professionalism is a complex and ill-defined concept and the impending Report of the Public Inquiry into thepaediatric cardiac surgery service at the Bristol Royal Infirmary continues to heighten debate on the subject.Bolsin offers examples of operational definitions from the Privy Council (United Kingdom), the state healthauthorities in New South Wales and Victoria, and the High Court of Australia. He also provides an implicitdefinition of professionalism that encompasses the collection and use of personal performance data forindividual health care providers and organisations.
Cost-effective clinical pathways at The Alfred Hospital: international lessons from Bayside Health, Australia
Authors: Antioch Kathryn , Chapman Richard , Elliott Barry , Santamaria Nick , Crawford Ruth , Fiddes Kaylene
Published: February 2010

The paper "Caring about carepaths" by Pearson and Macintosh (2001) is an interesting article for those considering the implementation of clinical pathways. The authors have attempted to describe the experiences and lessons learned in trying to introduce clinical pathways at Cairns Base Hospital (CBH). The paper is not a research report. Rather, it is a story of what was hoped to be achieved versus what actually was achieved. Hence, the term "experiment" was used in a non-technical sense. In our commentary of that paper below, we also outline our own experience in clinical pathways at The Alfred by way of comparison, drawing upon lessons learnt that may be of interest to other hospitals.
Using Australian DRGs in New Zealand:collaboration for progress
Authors: Rains Michael
Published: February 2010

During the course of writing this commentary, I invited opinions from several other people who have beenworking with DRGs over the last two or three years in New Zealand. Although the sample was hardlyrepresentative, there was a relatively high degree of consistency of views.
Clinicians' contributions tohealthcare management
Authors: Bull Robert
Published: February 2010

Primary tasks for clinical directors are to disseminate information to colleagues, provide feedback to senior professional managers, and to play key roles in strategic planning and resource allocation in health services. These tasks are seen to reduce barriers between clinicians and management. The application of clinical directorates across healthcare organisations is inconsistent and ambiguous. When set clear guidelines, clinical directors can impact on the decision-making process within senior management. As further applications of clinical directors in management occur, development of the role is required to realise the potential.
From I.T. to information management with casemix data
Authors: Diers Donna , Pelletier Dianne
Published: February 2010

The Australian investment in technological support for the collection and analysis of hospital data has paid off in thecreation of data depositories that can be used for system and policy analysis. Yet the inquiries that would informdecision for quality and efficiency improvement are made at the operational levels where there has not been equivalentinvestment in developing human capacity. This article suggests strategies and methods for using standard healthcareinformation that is now so much more readily available.
Queensland public sector nurse executives: job satisfaction and career opportunities
Authors: Courtney Mary , Yacopetti Jan , James Catherine , Walsh Anne
Published: February 2010

During the past decade, economic and political forces have caused radical transformations in health caresystems resulting in changed circumstances within which nursing executives must function. This paper providesan understanding of nursing executives' roles and responsibilities and the impact changes in the health industryhave had on their careers.One hundred and forty-seven (52%) of the 281 nursing executives employed in the Queensland Public HealthSector completed a postal self-administered survey. The findings of this study demonstrate their role hasexpanded to include not only nursing administration, but also responsibility for financial, human resources,strategic and resource management, staff development and quality improvement. The impact of these rolechanges has affected the health and well-being of nursing executives, with nearly half reporting increased stress,frustration and irritation. Their workload has increased and some reported deterioration in their health,specifically, exhaustion, fatigue and insomnia. Respondents reported they now have less time to spend withfamilies and friends, which has had a negative impact on family relationships. Overall, nursing executives weresatisfied with their current position, the work itself and their relationships with their co-workers, but dissatisfiedwith organisational aspects, especially the quality of mentorship and opportunities for promotion.
Community-based continuity of midwifery care versus standard hospital care: a cost analysis
Authors: Homer Caroline S , Matha Deborah V , Jordan Lesley G , Wills Jo , Davis Gregory K
Published: February 2010

This paper reports the costs of providing a new model of maternity care compared to standard care in anAustralian public hospital. The mean cost of providing care per woman was lower in the group who had the newmodel of care compared with standard care ($2 579 versus $3 483). Cost savings associated with new model of carewere maintained even after costs associated with admission to special care nursery were excluded. The cost saving wasalso sustained even when the caesarean section rate in the new model of care increased to beyond that of the standardcare group.
A framework for monitoring maternal and infant health status
Authors: Phung Hai , Young Lis , Greenfield David
Published: February 2010

