bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of social cognition in patients with multiple sclerosis
Authors: OUELLET JULIE , SCHERZER PETER B. , ROULEAU ISABELLE , MÉTRAS PHILIPPE , BERTRAND-GAUVIN CAROLINE , DJERROUD NADÉRA , BOISSEAU ÉMILIE , DUQUETTE PIERRE
Published: February 2010

We examined the capacity of patients with multiple sclerosis (MS) to attribute mental states to others and to identify cognitive abilities that subserve theory of mind (ToM). In this article, we report findings on 41 out-patients with diagnosed MS who underwent detailed neuropsychological and social-cognitive assessment. They were subdivided into a cognitively intact (n=15) and cognitively impaired (n=26) group according to their neuropsychological test results. Their results were compared with those of 20 age- and education-matched controls. MS patients with cognitive impairments were found to have more difficulties attributing mental states to others than did cognitively intact MS patients and normal controls on two ToM measures; short stories (Happé, Winner, & Brownell, 1998) and video clips (Ouellet, Bédirian, Charbonneau, & Scherzer, 2009). When attention, memory, and working memory were controlled, performance on the WAIS-III Picture Arrangement task accounted for 17.3% of the variance in performance on the video clips task. Performance on a WAIS-III index composed of Similarities and Comprehension subtests, accounted for 7.0% of the variance in performance on the short stories task. These results provide some preliminary information on the effect of MS-related cognitive deficits on the ability to attribute mental states to others. (JINS, 2010, 16, 287–296.)
Britain's first steps in Modernism: Cressing Road and the Clockhouse Way estate 1918–20
Authors: Jensen Finn , Thorogood-Page Ellen
Published: February 2010

In this paper architectural Modernism is used to describe the unadorned flat-roofed houses constructed using modern materials such as concrete, reinforced concrete and steel, and built mainly in the period following the First World War. This is a sparse definition that fails to do justice to the much broader interpretation of Modernism, which affected not only architecture, but all the arts in the first quarter of the twentieth century, a movement that reached maturity around 1930. However, even though the definition fails to reflect the richness of the Modernist idiom, the houses have long been recognised as representing Britain's first inroads into Modernist architecture as acknowledged by, for example, Gould, Bentley, Collins and Bettley.
Self-identity, rationalisation and cognitive dissonance in undergraduate architectural design learning
Authors: Bachman Christine , Bachman Leonard
Published: February 2010

This theoretical paper addresses the persistence of architecture students in undergraduate design learning despite the considerable sacrifices that this frequently entails, and proposes a framework for some of the mechanisms that explain students' diligence in their love-hate relationship with the design studio. Such love-hate association is poorly understood, but is clearly a pervasive dilemma in architecture education. The proposed model includes a number of cognitive mechanisms that students may use to reconcile their idealised and romanticised self-image with the incoherent sacrifices of design studio.
A practical approach to planning health services: using PBMA
Authors: Viney Rosalie , Haas Marion
Published: February 2010

Planning health services is a difficult and often complex task. There are many approaches to planning, including theuse of tools such as needs assessment, goals and targets, as well as economics-based tools such as cost of illness oreconomic evaluation. It is not always clear which planning tool is the most appropriate. In this paper we comparean economics approach to planning using program budgeting and marginal analysis (PBMA) with other approaches.We provide an overview of the methods of PBMA, report on experience with its use, and draw conclusions about itslikely usefulness to health services planners.
Bilingual health communicators:role delineation issues
Authors: Matthews Clair , Johnson Maree , Noble Cathy
Published: February 2010

Managers of health care services are seeking new opportunities to improve communication with clients who havelimited English proficiency. An increase in bilingual health staff and the frequent use of their language skills in patientencounters provides opportunities but also brings with it confusion surrounding the role of interpreters and bilingualhealth staff. Secondary analysis of transcripts from 18 focus groups with monolingual and bilingual health staff has provided amethod of distinguishing the roles of these complementary communicators. This paper clarifies the roles of interpretersand bilingual communication facilitators using seven key features: scope of language, language proficiency, nature ofcommunication/interaction, nature of the contact and relationship, client responsibilities, and relationship with otherhealth care providers. We discuss differences in how bilingual health staff use language when providing care, andalternative types of interactions interpreters could adopt to extend their current role. A collaborative group ofcommunicators located within a health team is proposed, that is able to identify need and select the best communicatorfor the task.
Designing teams that work
Authors: Wake-Dyster Wendy
Published: February 2010

This paper describes the development of clinical improvement teams in a multi-disciplinary acute health care setting. The process included an information-gathering phase that enabled a match of team structure and leadership to staff skills and experience. It was found that an environment that supported collaborative practice and shared decision-making was critical to staff support of the teams and the outcomes achieved.
Factors influencing patients' length of stay
Authors: Liu Yingxin , Phillips Mike , Codde Jim
Published: February 2010

