Design for Improving Hospital Stroke Unit Processes: Reducing Complex Systems Failures Leading to Adverse Patient Outcomes

This paper describes recent research involving a user-focused design analysis of in-hospital residential treatment for stroke patients. The focus of the research was to identify positive and negative design heuristics associated with addressing poor performance, errors and failures of patient care associated with current designs of hospital systems processes being inadequate to address actual levels of system complexity. The research findings are based on an in–depth case study following a single patient through a stroke unit in a medium scale hospital of (approximately 280 acute beds overall) with 26 stroke unit beds. The case study involved over 200 hours of observations over nine weeks and liaison with hospital and family over the four months of the patient’s stay in hospital. The findings suggest an explanation for the lack of effective advantage so far shown for integrated care as compared to conventional multidisciplinary care. In essence, they suggest that integrated stroke care and multidisciplinary care are both subject to similar serious systemic organisational failures that in effect reduce outcomes of both to a similar compromised position. The paper concludes with three design heuristics for improving stroke unit outcomes via improving the design of stroke unit organisational systems. These proposed heuristics may be of benefit more widely in hospital system design for improved outcomes. Keywords: Hospital System Design, Design Strategies, User-Based Assessment, Case Study, Viable System Model</p

Models of youth work: a framework for positive sceptical reflection

In the post-welfare state, youth workers need models to articulate the purpose and value of their work to politicians and the public, and to explain foundational assumptions about society, young people, values, and mechanisms for personal and social change. Robust on-going discussion about models clarifies the relationship between theory and practice and enables youth work to make use of advances in knowledge in other disciplines, and to innovate constructively when faced with social and political change. Theorisation of models of youth work flourished briefly in the final quarter of the twentieth century. Renewed models of youth work are urgently needed. To re-start this process, this article develops a Framework for Positive Scepticism Reflection. The framework is then used to review four models of youth work developed between 1978 and 1994, to identify their contemporary relevance and where further theoretical work is required to meet the challenges of the twenty-first century

Quality management in Australian higher education : A critical review

Quality management in higher education is a politically contentious issue in Australia. as it is in North America, New Zealand, and many European countries. The Australian government has instituted a quality management system for higher education that it claims will improve university efficiency, accountability and quality. Critics assert that the current quality management system is detrimental to universities and undermines the capability of universities to deliver maximal benefits to individuals and to society. Evaluation of the basis of conflicting claims is necessary to enable decisions about the usefulness of current practices and decisions about whether existing quality management arrangements should be retained, modified and developed, or replaced, or, abolished

Meaningful youth work careers: Assumptions, misconceptions, and realities

The existing literature pertaining to youth work as a career is sparse, limited, and outdated, with the literature that does exist representing a largely negative image of youth work as a career. What then of those who have had a long-term career in youth work? The authors use a recent phenomenological research study to question assumptions and identify misconceptions about youth work as a career, and to discuss the findings from this research to provide a more realistic and contemporary understanding of long-term youth work careers. The phenomenological study discussed in this paper interviewed ten degree-qualified youth workers in Western Australia who had experienced careers in youth work spanning over twenty years. The authors will discuss the disparity between the findings from this research with existing literature, including characteristics of continuous employment; sustainability through supportive connections; longevity through leadership opportunities; and a diverse fusion of opportunities, variety, and flexibility in roles undertaken. These characteristics were found to support career longevity in youth work, culminating in a provisional model of the youth work career. This article provides insight into youth work career longevity and invites further conversation and research to further explore if the research conducted is transferable to different contexts both nationally and internationally

A youth curfew: A retrospective view of the rise, fall and legacy of the Northbridge Policy

This article presents policy, practice and theory implications of a case study of a youth curfew. The original case study of the Northbridge Policy Project set out to document the purposes of the Northbridge Policy, how policy was implemented, and to evaluate the effectiveness of this approach as a generalised response to child welfare and youth crime. The study synthesised data from multiple sources. The original study concluded that although the project was well resourced, well managed and had improved greatly inter-agency collaboration for child protection, these benefits could have been achieved without the curfew, which undermined some preventative aspects of the project. The evaluation also concluded that previously documented successes of the curfew for crime protection and child protection had been achieved through displacement of young people to other locations that neither reduced crime nor increase safety. After the project was suddenly curtailed, analysis used moral panic theory to examine the legacy of the Northbridge curfew in terms of discourse about young people and legitimation of subsequent practices in youth policing. The analysis found that the legacy had been unhelpful because it reinforced the erroneous beliefs that the curfew had been an effective and necessary component of strategy

Achieving economic sustainability for niche social profession courses in the Australian higher education sector: final report

