Process redesign for time-based emergency admission targets

Purpose: Hospitals have used process redesign to increase the efficiency of the emergency department (ED) to cope with increasing demand. While there are published studies suggesting a positive outcome, recent reviews have reported that it is difficult to conclude that these approaches are effective as a result of substandard research methodology. The purpose of this paper is to explore the perceptions of hospital staff on the impact of a process redesign initiative on quality of care. Design/methodology/approach: A retrospective qualitative case study examining a Lean Six Sigma (LSS) initiative in a large metropolitan hospital from 2009 to 2010. Non-probability sampling identified interview subjects who, through their participation in the redesign initiative, had a detailed understanding of the implementation and outcomes of the initiative. Between April 2012 and January 2013 26 in-depth semi-structured interviews were conducted and analysed with thematic content analysis. Findings: There were four important findings. First, when asked to comment on the impact of the LSS implementation, without prompting the staff spoke of quality of care. Second, there was little agreement among the participants as to whether the project had been successful. Third, despite the recognition of the need for a coordinated effort across the hospital to improve ED access, the redesign process was not successful in reducing existing divides among clinicians and among managers and clinicians. Finally, staff expressed tension between production processes to move patients more quickly and their duty of care to their patients as individuals. Originality/value: One of the first studies to explore the impact of process redesign through in-depth interviews with participating staff, this study adds further evidence that organisation implementing process redesign must ensure the supporting management practices are in place

Active adults recall their physical activity differently to less active adults: test-retest reliability and validity of a physical activity survey

Issue addressed: This paper determined the test-retest reliability and criterion validity of a modified version of the Active Australia Survey (AAS) and whether these properties varied across participants' activity levels

Living, loving, dying: Insights into rural compassion

Objective:To improve understandings of the enablers and barriers to maintaining good quality of life for people dying, caring and grieving in rural areas.Design and setting:In‐depth interviews designed on participatory research principles were held with bereaved carers living in a small community in rural Tasmania. Participants had cared for someone until their death within the 3‐year period prior.Participants:Nineteen participants comprising 18 bereaved former carers and one person with a life‐limiting illness, and all but four were over retirement age.Study aim:To explore experiences of end‐of‐life care in a rural community.Results:Participants discussed the challenges they experienced during end‐of‐life caring, including transport into the city for treatment, and access to basic and specialised services. However, they also reported positive aspects of formal and informal palliative care, and described experiences of personable, expert, flexible and innovative caregiving.Conclusions:The rural location enabled personalised and innovative expressions of care. This research adds new insight into rural end‐of‐life palliation, as a complex intersection of supererogation, innovation and place‐driven care

Do the individual, social, and environmental correlates of physical activity differ between urban and rural women?

In this article, associations between individual, social, and environmental factors and physical activity among 3,669 women (18-45 years) living in socioeconomically disadvantaged urban and rural areas were compared. In 2007-2008, participants reported levels of leisure-time physical activity (LTPA) and transport-related physical activity (TRPA) as well as five individual, four social, and three environmental factors. Physical activity self- efficacy demonstrated stronger associations with LTPA among urban relative to rural women; child care was associated with LTPA and intentions with TRPA among urban women only, and enjoyment was associated with TRPA among rural women only. Correlates of physical activity among urban and rural women were generally similar, although some tailoring of physical activity promotion strategies may be warranted. <br /

Job satisfaction of staff and the team environment in Australian general practice

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Objective: To study the work satisfaction of general practice staff, the differences between types of staff, and the individual and organisational factors associated with work satisfaction. Design, setting and participants: Cross-sectional multipractice study based on a self-completed job satisfaction survey of 626 practice staff in 96 general practices in Australia between 16 December 2003 and 8 October 2004. Main outcome measures: Job satisfaction scores for all staff and for general practitioners alone; relationship between job satisfaction and the team climate, practice size, particular jobs within practices, demographic characteristics of participants, and geographical location of practices. Results: The response rate was 65%. Job satisfaction was high, with a mean score of 5.66 (95% CI, 5.60–5.72). Multilevel analysis showed that all general practice staff were highly satisfied if they worked in a practice with a good team climate. Practice managers reported the highest satisfaction with their work. Practice size and individual characteristics such as the sex of the participant were unrelated to job satisfaction. GPs tended to have lower satisfaction than other staff in relation to income, recognition for good work and hours of work. Rural GPs were more satisfied. Conclusions: Most general practice staff are satisfied with their work. Facilitating teamwork may be a key strategy for both recruitment and retention of the general practice workforce, especially staff who are not GPs.Mark F Harris, Judy G Proudfoot, Upali W Jayasinghe, Christine H Holton, Gawaine P Powell Davies, Cheryl L Amoroso, Tanya K Bubner and Justin J Beilb

Increase in computed tomography in Australia driven mainly by practice change: A decomposition analysis

