bluuebunny/crossref_metadata_2025 huggingface dataset:
Some drugs more equal than others: pseudo-generics and commercial practice
Authors: Probyn Andrew J
Published: February 2010

This article analyses the impact of the Department
of Health and Ageing?s brand price premium
policy for some products listed on the
Pharmaceutical Benefits Scheme. The policy,
introduced in 1990, allows pharmaceutical companies
to charge patients an out-of-pocket
expense for post-patent brands of pharmaceuticals.
One of the policy?s intended goals was to
increase consumer awareness of price differentials
between competing brands, with a view to
encouraging greater use of cheaper generic
products. More than fourteen years since its
introduction, it is debatable whether the policy
has achieved this aim. This article looks at how
the brand price premium policy can be exploited
by global pharmaceutical giants to entrench bigname
brands in the Australian pharmaceutical
market and, in some cases, prevent ?true? competition
from generic pharmaceuticals. This is being
done through the establishment of ?pseudogenerics?
that are sourced from the same factory
floor as the original product.
Effective discharge policy: are we getting there?
Authors: Middleton Sandy , Appleberg Michael , Girgis Seham , Ward Jeanette E
Published: February 2010

Purpose: To determine patients? knowledge
before admission about how many days they were
likely to be hospitalised and, after discharge, to
determine patients? perceptions of their ?readiness?
to leave hospital following carotid endarterectomy.
Usefulness of discharge communications
to patients? GPs also was ascertained.
Methods: Pre- and post-operative self-administered
questionnaires to 133 patients and a followup
telephone survey of GPs providing primary
care to 118 of these patients.
Results: Pre-operatively, the majority (84.2%) of
patients recalled being told how many days they
were likely to be hospitalised. Univariate analysis
did not demonstrate any factors predicting positive
recall. The majority (87.0%) of patients perceived
themselves ?ready to go home? at discharge.
Twenty-eight GPs (23.7%) had received both a
discharge summary from the hospital and a personalised
letter from the patient?s surgeon. GP?s
rated the surgeons? letters as significantly more
useful than discharge summaries (P = 0.01).
Conclusions: Although hospitals are required by
NSW Health?s Effective Discharge Policy to inform
patients about their likely length of stay in hospital,
not all patients recalled whether they were so
informed pre-operatively. Barriers impeding realisation of the NSW Health policy remain.
Setting priorities in the south west of Western Australia: where are we now?
Authors: Mitton Craig , Prout Sarah
Published: February 2010

Due to resource scarcity, health care decision
makers must make choices about what services
to fund. In exploring the potential for developing a
formal approach to priority setting in the South
West Area Health Service (SWAHS) in Western
Australia, we carried out a qualitative survey of
senior decision makers. Respondents indicated
that resources were primarily allocated on the
basis of historical patterns. Suggested improvements
for priority setting include development of a
transparent approach to priority setting, better
intra-organisational communication, public input in
the form of identifying social determinants of
health, and having an organisational ?credible
commitment? in planning processes.
'Closing the loop': the role of health care leaders in integrating research and practice
Authors: Stevens Stella , Scott Ian , Von Hellens Liisa , Iselin Greg
Published: February 2010

The study reported here examines what health care leaders do to implement the routine integration of information intoclinical practice decision making. Clinical leaders of a major Australian tertiary teaching hospital were interviewed.The study found that there is wide variation in the extent to which information is routinely used to inform practice.Those leaders who successfully integrated information used some common strategies. The ownership of information maybe the single most powerful factor in clinical leaders' ability to encourage its use. A lack of trust, inappropriate systemsand a fear of unfavourable consequences were identified as issues.The findings have implications for policy makers, hospital administrators and clinical leaders and question theeffectiveness of centralised approaches to driving clinical change.
Management competencies: intrinsic or acquired? What competencies are required to move into speech pathology management and beyond?
Authors: Pilling Samantha , Slattery Justine
Published: February 2010

Speech pathology managers frequently move into careers beyond their clinical discipline. As practicing speech pathologymanagers and students of business leadership, we were curious about the nature of career transitions out of speechpathology management. We conducted an exploratory, descriptive study investigating the perceived competencies thatfacilitate such career transitions and when further education is required to effectively equip one for such transition.The perceived skills related to a speech pathology background are identified along with the gaps in competence formoving into general management positions. Career management practices that facilitate this type of career transitionare provided as recommendations for career planning.
A tale of a few hospitals
Authors: Cahill Anne
Published: February 2010