This study was conducted to evaluate the ability of AN-DRG version 3.1 to predict variation in patients' lengthof stay in hospital (LOS) and identify other factors that can influence the LOS by using routinely collectedhospital morbidity data. A total of 18 DRGs that comprised 4,589 episodes were analysed. Multiple regressionwas used to model length of stay as a function of a number of independent variables. Overall only 37.6% ofvariation in mean length of stay could be explained. DRGs predicted 30% of the total variation. Other factorssuch as age, payment classification, source of referral, specialty of doctor, and ethnic group also influencedpatient length of stay. It was concluded that the limited explanation was a consequence of a lack of a betterindicator of severity within DRGs.
Re-engineering clinical records for production control
Authors: Codman Ernest
Published: February 2010

Ernest Codman is a medical manager at EAC Hospital, Boston, United States of America andPresident of the Congress of Surgeons.
Health care in Canada 2000:a first annual report
Authors: Hindle Don
Published: February 2010

Visiting Professor, University of New South Wales
Improving clinical management for consumers with co-existing mentalhealth and substance use disorders
Authors: Tobin Margaret  J , Matters Beth , Chen Luxin , Smith Roisin , Stuhlmiller Cynthia
Published: February 2010

Using Quality Improvement project methodology, complex organisational and clinical practice change was broughtabout to improve services for people with co-existing mental health and alcohol and drug misuse. The project describeslocal uptake and adaptation of national and state policy to achieve change that is sustainable within existing resources.Emphasis on engagement of staff and consumers and carers throughout the change was an essential component. Theproject has implications for the introduction of changes in response to other national policy directives.
Using Australian DRGs in Germany:a commentary
Authors: Hindle Don , Lenz Max J
Published: February 2010

Germany will begin a change to per case payment by DRG from January 2003. It has selected the Australian DRGclassification as the basis for patient categorisation, in preference to the many other DRG variants around the world.The main aim is increase control over expenditure. We describe some of the reasons for high levels of spending onhospital inpatient care, including the fragmented insurance system and supplier-induced demand. We summarise thereasons why Australian DRGs were selected, and note some of the benefits that will accrue for Australia.
The Illawarra Coordinated Care Trial: better outcomes with existing resources?
Authors: Perkins David , Owen Alan , Cromwell David , Adamson Linda , Eagar Kathy , Quinset Karen , Green Janette
Published: February 2010

The Illawarra Coordinated Care Trial was one of nine Australian trials undertaken to see whether different modelsof coordinated care could improve the health of people with multiple service needs within existing resources. This papersummarises the findings of an extensive local evaluation and discusses the impact of the trial on clients and serviceproviders. It examines the main findings related to the principal trial hypothesis and points to lessons that mightinform the next round of trials.
Macarthur Model for Ambulatory Services
Authors: Wilson Stephen , Chapman Margaret , Nancarrow Lynette , Collins Jennifer
Published: February 2010

The Macarthur Health Sector has embraced the concept of Ambulatory Care within all clinical streams. TheMacarthur Model for Ambulatory Services is multi faceted and has sought to encompass and combine the best featuresof many established services throughout Australia and the world. The result is one integrated, cohesive model thatallows patients multiple points of entry and exit. Ambulatory Care has developed an essential link in the continuumof care from acute 'illness' hospital-based to maintenance community 'health' care. The philosophy of sharedresponsibility between patient, carer, general practitioner and a hospital specialist team underpins the modeldeveloping in Macarthur.
Concurrent opioid dependence and mental health problems: a review of the issues for general practice
Authors: Duffy Janice , Ask Alex , Macdougall Colin
Published: February 2010

The literature is reviewed on the issue of concurrent opioid dependence and mental health problems within the general practice setting. People with such problems have poorer personal, clinical and social outcomes than people with either mental health or drug and alcohol (D&A) problems alone. Mental health and drug services operate from different policy systems and are generally not co-ordinated with each other, leaving the onus on the patient to move effectively through health systems. The common statement that GPs are ideal health professionals to manage concurrent problems is contrasted with the evident barriers in general practice such as lack of time, knowledge, skills and confidence. Models for managing concurrent problems tend towards shared care. However, these models either have received mixed evidence (eg. consultant-liaison psychiatry) or are amenable to development but remain untested (eg. co-ordinated care, community health centre programs). The Enhanced Primary Care items introduced in 1999/2000 may provide an incentive for GPs to participate in shared care arrangements with other health professionals. However, there is a need for mechanisms to increase the links between GPs and other health services.
Chronic disease guidelines and the Indigenous Coordinated Care Trials
Authors: Weeramanthri Tarun , Connors Christine , O'Leary Sherry , Yarmirr Daisy , Wright Jo , Bell Andrew
Published: February 2010

