Management organisation and ethics in the public sector

Over the past two decades in Australia and other developed nations, public sector management philosophies and how the public sector is organised have changed dramatically. At the same time, there have been many demands, and several attempts, to preserve and promote ethical behaviour within the public sector - though few go much beyond the publication of a Code. Both developments require an understanding of how public organisations operate in this new environment. Organisational and management theory are seen as providing important potential insights into the opportunities and pitfalls for building ethics into the practices, culture, and norms of public organisations. This book brings together the experience and research of a range of 'reflective practitioners' and 'engaged academics' in public sector management, organisational theory, management theory, public sector ethics and law. It addresses what management and organisation theory might suggest about the nature of public organisations and the institutionalisation of ethics

Improving models of care for diabetes in pregnancy: Experience of current practice in Far North Queensland, Australia

Aims: To map health practitioners' experiences and describe knowledge regarding screening and management of Diabetes in Pregnancy (DIP) in Far North Queensland, Australia. Methods: Mixed methods including a cross-sectional survey (101 respondents) and 8 focus groups with 61 health practitioners. All participants provided clinical care for women with DIP. Results: A wide range of healthcare professionals participated; 96% worked with Indigenous women, and 63% were from regional or remote work settings. Universal screening for gestational diabetes at 24-28 weeks gestation was reported as routine with 87% using a 75g Oral Glucose Tolerance Test. Early screening for DIP was reported by 61% although there was large variation in screening methods and who should be screened < 24 weeks. Health practitioners were confident providing lifestyle advice (88%), dietary and blood glucose monitoring education (67%, 81%) but only 50% were confident giving insulin education. Electronic medical records were used by 80% but 55% also used paper records. Dissatisfaction with information from hospitals was reported by 40%. In the focus groups improving communication and information technology systems were identified as key areas. Other barriers described were difficulties in care coordination and access for remote women. Conclusion: Communication, information technology systems, coordination of care and education for health professionals are key areas that will be addressed by a complex health systems intervention being undertaken by the DIP Partnership in North Queensland

The Armstrong Institute: An Academic Institute for Patient Safety and Quality Improvement, Research, Training, and Practice

Academic medical centers (AMCs) could advance the science of health care delivery, improve patient safety and quality improvement, and enhance value, but many centers have fragmented efforts with little accountability. Johns Hopkins Medicine, the AMC under which the Johns Hopkins University School of Medicine and the Johns Hopkins Health System are organized, experienced similar challenges, with operational patient safety and quality leadership separate from safety and quality-related research efforts. To unite efforts and establish accountability, the Armstrong Institute for Patient Safety and Quality was created in 2011. The authors describe the development, purpose, governance, function, and challenges of the institute to help other AMCs replicate it and accelerate safety and quality improvement. The purpose is to partner with patients, their loved ones, and all interested parties to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste in health care. A governance structure was created, with care mapped into seven categories, to oversee the quality and safety of all patients treated at a Johns Hopkins Medicine entity. The governance has a Patient Safety and Quality Board Committee that sets strategic goals, and the institute communicates these goals throughout the health system and supports personnel in meeting these goals. The institute is organized into 13 functional councils reflecting their behaviors and purpose. The institute works daily to build the capacity of clinicians trained in safety and quality through established programs, advance improvement science, and implement and evaluate interventions to improve the quality of care and safety of patients