Background: Publicly funded computed tomography (CT) procedure descriptions in Australia often specify the body site, rather than indication for use. This study aimed to evaluate the relative contribution of demographic versus non-demographic factors in driving the increase in CT services in Australia. Methods: A decomposition analysis was conducted to assess the proportion of additional CT attributable to changing population structure, CT use on a per capita basis (CPC, a proxy for change in practice) and/or cost of CT. Aggregated Medicare usage and billing data were obtained for selected years between 1993/4 and 2012/3. Results: The number of billed CT scans rose from 33 per annum per 1000 of population in 1993/94 (total 572,925) to 112 per 1000 by 2012/13 (total 2,540,546). The respective cost to Medicare rose from $145.7 million to$790.7 million. Change in CPC was the most important factor accounting for changes in CT services (88%) and cost (65%) over the study period. Conclusions: While this study cannot conclude if the increase is appropriate, it does represent a shift in how CT is used, relative to when many CT services were listed for public funding. This ‘scope shift’ poses questions as to need for and frequency of retrospective/ongoing review of publicly funded services, as medical advances and other demand- or supply-side factors change the way health services are used

Barriers and enablers to the provision of alcohol treatment among Aboriginal Australians: A thematic review of five research projects

Introduction and Aims: To review the results of five research projects commissioned to enhance alcohol treatment among Aboriginal Australians, and to highlight arising from them. Design and Methods: Drafts of the papers were workshopped by project representatives, final papers reviewed and results summarised. Lessons arising were identified and described. Results: While the impact of the projects varied, they highlight the feasibility of adapting mainstream interventions in Aboriginal Australian contexts. Outcomes include greater potential to: screen for those at risk; increase community awareness; build capacity and partnerships between organisations; and co-ordinate comprehensive referral networks and service provision. Discussion: Results show a small investment can produce sustainable change and positive outcomes. However, to optimise and maintain investment, cultural difference needs to be recognised in both planning and delivery of alcohol interventions; resources and funding must be responsive to and realistic about the capacities of organisations; partnerships need to be formed voluntarily based on respect, equality and trust; and practices and procedures within organisations need to be formalised. Conclusions: There is no simple way to reduce alcohol-related harm in Aboriginal communities. However, the papers reviewed show that with Aboriginal control, modest investment and respectful collaboration, service enhancements and improved outcomes can be achieved. Mainstream interventions need to be adapted to Aboriginal settings, not simply transferred. The lessons outlined provide important reflections for future research

'Zero tolerance' and drug education in Australian Schools

For a decade in Australia, drug education in schools has been shaped by the approach of harm minimization adopted by state and national governments alike. Harm minimization has been accepted broadly by drug educators, and has encouraged schools to deepen their commitment to drug education, allowed them to communicate honestly with students, and to respond to instances of drug use in a less confrontational and more caring manner. Despite those advances, the notion of 'zero tolerance' within schools has been promoted recently by protagonists in the formulation of drug policy and it is mentioned in the recently published national school drug education policy. This article suggests that the adoption of a zero tolerance policy will end the consensus among drug educators, reduce the efficacy of drug education, lead to more punitive treatment of youthful drug experimenters, while doing nothing to reduce drug use. It concludes the existing policy of harm minimization offers schools more scope to address drug issues in a constructive manner than does zero tolerance, which in practice may inflate the harmful effects on young people of drug use

Australia's insurance crisis and the inequitable treatment of self-employed midwives

Based upon a review of articles published in Australia's major newspapers over the period January 2001 to December 2005, a case study approach has been used to investigate why, when compared with other small business operators, including medical specialists, Australian governments have appeared reluctant to protect the economic viability of the businesses of self-employed midwives. Theories of agenda setting and structuralism have been used to explore that inequity. What has emerged is a picture of the complex of factors that may have operated, and may be continuing to operate, to shape the policy agenda and thus prevent solutions to the insurance problems of self-employed midwives being found

Caries experience among publicly-funded dental patients in Australia, 1995-96: Type of care and geographic location

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.Health card holders are a financially disadvantaged group and are the target population eligible for publicly-funded dental care. While their health status is generally worse compared with other Australians, there is also considerable variation among card holders. The aims of this study were to describe the oral health status of publicly-funded dental patients by type of care, geographic location and age, and to compare trends over time against other Australian studies. Patients were sampled randomly, based on date of birth, by State/Territory dental services in 1995-96. Dentists recorded oral health measures at the initial visit of a course of care using written instructions, but there was no formal calibration. The 6109 patients sampled were weighted in proportion to the numbers of publicly-funded dental patients for each State/Territory. Multiple linear regression analysis indicated that caries experience measured by the DMFT index increased across older age groups (p<0.05). For rural compared with urban patients, mean numbers of decayed and filled teeth tended to be higher. For emergency compared with non-emergency care, mean numbers of decayed and missing teeth were higher, and filled teeth lower. The findings of this monitoring survey document high levels of previous disease and treatment and indicate variation between subgroups of users of publicly-funded dental care. This included an uneven geographic distribution of oral health and disease, and variation in unmet treatment needs by type of course of care. Temporal comparisons indicate publicly-funded patients have experienced the population trend towards lower levels of tooth loss over time but have higher levels of untreated decayed teeth compared with the general population.D.S. Brennan, A.J. Spencer and G.D Slad