The Mother and Infant Network (MINET) Program was established in South Western Sydney Area Health Service(SWSAHS) in 1997. MINET developed and implemented an integrated clinical data network as a key strategy tosupport and inform a Continuum of Care comprising hospital and community based services. There are good datasources within the MINET program. Its scope spans care for mothers and children, which begins with the firstantenatal attendance and ends at school entry.This paper has three interrelated aims: to describe the development of the MINET program; to demonstrate thebenefits of a sustainable Information Culture which can assist an Area Health Services in adopting a health outcomesbased approach to service delivery; and to describe how MINET has the capacity to support Health Services Research.
Evidence-based health care and community nursing:issues and challenges
Authors: Macdonald John , Smith Janine
Published: February 2010

This paper examines the implications of the movement towards evidence-based health care for community-based,primary health care nursing in Australia. While both aim to improve health status, we argue that they are antitheticalin many respects. Community nurse practitioners draw upon primary health care principles and adopt a holistic,preventive, empowering approach to working with and in communities. By contrast, evidence-based approaches utilisesystematic reviews of primarily quantitative research to inform decisions about health at three levels: public health, thehealth care system, and individual patients. In response to this challenge, community nurses must reiterate theirphilosophies and practice models. Moreover, it is imperative to produce verifiable evidence of the effectiveness of theirapproach while mounting a thorough critique of the evidence-based movement.
Colorectal cancer screening:potential pitfalls
Authors: Duggan John
Published: February 2010

The National Health and Medical Research Council has recently issued guidelines on colo-rectal cancer, and givensignificant support to Colorectal Cancer Screening. However, the evidence of cost-effectiveness is inconclusiveaccording to the Cochrane Centre.I argue that it would be wise to undertake trials that are appropriately funded. Otherwise, there is a risk that muchmoney will be spent that cannot subsequently be justified.
Influences on the implementation of TQM in health care organisations:professional bureaucracies, ownership and complexity
Authors: Badrick Tony , Preston Arthur
Published: February 2010

TQM is introduced into many organisations in an attempt to improve productivity and quality. There are a numberof organisational variables that have been recognised as influencing the success of TQM implementation includingleadership, teamwork, and suppliers. This paper presents findings of a study of the implementation of TQM inAustralian health care organisations. Structural factors were observed to affect the progress of TQM. Professionalbureaucracies were less successful than machine bureaucracies. Private organisations were more successful than theirpublic counterparts.
Coping with health care reform
Authors: Van Eyk Helen , Baum Fran , Houghton Graeme
Published: February 2010

This paper describes the evaluation of a case study of health service reform in southern Adelaide. A mail survey,interviews and focus groups were used to gain an understanding of health care providers' perceptions and experiencesof reform. The paper discusses lessons learnt about health service reform and its impact on people working in thehealth system. It finds that continual change that is not based on a well-articulated vision is likely to lead to 'reformfatigue' and low morale. An action research approach can be used by researchers to help managers and staffunderstand the context in which reform is happening, and thus give support to organisational learning.
Funding the essentials: the Australian Health Care Agreements, 2003-2008
Authors: Deeble John
Published: February 2010

This editorial reviews a number of papers in a special issue of the Australian Health Review covering the Australian Health Care Agreements to be concluded by June 2003. These include a report on consultations by the Australian Healthcare Association with industry representatives from July-October 2002. For hospitals, the agreements will set the main financial parameters for the next five years. Apart from the quantum of Commonwealth grants, the issues seen as most important involved linkages with primary care providers and aged care facilities,the dominance of inpatient work in current arrangements, workforce planning and public/private sector relationships. The possibility of recent private health insurance changes reducing the sums available for public hospitals was noted. Some estimates are presented of the possible effects of private insurance reform, together with some data from a special AHA survey of public hospital activity this year.
Standardised assessment of older patients by a nurse in an emergency department
Authors: Basic David , Conforti David , Rowland Jeffrey
Published: February 2010