Anne Cahill is a former CEO of Women's Hospitals Australasia andChildren's Hospitals Australasia, and a Fellow of the ACHSE."I would like to think that the patients in my hospital are treated in the same way that I would like my mother to be treated." . . . . More CEOs than can be namedI am currently in the unhappy position of suffering a life threatening illness that involves outpatient attendances, inpatient care and other services provided by four Australian public hospitals. Three of the hospitals are tertiary referral centres, hospitals that provide the top end of care for patients in my predicament. Two of the hospitals are located in regional Australia.I hope that this article will serve as a stimulant to all health professionals to undertake a reality check on whether the services they provide are patient focussed, consumer- and family- friendly in nature. My experiences in these four hospitals so far have been dramatically different, yet very little effort and little or no funding would be required to fix the hospitals where the service has been less than ideal.
Demographics and utilisation of health services by paediatric refugees from East Africa: implications for service planning and provision
Authors: Cooke Regina , Murray Sally , Carapetis Jonathan , Rice James , Mulholland Nigisti , Skull Susan
Published: February 2010

Regina Cooke is a Clinical Fellow at the Royal Children's Hospital, Melbourne. Sally Murray is an Honorary Fellow of the University of Melbourne and former Program Coordinator of the Victorian Immigrant Health Program, Department of Paediatrics, University of Melbourne. Jonathan Carapetis is an Infectious Diseases Physician, Royal Children's Hospital, Senior Lecturer, Department of Paediatrics,University of Melbourne and Research Fellow, Murdoch Children's Research Institute. James Rice is a Clinical Fellow at University of British Columbia, Canada and formerly of Royal Children's Hospital, Melbourne. Nigisti Mulholland is a Social Scientist, formerly of Royal Children's Hospital, Melbourne.Susan Skull is Deputy Director of the Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, and Senior Lecturer, Department of Paediatrics, University of Melbourne.Little is known of difficulties in accessing health care for recently arrived paediatric refugees in Australia. We reviewedroutinely collected data for all 199 East African children attending a hospital Immigrant Health Clinic for the first time over a 16 month period. Although 63% of parents reported medical consultations since arrival, 77% of this group reported outstanding, unaddressed health problems. Availability of interpreters and information on health services were the main factors hindering access to care. These data have informed future service planning at the Clinic.Ongoing data collection is key to maintaining a responsive, targeted service for a continually changing population.
Sustaining evidence-based practice for young people who self-harm: a 4-year follow-up
Authors: Einfeld Stewart , Tobin Margaret , Beard John , Evans Elizabeth , Buss Richard , Dudley Michael
Published: February 2010

Stewart Einfeld is at the School of Psychiatry, University of New South Wales; the late Margaret Tobin was the Director of Mental Health, South Australia; John Beard is Head of the Northern Rivers University Department of Rural Health, University of Sydney; Elizabeth Evans is a Research Assistant at the School of Psychiatry, University of New South Wales; Richard Buss is the Area Manager, Northern Rivers Area Mental Health Service; Michael Dudley is a child psychiatrist at Prince of Wales Hospital and the School of Psychiatry, University of New South Wales.This report is dedicated to our late co-author Margaret Tobin, to honour her contribution to advancing the quality of mental health services.Objective: In 1998 and 1999, two NSW Area Health Services conducted the Youth At Risk of Deliberate Self Harm (YARDS) project. The YARDS project was designed to implement evidence-based service enhancements for the clinical management of young people with Deliberate Self Harm. This paper examines the extent to which service enhancements implemented during YARDS were maintained 4 years after the conclusion of the project and compares service quality with another NSW Area Health Service that did not participate in the YARDS project.Method: Staff from mental health services and emergency departments completed the Service Activity Scale, a measure developed for the YARDS project to assess the quality of health service response to individuals who present following a suicide attempt.Results: Results indicated that the service improvements made during the YARDS project were maintained 4years after the project ended. Furthermore, a significant difference was found between scores for services that participated in YARDS and services that did not participate in YARDS.Conclusions: These results suggest that projects such as YARDS which support evidence based service nhancements may be useful in improving the management of young people with deliberate self-harm, and that these improvements may be long-lasting.
Performance monitoring in the Victorian health care system: an exploratory study
Authors: Leggat Sandra G , Bartram Timothy , Stanton Pauline
Published: February 2010

This paper reports on an exploratory study which
aims to improve our understanding of how the
Chief Executive Officers of Victorian health services
monitor strategic and operational performance
in their organisations. As a component of a
large scale human resource management study,
we surveyed 130 Chief Executive Officers (CEOs)
of Victorian health sector agencies. Our findings
suggest that performance monitoring was more
advanced among the larger Victorian health sector
organisations, and that there were areas for
improvement throughout the system. Overall, the
CEOs reported limited use of performance indicators
related to service and clinical perspectives,
with financial and volume indicators most widely
used. There was little evidence that these organisations
had processes in place (such as benchmarking
and linking required outcomes to staff
performance management) to understand the
implications of the performance information and
translate them into management action. The findings
suggest that the sector requires technical
expertise and support in data reporting, benchmarking
and quality improvement in order to
improve performance monitoring and ensure its
relevance to strategic control, but further study is
required.
Hurdles to health: immigrant and refugee health care in Australia
Authors: Murray Sally B , Skull Sue A
Published: February 2010

