Performance and Output Measurement: A Joint Meeting of Euro Public Sector and Health Working Groups -- 14-16 January, 1980

Most governmental and public service bodies have developed methods for measuring and controlling the inputs to major programs, in terms of finance, manpower, and other resources. There has, however, been relatively little success in measuring the output of such programs -- except in rather special cases -- and such measurement as takes place is usually on secondary rather than primary measures of output; it is easy to measure the number of patients handled in a clinic, but much more difficult to determine how far their health is improved. The issue of performance and output measurement is thus of major concern to operational research workers and applied systems analysts, much of whose work is directed towards public service programs, and because it cuts across many fields of application. It therefore seemed particularly appropriate that two working groups of the European Association of Operational Research Societies should meet at the International Institute for Applied Systems Analysis in January 1980 to discuss this topic. As the discussion may be of wider interest than to those actually present it all seems appropriate to make these notes more widely available in the form of an IIASA Collaborative Paper. The meeting was the prime responsibility of Peter Turner and Duncan Boldy, chairmen respectively of the Public Sector and Health Working Groups of EURO. At IIASA the coordination was undertaken by Philip Aspden of the Health Care Systems Modeling Task. These three are the joint editors of this report. It was felt that the proceedings were worth recording but that, as they were really part of an ongoing debate, they should be made available as quickly as possible. To avoid further delay some of the papers are therefore presented in note form, and the discussion has been condensed to bring out the main topics of interest. It is too seldom that those engaged in the analytical study of policy issues get together specifically to discuss their problems, rather than to parade their solutions. We hope that this collaborative paper may help to stimulate further such meetings

Physical activity levels of older adults receiving a home care service

Sammenligning av aktivitetsnivå for personer som har hatt hverdagsrehabilitering og vanlige tjenester.The 3 study objectives were to compare the activity levels of older people who had received a restorative home care service with those of people who had received "usual" home care, explore the predictors of physical activity in these 2 groups, and determine whether either group met the minimum recommended activity levels for their age group. A questionnaire was posted to 1,490 clients who had been referred for a home care service between 2006 and 2009. Older people who had received a restorative care service were more active than those who had received usual care (p = .049), but service group did not predict activity levels when other variables were adjusted for in a multiple regression. Younger individuals who were in better physical condition, with good mobility and no diagnosis of depression, were more likely to be active. Investigation of alternatives to the current exercise component of the restorative program is needed

Developing and Testing the Standard of Practice and Evaluation of Critical-Care-Nursing Tool (SPECT) for Critical Care Nursing Practice.

BACKGROUND: Nurses working in critical care often undertake specialty education. There are no uniform practice outcomes for critical care programs, and consumer input to practice standards has been lacking. METHODS: A structured multiphase project was undertaken to develop practice standards and an assessment tool informed by critical care nursing stakeholders as well as patients and families-the Standards of Practice and Evaluation of Critical-Care-Nursing Tool (SPECT). RESULTS: Testing of the SPECT revealed adequate content validity index (CVI), domain CVI (range, 0.772 to 0.887), and statement CVI (range, 0.66 to 1.00). Reliability was adequate in terms of internal consistency (Cronbach's α > 0.864) and test-retest Spearman rank correlation (range, 0.772 to 0.887); intra-rater kappa agreement was significant for 102 of 104 statements with moderate agreement for 94.2% of statements. CONCLUSION: The SPECT appears to have clinical feasibility, preliminary validity and reliability, and provides a clear definition for the expected practice level for graduates of a critical care education program

Development of <scp>A</scp>ustralian clinical practice outcome standards for graduates of critical care nurse education

Aims and objectivesTo develop critical care nurse education practice standards.BackgroundCritical care specialist education for registered nurses in Australia is provided at graduate level. Considerable variation exists across courses with no framework to guide practice outcomes or evidence supporting the level of qualification.DesignAn eDelphi technique involved the iterative process of a national expert panel responding to three survey rounds.MethodsFor the first round, 84 statements, organised within six domains, were developed from earlier phases of the study that included a literature review, analysis of critical care courses and input from health consumers. The panel, which represented the perspectives of four stakeholder groups, responded to two rating scales: level of importance and level of practice.ResultsOf 105 experts who agreed to participate, 92 (88%) completed survey round I; 85 (92%) round II; and 73 (86%) round III. Of the 98 statements, 75 were rated as having a high level of importance – median 7 (IQR 6–7); 14 were rated as having a moderate level of importance – median 6 (IQR 5–7); and nine were rated as having a low level of importance – median 4 (IQR 4–6)–6 (IQR 4–6). The majority of the panel rated graduate level of practice as ‘demonstrates independently’ or ‘teaches or supervises others’ for 80 statements. For 18 statements, there was no category selected by 50% or more of the panel. The process resulted in the development of 98 practice standards, categorised into three levels, indicating a practice outcome level by the practitioner who can independently provide nursing care for a variety of critically ill patients in most contexts, using a patient‐ and family‐focused approach.Conclusion/relevance to clinical practiceThe graduate practice outcomes provide a critical care qualification definition for nursing workforce standards and can be used by course providers to achieve consistent practice outcomes.</jats:sec

Development of Australian clinical practice outcome standards for graduates of critical care nurse education.

