Engaging rural communities in health care through a paramedic expanded scope of practice

Introduction: This article explores how community engagement by paramedics in an expanded scope role contributes to both primary health care and to an overall improved emergency response capacity in rural communities. Understanding how expanded scope paramedics (ESP) can strengthen community healthcare collaborations is an important need in rural areas where low workforce numbers necessitate innovation.Methods: Four examples of Australian rural ESP roles were studied in Tasmania, New South Wales, South Australia and Victoria to gather information on consistent elements that could inform a paramedic expanded scope model. Qualitative data were collected from semi-structured interviews with key stakeholders and organisational documents. Thematic analysis within and across cases found community engagement was a key element in the varied roles. This article relies heavily on data from the Victorian and Tasmanian case studies because community engagement was a particularly strong aspect of these cases.Results: The ESP in the case studies increased interactions between ambulance services and rural communities with an overall benefit to health care through: increasing community response capacity; linking communities more closely to ambulance services; and increasing health promotion and illness prevention work at the community level. Leadership, management and communication skills are important for paramedics to successfully undertake expanded scope roles.Conclusion: ESP in rural locations can improve health care beyond direct clinical skill by active community engagement that expands the capacity of other community members and strengthens links between services and communities. As health services look to gain maximum efficiency from the health workforce, understanding the intensification of effort that can be gained from practitioner and community coalitions provides important future directions.<br /

The organisational and human resource challenges facing primary care trusts : protocol of a multiple case study

BACKGROUND: The study is designed to assess the organisational and human resource challenges faced by Primary Care Trusts (PCTs). Its objectives are to: specify the organisational and human resources challenges faced by PCTs in fulfilling the roles envisaged in government and local policy; examine how PCTs are addressing these challenges, in particular, to describe the organisational forms they have adopted, and the OD/HR strategies and initiatives they have planned or in place; assess how effective these structures, strategies and initiatives have been in enabling the PCTs to meet the organisational and human resources challenges they face; identify the factors, both internal to the PCT and in the wider health community, which have contributed to the success or failure of different structures, strategies and initiatives. METHODS: The study will be undertaken in three stages. In Stage 1 the key literature on public sector and NHS organisational development and human resources management will be reviewed, and discussions will be held with key researchers and policy makers working in this area. Stage 2 will focus on detailed case studies in six PCTs designed to examine the organisational and human resources challenges they face. Data will be collected using semi-structured interviews, group discussion, site visits, observation of key meetings and examination of local documentation. The findings from the case study PCTs will be cross checked with a Reference Group of up to 20 other PCG/Ts, and key officers working in organisational development or primary care at local, regional and national level. In Stage 3 analysis of findings from the preparatory work, the case studies and the feedback from the Reference Group will be used to identify practical lessons for PCTs, key messages for policy makers, and contributions to further theoretical development

Extending the paramedic role in rural Australia : a story of flexibility and innovation

Introduction: This article identifies trends in the evolving practice of rural paramedics and describes key characteristics, roles and expected outcomes for a Rural Expanded Scope of Practice (RESP) model.Methods: A multiple case study methodology was employed to examine the evolution of rural paramedic practice. Paramedics, volunteer ambulance officers and other health professionals were interviewed in four rural regions of south-eastern Australia where innovative models of rural paramedic practice were claimed to exist. The research team collected and thematically analysed the data using the filter of a sociological framework throughout 2005 and 2006.Results: The study found that paramedics are increasingly becoming first line primary healthcare providers in small rural communities and developing additional professional responsibilities throughout the cycle of care.Conclusions: Adoption of the RESP model would mean that paramedics undertake four broad activities as core components of their new role: (1) rural community engagement; (2) emergency response; (3) situated practice; and (4) primary health care. The model&rsquo;s key feature is a capacity to integrate existing paramedic models with other health agencies and health professionals to ensure that paramedic care is part of a seamless system that provides patients with well-organized and high quality care. This expansion of paramedics&rsquo; scope of practice offers the potential to improve patient care and the general health of rural communities.<br /

To Act and Learn: A Bakhtinian Exploration of Action Learning

This paper considers the work of the Russian social philosopher and cultural theorist, Mikhail Mikhailovich Bakhtin as a source of understanding for those involved in action learning. Drawing upon data gathered over two years during the evaluation of 20 action learning sets in the north of England, we will seek to work with the ideas of Bakhtin to consider their value for those involved in action learning. We consider key Bakhtin features such as Making Meaning, Participative Thinking, Theoreticism and Presence, Others and Outsideness, Voices and Carnival to highlight how Bakhtin's can enhance our understanding of the nature of action and learning

Do institutional arrangements make a difference to transport policy and implementation? Lessons for Britain

This paper describes local government decision-making in transport in three areas of the UK, London, West Yorkshire and Edinburgh, in which major changes in local government decision-making structures have taken place over the last decade, and between which arrangements are now very different. The research discusses whether institutional change has had a beneficial or adverse effect, and whether any of the current structures provides a more effective framework for policy development and implementation. The results show that although the sites share a broadly common set of objectives there are differences in devolved responsibilities and in the extent to which various policy options are within the control of the bodies charged with transport policy delivery. The existence of several tiers of government, coupled with the many interactions required between these public sector bodies and the predominantly private sector public transport operators appears to create extra transactional barriers and impedes the implementation of the most effective measures for cutting congestion. There is, however, a compelling argument for the presence of an overarching tier of government to organise travel over a spatial scale compatible with that of major commuter patterns. The extent to which such arrangements currently appear to work is a function of the range of powers and the funding levels afforded to the co-ordinating organisation