Refugees and asylum seekers face a number of
barriers to accessing health care and improved
health status. These include language difficulties,
financial need and unemployment, cultural differences,
legal barriers and a health workforce with
generally low awareness of issues specific to
refugees. Importantly, current Australian government
migration and settlement policy also impacts
on access to health and health status. An adequate
understanding of these ?hurdles to health? is
a prerequisite for health providers and health
service managers if they are to tailor health care
and services appropriately. We include tables of
available resources and entitlements to health
care according to visa category to assist providers
and managers.
Hands on finance
Authors: Day Gary , Lloyd Sheree , Tschaut Nicole
Published: February 2010

FROM TIME TO TIME, the Australian Health
Review will include multiple reviews regarding
the same publication. This has been undertaken
where the publication may be useful to different
groups of readers and to provide readers of the
AHR with different perspectives. To provide further
information, a 5-star rating based on readability,
useability and content has been included as
part of the review. Happy reading!
The ethical dilemmas of nursing
Authors: Mason Janie
Published: February 2010

OVER RECENT DECADES, the health consumer voice
has risen in significance and receives considerable
space in the popular media. No longer are patients,
relatives of patients or ordinary citizens just silent
witnesses to how services for health and illness are
structured and managed. Health and illness care can
no longer be regarded as solely the province of the
industry, its professionals, managers and bureaucrats.
Megan-Jane Johnstone?s new, fourth edition of her
popular Bioethics ? a nursing perspective is therefore
timely. It is up-to-date in the changing and demanding
political economy of the Australian health care
system and current in its bioethical discourse. This is
an essential text for nurses, who comprise the biggest
component of carers in the industry and are the only
practitioners providing immediate face-to-face,
twenty-four hour care. Now, more than ever before,
nurses must be aware of the bioethical implications of
their actions, decisions and non-decisions.
Sex education and unintended pregnancy: are we seeing the results?
Authors: Dyson Sue , Mitchell Anne
Published: February 2010

THE RECENT DEBATE about the pregnancy rate
among adolescents in Australia has led to
increased interest in the most successful way to
prevent unintended pregnancies, and in the
potential contribution of sex education with
young people in schools. We address these questions
in the light of the available evidence on
effective sexual health education, and current
Australian policy and practice.
Late terminations of pregnancy – an obstetrician's perspective
Authors: Ellwood David
Published: February 2010

THE RECENTLY REIGNITED DEBATE on abortion has
raised many questions, including the number
performed, the age of the women and indications
for the procedure. Those on the ?pro-life? side of
the highly polarised participants have also
focused attention on ?late abortions?. There have
been suggestions that there may be large numbers
of late terminations of pregnancy being performed,
in some cases close to full term, with no
medical indication other than a woman?s choice
not to continue the pregnancy. Indeed, the phrase
?partial-birth abortion? which is sometimes used
by political activists on the pro-life side may lead
the uninformed listener to conclude that this is
something close to infanticide, being performed
at a time when survival for the infant is a realistic
possibility. What then is the real situation with
late terminations in Australia?
The term ?late termination? is understood by
most obstetricians to mean one that is carried out
at or above 20 weeks? gestation. This legal watershed,
beyond which the fetus attains a legal
identity, often triggers a change in the decisionmaking
process when a request for termination is
made. This depends on the practice and laws that
apply in various jurisdictions.
Nursing in Australian general practice: directions and perspectives
Authors: Halcomb Elizabeth J , Davidson Patricia M , Daly John P , Griffiths Rhonda , Yallop Julie , Tofler Geoffrey
Published: February 2010

Primary health care services, such as general
practices, are the first point of contact for many
Australian health care consumers. Until recently,
the role of nursing in Australian primary care was
poorly defined and described in the literature.
Changes in policy and funding have given rise to
an expansion of the nursing role in primary care.
This paper provides a review of the literature and
seeks to identify the barriers and facilitators to
implementation of the practice nurse role in Australia
and identifies strategic directions for future
research and policy development.
Distributional impact of recent changes in private health insurance policies
Authors: Walker Agnes , Percival Richard , Thurecht Linc , Pearse James
Published: February 2010

