bluuebunny/crossref_metadata_2025 huggingface dataset:
Polymer:metal nanoparticle devices with electrode-sensitive bipolar resistive switchings and their application as nonvolatile memory devices
Authors: Ouyang Jianyong , Yang Yang
Published: February 2010

Devices with a polystyrene film blended with gold nanoparticles capped with conjugated 2-naphthalenethiol exhibited electrode-sensitive bipolar resistive switchings. The resistances of the two states could be different by almost three orders of magnitude, and the devices could be switched between the two states for numerous times. Thus, these devices can be used as nonvolatile memory devices. The resistive switching voltage is related to the work function of the electrode. The electrode sensitivity of the resistive switchings is attributed to the contact potential at the contact of gold nanoparticles and electrode arising from charge transfer between them.
Assessing the relationship between inpatient and outpatient activity:a clinical specialty analysis
Authors: Sharwood Penny , O'Connell Bernadette
Published: February 2010

General and specialist services in public acute hospital outpatient departments play a key role in the health care systemand represent a vital interface between inpatient and community care. Typically outpatient services involve millionsof patient visits within a very short time frame and in Victoria alone between 8-10 million outpatient occasions ofservice are provided each year. Drawing on the first full year of data from the Victorian Ambulatory ClassificationSystem (VACS) this paper examines the patterns underlying the distribution of inpatient separations and outpatientencounters at 16 major Victorian public hospitals and assesses the relationship between inpatient and outpatientactivity at the clinical specialty level.
Improving the utilisation of bilingual counsellors within a public sector mentalhealth service
Authors: Tobin Margaret , Chen Luxin , Edwards Julie L.
Published: February 2010

An urban, public sector Area Mental Health Program reviewed its own bilingual counsellor programas part of an Area-wide quality improvement project, and found that the counsellors' roles needed tobe better defined; that mainstream staff needed to have more access to their expertise as culturalconsultants; and that their function as an Area team, rather than as service based staff, needed to beencouraged. The bilingual counsellors decided to take up this challenge, and with the support of theArea Director of Mental Health, worked together to redefine their roles.
RGs and the development of service delivery strategies
Authors: Van Der Wel Onno
Published: February 2010

Having used DRGs extensively over the past decade for research, trend analysis and funding purposes, it isapparent to me that we have come a long way since the early inception of the DRG work by Fetter and theCommonwealth need to be acknowledged for the leadership and support they have provided in this process.However it is also apparent that we can make more significant improvements given what we have learned to date.I am interested in structural changes of DRGs for at least three purposes: funding, clinical understanding, andstrategic development of service delivery.
Public health advocacy - determining a role for staff of a public hospital
Authors: Johnson Anne
Published: February 2010

This study explored the public health advocacy role of staff employed at a major South Australian specialist publichospital that had made an organisational commitment to health promotion.It was concluded that staff did have a role to play in public health advocacy, though the issues pursued primarilyrelated to disease and injury prevention rather than the broader social determinants of health. Staff gained valuableexperience in the political processes of public health advocacy. The hospital had to develop organisationalinfrastructures to support staff so they could undertake public health advocacy on behalf of the hospital. It was alsonecessary for the hospital to implement other changes in order to 'get its own house in order' before issues could beaddressed in the broader community.
Prosthetic inventory management
Authors: Brinkman Peter , Seipel Christine , Juers Alison
Published: February 2010

An improved approach to inventory management in the Operating Theatre has been initiated at Princess AlexandraHospital. A Clinical Resource Co-ordinator (CRC) position was created to provide access to expertise in purchasingand materials management at the clinical level. A review of existing inventory management practices conducted bythe CRC revealed reporting inadequacies, lack of product specialisation and inadequate control over pricing, stocklevels and product usage. Through liaison with key stakeholders, a competitive tendering process was introduced whichresulted in a standing offer arrangement being installed for three specialty orthopaedic areas. Outcomes of thisarrangement are discussed. The importance of raising the area of prosthetic inventory management for debate in theAustralian literature is also highlighted.
Treatment for childhood acutelymphoblastic leukaemia:the fathers' perspective
Authors: McGrath Pam
Published: February 2010

Research on parental adaptation to a child's chronic illness is still scant, and this is particularly so in relation to theexperience of treatment for paediatric Acute Lymphoblastic Leukaemia (ALL). The work that does exist on parentalreactions tends to conflate maternal responses with paternal responses, as fathers are usually seen as having a secondaryrole. Consequently, little is known about how fathers cope with treatment for childhood ALL. The present discussionseeks to make a contribution to this area by presenting findings on the paternal experience of treatment for paediatricALL from a longitudinal study conducted at Royal Children's Hospital in Brisbane, Queensland. The findings fromthis research clearly indicate the emotional pain that fathers face in their struggle to accept the diagnosis of a serious,life-threatening illness such as ALL in their child. The findings challenge the notion of the male stereotype by showingthat the shock of diagnosis, the emotional pain of coping with the illness, the expression of pain through tears, thedesire to be with the child, the struggle to cope with the medical interventions, and concerns about other familymembers are not gender specific, but are rather issues common to both parents.
Management and the creation ofoccupational stressors in an Australian and a UK Ambulance Service
Authors: Mahony Kerry L
Published: February 2010