The purpose of this fellowship was to develop a nationwide collaborative strategy to improve the economic sustainability and geographic availability of niche social profession courses. The niche courses in social professions examined in this program meet specialist social needs in disability services, social gerontology, and youth work. Specialist courses in social professions have limited availability across the Australian university sector and availability has declined over the last decade. This is despite a continuing need for specialist graduates, as attested by the relevant professional bodies, and by policy implementation reviews in the areas where graduates from these courses might provide stronger leadership. To improve learning opportunities for students and achieve collaboration, the program leader worked with colleagues and professional bodies nationally to analyse trend data and develop a working plan for each field of education. The program has raised awareness about the need for urgent system-wide action to support niche social professions and has developed collaborative network(s) to strengthen cross-institutional relationships between staff offering courses in niche social professions. The program has strengthened relationships with relevant state and federal professional bodies in each field and has established a network of colleagues to help resolve these challenges. In addition, the fellowship has proposed changes to support a nationwide collaborative strategy that will enable institutions to offer viable programs for the niche social professions. Dissemination has occurred to move beyond known interest groups, and staff from 16 universities and nine professional associations have been involved in discussions, consultations and planning for change. The issues and proposed strategies are outlined in this document. The working groups in each discipline will continue to collaborate to build momentum for change and to engage with colleagues at other universities to continue the work commenced by this fellowship. [Executive summary, ed

Support for homeless young people under 16 years old: Towards a new paradigm

Young people who become homeless before the age of 16 years face particular problems finding appropriate services that address their needs. This has been acknowledged in Australia and internationally, but successful system-wide resolution has not been achieved. The purpose of this study was to find out what would be required to improve policy in this area. The study set out to establish both the nature of the problem, and the nature of the changes needed to improve outcomes for young people. The research documented young people’s experiences of early homelessness and service provider’s perspectives on the adequacy of existing services. These were compared with the theoretical models and assumptions that informed the design of policy and service delivery. The study found that existing policy left some homeless 12–15-year-olds with fewer options and in much riskier circumstances than homeless young people aged 16–17 years. This perverse outcome occurred because the theoretical assumptions that informed policy did not align with either the reality of service delivery or with young people’s capabilities and aspirations. The study concluded that a new paradigm was required to improve outcomes. In addition, more varied types of accommodation are required for homeless young people under 16 years, and, where developmentally appropriate, young people aged 12–15 years should be treated as mature minors, and assistance should be provided through supported youth accommodation services

Sustainability, survival and engagement: implications for curriculum and pedagogy in social professions

The purpose of this paper is primarily to provide conceptual discussion of the implications of social sustainability for higher education. In this paper we examine the implications of concepts of social sustainability, survival and engagement for university curriculum and pedagogy in social professions. The first part of this paper briefly discusses the implications of social sustainability for the vision of university education and curriculum in the context of current debates in higher education. The second part of this paper provides an example of successful methods to engage initially reluctant learners with analysis of political, social and ethical issues relevant to social sustainability and survival. The first part of this paper is conceptual, whilst the second part provides an example of practice

Curriculum Renewal: Barriers to Successful Curriculum Change and Suggestions for Improvement

This article examines the practical difficulties encountered when a renewed curriculum is implemented in higher education. Attention has been given in the literature to the importance of coherent curriculum and approaches to curriculum design. Less attention has been paid to whether the renewed curriculum can be faithfully implemented within a given university context and how constraints to implementation change the curriculum design. Practical barriers to implementation arose from several sources. These included: how to ensure that all staff understood and supported the new approaches, in the context of a casualized academic workforce; the need for academics to find sufficient time to engage with the renewal process and complete the necessary work to implement the new curriculum, in the context of intensification of academic work; how to support academic staff to gain an understanding of curriculum design changes in a context where few staff have formally studied education; and, the tension between explicit curriculum philosophies that inform alternative curriculum designs and tacit curriculum philosophies embedded in university systems. The project used an action-learning approach and situated the learning in the context of literature on curriculum, academic work and contemporary university practices, to draw conclusions about how universities can better support successful implementation of curriculum change. The article concludes that successful realisation of curriculum change requires on-going support from management and a flexible environment to ensure that planned changes can be implemented effectively. This has implications for many university systems including, academic support, professional development, academic workloads, and university reporting systems

From criminalisation to individual choice: Policy responses to changing constructions of intellectual disability in Western Australia

This article uses an historical perspective to explore how constructions of disability influenced policy and services for people with intellectual disabilities in Western Australia (WA) from the time of British colonisation until the present day. The authors approach the discussion from a critical disability perspective in the analysis of disability constructs, political responses and social change, incorporating the Foucauldian concept of biopower to explain the physical infrastructure, classification and dividing practices that produced ‘docile subjects’. The authors argue that changing social constructions of disability since the 18th century affected the lives of people with disability in WA and continue, through their embodiment in infrastructure, to influence present-day practices, even after policy has changed. This approach illuminates the interplay between metaphorical and literal constructions of disability and allows the legacy of past assumptions to be examined