The impacts of changes to private health insurance
(PHI) policies introduced since 1999 ? in particular
the 30% PHI rebate and the Lifetime Health Cover
? have been much debated. We present historical
analyses of the impacts in terms of the proportion of
Australians having hospital insurance cover under
different PHI policies, by age, gender and socioeconomic
status, and project these to 2010 using a new
Private Health Insurance coverage model.
The combined effect of the 30% rebate and Lifetime
Health Cover was to increase PHI membership from
just over 30% in 1998 to just under 50% by the end
of 2000, due mainly to more people taking out PHI
cover from among the richest 20% of the population.
Among the poorest 40% the impact was minimal.
Model projections suggested that, had the new PHI
policies not been introduced, then the proportion of
Australians with PHI would have declined to around
20% by 2010, compared with 40% if the current
arrangements remained in place. Also, analysis of
2001 survey data regarding choices to use a public
or a private hospital indicated that higher income
groups with or without PHI were the more likely to
have used a private hospital than lower income
groups. Among those with PHI, older people were
more likely to have used a private hospital than
younger ones.
Health workforce design for the 21st century
Authors: Duckett Stephen J
Published: February 2010

The Australian health workforce has changed
dramatically over the last 4 years, growing in size
and changing composition. However, more
changes will be needed in the future to respond to
the epidemiological and demographic transition of
the Australian population. A critical issue will be
whether the supply of health professionals will
keep pace with demand. There are current
recorded shortages of most health professionals,
but this paper argues that future workforce planning
should not be based on providing more of the
same. Rather, the roles of health professionals will
need to change and workforce planning needs to
place a stronger emphasis on issues of workforce
substitution, that is, a different mix of responsibilities.
This will also require changes in educational
preparation, in particular an increased emphasis
on interprofessional work and common foundation
learning.
Public health job vacancies — who wants what, where?
Authors: Rotem Arie , Dewdney John C , Mallock Nadine A , Jochelson Tanya R
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.
The effects of increased private health insurance: a review of the evidence
Authors: Savvides George
Published: February 2010

Letters to the editors
Factors influencing decisions about the state in which doctors plan to practise: additional results from the 2002 Australian Medical Workforce Advisory Committee national survey
Authors: Harris Mary , Gavel Paul H
Published: February 2010

As a result of growing doctor shortages, postgraduate
doctor recruitment and retention within Australian
states and territories has become an issue of
concern. Australia?s policy of national self-sufficiency
in health workforce supply implies that state
medical schools will, at a minimum, enrol a sufficient
number of locally born students to meet future
medical workforce requirements. This article
focuses on factors influencing the state or territory
in which doctors plan to practise medicine, identified
through a national survey. Independent variables
of interest were birth place, medical school
and vocational training location because of their
importance to medical workforce policy. The study
found that the career location plans of Australianborn
and overseas-born doctors in vocational training
were similar and that 5% of doctors planned to
work overseas. Of Australian-born doctors who
planned to work in Australia, 88% graduated from a
medical school in the state in which they were born,
while 78% and 65%, respectively, were undertaking
vocational training in, and proposed to work in, the
state in which they were born. The study concludes
that trainee-doctor decisions about the state or
territory in which they will practise medicine when
they are fully qualified are more complex than
location of birth.
Healthcare reform in New South Wales 1986–1999: using the literature to predict the impact on senior health executives
Authors: Ming Liang Zhan , Short Stephanie D , Lawrence Bill
Published: February 2010

While numerous reviews have examined the
changing roles, skills, competencies, and educational
needs of health service managers as the
result of health care reforms, no study has
focused specifically on the impact of New South
Wales health reforms on the roles, responsibilities
and behaviours of senior health executives in the
public health sector. This paper briefly illustrates
the significant changes in New South Wales
health management since 1986. It also examines
the forces behind these changes and predicts
their impact on NSW Senior Health Executives
based on national and international literature, and
provides a foundation for further empirical
research.
Networks: a key to the future of health services
Authors: Southon Gray , Perkins Rod , Galler David
Published: February 2010

Health service reforms and structures have, in
general, emphasised hierarchical systems to enable
control and accountability. In doing so, policies
have substantially sidelined networks and their
potential for contributing to health service performance.
Networks play a number of roles, such as in
supporting expertise development, arranging
referrals, coordinating programs, undertaking
projects, sharing common interests and providing
mutual support in managing common conditions.
They handle knowledge, support expertise and
deal with complexity in ways that hierarchies are
unable to, and are fundamental to supporting
professionalism. Until networks are used to a
greater extent, the development of health services
will be substantially impeded. This will require
enhancing the role and contribution that networks
play, which is dependent on resources, leadership
and skills.
Australian Health Review call for papers
Authors: Dwyer Judith , Leggat Sandra
Published: February 2010