The establishment of the NT Coordinated Care Trials in 1997 provided an opportunity for the funding and development of detailed guidelines, designed specifically for the Indigenous population, covering screening and clinical management of major chronic diseases. All guidelines were incorporated into the NT Coordinated Care Trials Information System on the Tiwi Islands and in the Katherine West region, and used to generate individual and population care plans. In contrast to what is usually written, a broad range of guidelines can be developed in a relatively short period of time utilising a dedicated multi-disciplinary team and local working groups. Having a receptive service delivery model, such as the Coordinated Care Trials, allows for a high level of uptake and use. The key features were the linking of guidelines to a computerised information system that translated them into items of service and presented themto the clinician at the time of consultation, combined with ongoing education of clinicians and clients.
Corruption in the health care system: the circumstantial evidence
Authors: Ibrahim Joseph , Majoor Jennifer
Published: February 2010

Health care systems are under intense scrutiny, and there is an increasing emphasis on patient safety and quality of care in general. Evidence continues to emerge demonstrating that health systems are performing at sub-optimal levels. The evidence includes the under-use, over-use and mis-use of health care services; new standards asking for respect, dignity,honesty and transparency; the corporatisation of health; and the existing inequalities in power and health outcomes.Recommendations for improving health care often refer to increasing the level of collaboration and consultation. These strategies are unlikely to remedy the root causes of our ailing health systems if we accept the circumstantial evidence that suggests the system is rotten.
Policy change and private health insurance: did the cheapest policy do the trick?
Authors: Butler James R G
Published: February 2010

From the introduction of Australia's national health insurance scheme (Medicare) in 1984 until recently, the proportion of the population covered by private health insurance declined steadily. Following an Industry Commission inquiry into the private health insurance industry in 1997,a number of policy changes were effected in an attempt to reverse this trend. The main policy changes were of two types: "carrots and sticks" financial incentives that provided subsidies for purchasing, or tax penalties for not purchasing, private health insurance; and lifetime community rating, which aimed to revise the community rating regulations governing private health insurance in Australia. This paper argues that the membership uptake that has occurred recently is largely attributable to the introduction of lifetime community rating which goes some way towards addressing the adverse selection associated with the previous community rating regulations. This policy change had virtually no cost to government. However, it was introduced after subsidies for private health insurance were already in place. The chronological sequencing of these policies has resulted in substantial increases in government expenditure on private health insurance subsidies, with such increases not being a cause but rather an effect of increased demand for private health insurance.The paper also considers whether the decline in membership that has occurred since the implementation of lifetime community rating presages the re-emergence of an adverse selection problem in private health insurance. Much of the decline to date may be attributable to failure on the part of some members to honour premium payments when they first fell due. However, the changing age composition of the insured pool since September 2000,resulting in an increasing average age of those insured, suggests the possible reappearance of an adverse selection dynamic. Thus the 'trick' delivered by lifetime community rating may not be maintained in the longer term.
The Fetal Tele-Ultrasound Project in Queensland
Authors: Soong Barbara , Yee Chan Fung , Bloomfield Sue , Smith Mark , Watson David
Published: February 2010

The need for access to tertiary centre experts for those living in rural and remote areas of Queensland is well recognised. With an estimated population of 3.3 million people of whom 55% live outside the capital city, Queensland is ideally suited to telemedicine, as it provides a potential opportunity to improve access to specialist care. Congenital fetal abnormalities are the major causes of perinatal morbidity and mortality. With only two Maternal Fetal Medicine Specialists in Queensland located in a major teaching hospital in Brisbane, the opportunity to use videoconferencing technology to develop a tertiary level tele-ultrasound service presented a challenge - that is, to find a technical and clinical solution to enable such a service. We report on some of our practical experiences and difficulties in establishing such a service.
Managing the healthcare workforce: cost reduction or innovation
Authors: Stanton Pauline
Published: February 2010

Few studies have explored the socio-economic profile, service utilisation, obstetric history and pregnancy outcomes of ethnic women who utilise ethno-specific obstetric services in Australia. The purpose of this study was to form a profile of women who accessed the Ethnic Obstetric Liaison Services (EOLO) in South Western Sydney Area Health Service (SWSAHS), New South Wales and explore their beliefs about using maternal and infant health services. We found that the prevalence of risks and special needs varied significantly by language groups in this study sample. Our results suggest that equity of access to quality care for this group of mothers and infants can be assured if models similar to the EOLO in SWSAHS are thoroughly planned and developed, and take account of cultural appropriateness for the population served.
Moe After Hours Medical Service: 'pillars' of success
Authors: O'Meara Peter , Strasser Roger
Published: February 2010

