Health care and patient safety: The failure of traditional approaches – how human factors and ergonomics can and MUST help

Hazard and harm to patients as well as inefficiencies associated with health care have been well described as worldwide problems that result in hundreds of thousands of patient deaths and billions of dollars of waste every year. The underlying causes for these problems have not been nearly so well described; more importantly, generalizable mitigation strategies have not been effectively identified or used. The current state of health care and patient safety will be discussed with particular attention to the essential role that an engineering‐based approach, which is heavily rooted in human factors and ergonomics, must play if real and sustainable progress in the safe and efficient delivery of health care is to be achieved. Specific case studies that illustrate the compelling opportunities for the application of human factors and ergonomics–related knowledge will be discussed. © 2011 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89498/1/20261_ftp.pd

The development of national injury prevention policy in the Australian health sector: and the unmet challenges of participation and implementation

For the last 20 years injury prevention policy in Australia has been hampered by poor consultation practices, limited stakeholder involvement, inadequate allocation of resources, poor implementation, and an absence of performance measures. This paper describes the development of injury prevention policy in Australia from its beginnings in 1981 to the current day and considers what measures should be undertaken to create an effective platform for the reduction of the burden of injury in Australia. The National Injury Prevention and Safety Promotion Plan 2004–2014, released in 2005, needs to be supported by a whole of government commitment to the reduction of injury. The Council of Australian Governments would be an ideal forum to monitor progress, supported by a cross-government Ministerial Council

The Australian longitudinal study of health and relationships

BackgroundEnsuring the sexual and reproductive health of the population is essential for the wellbeing of a nation. At least three aspects of sexual and reproductive health are among the key policy issues for present Australian governments: maintaining and increasing the birth rate; reducing the abortion rate; and preventing and controlling Chlamydia infections.The overall aim of the Australian Longitudinal Study of Health and Relationships is to document the natural history of the sexual and reproductive health of the Australian adult population.Methods/designA nationally representative sample of Australian adults 16&ndash;64 years of age was selected in a two-phase process in 2004&ndash;2005. Eligible households were identified through random digit dialling. We used separate sampling frames for men and women; where there was more than one eligible person in a household the participant was selected randomly. Participants completed a computer-assisted telephone interview that typically took approximately 25 minutes to complete. The response rate was 56%. A total of 8,656 people were interviewed, of whom 95% (8243) agreed to be contacted again 12 months later. Of those, approximately 82% have been re-contacted and re-interviewed in 2006&ndash;07 (Wave Two), with 99% of those agreeing to be contacted again for Wave Three.DiscussionALSHR represents a significant advance for research on the linked topics of sexual and reproductive health. Its strengths include the large sample size, the inclusion of men as well as women, and the wide age range of the participants.<br /

The effectiveness of coordinated care for people with chronic respiratory disease

The document attached has been archived with permission from the editor of the Medical Journal of Australia (10 January 2008). An external link to the publisher’s copy is included.Objectives: To evaluate the effectiveness of coordinated care for chronic respiratory disease. Design and setting: Community-based geographical control study, in western (intervention) and northern (comparison) metropolitan Adelaide (SA). Participants: 377 adults (223 intervention; 154 comparison) with chronic obstructive pulmonary disease, asthma or other chronic respiratory condition, July 1997 to December 1999. Intervention: Coordinated care (includes care coordinator, care guidelines, service coordinator and care mentor). Main outcome measures: Hospital admissions (any, unplanned and respiratory), functionality (activities of daily living) and quality of life (SF-36 and Dartmouth COOP). Results: At entry to the study, intervention and comparison subjects were dissimilar. The intervention group was 10 years older (P < 0.001), less likely to smoke (P = 0.014), had higher rates of hospitalisation in the previous 12 months (P < 0.001) and had worse self-reported quality of life (SF-36 physical component summary score [P < 0.001] and four of nine COOP domains [P = 0.002–0.013]). After adjustment for relevant baseline characteristics, coordinated care was not associated with any difference in hospitalisation, but was associated with some improvements in quality of life (SF-36 mental component summary score [P = 0.023] and three of nine COOP domains [P = 0.008–0.031]) compared with the comparison group. Conclusions: Coordinated care given to patients with chronic respiratory disease did not affect hospitalisation, but it was associated with an improvement in some quality-of-life measures.Brian J Smith, Heather J McElroy, Richard E Ruffin, Peter A Frith, Adrian R Heard, Malcolm W Battersby, Adrian J Esterman, Peter Del Fante and Peter J McDonal

Family day care educators : an exploration of their understanding and experiences promoting children\u27s social and emotional wellbeing

This study aimed to explore family day care (FDC) educators&rsquo; knowledge of child social and emotional wellbeing and mental health problems, the strategies used to promote children&rsquo;s wellbeing, and barriers and opportunities for promoting children&rsquo;s social and emotional wellbeing. Thirteen FDC educators participated in individual semi-structured interviews. FDC educators were more comfortable defining children&rsquo;s social and emotional wellbeing than they were in identifying causes and early signs of mental health problems. Strategies used to promote children&rsquo;s mental health were largely informal and dependent on educator skills and capacities rather than a systematic scheme-wide approach. Common barriers to mental health promotion were limited financial resources, a need for more training and hesitance raising child mental health issues with parents. There is a need to build FDC educators&rsquo; knowledge of child social and emotional wellbeing and for tailored mental health promotion strategies in FDC.<br /

Factors associated with self-efficacy for managing recovery in the trauma intensive care population: A prospective cohort study