Qualitative methods were used to explore the aetiology of occupational stress experienced by on-road ambulance officers. The researcher found that the way in which a service is organised and its officers valued can create and reproduce workplace stressors that are as causative of occupational stress as the often acknowledged occupational specific stressors like night shifts, irregular work hours and witnessing human trauma and tragedy. These stressors thought to be intrinsic to the work of ambulance officers were found to have an organisational dimension.
Mongolia's system-wide health reforms:lessons for other developing countries
Authors: O'Rourke Michael , Hindle Don
Published: February 2010

Mongolia is a poor country that lost 30% of its GDP when the Soviet Bloc collapsed in 1990. Its health care systemhad the typical weaknesses of centrally planned economies - quantity rather than quality, excessive medicalspecialisation, dominance of the hospital sector, weak policy and management capabilities, little communityparticipation in decision making, and so on.This paper describes Mongolia's attempts to resolve these problems through a radical program of reform that began in1998. There have been significant successes in spite of almost overwhelming difficulties, and this may be aconsequence of the strong sense of community that has been present for five hundred years and re-emerged intact atthe end of 70 years of Soviet dominance.We argue, however, that good design and skilful implementation of the reform program may have made acontribution. Its notable features have included the use of a comprehensive and integrated model rather thanpiecemeal reform, the generation of political support for change through social marketing campaigns, a team approachusing local and international experts, and co-ordination of international donor activities. Some of these features maybe relevant to other transitional and developing countries.
The changing attitudes of health professionals and consumers towards a coordinated care trial - SA HealthPlus
Authors: Battersby Malcolm , McDonald Peter , Pearce Rodney , Tolchard Barry , Allen Ken
Published: February 2010

The national coordinated care trials have been a vehicle for health reform in Australia, driven by escalating healthcare costs and projections of an ageing population. The first round of trials conducted between 1997 and 1999 set thetrials a challenge to reduce financial and system barriers to enable health professionals in all sectors and consumers todevelop service delivery models which would give better outcomes for patients within existing resources. As part of achange management strategy, the developers of the SA HealthPlus trial assessed the attitudes of health professionalsand consumers involved in designing the projects which made up the larger trial, prior to trial development and twelvemonths later. This paper reports on the results of the survey and how initial enthusiasm gave way to appropriateanxiety as the complexities of creating a new system of care from reactive to prospective patient centred care planning,became a reality. The survey enabled trial developers to show evidence of acceptability for the new model of care andidentify areas of concern and appropriate strategies for the project teams. This type of survey and the issues identifiedmay be of benefit to the second round coordinated care trials and health regions aiming to initiate coordinated careprograms.
Cost comparison of hospital- and home-based treatment models for acute chronic obstructive pulmonary disease
Authors: Nicholson Caroline , Bowler Simon , Jackson Claire , Schollay Dimity , Tweeddale Margaret , Peter O'Rourke and
Published: February 2010

This trial compared the cost of an integrated home-based care model with traditional inpatient care for acute chronic obstructive pulmonary disease (COPD). 25 patients with acute COPD were randomised to either home or hospital management following request for hospital admission. The acute care at home group costs per separation ($745, CI95% $595- $895, n=13) were significantly lower (p<0.01) than the hospital group ($2543, CI95% $1766-$3321, n=12). There was an improvement in lung function in the hospital-managed group at the Outpatient Department review, decreased anxiety in the Emergency Department in the home-managed group and equal patient satisfaction with care delivery. Acute care at home schemes can substitute for usual hospital care for some patients without adverse effects, and potentially release resources. A funding model that allows adequate resource delivery to the community will be needed if there is a move to devolve acute care to community providers.
Innovation in Australian hospitals
Authors: Dwyer Judith , Leggat Sandra G
Published: February 2010

This paper examines the challenge of innovation,and reports on innovation in the Australian hospital sector. Through review of both published and 'grey' literature,the analysis of the innovative record of Australian hospitals is focused on two key questions: How has the hospital sector made use of opportunities for renewal and improved effectiveness in its ongoing response to the challenges it faces? And are the conditions for effective innovation in place? To be truly innovative,the Australian hospital sector requires greater supporting mechanisms including:a consistent policy and funding framework,greater ability to harness the power of information,and development of innovation skills.The government has an important role to play in stimulating the creative capacities of hospitals and their staff.
The Victorian Ambulatory Care Sensitive Conditions Study: reducing demand on hospital services in Victoria
Authors: Ansari Zahid , Carson Norman , Serraglio Adrian , Barbetti Toni , Cicuttini Flavia
Published: February 2010

Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable ifpreventive care and early disease management are applied, usually in the ambulatory setting. The Victorian ACSCs study offers a new set of indicators describing differentials and inequalities in access to the primary healthcare systemin Victoria. The study used the Victorian Admitted Episodes Dataset (1999-2000) for analysing hospital admissions for diabetes complications, asthma, vaccine preventable influenza and pneumococcal pneumonia. The analyses were performed at the level of Primary Care Partnerships (PCPs). There were 12 100 admissions for diabetes complicationsin Victoria. There was a 12-fold variation in admission rates for diabetes complications across PCPs, with 13 PCPs having significantly higher rates than the Victorian average, accounting for just over half of all admissions (6114) and39 per cent total bed days. Similar variations in admission rates across PCPs were observed for asthma, influenza and pneumococcal pneumonia. This analysis, with its acknowledged limitations, has shown the potential for using theseindicators as a planning tool for identifying opportunities for targeted public health and health services interventions in reducing demand on hospital services in Victoria.
The changing face of community and district nursing
Authors: Smith Judy
Published: February 2010

The Royal District Nursing Service (RDNS) of South Australia provides home- and community-based nursing care to people residing in the Adelaide Metropolitan area. The service is funded predominantly by the Home and Community Care Program. It provides community nursing services in the areas of wound management, palliative care, HIV/AIDS care, continence management, disability care, mental health and dementia care, and diabetes management. In 2000-2001, the service made 439,700 visits to people's homes or saw them in a nurse-led nursing centre. In addition, the nursing staff had 84,000 contacts other than face to face that were related to client care. These contacts include the co-ordination of care with other service providers for new and existing clients of RDNS.
Introducing soft systems methodology plus (SSM+): why we need it and what it can contribute
Authors: Braithwaite Jeffrey , Hindle Don , Iedema Rick , Westbrook Johanna I
Published: February 2010

There are many complicated and seemingly intractable problems in the health care sector. Past ways to address them have involved political responses, economic restructuring, biomedical and scientific studies, and managerialist or business-oriented tools. Few methods have enabled us to develop a systematic response to problems. Our version of softsystems methodology, SSM+, seems to improve problem solving processes by providing an iterative, staged framework that emphasises collaborative learning and systems redesign involving both technical and cultural fixes.
Per case payment in Germany: all in a mess
Authors: Roeder Norbert , Rohell Bernhard , Hindle Don
Published: February 2010

In 2000,the German government legislated a change to per case payment by DRG, and devolved the responsibility for design to an industry group of hospitals and insurance companies. In June 2002,the industry group formally announced that agreement could not be reached, and the Ministry of Health has consequently taken direct control. We argue that important decisions are consequently being made in haste (with significant risk of errors) and that sole-sourcing of some preparatory tasks (for reasons of time pressure) has disturbing aspects.We suggest three factors that might have contributed to this unfortunate state of affairs. First, Germany did not establish a largely independent research and development program of the style applied in Australia. Second, there was a failure to recognise at an early stage that the industry group was unlikely to reach the consensus required by its terms of reference, if only because of the significant competitive aspects of most elements of the design. Finally, too little was done to address the pervasive culture of mistrust between and among hospitals and insurers. We suggest that there needs to be talk about the process of talking if design work is to be more successful in future.
The Northern Territory Preventable Chronic Disease Strategy - promoting an integrated and life course approach to chronic disease in Australia
Authors: Weeramanthri Tarun , Hendy Shirley , Connors Christine , Ashbridge David , Rae Cheryl , Dunn Maree , Fittock Marea , Cleary Jenny , O'Donohoe Lynette , Morton Steve , Swanson Noelene
Published: February 2010

The need for an integrated and life course approach to the prevention and control of chronic diseases is increasinglybeing recognised. This paper describes the development of the Northern Territory Preventable Chronic Disease Strategy(PCDS), the strategic framework and evidence base, the design of implementation and monitoring phases, and earlyoutcomes. The PCDS is premised on the belief that the major chronic diseases, and their common underlying riskfactors, are potentially preventable. The structural challenges to larger jurisdictions taking such an integrated approachare undoubtedly larger, but the benefits are potentially great. Continuing with a series of vertical programs aimed at each single noncommunicable disease will not deliver the desired national health outcomes.
Violence in the workplace: awareness and prevention
Authors: Hinson Jan , Shapiro Margaret
Published: February 2010