This study aimed to identify and explore the factors that are crucial to the successful operation of rural after-hoursmedical services. It sought to determine the attributes that contribute toward the successful operation of after-hours medical services in rural towns. It drew on computer-assisted telephone interviews with stakeholders, and operational, demographic and financial data. The findings were brought together and analysed within an integrated framework for the guidance of policy makers.In a rural setting, the most important factors for a successful after-hours medical service are related to, 'place', 'process','people' and 'time'. These need to be integrated through effective management of relationships.
Oncology/haematology nurses: a study of job satisfaction, burnout, and intention to leave the specialty
Authors: Barrett Linda , Yates Patsy
Published: February 2010

The impact of the current nursing shortage on the health care system is receiving attention by both state and federal governments. This study, using a convenience sample of 243 oncology/haematology nurses working in 11 Queensland health care facilities, explored factors that influence the quality of nurses' working lives. Although nurses reported high levels of personal satisfaction and personal accomplishment, results indicated that nearly 40% of registered nurses (RNs) are dealing with workloads they perceive excessive, 48% are dissatisfied regarding pay, and professional support is an issue. Furthermore, emotional exhaustion is a very real concern: over 70% of the sample experienced moderate to high levels. Over 48% of the sample could not commit to remaining in the specialty for a further 12 months. Health care managers and governments should implement strategies that can increase nurses' job satisfaction and reduce burnout, thereby enhancing the retention of oncology/haematology nurses.
Report of the mid-term review of Victoria's Maternity Services Program
Authors: Keleher Helen , Round Rebecca , Wilson Gay
Published: February 2010

Substantial State Government funding has been committed in Victoria for the enhancement of maternity services. The funding is intended to improve the quality of care for women and meet consumer expectations for choice and continuity of care in maternity services. This paper reports on a mid-term review (the 'Review') of the Victorian Maternity Services Program, which was conducted by the authors on behalf of the Victorian Department of Human Services. Documentary analysis was conducted for the review, and workshops and key informant interviews were held throughout Victoria with midwives, medical staff and Department of Human Services staff. The Review found that there had been many gains as a result of the Maternity Services Program and identified directions for further development. Issues of change and facilitators of change processes in maternity services are highlighted in this article.
Dietitians in New South Wales: workforce trends 1984-2000
Authors: Meyer Roslyn , Gilroy Rachelle , Williams Peter
Published: February 2010

Complete surveys of the dietetic workforce in NSW were conducted in 1984 and 1991 and have now been updated with a new survey in 2000. In the nine years since 1991, the total active workforce grew by 48%. Although there were significant improvements in the ratios of hospital dietitians per 100 acute beds (from 0.88 to1.08) and dietitians per million population (from 69.7 to 96.5), the supply of dietitians does not yet reach recommended levels, especially in rural areas. Other trends were significant increases in the proportion of dietitians employed outside hospitals (to 38% in 2000) and in non-clinical work (50% in 2000), and declines in the number of technical support staff for dietitians.
Benchmarking working time in health care: the case of Excelcare
Authors: Willis Eileen
Published: February 2010

In the 2000-2004 Enterprise Bargaining round between the Australian Nursing Union and the South Australian state government, it was agreed that public hospitals would be staffed according to Excelcare timings or benchmarks. Excelcare is a computerised workload produce that measures the number of hours and minutes needed to perform a range of nursing tasks for patients on a given ward. This brought into sharp relief disagreements between the various parties over Excelcare timings, but more importantly, it illustrates the unions' strategic use of the Enterprise Bargaining process to de-intensify nursing labour.
Hospital services in Tasmania
Authors: Duckett Stephen , Geeves Paul , Kinne Lawrence , Ratcliffe Kevin
Published: February 2010

Tasmania's hospitals, as in most jurisdictions in Australia, have been undergoing significant changes in organisational basis, type of funding base, range and distribution of services and funding models over the past decade. There has been a return from regional to statewide reporting and accountability. There is a greater diversity of funding types, from pure public provision through co-location of public and private facilities, to thecontracting-out of hospital and rehabilitation sevices to market providers. The development of telehealthtechnology is also adding new facets to the relationship between health professional, client/patient and the state.Given these changes, the account of Tasmania's hospitals given here is necessarily that of a snapshot in a dynamicorganisational landscape.
Democratising health care governance? New Zealand's inaugural district health board elections, 2001
Authors: Gauld Robin
Published: February 2010

New Zealand's 'district health board' (DHB) system has been under implementation since the 1999 general election. A key factor motivating the change to DHBs is the democratisation of health care governance. A majority of the new DHB members are popularly elected. Previously, hospital board members were government appointees. Inaugural DHB elections were held in October 2001. This article reports on the election results and the wider operating context for DHBs. It notes organisational issues to be considered for the next DHB elections in 2004, and questions the extent to which the elections and DHB governance structure will enhance health care democratisation in New Zealand.
Moving a hospital - a once in a lifetime experience
Authors: Duffy Kerry , Pearson Adam , Waters Mark
Published: February 2010