AIMS AND OBJECTIVES: To develop critical care nurse education practice standards. BACKGROUND: Critical care specialist education for registered nurses in Australia is provided at graduate level. Considerable variation exists across courses with no framework to guide practice outcomes or evidence supporting the level of qualification. DESIGN: An eDelphi technique involved the iterative process of a national expert panel responding to three survey rounds. METHODS: For the first round, 84 statements, organised within six domains, were developed from earlier phases of the study that included a literature review, analysis of critical care courses and input from health consumers. The panel, which represented the perspectives of four stakeholder groups, responded to two rating scales: level of importance and level of practice. RESULTS: Of 105 experts who agreed to participate, 92 (88%) completed survey round I; 85 (92%) round II; and 73 (86%) round III. Of the 98 statements, 75 were rated as having a high level of importance - median 7 (IQR 6-7); 14 were rated as having a moderate level of importance - median 6 (IQR 5-7); and nine were rated as having a low level of importance - median 4 (IQR 4-6)-6 (IQR 4-6). The majority of the panel rated graduate level of practice as 'demonstrates independently' or 'teaches or supervises others' for 80 statements. For 18 statements, there was no category selected by 50% or more of the panel. The process resulted in the development of 98 practice standards, categorised into three levels, indicating a practice outcome level by the practitioner who can independently provide nursing care for a variety of critically ill patients in most contexts, using a patient- and family-focused approach. CONCLUSION/RELEVANCE TO CLINICAL PRACTICE: The graduate practice outcomes provide a critical care qualification definition for nursing workforce standards and can be used by course providers to achieve consistent practice outcomes

Modelling home care organisations from an operations management perspective

Home Care (HC) service consists of providing care to patients in their homes. During the last decade, the HC service industry experienced significant growth in many European countries. This growth stems from several factors, such as governmental pressure to reduce healthcare costs, demographic changes related to population ageing, social changes, an increase in the number of patients that suffer from chronic illnesses, and the development of new home-based services and technologies. This study proposes a framework that will enable HC service providers to better understand HC operations and their management. The study identifies the main processes and decisions that relate to the field of HC operations management. Hence, an IDEF0 (Integrated Definition for Function Modelling) activity-based model describes the most relevant clinical, logistical and organisational processes associated with HC operations. A hierarchical framework for operations management decisions is also proposed. This analysis is derived from data that was collected by nine HC service providers, which are located in France and Italy, and focuses on the manner in which operations are run, as well as associated constraints, inputs and outputs. The most challenging research areas in the field of HC operations management are also discussed

Australian health care providers' views on opt-out HIV testing

Background: Opt-out HIV testing is a novel concept in Australia. In the opt-out approach, health care providers (HCPs) routinely test patients for HIV unless they explicitly decline or defer. Opt-out HIV testing is only performed with the patients' consent, but pre-test counselling is abbreviated. Australian national testing guidelines do not currently recommend opt-out HIV testing for the general population. Non-traditional approaches to HIV testing (such as opt-out) could identify HIV infections and facilitate earlier treatment, which is particularly important now that HIV is a chronic, manageable disease. Our aim was to explore HCPs' attitudes toward opt-out HIV testing in an Australian context, to further understanding of its acceptability and feasibility. Methods: In this qualitative study, we used purposeful sampling to recruit HCPs who were likely to have experience with HIV testing in Western Australia. We interviewed them using a semi-structured guide and used content analysis as per Graneheim to code the data. Codes were then merged into subcategories and finally themes that unified the underlying concepts. We refined these themes through discussion among the research team. Results: Twenty four HCPs participated. Eleven participants had a questioning attitude toward opt-out HIV testing, while eleven favoured the approach. The remaining two participants had more nuanced perspectives that incorporated some characteristics of the questioning and favouring attitudes. Participants' views about opt-out HIV testing largely fell into two contrasting themes: normalisation and routinisation versus exceptionalism; and a need for proof versus openness to new approaches. Conclusion: Most HCPs in this study had dichotomous attitudes toward opt-out HIV testing, reflecting contrasting analytical styles. While some HCPs viewed it favourably, with the perceived benefits outweighing the perceived costs, others preferred to have evidence of efficacy and cost-effectiveness