The editors of Australian Health Review are seeking
articles for an upcoming issue on mental
health services in Australia and New Zealand.
It is estimated that mental health problems and
mental illness will affect more than 20% of the
adult population in their lifetime and between
10%?15% of young people in any one year. In
Australia, through the National Mental Health
Strategy, all levels of Australian government have
recognised the need to work together to reform
services and policy to ensure that, wherever
possible, people with a mental illness are able to
enjoy the same opportunities as other Australians.
In New Zealand, the Mental Health Commission
envisions a place where people with mental illness
have personal power, full participation in
their communities and access to a fully developed
range of recovery-oriented services.
To help inform policy and practice, Australian
Health Review is looking to publish research
papers, case studies and commentaries related to
mental health. Some potential topic areas include:
� Governance and management
� Consumer and community perspectives
� Program evaluation and economic analysis
� Impact of policy.
Submissions related to international programs
with lessons for Australia and New Zealand will
also be welcomed.
Submissions can be short commentaries of
1000 to 2000 words, or a more comprehensive
review of the topic of 2000 to 3000 words. The
deadline for submission is 15 February 2006.
From Council to Commission: building on a solid foundation for safety and quality
Authors: Barraclough Bruce H
Published: February 2010

THE AUSTRALIAN COUNCIL for Safety and Quality
in Health Care was established in January 2000
by all Australian Health Ministers to lead
improvements in the safety and quality of health
care in Australia. The Council will complete its
term in mid-2006, so it is timely to consider the
work that it has led and the possible implications
for the future health care system.
There is no doubt that stakeholders are now
keenly aware of the importance of safety and
quality issues, and that future priorities can be
further developed and implemented by those
with the responsibility and authority to do so
across the system.
Managing quality in cancer services: why improvement isn't easy
Authors: Sorensen Roslyn , Lloyd Anne J , Van Kemenade Cathelijne , Harnett Paul R
Published: February 2010

Optimising the quality of care is an imperative for
health services worldwide, including in Australia.
Recognition that poor quality often has its roots in
system failures is beginning to shift strategies for
improvement to the systems of care, although the
tendency remains to focus on eliminating the
practice variations of individual clinicians. In those
instances where systems improvement is
addressed, strategies tend to be generic and
technical, and often unrelated to the context in
which they are applied.
This paper reports an interim evaluation of a
quality management program in cancer services
implemented in a Sydney metropolitan teaching
hospital dispersed across multiple campuses. The
paper aims to inform the debate on quality
improvement by reporting not only on what was
achieved, but why change seems to be so hard.
We found that organisational and social factors
that influence the quality of health services were
not sufficiently addressed, compared with technical
factors. We conclude that service quality
needs to be repositioned as an organisational
goal, and implemented via a structured process
that addresses organisational and social factors,
as well as technical factors.
Safe times: 11.30am–12.00 and 4.30pm–5.00'
Authors: Epstein Merinda
Published: February 2010

RECENTLY I WENT to visit a friend in a public
psychiatric unit. I had quite a long wait as she
was being brought out of the High Dependency
Unit. As I was sitting there I was staring at the
nurses? station when I spotted the sign attached
to the wall. It simply said, ?SAFE TIMES:
11.30am?12.00 and 4.30pm ? 5.00?. I laughed.
As a veteran of acute psychiatric wards it seemed
absolutely appropriate that two half-hour slots
were the only times that the unit staff felt
confident to claim that safety for patients could
be anticipated.
Eventually I worked out what it really meant.
Of course, silly me, these were the times the safe
would be unlocked and you?d be able to get your
money out!
Routine outcome measurement in public mental health: results of a clinician survey
Authors: Callaly Tom , Hyland Mary , Coombs Tim , Trauer Tom
Published: February 2010

This paper explores the attitudes of mental health
workers in one public mental health service
towards the implementation and use of routine
outcome measurement. Two years after their
introduction into routine clinical practice, there
were equal numbers of positive and negative
observations from clinicians about the clinical
value of the clinician-rated outcome measures,
while more positive observations were made
about value of the consumer-rated outcome
measure. The most frequent observation from
clinicians in relation to making outcome measures
more useful to them in clinical practice was that
more training, particularly refresher training, is
needed. In addition, clinicians indicated that more
sophisticated support which assists them to
understand the meaning and possible use of
outcome measure ratings is required.
The influence of federal health care policy reforms on the use of private health insurance in disadvantaged groups
Authors: Moorin Rachael , Holman C D'Arcy J
Published: February 2010