Occupational violence is of growing interest to both individuals and organisations in the health field.Not surprisingly, staff who work directly on the front line are more vulnerable to episodes of physical violence from the general public. However, violence manifests in a number of ways,and any person in the workplace can experience it at anytime. Occupational violence should be viewed as an event to be identified, understood and managed, with a consequent need to identify types of violence in order to provide policy direction and preventive strategies to enhance workplace safety. Violence cannot be totally prevented but the risk of violence and its negative impacts on the individual can be reduced with carefully considered planning and swift action following a violent event. This paper reports various types of violence, the magnitude of the problem and who is at risk. Policy initiatives are suggested and methods of prevention discussed.
Information technology creeps into rural general practice
Authors: Robinson Anske
Published: February 2010

This study looked at the effect of information technology on rural medical practice. Eight GPs in rural medial practice in Victoria were interviewed,and World Wide Web sites were accessed for information relevant to the rural GPs use of information technology. The results indicated that rural GPs are developing their use of information technology according to their needs. The use of information technology is changing the nature of rural medical practice, and bringing more support and information to rural GPs. However, some of the technologies now available are of little perceived use to the GPs,and GPs with good support staff are better able to take advantage of the technology than GPs with little or inadequate support. The findings of this study have implications for policies being implemented to increase the availability of information technology to support rural health care.
The weakest link?
Authors: Eagar Kathy
Published: February 2010

THE EXTRAORDINARY COVERAGE of complaints of
poor and dangerous patient care at Macarthur
Health Service (Campbelltown and Camden Hospitals)
has all the hallmarks of a pulp novel ?
relentless and emotional media coverage, tragic
personal stories, political intrigue at high levels and
eloquent legal argument. Never before has New
South Wales experienced such an event, nor most
other jurisdictions for that matter. Perhaps only the
coverage of King Edward Hospital in Perth comes
close.
Clinicians at the two hospitals have been variously
portrayed as everything from doctors and
nurses who were happy to turn their backs on
dying patients through to one of the many victims
of a fundamental political, policy and structural
failure to distribute health care resources in proportion
to need. In the same vein, the local hospital-
management group has been portrayed as
either an incompetent and corrupt group who
engaged in cover-ups, shredding documents and
targeting anyone who raised concerns, or as a
caring but embattled group who were doing their
best to manage a continuously increasing gap
between demand and supply.
Likewise, the nurses who publicly raised the
allegations have been variously portrayed as either
whistleblowers acting solely in the public interest,
who were punished and sacked for bringing the
truth to light, or as vexatious troublemakers seeking
revenge on hospital managers who had previously
disciplined them for bullying, harassment
and/or poor clinical care.
And, as usual, the truth lies somewhere in
between.
Patient safety, ethics and whistleblowing: a nursing response to the events at the Campbelltown and Camden Hospitals
Authors: Johnstone Megan-Jane
Published: February 2010

IN NOVEMBER 2002, in what stands as one of the
most significant whistle blowing cases in the history
of the Australian health care system, four
nurses went public with concerns they had about
the management of clinical incidents and patient
safety at two hospitals in Sydney, New South
Wales. The handling of this case and its aftermath
raises important moral questions concerning the
nature of whistleblowing in health care domains
and the possible implications for the patient
safety and quality of care movement in Australia.
This paper presents an overview of the case, the
moral risks associated with whistleblowing, and
some lessons learned.
The International Council of Nurses (2000)
Code of Ethics stipulates that nurses have a
stringent responsibility to 'take appropriate
action to safeguard individuals when their care is
endangered by a co-worker or any other person'.
Other local and international nursing codes of
ethics and standards of professional conduct likewise
obligate nurses to take appropriate action to
safeguard individuals when placed at risk by the
incompetent, unethical or illegal acts of others ?
including the system. Despite these coded moral
prescriptions for responsible and accountable
professional conduct, taking appropriate action
when others are placed at risk (including making
reports to appropriate authorities) is never an
easy task nor is it free of risk for nurses. As has
been amply demonstrated in the literature, taking
a moral stance to protect patient safety and
quality of care can be extremely hazardous to
nurses (Johnstone 1994, 2002, 2004; Ahern &
McDonald 2002). In situations where nurses
report their concerns to an appropriate authority
but nothing is done to either investigate or validate
their claims, nurses are faced with the ethical
dilemma and 'choice' of whether to: do nothing
('put up and shut up'); leave their current place of
employment (and possibly even the profession); or
take the matter further ('blow the whistle') by
reporting their concerns to an external authority
that they perceive as having the power to do
something about their concerns.
It is rare for nurses to 'blow the whistle' in the
public domain. When they do, it is usually
because they perceive that something is terribly
wrong and, as a matter of conscience, they cannot
just look on as morally passive bystanders. For
those nurses who do take a stand, the costs to
them personally and professionally are almost
always devastating, with no guarantees that the
situation on which they have taken a public
stance will be improved. Nurses who blow the
whistle often end up with their careers and lives
in tatters (see case studies in Johnstone 1994 &
2004).
What's wrong with our hospitals?
Authors: Wilson Lionel L
Published: February 2010