A simple inverse method for the interpretation of pumped flowing fluid electrical conductivity logs

Pumped flowing fluid electrical conductivity (FFEC) logs, also known as pumped borehole dilution testing, is an experimentally easy‐to‐perform approach to evaluating vertical variations in the hydraulic conductivity of an aquifer. In contrast to the simplicity of the logging equipment, analysis of the data is complex and laborious. Current methods typically require repeated solution of the advection‐dispersion equation (ADE) for describing the flow in the borehole and comparison with the experimental results. In this paper, we describe a direct solution for determining borehole fluid velocity that bypasses the need for complex numerical computation and repetitive optimization. The method rests on the observation that, while solving the ADE for concentration profile in the borehole (as required for modeling and combined methods) is computationally challenging, the solution for flow distribution along the length of the borehole given concentration data is straightforward. The method can accommodate varying borehole diameters, and uses the fact that multiple profiles are taken in the standard logging approach to reduce the impact of noise. Data from both a simulated borehole and from a field test are successfully analyzed. The method is implemented in a spreadsheet, which is available as supporting information material to this paper

Experiencing uncertainty – on the potential of groups and a group analytic approach for making management education more critical.

This document is the Accepted Manuscript. The final, definitive version of this paper has been published in Management Learning, November 2017, DOI: https://doi.org/10.1177/1350507617697868. Published by SAGE Publishing. All rights reserved.This article points to the potential of methods derived from group analytic practice for making management education more critical. It draws on the experience of running a professional doctorate for more experienced managers in a university in the UK over a 16 year period. Group analysis is informed by the highly social theories of S.H. Foulkes and draws heavily on psychoanalytic theory as well as sociology. First and foremost, though, it places our interdependence at the heart of the process of inquiry, and suggests that the most potent place for learning about groups, where we spend most of our lives, is in a group. The article prioritises three areas of management practice for which group analytic methods, as adapted for research environment, are most helpful: coping with uncertainty and the feelings of anxiety which this often arouses; thinking about leadership as a relational and negotiated activity, and encouraging reflexivity in managers. The article also points to some of the differences between the idea of the learning community and psychodynamic perspectives more generally and the limitations of group analytic methods in particular, which may pathologise resistance in the workplace.Peer reviewe

Radio-Excess IRAS Galaxies: PMN/FSC Sample Selection

A sample of 178 extragalactic objects is defined by correlating the 60 micron IRAS FSC with the 5 GHz PMN catalog. Of these, 98 objects lie above the radio/far-infrared relation for radio-quiet objects. These radio-excess galaxies and quasars have a uniform distribution of radio excesses and appear to be a new population of active galaxies not present in previous radio/far-infrared samples. The radio-excess objects extend over the full range of far-infrared luminosities seen in extragalactic objects. Objects with small radio excesses are more likely to have far-infrared colors similar to starbursts, while objects with large radio excesses have far-infrared colors typical of pure AGN. Some of the most far-infrared luminous radio-excess objects have the highest far-infrared optical depths. These are good candidates to search for hidden broad line regions in polarized light or via near-infrared spectroscopy. Some low far-infrared luminosity radio-excess objects appear to derive a dominant fraction of their far-infrared emission from star formation, despite the dominance of the AGN at radio wavelengths. Many of the radio-excess objects have sizes likely to be smaller than the optical host, but show optically thin radio emission. We draw parallels between these objects and high radio luminosity Compact Steep-Spectrum (CSS) and GigaHertz Peaked-Spectrum (GPS) objects. Radio sources with these characteristics may be young AGN in which the radio activity has begun only recently. Alternatively, high central densities in the host galaxies may be confining the radio sources to compact sizes. We discuss future observations required to distinguish between these possibilities and determine the nature of radio-excess objects.Comment: Submitted to AJ. 44 pages, 11 figures. A version of the paper with higher quality figures is available from http://www.mso.anu.edu.au/~cdrake/PMNFSC/paperI

Solid intentions:an archival ethnography of corporate architecture and organizational remembering

Research on organizational spaces has not considered the importance of collective memory for the process of investing meaning in corporate architecture. Employing an archival ethnography approach, practices of organizational remembering emerge as a way to shape the meanings associated with architectural designs. While the role of monuments and museums are well established in studies of collective memory, this research extends the concept of spatiality to the practices of organizational remembering that focus on a wider selection of corporate architecture. By analyzing the historical shift from colonial to modernist architecture for banks and retailers in Ghana and Nigeria in the 1950s and 1960s on the basis of documents and photographs from three different companies, this article shows how archival sources can be used to untangle the ways in which companies seek to ascribe meaning to their architectural output. Buildings allude to the past and the future in a range of complex ways that can be interpreted more fully by reference to the archival sources and the historical context of their creation. Social remembering has the potential to explain why and how buildings have meaning, while archival ethnography offers a new research approach to investigate changing organizational practices