It is a hugely complex task to move a 525-bed acute tertiary health facility to a new building whilst continuing to provide services to the public - a task that was undertaken at Brisbane's Princess Alexandra Hospital in March/April 2001. There were complex issues to manage, ranging from clinical unit interdependence across a split campus to the development of detailed plans for transferring telephone extensions/personal computers in a "live environment". The success of the Princess Alexandra exercise is shown by there having been no adverse effects on patients, the lack of negative media attention and the occurrence of only two staff injuries during the move. Meticulous planning and good communication with staff and stakeholders (other hospitals, general practitioners)supported this success. The decision to reduce clinical services where possible during the shift was helpful.Understanding the complexity and richness of the information technology, the work environment and the humanelements on campus was also critical to success. One major error was the initial decision to schedule the move within weeks of receiving practical completion of the new building. It became all too clear in November 2000 that further time was required to commission the building. The Transition was therefore rescheduled from January to March 2001. This decision was critical to the success of the move.
Evaluation of the health services management training course of Jiangsu, China
Authors: Yaping nad Pauline Stanton Dong
Published: February 2010

Health service management education programs emerged in the early 1980s in China as a result of changing demands on health service managers created by new directions in health policy. This paper reports on an evaluation of the Jiangsu-Victoria Health Management Training Program and discusses five of the main findings. Participants in the study believed that the Program has impacted positively on the health management practice of Jiangsu Province, and has made a significant contribution to health services management education in China. However, certain areas in teaching practice need to be improved and participants in the study provided suggestions to achieve this. The study also found that there were limitations to the impact of managerial education due to administrative and environmental factors.
Treating organisational illness: a practical approach to facilitating improvements in health care
Authors: Hindle Don , Natsagdorj Tserendorj
Published: February 2010

The health sector contains many problems that are widely recognised and ought to be easily resolved, and yet some organisations seem to be powerless to act. We argue that this mainly reflects weaknesses in the organisational culture, and present an approach that we have been using to address them. We describe some simple analytical tools, and report our experiences in using them in organisations in several countries. We conclude that most people believe organisational weaknesses are important, are willing and eager to try to address them, and do in fact find ways of making some useful changes - at least, in the short term.
Response from the Australian Medical Association
Authors: Phelps Kerryn
Published: February 2010

Response to 'A response to the Australian Health Care Agreement Series' by Graham Wright.
Self-management: its place in the management of chronic illnesses
Authors: Walker Christine , Swerissen Hal , Belfrage John
Published: February 2010

Self-management programs are now regarded as important facets in the overall care of people with chronic illnesses.They are seen as producing long-lasting benefits both to participants and to the health system in terms of reducedhospitalisations and reduced lengths of stay, as well as decreasing medication usage. In this article we examine whatconstitutes self-management and the evidence supporting the views that the benefits are unequivocal. We argue thatgreater attention to research design is required before the benefits can be assessed. We also argue that greater attentionmust be paid to access issues for people from culturally and linguistically diverse backgrounds (CALD) and lower socioeconomicstatus.
Are socio-economically disadvantaged Australians making more or less use of the Enhanced Primary Care Medicare Benefit Schedule item numbers?
Authors: Wilkinson David , McElroy Heather , Beilby Justin , Mott Kathy , Price Kay , Morey Sue , Best John
Published: February 2010

We aimed to examine the relationship between levels of socio-economic disadvantage (measured by the Socio EconomicIndexes for Areas [SEIFA] used by the Australian Bureau of Statistics) and uptake of the Enhanced Primary Care(EPC) item numbers on the Medicare Benefits Schedule. Health services are often less likely to reach those that mostneed them and so it is important to monitor whether disadvantaged communities are accessing EPC. The rates ofhealth assessments, care plans and case conferences are similar in each SEIFA quartile (from advantaged todisadvantaged populations), favouring the more disadvantaged quartiles in some cases. These national trends are notobserved in each state and territory. For all EPC services combined, the lowest number of doctors that provide EPCservices are found in the 2 most disadvantaged quartiles, yet more EPC services are provided in these quartiles, due tothe higher mean and median number of services provided by general practitioners in these quartiles. Overall,populations living in the most disadvantaged quartiles have similar or higher levels of EPC uptake, apparently due,at least in part, to greater than average use of EPC services by general practitioners in these areas.
Who, where and why: situational and environmental factors contributing to patient falls in the hospital setting
Authors: Donoghue Judith , Graham Jennifer , Gibbs Julie , Mitten-Lewis Suzanne
Published: February 2010