The primary aim of this study was to evaluate the ability of a nurse practitioner in geriatrics, working in the emergency department of a tertiary referral hospital, to assess high-risk elderly patients comprehensively. A secondary aim was to explore patient characteristics associated with referral to community aged care services. Of 469 patients assessed by the nurse, 327 (70%) were admitted to the hospital. A comprehensive set of data was obtained for 334 (71%) patients. For 142 patients not admitted, 163 new referrals were made, mostly to the Aged Care Assessment Team. Those referred were more likely to be living alone and non-English speaking. They were also less satisfied with the support they received from family and friends. A single nurse working in a busy emergency department can successfully identify patients with increased care needs, and direct high-risk patients to existing services.
Training in Routine Mental Health Outcome Assessment: an evaluation of the Victorian experience
Authors: Coombs Tim , Trauer Tom , Eagar Kathy
Published: February 2010

This paper evaluates training in the use of measures of outcomes and casemix provided to four pilot agencies in Victoria, Australia. The training program is outlined along with key evaluation findings. The knowledge and skills of participants developed during training is described. Deficiencies in the training program are identified and opportunities for improvement outlined.
Conflicting interests in private hospital care
Authors: Ann O'Loughlin Mary
Published: February 2010

This article looks at key changes impacting on private hospital care: the increasing corporate ownership of private hospitals; the Commonwealth Government's support for private health;the significant increase in health fund membership; and the contracting arrangements between health funds and private hospitals. The changes highlight the often conflicting interests of hospitals, doctors, Government, health funds and patients in the provision of private hospital care. These conflicts surfaced in the debate around allegations of 'cherry picking' by private hospitals of more profitable patients. This is also a good illustration of the increasing entanglement of the Government in the fortunes of the private health industry.
The management of change in aCommunity Mental Health Team
Authors: Mander Anthony , Gomes Allen , Castle David
Published: February 2010

Assertive Community Treatment (ACT) is the most widely studied and well supported evidence based communitymanagement model for persons with severe mental illness (SMI) in the mental health literature. This report details the replacement of an unevaluated generic model of case management with ACT in a metropolitan inner city area.This is work in progress and detailed patient outcomes are not yet available. The steps taken and the problemsencountered in changing clinical practice are important over and above the intervention itself and are discussed. The main difficulty that we encountered was moving staff from focusing on and becoming demoralised by potentialproblems and obstacles to problem solving and implementation of the best available solution. Staff were consulted at all stages of the project. The use of an 'action research' strategy maximised their sense of ownership and ultimatelyenabled the project to be implemented although in a revised format to that originally envisaged. Flexibility in this regard was crucial since the budget granted was only 40% of that requested. The original aim of having all 3 sector teams of the Inner City Mental Health Service (ICMHS) involved did not eventuate due to internal organisational issues and only one team undertook to implement the ACT approach.
Health care funding in the Australian Capital Territory: From hospital to community
Authors: Hindle Don
Published: February 2010

This paper presents an outline of the socio-demographic features of the Australian Capital Territory (the ACT) and of its health care system. I describe how health care resources are allocated in the government sector, present a moredetailed description of the way that hospital services are purchased, and summarise the government's policy directions for health. I argue that the main directions are sensible, and particularly those that support more integrated care that is largely based in the community. There appear to be no major weaknesses in the budget-share output-based funding model used in the purchase of hospital services, although the rationale for some of the components might be clarified.In total, the ACT government appears to be on the right track. However, I argue that more rapid progress might bepossible if there were greater collaboration between the Territory health authority and the relatively powerful private medical profession.
Variation in levels of uptake of Enhanced Primary Care item numbers between rural and urban settings, November 1999 to October 2001
Authors: Wilkinson David , McElroy Heather , Beilby Justin , Mott Kathy , Price Kay , Morey Sue , Best John
Published: February 2010

We aimed to report on variation in levels of uptake of enhanced primary care item numbers between rural and urban Divisions of General Practice between November 1999 and October 2001.Most providers of EPC services and most services (close to 70%)are located in capital cities and other metropolitan centres. The average number of health assessments done per provider was slightly lower (8-14) in remote than urban and rural (20-30) areas. A similar pattern was observed for care plans, but rates of case conferences were similar in rural and urban areas. However, adjusted for population aged 75 years and over, in all jurisdictions except South Australia, between 30% and 144% more health assessments were done per full time equivalent general practitioner (FTE GP) in rural divisions. For rural and urban Divisions of General Practice, there is a wide range in the rate of services provided, between and within Divisions. However, overall, more services are provided per FTE GP in rural Divisions.
The interface between hospital and residential aged care
Authors: Gibson Diane
Published: February 2010