Objective: To examine changes in the incidence
rate ratio of private health insurance (PHI) and
Medicare use for episodes of hospitalisation as a
function of socio-economic status and accessibility
to evaluate the impact of federal health policy
reforms.
Methods: The WA Data Linkage System was
used to extract all hospital morbidity records in
Western Australia from 1991, 1996 and 2001.
Adjusted odds ratios of PHI use were estimated in
each socio-economic and locational accessibility
category in each year using logistic regression.
The odds ratios were then converted to adjusted
incidence rate ratios controlled for population size.
Results: In all cases between 1991 and 1996 the
adjusted incident rate ratios fell; this was followed
by an increase in the adjusted rate ratio in 2001 to
levels near those of 1991 in the most accessible?
highest socio-economically advantaged group.
However in all other groups the increase fell short
of the 1991 levels. The magnitude of the shortfall
was associated with worsening accessibility or
socio-economic status. In addition, significant
changes in the within-group differential incident
rate ratios were also observed over time.
Conclusion: Our study indicates that the recent
federal government policies which were aimed at
making PHI more affordable to, and therefore
more widely used by, lower to middle income
earners were successful, lending empirical support
for price elasticity of demand for PHI. Our
results also indicate that the magnitude of their
success varied according to disadvantage, suggesting
that this elasticity is variable across both
the level and typology of disadvantage.
Book Reviews
Authors: Day Gary E
Published: February 2010

Book reviews of 'Economic Analysis for Management and Policy' and 'Really Managing Health Care'.
Safe times: 11.30am-12.00 and 4.30pm-5.00
Authors: Epstein Merinda
Published: February 2010

Correction: Re: ?Safe times: 11.30am?12.00 and 4.30pm?
5.00?, by Merinda Epstein (Aust Health Rev
2006, vol 30, no 2, pp. 137-143).
The order of two paragraphs on page 142 of the
article was reversed due to an error in the production
and proofreading process. These paragraphs
are reprinted below in the correct order.
Also within my records was a direct quote
from a private telephone conversation I
had with a friend and colleague. In this
instance, the phone ? as is very common
? was placed right opposite the nurse?s
station. There was no privacy, and I guess
we all knew that you took your private
life into your hands every time you made
a call. Sometimes I got so desperate for
contact with the outside world I took a
risk. I knew it was a calculated one.
It?s amazing to me that this private conversation
was actually recorded in a file
and no one subsequently reading the file
(day after day after day) seemed to have
had the ethical drive to black it out and
bring it to the attention of those with
authority within the unit. This was even
more shocking given the fact that what I
had said that was so worth recording was
something that I believe was entirely
sensible. I had asked my boss not to tell
too many people that I was an inpatient
in a psychiatric unit. To this day I have no
idea why this was seen as an example of
me being ?manipulative with a work colleague?.
Demographic change and the future demand for public hospital care in Australia, 2005 to 2050
Authors: Schofield Deborah J , Earnest Arul
Published: February 2010

Background: Over the next 45 years the Australian
population will age rapidly as the baby boomer
cohort moves into retirement and then old age. As
the population ages there will be substantial
growth in the demand for hospital bed-days, placing
a corresponding demand on infrastructure
and staffing.
Methods: Australian Bureau of Statistics population
projections to 2050 and Australian Institute of
Health and Welfare public hospital bed-day data
from 1993?94 to 2003?04 were used to develop
models of future demand and examine the sensitivity
of the results to model assumptions.
Results: Over the long term, demand for public
hospital bed-days was projected to grow faster
than population growth. By 2050, ageing will
increase the demand for bed-days by between
70% and 130% depending on the underlying
assumptions, and the proportion of bed-days
devoted to older people will increase from under
50% in 2005 to over 70%.
Conclusions: Ageing of the population will
increase the demand for health services just as it
will become harder to recruit health professionals
as the large baby boomer cohort retires from the
health workforce. Accordingly, we need to plan
now to ensure future needs of the ageing population are met.
Impact of streaming "fast track" emergency department patients
Authors: O'Brien Debra , Williams Aled , Blondell Kerrianne , Jelinek George A
Published: February 2010

Objective: Fast track systems to stream emergency
department (ED) patients with low acuity
conditions have been introduced widely, resulting
in reduced waiting times and lengths of stay for
these patients. We aimed to prospectively assess
the impact on patient flows of a fast track system
implemented in the emergency department of an
Australian tertiary adult teaching hospital which
deals with relatively few low acuity patients.
Methods: During the 12-week trial period, patients
in Australasian Triage Scale (ATS) categories 3, 4
and 5 who were likely to be discharged were
identified at triage and assessed and treated in a
separate fast track area by ED medical and nursing
staff rostered to work exclusively in the area.
Results: The fast track area managed 21.6% of
all patients presenting during its hours of operation.
There was a 20.3% (?18 min; 95%CI, ?26
min to ?10 min) relative reduction in the average
waiting time and an 18.0% (?41 min; 95%CI, ?52
min to ?30 min) relative reduction in the average
length of stay for all discharged patients compared
with the same period the previous year. Compared
with the 12-week period before the fast track trial,
there was a 3.4% (?2.1 min; 95%CI, ?8 min to 4
min) relative reduction in the average waiting time
and a 9.7% (?20 min; 95%CI, ?31 min to ?9 min)
relative reduction in the average length of stay for
all discharged patients. There was no increase in
the average waiting time for admitted patients.
This was despite major increases in throughput
and access block in the study period.
Conclusion: Streaming fast track patients in the
emergency department of an Australian tertiary
adult teaching hospital can reduce waiting times
and length of stay for discharged patients without
increasing waiting times for admitted patients,
even in an ED with few low acuity patients.
A framework to provide clarity in the use of predictive technologies in health care management
Authors: Bain Christopher  A , Au Leon K
Published: February 2010