EVENTS occurring from 1999 to 2003 at Campbelltown
and Camden hospitals within the South
Western Sydney Area Health Service received
extensive coverage in the media during the first
half of 2004 and led to significant government
intervention. It has been claimed that some 17
deaths could have been avoided. Other accusations
of less than appropriate care by both nurses
and doctors have also been made. A group of
nurses complained about mismanagement and
patient neglect, and alleged that management
failed to address their concerns. Medical staff
claimed serious under-funding of the two hospitals
were reasons for these events. The media and
political debate that erupted was highly emotive
and further muddied and confused the issues.
This article draws on these events to explore
the issues of quality and risk management generally
in Australian hospitals. Gaps in current
approaches and attitudes particularly prevalent in
NSW are analysed and suggestions made as to
how these gaps should be eliminated.
Private health insurance and the Pharmaceutical Benefits Scheme: how effective has recent government policy been?
Authors: Richardson Jeff R J , Segal Leonie
Published: February 2010

The cost to government of the Pharmaceutical
Benefits Scheme (PBS) is rising at over 10 percent
per annum. The government subsidy to
Private Health Insurance (PHI) is about $2.4
billion and rising. Despite this, the queues facing
public patients ? which were the primary justification
for the assistance to PHI ? do not appear to
be shortening.
Against this backdrop, we seek to evaluate recent
policies. It is shown that the reason commonly
given for the support of PHI ? the need to
preserve the market share of private hospitals and
relieve pressure upon public hospitals ? is based
upon a factually incorrect analysis of the hospital
sector in the last decade. It is similarly true that
the ?problem? of rising pharmaceutical expenditures
has been exaggerated. The common element
in both sets of policies is that they result in
cost shifting from the public to the private purse
and have little to do with the quality or quantity of
health services.
Pharmaceuticals, the state and the global harmonisation process
Authors: Abraham John
Published: February 2010

This article examines how regulatory agencies?
mission to protect and promote public health,
enshrined in legislation, has been shaped and
limited by commitments to the commercial interests
of the pharmaceutical industry. It is argued
that the regulatory state has become largely a
?competition state? which considers its primary role
to be the maintenance of industry?s competitive
position in world markets. By examining regulatory
developments across the EU, Japan and the US, I
shall explain how the competition state became a
building block for the global harmonisation process.
To legitimise the global harmonisation process
in terms of their mission to protect and
promote public health, regulators claim that it
does not lower safety standards and will accelerate
the availability of pharmaceutical innovations
to patients who need them. However, evidence is
presented to suggest that these legitimising
claims are not tenable.
Retention of nursing staff — a team-based approach
Authors: Collette Julienne E
Published: February 2010

This case study discusses a team-based
approach to the retention of nursing staff. In
2001, Mercy Hospital for Women (Mercy) was
part of a benchmarking study to try to understand
more about its nursing workforce. The results
indicated that 40% of nursing staff were at risk of
leaving the Mercy and 41% of nursing staff at risk
of leaving their profession. With a pending relocation
of the hospital, increased agency costs,
and a high number of nursing staff at risk of
leaving, the hospital established a project to
address this issue.
A team of nurses worked together to improve the
retention of staff and the culture of the organisation.
The team spent time developing their own
skills and competencies in teamwork, and understanding
more about the workforce. A project plan
was established, and over a period of eighteen
months nurses reported an improvement in the
culture of the organisation and a reduction in the
risk of nurses leaving the Mercy.
This is an example of what an empowered team
can do. The fundamental drivers underpinning the
process were effective teamwork combined with
employee involvement and a shared vision. This
project used the principles of the learning organisation ? a more recent aspiration of the Mercy.
Refashioning child and family health services in response to family, social and political change
Authors: Vimpani Graham
Published: February 2010

Professor Graham Vimpani is head of the Discipline of Paediatrics & Child Health, University of Newcastle.One hundred years ago maternal and child health services emerged as a community response in Australia, and most other industrialised countries, to concerns about the high rates of infant and early childhood mortality from infectious disease and poor nutrition. Major family and social changes over the past 30 years have impacted in new ways on children's health and wellbeing leading to a profound rethink about the kinds of services that are needed. At the same time, second thoughts have emerged about the role of government in service provision, driven by neoliberal and rational economic philosophies as outlined in the paper in this issue by Keleher and Reiger (2004). Together, these issues have challenged the very foundations on which the services were traditionally based.
Blood transfusion prescribing in the ACT: an insight into clinical decision making
Authors: Crispin Philip J , Crowe Bethany J , McDonald Anne M
Published: February 2010