The last 15 years have seen substantial changes in both the aged care and the acute hospital sectors. This article focuses on the impact of those changes on the interface between hospital and residential care. It examines trends in expenditure, supply and patterns of service use in the two sectors.Despite good national databases on hospitals and aged care services, there is little national information on the interface of the two sectors.The material presented here is based on work being undertaken at the Australian Institute of Health and Welfare, as part of a project aimed at developing a national database linking residential aged care and hospital morbidity data.
Will the new Australian Health Privacy Law provide adequate protection?
Authors: Bomba David , Hallit George
Published: February 2010

Amendments to the original Privacy Act (1988) come at a key point in time, as a national medical record system looms on the Australian horizon. Changes to The Privacy Act have the potential to define a level of information privacy prior to the implementation of such a system. We have therefore collected expert opinions on the ability of the Health Privacy Guidelines(enacted in December 2001 under The Privacy Act and hereafter more specifically known as Health Privacy Legislation) to ensure the privacy and security of patient information. We conclude that the legislation is flawed in its capacity to withstand an increasingly corporatised health sector. Deficiencies in consent requirements, together with feeble enforcement capabilities, mean The Legislation cannot effectively ensure that personally identifiable information will not end up in corporate third party hands. To significantly bolster the new legislation, we argue that it should be supplemented with explicit health data legislation and privacy auditing.
Reorganisation of an ailing aged care service
Authors: Lowe Julia , Kasap Draginja
Published: February 2010

This paper evaluates the impact of reorganisation of geriatric and general medical services in a tertiary referral hospital. The patients involved were predominantly elderly with multiple medical problems. We used an iterative process of bed utilisation review, stakeholder consultation and service remodelling to improve bed management. Reduced length of stay and increased throughput allowed closure of between 22 and 30 beds and generated recurrent cost savings of $900,000 annually. Even under pressure it is possible to describe and evaluate the process of change. Such description and evaluation may help to avoid expensive mistakes.
Health service capacity modelling
Authors: Trye Peter , Murray Nigel , wolstencroft Ian , Stewart Alistair
Published: February 2010

This paper aims to describe a modelling tool that gives a framework for the estimation of future bed demand for hospital services. It also outlines some issues regarding the application of the model. A quantitative mathematical model was constructed that was based on two years of seasonally adjusted inpatient data. To calculate the number of beds required five years into the future, ten factors were applied to the number of bed-days used for each service. In the example given (Figure 1), 7,924 bed-days used in 1998-99 translated into a requirement for twenty-six beds in 2004. The value of this approach lies in the ability to describe and delineate each of the varying factors, and thus allowing clinicians, healthcare managers, the purchasers of health services and other stakeholders to be involved in a clear and explicit decision-making process.
Assistive devices: self-reported use by older people in Victoria
Authors: Smith Robyn , Quine Susan , Anderson Julie , Black Kirsten
Published: February 2010

A qualitative study was conducted in Victoria to explore factors affecting the acceptability and use of assistive devices by older people. Four focus groups and fifteen home-based interviews were conducted with older people (mean age 77 years) who had been issued with 2 or more assistive devices. Analysis of the data indicated that almost all participants were content to be advised by professionals on suitable equipment. Most considered the equipment and home modifications safe and easy to use, and appreciated the benefits for mobility, confidence and independence. Reasons for non-use were commonly related to changes in functional ability. Cost was a major deterrent for a small number who opted to 'make do'. Recommendations are made for improvements to the existing system of equipment provision and use, including: review and development of consistency of provision and payment policy among service providers; flexibility of payment options; adequate education and follow-up support for clients.
Organisational culture and safety: an interdependent relationship
Authors: Clark Geoff
Published: February 2010

Since the early 1990s,a body of evidence regarding the lack of quality in health care has emerged in many countries including Australia, the United Kingdom, New Zealand and the United States of America. It has brought the subject of health care safety to the top of the policy agenda and the forefront of the public debate worldwide. Studies show not only that failure of quality occurs, but also that it inflicts harm and wastes resources on a large scale. Experts in risk management, both within and outside the health care industry, emphasize system failures and system-driven errors over direct human error, and accentuate the crucial role that organisational culture plays in ensuring safety. Examination of the interrelationship between culture and safety in organisations demonstrates that organisational relationships influence both culture and safety and that effective two-way communication is pivotal to the success of the development of a corporate 'safety culture'.
Letter to The Editor
Authors: Barclay Lesley , Brodie Pat
Published: February 2010