Objective: The aim of this paper was to identify factors associated with self-efficacy for managing recovery in the trauma intensive care population. Introduction: Injury accounts for 6.5% of disease burden in Australia, with similar levels being reported in other developed countries. While some studies regarding self-efficacy have identified a relationship to patient recovery post acute injury, others have been inconclusive. This study will identify factors associated with self-efficacy for managing recovery in the trauma intensive care population. Methods: A prospective cohort study of patients aged ≥18 years, admitted to a metropolitan tertiary hospital in South East Queensland between June 2008 and August 2010 for the acute treatment of injury. Demographic, injury, acute care and psychosocial factors were considered. The primary outcome was self-efficacy measured by the 6-item self-efficacy scale (SES) 1 and 6 months post hospital discharge. All factors significant (p < 0.10) on univariate analysis were included in multivariable modelling where p < 0.05 was considered significant. Results: A total of 88 patients were included. The mean self-efficacy score at 1 and 6 months was similar (6.8 vs 6.9 respectively). Self-efficacy at 1 month, psychological distress (K-10) Score and illness perception (K10) Score accounted for 68.4% (adjusted R2) of the variance in 6 month self-efficacy (F3,75) = 57.17, p < 0.001. Illness perception was the strongest contributor to 6 month self-efficacy (beta = −0.516), followed by psychological distress (beta = −0.243) and self-efficacy at 1 month (beta = 0.205). Conclusion: Significant factors associated with self-efficacy for managing recovery at 6 months included 1 month self-efficacy, illness perception and psychological distress. To promote patient recovery, screening patients at 1 month in order to commence relevant interventions could be beneficial

Do early life cognitive ability and self-regulation skills explain socio-economic inequalities in academic achievement? An effect decomposition analysis in UK and Australian cohorts

SSocio-economic inequalities in academic achievement emerge early in life and are observed across the globe. Cognitive ability and “non-cognitive” attributes (such as self-regulation) are the focus of many early years’ interventions. Despite this, little research has compared the contributions of early cognitive and self-regulation abilities as separate pathways to inequalities in academic achievement. We examined this in two nationally representative cohorts in the UK (Millennium Cohort Study, n = 11,168; 61% original cohort) and Australia (LSAC, n = 3028; 59% original cohort). An effect decomposition method was used to examine the pathways from socio-economic disadvantage (in infancy) to two academic outcomes: ‘low’ maths and literacy scores (based on bottom quintile) at age 7–9 years. Risk ratios (RRs, and bootstrap 95% confidence intervals) were estimated with binary regression for each pathway of interest: the ‘direct effect’ of socio-economic disadvantage on academic achievement (not acting through self-regulation and cognitive ability in early childhood), and the ‘indirect effects’ of socio-economic disadvantage acting via self-regulation and cognitive ability (separately). Analyses were adjusted for baseline and intermediate confounding. Children from less advantaged families were up to twice as likely to be in the lowest quintile of maths and literacy scores. Around two-thirds of this elevated risk was ‘direct’ and the majority of the remainder was mediated by early cognitive ability and not self-regulation. For example in LSAC: the RR for the direct pathway from socio-economic disadvantage to poor maths scores was 1.46 (95% CI: 1.17–1.79). The indirect effect of socio-economic disadvantage through cognitive ability (RR = 1.13 [1.06–1.22]) was larger than the indirect effect through self-regulation (1.05 [1.01–1.11]). Similar patterns were observed for both outcomes and in both cohorts. Policies to alleviate social inequality (e.g. child poverty reduction) remain important for closing the academic achievement gap. Early interventions to improve cognitive ability (rather than self-regulation) also hold potential for reducing inequalities in children's academic outcomes.Anna Pearce, Alyssa C.P. Sawyer, Catherine R. Chittleborough Murthy N. Mittinty Catherine Law, John W. Lync

The General Practice Care of People With Intellectual Disability: Barriers and Solutions

A questionnaire exploring general practitioners' (GPs) perceptions of the barriers and solutions to providing health care to people with intellectual disability was sent to 912 randomly selected GPs throughout Australia. a response rate of 58% was obtained. Results indicated that numerous barriers compromised the quality of health care able to be provided to people with intellectual disability. communications difficulties with patients and other health professionals, and problems in obtaining patient histories stood out as the two most significant barriers. A range of other barriers were identified, including GPs' lack of training and experience, patients' poor compliance with management plans, consultation time constraints, difficulties in problem determination, examination difficulties, poor continuity of care, and GPs' inadequate knowledge of the services and resources available. General practitioners also suggested numerous solutions to these barriers, and emphasized the need for increased opportunities for education and training in intellectual disability. The GPs showed an overwhelming interest to be involved in further education. Other major solutions included increasing consultation duration or frequency, proactively involving families and carers in patients' ongoing health care, and increasing remuneration

‘Cruel and unusual punishment’: an inter-jurisdictional study of the criminalisation of young people with complex support needs

Although several criminologists and social scientists have drawn attention to the high rates of mental and cognitive disability amongst populations of young people embroiled in youth justice systems, less attention has been paid to the ways in which young people with disability are disproportionately exposed to processes of criminalisation and how the same processes serve to further disable them. In this paper, we aim to make a contribution towards filling this gap by drawing upon qualitative findings from the Comparative Youth Penality Project - an empirical inter-jurisdictional study of youth justice and penality in England and Wales and in four Australian states. We build on, integrate and extend theoretical perspectives from critical disability studies and from critical criminology to examine the presence of, and responses to, socio-economically disadvantaged young people with multiple disabilities (complex support needs) in youth justice systems in our selected jurisdictions. Four key findings emerge from our research pertaining to: (i) the criminalisation of disability and disadvantage; (ii) the management of children and young people with disabilities by youth justice agencies; (iii) the significance of early and holistic responses for children and young people with complex support needs; and (iv) the inadequate nature of community based support