This paper reports on a survey of health care
managers and other stakeholders which
assesses the need for a framework regarding
predictive technologies in health care management.
In the context of this paper, predictive
technologies are defined as those that enable an
insight into, or measurement of, events yet to
occur. A framework could include the ability to
classify the problems confronting managers, and
the range of possible tools and techniques that
could be used to address those problems. This
could be of mutual benefit to health care managers,
technologists and modellers. The survey was
intended to clarify the level of interest in such a
framework, and also the possible dimensions that
it ought to contain. Our results indicate that there
is strong support for a proposed framework, with
97% of respondents indicating that a framework
would be possibly or very useful. The results also
show a low level of background knowledge in
relation to existing tools, techniques and technologies.
The draft framework is also presented. It
includes dimensions relating to problem and tool
definitions, scenarios to be investigated and the
findings of those investigations.
Measuring the impact of a team model of nursing practice using work sampling
Authors: Walker Kim , Donoghue Judith , Mitten-Lewis Suzanne
Published: February 2010

The increasing number of inexperienced graduates,
as well as other levels of nurse such as the
enrolled nurse and assistant-in-nursing, requires
health service and nursing managers in the acute
care sector to rethink the long-preferred ?patient
allocation? model of care provision. As well, the
escalating shortage of registered nurses and subsequent
low morale among those remaining in the
workforce require hospitals to re-examine skills mix
and staffing ratios. This paper presents the results
of two work-sampling studies conducted in a major
metropolitan private hospital, the first of which was
to provide a rationale for changing from the patient
allocation model to a team model of care. The
second study aimed to evaluate and provide data
on the impact of the change. Staff were heavily
involved in both studies as well as the change
process. The findings highlight how effective the
new model has been in redistributing certain
aspects of care to make better use of each nurse
level?s knowledge and skills.
Disclosure of treatment injury in New Zealand's no-fault compensation system
Authors: Malcolm Laurence , Barnett Pauline
Published: February 2010

In July 2005 New Zealand became the first country
to establish comprehensive no fault coverage
for all treatment injury. This paper reports on a
study of disclosure policies and practices related
to treatment injury within the New Zealand hospital
system. All 21 district health boards (DHBs),
which provide publicly funded hospital services,
were asked to complete a detailed questionnaire,
with 90% responding. This was followed by an
extended telephone interview with the chief clinical
advisers and quality managers of 11 DHBs.
Most respondents reported that their boards had
an established policy or were developing one.
DHBs reported a high level of disclosure practice,
even for preventable harm. All indicated that disclosure
was now felt to be safer than non-disclosure,
although this view was not shared by all
grassroots clinicians. The New Zealand experience
may point to ways of achieving fairer and
accessible compensation for patients.
A tale of two colleges: do specialist trainees receive adequate hospital-based training?
Authors: Rozen Warren M , Kaplan Elan D , Drummond Katharine J , Millar Robert  J
Published: February 2010

Background: Both medical and surgical trainees
have a dual reliance on their specialist training
college and their respective teaching hospitals to
maintain standards in teaching and training.
Although guidelines are in place for the administration
of this teaching, hospital-based teaching
has been minimally regulated. A review of trainee
satisfaction with current levels of hospital-based
training was performed, both to reflect the
thoughts of trainees themselves and to highlight
specific areas requiring improvement.
Methods: Sixty-four basic specialist trainees
(44 surgical [BSTs] and 20 physician [BPTs])
from all of the major Melbourne metropolitan
teaching hospitals completed an anonymous
survey.
Results: Surgical trainees considered all areas
of hospital-based training to be deficient, with
overall dissatisfaction significantly greater for
BSTs compared with BPTs (P = 0.046). A
requirement for increased hospital-based training
was similarly greater for BSTs (P = 0.0072).
Conclusion: The study confirms the need for a
change in the regulation and administration of
hospital-based teaching for surgical trainees.
Stakeholders' perspectives on health workforce policy reform
Authors: Hepburn Valerie A , Healy Judith
Published: February 2010