We write in response to a letter from the Chair of the Nursing Board of Northern Territory that was published in Issue 25 number 3 of the AHR, in respect to our paper on midwifery regulation that was published in Issue 24 number 4. The Chair of the Nursing Board raised three matters, and we will cover them in turn.
A Response to the Australian Health Care Agreements series
Authors: Wright Graham
Published: February 2010

A Response to the Australian Health Care Agreements series by Graham Wright, Management Consultant
A Private Hospitals Perspective
Authors: Roff Michael
Published: February 2010

Response by Michael Roff from the Australian Private Hospitals Association to the 'Australian Health Care Agreements (AHCAs)' series published in AHR 25-6.
A comment on the response from Graham Wright
Authors: Butler Jim
Published: February 2010

A comment on the response from Graham Wright published in AHR 26-1.
The Griffith Area Palliative Care Service: A Pilot Project
Authors: Hatton Ian , Mcdonald Keith , Nancarrow Lynette , Fletcher Keith
Published: February 2010

In September 2000 the Commonwealth released, as part of its National Palliative Care Strategy under the AustralianHealth Care Agreements, a National Framework for Palliative Care Service Development. The new NationalFramework stressed an important set of values to guide models of palliative care delivery. It notes that the challenge isto secure the place of palliative care as an integral part of health care across Australia, routinely available within localcommunities to those people who need it. Care and support for people who are dying and their families need to bebuilt not only into health care services, but also into the fabric of communities and their support networks. While fewwould disagree with this, little is known about how best to achieve it in rural Australia. The Griffith Area PalliativeCare Service (GAPS) is a two-year pilot project delivering a palliative care service through a truly integrated approachto care for patients, their carers and families within the Griffith Local Government Area and Carrathool Shire areas.This paper describes how GAPS is successfully meeting the challenges of service provision to rural and remote areas.
Identification of Aboriginal and Torres Strait Islander women using an urban obstetric hospital
Authors: Jackson Pulver Lisa R , Bush Alison , Ward Jeanette
Published: February 2010

Objectives: To determine the accuracy of routine identification of Aboriginal and Torres Strait Islander womenconfining at King George V (KGV) Hospital, located in Sydney, Australia.Design: Interviewer-administered survey.Participants: Consecutive sample of women who delivered live, well infants from May to July 1999.Main Outcome Measure: Comparison of hospital documentation compared with confidential self-disclosureof Aboriginal or Torres Strait Islander status to a female Aboriginal health professional.Results: Of 536 women in our sample, 29 (5%) self-disclosed as being Aboriginal or Torres Strait Islander.Only 10 of these were identified as Aboriginal or Torres Strait Islander in hospital records (p<0.001). While specificity as determined by us was 100%, sensitivity was low (34.5%). Those Aboriginal and Torres Strait Islander women referred by another organisation were significantly more likely than those who self-referred to the hospital to be correctly identified (p=0.011). Only 1% of non-Aboriginal women indicated they would have objected to an explicit question by staff about their Aboriginal or Torres Strait Islander status.Conclusions: Routine identification significantly under-represents Aboriginal or Torres Strait Islander women giving birth at an urban obstetric hospital. We recommend the development and use of a sensitive but also specific series of questions to ensure women always are given the opportunity to disclose their status, especially as few women appear to mind such questions.
Commentary on the King Edward Inquiry: perspectives from the Chair, Australian Council for Safety and Quality in Health Care
Authors: Barraclough Bruce
Published: February 2010

Commentary on the King Edward Inquiry by Bruce Barraclough, Chair of the Australian Council for Safety and Quality in Health Care.
Stakeholder perspectives on outpatient services performance: what patients, clinicians and managers want to know
Authors: Martin Kerri , Balding Cathy , Sohal Amrik
Published: February 2010

The development of performance measures in outpatient services is trailing in the wake of an emphasis on inpatientmeasures. Research was undertaken at The Royal Victorian Eye and Ear Hospital (RVEEH) to determine key areasfor the development of performance measures in eye outpatient services from the perspective of three stakeholder groups:clinicians, managers and patients. The study identified four key areas for the development of performancemeasurement: waiting time to first outpatient appointment, patient discharge from outpatient clinics, waiting timein clinic and patient throughput. It was also shown that there are some significant differences of opinion betweenstakeholder groups. Such similarities and differences are unlikely to be unique to RVEEH and may serve as usefulprompts for other organisations considering outpatient performance measures.
Building capacity in the Mongolian health sector: a training methodology based on identified needs assessments
Authors: O'Rourke Michael , Tungalag Kainyam , Hindle Don , Yasukawa Takako
Published: February 2010