Falls are a significant burden on the Australian healthcare budget and can result in loss of personal independence,injury or death. A sustained high rate of inpatient falls at St George Hospital has made it imperative for nurses toidentify those patients at highest risk in order to implement preventive interventions. Ninety-one inpatients fell over aten-week period, with a total of 118 falls. Our study examined the prevalence of 'intrinsic high risk' characteristicsidentified in the literature in people who fell during hospitalisation. These results will be reported elsewhere. Extrinsicenvironmental factors contributing to falls were also identified, including time of fall, activity at time of fall and location of fall. This paper describes and discusses the study findings related to extrinsic risk factors.
Health: IT leader or laggard? A comparative assessment of IT maturity
Authors: England Ian , Stewart Don
Published: February 2010

The health industry has acquired a reputation as lagging in the use of IT. This reputation is usually based upon therelatively narrow measure of comparative IT expenditure, often examined as a proportion of total revenue. This studyhas been undertaken to assess health's use of IT using a broader frame of reference. The health industry was comparedto the banking industry, on the basis that the banking industry is widely perceived as a leading IT user.The research confirmed that in these two 'knowledge' industries, health is slower to adopt IT with an apparent lowermaturity level. This was the case across a range of best practice management, procedural and cultural topics as wellas in the level of resources applied to IT.
Beyond organisational design: moving from structure to service enhancement
Authors: Law Debbie , Boyce Rosalie A
Published: February 2010

The Australian health care industry prior to the 1990s was notable for its relative stability and uniformity in relation to organisational design.Since then, new organisational designs have proliferated and a diversity of approaches is evident.The new fluidity in organisational design is particularly evident amongst the allied health professions. The aim of this paper is two-fold.Firstly,to summarise recent changes in organisational design as they relate to the allied health professions and secondly,to move beyond design issues to focus on service level enhancement in an organisational change context. This later aim is achieved by presenting data from an in-depth study of one institution's experience with wide-ranging organisational reforms. The recent formation of the National Allied Health Organisational Structures Network (NAHOSN) has given energy to the impetus of placing a research-based framework around the change experiences reported by Allied Health groups. An objective of the network is to foster research,rather than rely on commentary and anecdote, in the often highly contested arena of organisational design and reform.
The causes and consequences of nursing shortages: a helicopter view of the research
Authors: Duffield Christine , O'Brien-Pallas Linda
Published: February 2010

In Australia,as in most industrialised countries,there is an acute shortage of registered nurses.While there are numerous research reports emanating from Canada,the United States and Great Britain that provide insight into reasons for this shortage, little comparable work has been undertaken in Australia. This paper presents an overview of the complex interlinking set of factors which cause or are the consequences of nursing shortages including lifestyle preferences, workforce composition,quality of work life and workload and the impact of organisational change and altered management practices. It is important that managers in Australian health care settings understand these issues in order to work towards developing sustainable solutions for retention.
Type of housing predicts rate of readmission to hospital but not length of stay in people with schizophrenia on the Gold Coast in Queensland
Authors: Browne Graeme , Courtney Mary , Meehan Tom
Published: February 2010

Accommodation is considered to be important by institutions interested in mental health care both in Australia andinternationally. Some authorities assert that no component of a community mental health system is more importantthan decent affordable housing. Unfortunately there has been little research in Australia into the consequences ofdischarging people with a primary diagnosis of schizophrenia to different types of accommodation. This paper usesarchival data to investigate the outcomes for people with schizophrenia discharged to two types of accommodation.The types of accommodation chosen are the person's own home and for-profit boarding house. These two were chosenbecause the literature suggests that they are respectively the most and least desirable types of accommodation.Results suggest that people with schizophrenia who were discharged to boarding houses are significantly more likelyto be readmitted to the psychiatric unit of Gold Coast Hospital, although their length of stay in hospital is notsignificantly different.
Tensions in maternal and child health policy in Victoria: looking back, looking forward
Authors: Keleher Helen , Reiger Kerreen
Published: February 2010

Helen Keleher is Associate Professor in the School of Health and Social Development, Deakin University.Kerreen Reiger is Associate Professor in the School of Social Sciences, La Trobe University.Since the late 1980s, Maternal and Child Health Services (MCHS) in Victoria have undergone significant change. This paper provides an historically-informed analysis of the complex intersection of policy, administrative restructuring and stakeholder interests. It draws on and extends the authors' previous research into MCH Service policy directions and administration, including the impact of Compulsory Competitive Tendering (CCT) on MCH nurses in the 1990s. Historically there has been little explicit debate about either organisational arrangements, or the policy objectives of the MCHS. The dominant focus on health surveillance of infants never adequately reflected nurses' wider role in the community and was not consistent with a wider social model of health. Tensions between professional, consumer and administrative stakeholders became heightened by the implementation of the 1990s neoliberal political agenda. During this period, when restructuring linked funding to service delivery through tendering arrangements, apolitical and policy settlement further institutionalised surveillance as the basis of the MCHS. The restructured Service has remained constrained by the dominance of health surveillance as the primary program goal even after more varied contracting arrangements replaced CCT. Although recent initiatives indicate signs of hange, narrow surveillancebased guidelines for Victorian MCH Services are not consistent, we argue, with recent early years of life policy which calls for approaches derived from socio-ecological models of health.
A preliminary casemix classification system for Home and Community Care Clients in Western Australia
Authors: Calver Janine , Holman C D'Arcy J. , Lewin Gill
Published: February 2010