We administered an electronic survey in October?
November 2006 to gauge stakeholder perspectives
on Australia?s recently adopted health workforce
policies. Nearly all of the 41 survey respondents
(65% response rate) ranked workforce as very
important to overall health policy. Respondents
identified decreasing health disparities and rates of
disease and mortality as top goals, and identified
improved quality and safety and more professionals
in rural areas as priority measures for success.
Lack of coordination between the governments and
insufficient long-range planning were seen as
threats to the success of the new workforce initiatives.
The survey results suggest the need for clear
goals and measurable outcomes. Although they
represented different organisations and perspectives,
the health workforce policy opinion leaders
that participated in this survey reflected remarkable
commonality in goals, measures, alternatives, and
potential threats.
Implementing chronic disease self-management in community settings: lessons from Australian demonstration projects
Authors: Francis Caitlin F , Feyer Anne-Marie , Smith Ben J
Published: February 2010

The evaluation of the Sharing Health Care Initiative
addressed the translation of different models
of chronic disease self-management into health
and community service contexts in Australia.
Across seven projects, four intervention models
were adopted: (1) the Stanford Chronic Disease
Self Management course; (2) generic disease
management planning, training and support; (3)
tailored disease management planning, training
and support, and; (4) telephone coaching. Targeted
recruitment through support groups and
patient lists was most successful for reaching
high-needs clients. Projects with well developed
organisational structures and health system networks
demonstrated more effective implementation.
Engagement of GPs in recruitment and client
support was limited. Future self-management programs
will require flexible delivery methods in the
primary health care setting, involving practice
nurses or the equivalent. After 12 months there
was little evidence of potential sustainability,
although structures such as consumer resource
centres and client support clubs were established
in some locations. Only one project was able to
use Medicare chronic disease-related items to
integrate self-management support into routine
general practice. Participants in all projects
showed improvements in self-management practices,
but those receiving Model 3, flexible and
tailored support, and Model 4, telephone coaching, reported the greatest benefits
Ten lessons for developing a health information website
Authors: Ottmann Goetz , Street Annette F
Published: February 2010

This paper outlines ten lessons derived from the
development of a palliative care website,
www.pallcarevic.asn.au. The following program
elements contributed to the success of the
project: (1) peer and stakeholder participation;
(2) response to a significant need; (3) networking
skills; (4) administrative skills; (5) mediation of
conflicts; (6) project management skills; (7)
sourcing of good evidence; (8) iterative evaluation
involving users and stakeholders; (9) iterative
expert evaluation; and (10) a well thought
through sustainability strategy.
Development of a systematic approach to assessing quality within Australian residential aged care facilities: the Clinical Care Indicators Tool
Authors: Courtney Mary , O'Reilly Maria T , Edwards Helen , Hassall Stacey
Published: February 2010

Recent years have seen the introduction of formalised
accreditation processes in both community
and residential aged care, but these only
partially address quality assessment within this
sector. Residential aged care in Australia does not
yet have a standardised system of resident
assessment related to clinical, rather than administrative,
outcomes. This paper describes the
development of a quality assessment tool aimed
at addressing this gap. Utilising previous research
and the results of nominal groups with experts in
the field, the 21-item Clinical Care Indicators (CCI)
Tool for residential aged care was developed and
trialled nationally. The CCI Tool was found to be
simple to use and an effective means of collecting
data on the state of resident health and care, with
potential benefits for resident care planning and
continuous quality improvement within facilities
and organisations. The CCI Tool was further
refined through a small intervention study to
assess its utility as a quality improvement instrument
and to investigate its relationship with resident
quality of life. The current version covers 23
clinical indicators, takes about 30 minutes to complete
and is viewed favourably by nursing staff
who use it. Current work focuses on psychometric
analysis and benchmarking, which should enable
the CCI Tool to make a positive contribution to the
measurement of quality in aged care in Australia.
The dynamics of residential aged care in Australia: 8-year trends in admission, separations and dependency
Authors: Andrews-Hall Sharon , Howe Anna , Robinson Andrew
Published: February 2010

The aims of this paper are to analyse changes in
dependency of residents in residential aged care
homes consequent upon the passing of the Commonwealth
Aged Care Act in late 1997, and to
establish the extent of resultant changes in the
dynamics of residential aged care. The paper
outlines the major changes brought by the Aged
Care Act, and evidence for the effects of these
changes is examined to test the hypothesis that
changes in dependency generated changes in
turnover and length of stay. The findings show that
the proportion of admissions classified at higher
categories of the Resident Classification Scale
has increased over time, and that the trend to
higher classification is even more pronounced by
the time residents separate. As funding of residential
aged care is based on resident dependency,
change in dependency and in the dynamics of the
aged care system have potentially significant consequences
for Commonwealth funding of providers
to ensure care can be provided commensurate
with resident needs. The conclusions take up a
number of implications of the findings for future
policy in relation to planning and funding of residential
aged care as a new resident funding
system based on the Aged Care Funding Instrument (ACFI) is phased in from mid 2007.