This study aimed to determine the perspectives of a
group of patients categorised as ?long-stay outliers?
at a large South Australian metropolitan hospital
about aspects of organisation of care and the perceived
impact of long-term hospitalisation. Nineteen
patients were interviewed using a semi-structured
questionnaire. Eighty-nine percent of participants
stated that they had no knowledge of how long they
were to be in hospital. Forty-two percent indicated
that they did not know when they would be discharged
from hospital. This was of concern, especially
considering the vulnerability of this patient
group and the known benefits of patient involvement
in decision making and the improvements this can
make to health outcomes and early discharge. Participants
indicated concern about sleep deprivation,
diet, ability to return to paid employment, and missing
their family as the main areas of impact of their
long hospitalisation. Concerns about being discharged
from hospital included: apprehension as to
whether they were well enough to leave; the recurrence
of infection; whether they would be able to
sleep well when they got home; their recent loss of
appetite and associated weight loss; mobility concerns;
and what supports they would have when
they were discharged home. All these issues require
staff to be more patient and family-centred in their
approach to preparing for discharge.
A bicultural perspective on health
Authors: Perkins Rod
Published: February 2010

THE WAY PEOPLE THINK about
health, ill-health and health
services has changed enormously
over the past 20 years
in New Zealand. This book
reviews these topics within a
sociological frame. It is distinctly
New Zealand and its
contributions were written by
academics. Dr Kevin Dew and
Professor Peter Davis have
edited a coherent text in which the contributors have
taken the opportunity offered to give fresh insights
into sometimes controversial subjects.
Using portable digital technology for clinical care and critical incidents: a new model
Authors: Bolsin Stephen N , Faunce Tom , Colson Mark
Published: February 2010

The number of patients suffering adverse incidents
during treatment in hospitals is not declining.
The cost of this poor safety record in Australia
is $1 billion to $4.7 billion each year. Quality and
safety initiatives focus on promoting adverse event
reporting. Major problems include poor reporting of
adverse events and lack of clinician involvement.
We propose a model for clinician-led reporting
based on secure transmission of encrypted data
from a programmed personal digital assistant
(PDA) to a secure database, leading to automated
analysis of clinician-performance data. The programmed
PDA also facilitates the reporting of
critical incidents. All critical incidents are automatically
fed back by email to the organisational
quality managers.
Markets in health care: taking a tiger by the tail?
Authors: Shapiro Jonathan
Published: February 2010

AS THE UNITED KINGDOM National Health Service
(NHS) moves towards structural reorganisation
once again, both ?contestability? and ?choice? reflect
the underlying theme of the current reforms: that is,
an open market in health care. This paper describes
how this reform has come into being and the
implications for the UK, but also for the wider
developed world.
The NHS was established on the wave of altruistic
community spirit that followed the end of the
Second World War, when the new Labour government
introduced publicly funded education and
social care as well as health services. In what may be
characterised as a ?socialist? model of care, individual
needs were often subsumed into the needs of
society at large, and egalitarianism and perceived
fairness trumped any sense of consumerism.
Paternalistic professionals ?knew best?, and grateful
patients joined the queues that ensured that
there was a steady ?header tank? of users to keep
expensive hospitals running at a set capacity, and
hence a set efficiency. The NHS was perceived as the
envy of the world because it seemed to manage to
squeeze a quart of activity out of every meagre pint
of funding.
Moreover, in this model of planned health care (a
local hospital in every district, and general practitioners
distributed to ensure a fair population coverage),
public services were funded through general
taxation and were all delivered by public organisations
employing public servants, working alongside
each other for the common good.
Implementing root cause analysis in an area health service: views of the participants
Authors: Middleton Sandy , Walker Carol , Chester Rosemary
Published: February 2010

Purpose: This study identifies the attitudes of participants
in the root cause analysis (RCA) process
and barriers to it?s implementation within one New
South Wales area health service.
Method: Employees and consumer representatives of
the former South Western Sydney Area Health Service
who participated in an RCA as either a team member or
a team leader between December 2002 and October
2003 completed a self-administered survey.
Results: Thirty seven of 39 eligible participants
completed the survey (response rate 95%). The
respondents identified formulation of causal statements,
ensuring the causal statements met the ?rules
of causality? outlined by New South Wales Health,
and arranging times for interviews as most difficult.
Team leader respondents (n = 7) ranked keeping the
team focused, organising the first meeting within 7
days of the incident, and completing the RCA in three
2-hour meetings as barriers to the process.
Conclusions: Training was valued by participants,
however greater emphasis on the development of
causal statements could be beneficial. Team leaders
expressed difficulty in keeping the team focused and
meeting the stipulated RCA timeframes, suggesting
that additional support for RCA participants may be
warranted.
Identification of Australians from culturally and linguistically diverse backgrounds in national healthdata collections
Authors: Blignault Ilse , Haghshenas Abbas
Published: February 2010