The objective of the study was to examine the feasibility of using routinely available assessment, Minimum Data Set (MDS), socio-economic, geographic and unit cost data to define a discrete number of clinically meaningful, costhomogeneous Home and Community Care (HACC) client groups. Participants included new and existing Western Australian (WA) HACC beneficiaries from 1 January to 31 September 2001. Seventy two HACC agencies from metropolitan and rural regions participated, which represented 29% of the sector. A total of 9,404 quarterly periods of care contributed to the exploratory classification analysis and 12,697 to the confirmatory analysis. The final structure contained nine terminal nodes, achieved an R 2 of 23.7%, and was robust to fluctuations in cost. Higher costs were associated with increased functional dependency and the need for clinical services. The classification is empirically grounded, simple and robust, and has a number of potential policy and practice applications. Further refinement is required to improve its suitability as a funding tool.
The influence of socio-economic and locational disadvantage on patterns of surgical care for lung cancer in Western Australia 1982-2001
Authors: Hall Sonya E , Holman C D'arcy , Sheiner Harry
Published: February 2010

Sonja E Hall is with the School of Population Health, The University of Western Australia.C D'Arcy J Holman is Head, School of Population Health, The University of Western Australia.Harry Sheiner is Chairman, WA Clinical Oncology Group, c/o Cancer Foundation of Western Australia.Objective: Patterns of in-hospital surgical care for lung cancer in Western Australia were examined, including the effects of demographic, locational and socio-economic disadvantage and the possession of private health insurance, on the likelihood of receiving surgeryPatients and methods: The WA Record Linkage Project was used to extract hospital morbidity, cancer and death records of all people with lung cancer in Western Australia from 1982 to 2001. The likelihood of receiving lung cancer surgery was estimated, after adjustment for co-variates, using logistic regression.Results: Overall, 16% of patients received surgery for their lung cancer, although this varied according to histology. Patients who received surgery were typically younger, female, non-indigenous and had less comorbidity. Patients from socio-economically disadvantaged groups tended to be less likely to receive surgery (OR 0.79; 95% CI 0.61-1.04) although this was not significant for each category of disadvantage. Those who had their first hospital admission, with a mention of lung cancer, in a rural hospital were less likely to receive surgery (OR 0.26; 95% CI 0.19-0.36) than those in metropolitan hospitals, although residential location generally had less effect (OR 0.36; 95% CI 0.14-0.92). Patients admitted as a private patient either to a private or public hospital for their first mention of lung cancer had increased likelihood of receiving surgery (OR 1.15; 95% CI 1.02-1.30); however first admission to a private hospital had no effect (OR 0.99: 95% CI 0.85-1.16).Conclusion: The utilisation of lung cancer surgery was low with several factors found to affect the rate. Patients from socio-economically or locationally disadvantaged backgrounds, indigenous patients or patients without private health insurance were less likely to receive lung cancer surgery than those from more advantaged groups.
Abortion in Australia: a legal misconception
Authors: Petersen Kerry
Published: February 2010

Abortion is a procedure and practice which
has been universally practised in some form
since the beginning of recorded history.
While deliberate terminations of pregnancy
are reported throughout history, all races,
cultures and religious groups have sharply
divergent and frequently irreconcilable opinions
on this highly controversial subject.1
Evaluating the effectiveness of health care teams
Authors: Mickan Sharon M
Published: February 2010

While it is recognised that effective health care
teams are associated with quality patient care, the
literature is comparatively sparse in defining the
outcomes of effective teamwork. This literature
review of the range of organisational, team and
individual benefits of teamwork complements an
earlier article which summarised the antecedent
conditions for (input) and team processes (throughput)
of effective teams. This article summarises the
evidence for a range of outcome measures of
effective teams. Organisational benefits of teamwork
include reduced hospitalisation time and
costs, reduced unanticipated admissions, better
accessibility for patients, and improved coordination
of care. Team benefits include efficient use of
health care services, enhanced communication
and professional diversity. Patients report benefits
of enhanced satisfaction, acceptance of treatment
and improved health outcomes. Finally, team members
report enhanced job satisfaction, greater role
clarity and enhanced well-being. Due to the inherent
complexity of teamwork, a constituency model
of team evaluation is supported where key stakeholders
identify and measure the intended benefits
of a team.
Routine outcome measurement in public mental health — what do clinicians think?
Authors: Trauer Tom , Gill Lisa , Pedwell Glenda , Slattery Peta
Published: February 2010