Mongolian health care is moving from a centrally planned hierarchical basis towards greater decentralisation as partof overall sector wide reform. To identify key needs of health personnel to help to build capacity, we undertook researchaimed at assessing priority training areas. The research results indicated gaps and weaknesses in many technical areas,but also significant problems in terms of how Mongolian health organizations function, including rigid structures,isolated management, and little internal communication. These features militate against optimal agency effectiveness.This paper discusses how specific training programs were developed based on quantitative research and an overarchingorganisation improvement theme emphasizing openness; communication; and participation to maximize the benefitsof skills transfer and capacity development.
Will health fund rationalisation lead to significant premium reductions?
Authors: Hanning Brian
Published: February 2010

It has been suggested that rationalisation of health funds will generate significant albeit unquantified cost savings andthus hold or reduce health fund premiums. 2001-2 Private Health Industry Administration Council (PHIAC) datahas been used to analyse these suggestions. Payments by funds for clinical services will not vary after fundrationalisation. The savings after rationalisation will arise from reductions in management expenses, which form10.9% of total fund expenditure. A number of rationalisation scenarios are considered. The highest theoreticalindustry wide saving found in any plausible scenario is 2.5%, and it is uncertain whether this level of saving couldbe achieved in practice. If a one off saving of this order were achieved, it would have no medium and long term impacton fund premiums increases given funds are facing cost increases of 4% to 5% per annum due to demographic changesand age standardised utilization increases. It is suggested discussions on fund amalgamation divert attention from themajor factors increasing fund costs, which are substantially beyond fund control.
The provision and utilisation of casemix and demographic data by nursing managers in seven hospitals
Authors: Blay Nicole , Donoghue Judith
Published: February 2010

The role of the nursing manager has evolved from clinician and bed manager to one with greater accountability for evidence based practice, benchmarking and more recently, budget liability. Casemix data are widely believed to be a means of providing essential information for effective decision making and financial management but have not been widely utilised by nursing managers (Diers & Bozzo,1999). This paper will report the results of a survey of nursing managers in seven hospitals within a metropolitan area health service. The hospitals include tertiary referral hospitals, specialist public hospitals and an affiliated public hospital for aged care and rehabilitation services. The survey sought to establish what casemix and related data were provided to nurse managers, who provided these data and how supplied data were utilised by the nurse managers. Results demonstrated that the majority of nursing managers surveyed received minimal (if any) casemix and/or demographic data on a routine basis. Some were provided with data in response to specific requests. The information that was provided varied both within and across hospitals, and no consistent methods of data distribution were available. Few nursing managers believed that the information provided aided their decision-making processes partly due to the minimalist nature of provided data while some nursing managers demonstrated a lack of understanding of the potential benefit of casemix data as a resource to support management decision making.
Peer review of adverse events – a perspective on Macarthur
Authors: Masso Malcolm
Published: February 2010

Recent investigations into the Macarthur Health
Service have resulted in multiple reviews of a
small number of cases. This article was prompted
by a casual observation that these reviews have
resulted in differing conclusions about what
occurred in each case and what might have been
done in response. The reliability of peer review is
examined, together with the literature on the scale
of adverse events and the issue of problem identification.
Potential sources of bias and error during
peer review are considered. Drawing on the lessons
from the literature and the experience of
Macarthur, suggestions are made to improve the
identification and review of adverse events.
Why protect confidentiality in health records? A review of research evidence
Authors: Mulligan Ea , Braunack-Mayer Annette
Published: February 2010

We present the main arguments for protecting the
confidentiality of health services, along with those
for limiting confidentiality. These arguments are
then substantiated by reference to research evidence.
There is evidence that access to health care is
restricted if confidentiality is not promised to some
groups of patients. Fear of disclosure does diminish
patients? candour, and this can compromise
the quality of care.
While patients are concerned about confidentiality
and some are harmed by ?leaks? from health
services, most people in Australia still trust health
providers to keep their secrets, and patients rarely
become aware of a breach of confidence.
It has been claimed that strict protection of confidentiality
may obstruct the pursuit of medical
research and the use of electronic medical
records. There is, as yet, no evidence that gaining
full benefit from the use of electronic medical
records entails reduced protection for confidentiality.
The losses to epidemiological research if
patient consent were always required are hotly
debated.
Confidentiality should be protected because it
protects patients from harm, supports access to
health care and produces better health outcomes.