In multicultural Australia, comprehensive and upto-
date information on ethnicity and health is
essential to guide policy and service development
in the health sector. Data collected for purposes
other than research are a potentially important
source of information. This study explored the
extent to which indicators of cultural and linguistic
diversity are currently included in national health
and welfare service data collections, and the data
standards employed.
We identified and reviewed 44 relevant bodies of
work: 7 national data dictionaries, 15 national data
sets, 10 national health data collections and 12
national surveys. Each of the large data dictionaries
(health, community services and housing
assistance) contained several ethnicity-related
variables. Immigrant Australians were identified
(usually by country of birth, sometimes by language,
and occasionally by period of residence or
year of arrival) in all the major national health and
community data sets, health data collections and
surveys. Australian Bureau of Statistics standards
and classifications relating to cultural and linguistic
diversity were widely used. Researchers,
health policy makers and planners should fully
exploit these secondary data sources, as well as
undertaking or commissioning primary research.
Reviewing the learning organisation model in a child and adolescent mental health service
Authors: Birleson Peter , Brann Peter
Published: February 2010

From 1995 onwards, a child and adolescent mental
health service (CAMHS) applied Senge?s
learning organisation model. This review compared
service performance with that of peer services
5 years later and explored whether any
differences were associated with the application of
this model. The comparison methodology used
quantitative analysis of external data from the
Department of Human Services, together with
qualitative analysis of material including interviews
with CAMHS directors and service managers.
Results showed high evaluation activity and high
quality, efficiency and efficacy of care compared
with other services. Several restraints to the optimal
application of the model were identified,
including inadequate training of new managers,
service overload, major external organisational
change and limited investment in information systems. Other outcomes are discussed.
Non-traumatic spinal cord injury: what is the ideal setting for rehabilitation?
Authors: New Peter W
Published: February 2010

Objective: To survey rehabilitation physicians
about management of patients with non-traumatic
spinal cord injury (NTSCI).
Methods: Postal and email survey of Australian
physicians treating adult inpatients in neurological
rehabilitation or Spinal Injury Units (SIUs). 59/69
returned surveys met inclusion criteria. 75% (44)
of respondents were from neurological rehabilitation
units (response rate 72%) and 25% (15) were
from SIUs (response rate 94%). Outcomes were:
incidence of NTSCI, opinion regarding ideal setting
for NTSCI inpatient rehabilitation, and availability
of key services for NTSCI patients in
neurological rehabilitation units.
Results: Estimated incidence of NTSCI was
26/million adults/year. 60% of NTSCI patients
were managed in general neurological rehabilitation
units. The majority of respondents (85% (50/59);
95% CI, 73%?92%) believed that the most appropriate
setting for NTSCI rehabilitation was either
an SIU or a neurological team that specialises in
NTSCI patients. Neurological rehabilitation units
offered NTSCI patients the following services:
education regarding coping with NTSCI and
preventing complications (55% [18/33]); specialised
wheelchair and seating prescription (85%
[28/33]); Environmental Control Unit training (36%
[12/33]); and bladder training (97% [32/33]).
Conclusions: The most appropriate setting for
rehabilitation of NTSCI patients is either a dedicated
SIU or a neurological rehabilitation team
that specialises in NTSCI. The organisation of
inpatient rehabilitation services for NTSCI patients
in Australia should be improved.
Mind the gap
Authors: Leggat Sandra G
Published: February 2010

In this issue of Australian Health Review, the contributing
authors explore the issues associated with
their attempts to bridge the well recognised gap
between research and practice in health policy and
management. We have heard that it took nearly 200
years from the time that a cure was found for scurvy
to the time when the new practices were adopted by
the British navy.1 Perhaps the timeframes are not as
long, but there still appears to be little evidence of
research informing policy development and management
practice in health care. There have been
discussions over many years in many disciplines on
the most appropriate ways to bridge this gap.
Sisyphus and self-management: the chronic condition self-management paradox
Authors: Harvey Peter W , Docherty Barbara M
Published: February 2010