IN ORDER TO FULLY EVALUATE and manage a
service, one should be able to answer all parts of
the question ?Who receives what services, from
whom, at what cost, and with what effect??1 While
there is good information on the first four elements,
mental health services generally do less well
in demonstrating the effectiveness of what they do,
and it is here that routine outcome measurement
(ROM) can make a contribution. Despite the very
real progress that has been made in implementing
ROM in Australia it is evident from a variety of
sources, formal and informal, that not everyone is
convinced of its necessity or value.
Better Outcomes in Mental Health Care — a general practice perspective
Authors: Thomas Julian E , Jasper Amy , Rawlin Morton
Published: February 2010

THE BURDEN OF DISEASE AND INJURY report of
1999 noted that the ?remarkable progress in the
physical and material wellbeing for most Australians
over the twentieth century has not necessarily
been matched by gains in mental and
subjective wellbeing?. In 1996, mental illness was
associated with nearly 30% of the non-fatal disease
burden in Australia.1
The need for a national approach to mental
health reform was formally acknowledged with
the development in 1992 of the National Mental
Health Strategy, which gave birth to the National
Mental Health Plan 1992?1998,2 and was subsequently
reaffirmed by the second and third
National Mental Health Plans in 19983 and
2003.4
Balancing the balanced scorecard for a New Zealand mental health service
Authors: Coop Colleen F
Published: February 2010

Given the high prevalence of mental disorders,
there is a need to evaluate mental health services
to ensure they are efficient, effective, responsive
and accessible. One method that is being used is
the ?balanced scorecard? which uses performance
indicators in four quadrants to assess various
dimensions of service provision. This case study
describes the steps taken by a New Zealand
mental health service to improve service management
through greater use of key performance
indicators in relation to preset targets using this
approach.
Australia's National Suicide Prevention Strategy: the next chapter
Authors: Robinson Jo , McGorry Patrick , Harris Meredith G , Pirkis Jane , Burgess Philip , Hickie Ian , Headey Alan
Published: February 2010

Australia?s National Suicide Prevention Strategy
(NSPS) is about to move into a new funding
phase. In this context this paper considers the
emphasis of the NSPS since its inception in
1999. Certain high-risk groups (particularly people
with mental illness and people who have selfharmed)
have been relatively neglected, and
some promising approaches (particularly selective
and indicated interventions) have been
under-emphasised. This balance should be
redressed and the opportunity should be taken
to build the evidence-base regarding suicide
prevention. Such steps have the potential to
maximise the impact of suicide prevention activities in Australia.
Ethnicity, deprivation and mental health outcomes
Authors: Trauer Tom , Eagar Kathy , Mellsop Graham
Published: February 2010

Aims: To describe and measure differences
between ethnic groups on standard measures of
mental health outcome.
Methods: Clinical staff in eight New Zealand
Health Districts collected consumer outcomes
data at the start, end and review of episodes of
care. Consumers were allocated to one of three
ethnicity groupings ? Maori, Pacific Island and
?All Other?.
Results: There were large differences between
the three ethnicity groupings on the measures.
Maori and Pacific Island consumers appeared to
demonstrate more psychotic phenomena and
overall worse scores, and the All Other group,
more depression. Changes in scores between
start and end of episodes of care were proportionately
similar across the three groups. Differences
between ethnic groupings varied according to
socio-economic deprivation level.
Conclusions: Potential reasons for some of the
effects observed are discussed, including differing
pathways to care, clinician and selection bias, and
differing models of mental health.
A case study of the evaluation of a public health intervention
Authors: Forssman Bradley , Gupta Leena , Burgess Graham
Published: February 2010

Large public health interventions to control infectious
disease outbreaks are common, but rigorous
evaluation to improve the quality and effectiveness
of these is rarely undertaken. Following a large
community-based clinic to prevent a hepatitis A
outbreak, a multifaceted and multidisciplinary evaluation
was conducted involving consumers, health
professionals and industry partners. The results of
this evaluation were used to produce practical
operational guidelines for the planning and conduct
of future interventions. These guidelines have been
distributed to all public health units in New South
Wales and may be included in the next edition of
the NSW Health notifiable diseases manual. The
evaluation approach can be applied to all public
health interventions across NSW and Australia to
assist in the development of operational guidelines,
in order to increase the quality of public health
action in outbreak prevention.
Nursing morale: what does the literature reveal?
Authors: Day Gary E , Minichiello Victor , Madison Jeanne
Published: February 2010

There is increasing attention to nursing workforce
issues such as recruitment, retention, turnover,
workplace health and safety issues and their
impact on quality patient care. A number of these
problems have been linked to poor morale. While
there has been a lack of consensus on the
determinants of morale, it is clear that the outcomes
of poor morale not only add considerable
cost to the organisation but also impact negatively
on patient care. This article provides a systematic
overview of the literature surrounding nursing
morale and the variables identified in the literature
that impact upon morale, and discusses the implications for future research.