Chronic condition self-management is promoted
internationally as not only a possible solution to the
health problems of our increasingly chronically ill
and ageing population, but as part of a new wave of
consumer-led and volunteer-managed health care
initiatives. Consumers are now indicating that they
want to be more involved in the management of
their lives and their health care options, while,
especially in rural and smaller communities in
Australia, a shortage of clinicians means that
health care is rapidly changing. This emphasis on
self-management raises crucial questions about
where consumer action and control in health care
should end and where clinical and medical intervention
might begin. Hence, as in the case of
Sisyphus and his rock, the self-management process
is a difficult and demanding one that poses
major challenges and loads for health system
reformers and represents a struggle in which new
difficulties are constantly emerging.
This paper examines some implications of new
self-management approaches to chronic illness
from an ideological perspective and highlights key
elements that underpin the effort to promote
health-related lifestyle change. While peer-led
self-management programs may assist certain
individuals to live engaged and meaningful lives,
the essential social and economic determinants of
health and wellbeing mean that these programs
are not the answer to our urgent need for major
reform in the health care arena. Rather, selfmanagement,
from an ideological perspective,
represents a minor adjustment to the fabric of our
health system.
Predicting professional resource input in home care: the ONI survey
Authors: Vecchio Nerina , Stevens Stella
Published: February 2010

Objective: To assess the use of the ONI (Ongoing
Needs Identification) survey to predict
resource requirements in the home care sector.
Methods: Data from an urban community-based
services provider was used to test whether certain
indicators captured in the ONI survey may also
predict professional service time.
Results: The data revealed a link between several
ONI indicators and professional service time. This
explained 30% and 40% of the variance in nursing
and allied health time, respectively. Both functional
profile and gender impacted on nursing time. There
was also an inverse relationship between allied
health and nursing service time. The overall needs
priority rating (OPR) score, derived from the ONI
survey, was found to be less effective as a predictor.
Conclusion: ONI variables impacted differently on
nursing and allied health hours. It is therefore
important to consider variables based on profession
when planning for resources in the community
sector. As labour costs are the largest component
of home-based service provision, the ONI survey
has the potential to become a cost predictor which
is integrated into the processes of clinical care, and
hence acceptable to clinicians.
Falls in the acute hospital setting — impact on resource utilisation
Authors: Hill Keith D , Vu Michelle , Walsh Willeke
Published: February 2010

Objective: To determine the resource utilisation of
patients who fall within an acute metropolitan hospital.
Design: Retrospective observational study, part
of a larger falls prevention project in a 323-bed
acute care, tertiary teaching hospital in Melbourne,
Australia. A review of falls incidents was undertaken
for all patient admissions for 18 months from
January 2002, excluding the Day Procedure Unit,
Intensive Care Unit, Coronary Care Unit and the
Emergency Department.
Procedure: The most common diagnosis related
groups (DRGs) associated with fallers were identified,
and within each DRG, fallers were matched to
non-fallers by age and gender. Difference in hospital
length of stay (LOS) and disparity in resource
consumption by these two groups were calculated.
Results: The DRG with the highest proportion of
fallers was 'Dementia and other chronic disturbances
of cerebral function' (24%). Three of the
top six DRGs had significantly longer LOS for
fallers compared with non-fallers ('Delirium',
'Stroke' and 'Respiratory conditions') (P<0.05).
Hospital-related costs were significantly higher for
fallers compared with non-fallers for the DRG
'Stroke with severe/complicating diagnosis/procedure'
only (P< 0.05).
Conclusions: Inpatient LOS and total associated
costs for patients who fell and were classified
among the DRGs with the highest proportion of
fallers were substantially higher than those of
matched non-fallers. Effective falls prevention
activities targeting these high-risk groups should
be a priority, in the context of broader falls prevention activities within a hospital setting.
The use of a closed-circuit hospital television channel to promote health: the reach and appeal of RPAtv to patients and visitors
Authors: Orr Neil , Catsi George , Guirguis Nermeen , Balafas Angela , Rissel Chris
Published: February 2010

Closed-circuit television has the potential to promote
health in hospitals, as a significant number
of patients watch large amounts of television
(TV) during their stays. This project sought to
investigate the potential of a dedicated hospital
TV channel to communicate health messages in
an entertaining way by assessing the reach and
appeal of a closed-circuit hospital TV channel ?
RPAtv. A cross-sectional survey of 162 inpatients
and visitors at the Royal Prince Alfred Hospital
was conducted.
Sixty-four percent of participants were aware of
RPAtv, with patients (72%) significantly more
likely (P < 0.001) to be aware of RPAtv than
visitors (41%). Almost 60% of those who were
aware of the channel had viewed it. Of those who
had viewed RPAtv, 73.3% rated the programming
as 'good' or 'very good'.
When asked about programming preferences,
34% suggested that the channel should include
health and hospital information. However, 66%
said that they would rather watch programming
that was entertaining, light-hearted and escapist.
The high approval rating of programming by
viewers suggests that the channel is improving
the experience of patients and visitors during
their time in hospital. However, its effectiveness
as a vehicle for health promotion could be somewhat
limited. Any health education-focused
objectives of similar channels need to be realistic
about the extent of likely increases in health
knowledge.