Possible versus desirable in instructional systems: Who's driving?

This paper takes a pragmatic stance that the key to successful application of technology in education is good teaching: using technology only when it is a cost‐effective servant of pedagogy. The paper discusses some fundamental issues in the production of computer‐based materials, and considers them in the context of an on‐going evaluation of an Internet courseware project

Gaming New Zealand’s Emergency Department Target: How and Why Did It Vary Over Time and Between Organisations?

Background: Gaming is a potentially dysfunctional consequence of performance measurement and management systems in the health sector and more generally. In 2009, the New Zealand government initiated a Shorter Stays in Emergency Department (SSED) target in which 95% of patients would be admitted, discharged or transferred from an emergency department (ED) within 6 hours. The implementation of similar targets in England led to well-documented practices of gaming. Our research into ED target implementation sought to answer how and why gaming varies over time and between organisations. Methods: We developed a mixed-methods approach. Four organisation case study sites were selected. ED lengths of stay (ED LOS) were collected over a 6-year period (2007-2012) from all sites and indicators of target gaming were developed. Two rounds of surveys with managers and clinicians were conducted. Interviews (n = 68) were conducted with clinicians and managers in EDs and the wider hospital in two phases across all sites. The interview data was used to develop explanations of the patterns of variation across time and across sites detected in the ED LOS data.Results: Our research established that gaming behaviour – in the form of ‘clock-stopping’ and decanting patients to short-stay units (SSUs) or observation beds to avoid target breaches – was common across all 4 case study sites. The opportunity to game was due to the absence of independent verification of ED LOS data. Gaming increased significantly over time (2009-2012) as the means to game became more available, usually through the addition or expansion of short-stay facilities attached to EDs. Gaming varied between sites, but those with the highest levels of gaming differed substantially in terms of organisational dynamics and motives. In each case, however, high levels of gaming could be attributed to the strategies of senior management more than to the individual motivations of frontline staff.Conclusion: Gaming of New Zealand’s ED target increased after the real benefits (in terms of process improvement) of the target were achieved. Gaming of ED targets could be minimised by eliminating opportunities to game through independent verification, or by monitoring and limiting the means and motivations to game

Implementing performance improvement in New Zealand emergency departments: the six hour time target policy national research project protocol

<p>Abstract</p> <p>Background</p> <p>In May 2009, the New Zealand government announced a new policy aimed at improving the quality of Emergency Department care and whole hospital performance. Governments have increasingly looked to time targets as a mechanism for improving hospital performance and from a whole system perspective, using the Emergency Department waiting time as a performance measure has the potential to see improvements in the wider health system. However, the imposition of targets may have significant adverse consequences. There is little empirical work examining how the performance of the wider hospital system is affected by such a target. This project aims to answer the following questions: How has the introduction of the target affected broader hospital performance over time, and what accounts for these changes? Which initiatives and strategies have been successful in moving hospitals towards the target without compromising the quality of other care processes and patient outcomes? Is there a difference in outcomes between different ethnic and age groups? Which initiatives and strategies have the greatest potential to be transferred across organisational contexts?</p> <p>Methods/design</p> <p>The study design is mixed methods; combining qualitative research into the behaviour and practices of specific case study hospitals with quantitative data on clinical outcomes and process measures of performance over the period 2006-2012. All research activity is guided by a Kaupapa Māori Research methodological approach. A dynamic systems model of acute patient flows was created to frame the study. Consequences of the target (positive and negative) will be explored by integrating analyses and insights gained from the quantitative and qualitative streams of the study.</p> <p>Discussion</p> <p>At the time of submission of this protocol, the project has been underway for 12 months. This time was necessary to finalise both the case study sites and the secondary outcomes through key stakeholder consultation. We believe that this is an appropriate juncture to publish the protocol, now that the sites and final outcomes to be measured have been determined.</p

Future Directions in Sea Otter Research and Management

The conservation and management of sea otters has benefited from a dedicated research effort over the past 60 years enabling this species to recover from a few thousand in the early 20th century to about 150,000 today. Continued research to allow full, pre-exploitation recovery and restoration of nearshore ecosystems should focus on at least seven key challenges: (1) Defining sea otter populations at smaller spatial scales that reflect this species’ life history and dispersal patterns; (2) Understanding factors that regulate sea otter population density with a focus on index sites that are representative of the variety of littoral habitats occupied by sea otters around the North Pacific Rim; (3) Quantifying the effects of sea otters on the littoral community with a focus on how food availability limits population and ecosystem recovery and on predicting the effect of sea otter reoccupation on commercially valuable invertebrates; (4) Making sea otter monitoring programs comparable across geo-political boundaries through international collaboration to optimize survey efforts both spatially and temporally and to determine the cause of changes in sea otter demographics; (5) Evaluating the conservation benefits of sea otter reintroductions into historical habitat; (6) Assessing the socioeconomic costs and benefits of sea otter range expansion to anticipate and mitigate conflicts; (7) Recognizing in conservation and management plans that sea otters can be significantly affected by higher level predators in some circumstances. Many of these challenges will require new tools including the next generation geolocation tag technology that will allow assessments of long-range movements, dispersal and gene flow in various populations

The Open University

This paper describes how the Computing Department of the Open University is using the Internet for collaborative learning in a distributed educational process. Our research has been to see the extent to which traditional communications media can be replaced by electronic communication for the whole educational process and in particular to assess the role of collaborative learning in a distributed education environment. We set in context what constitutes a distributed learning environment and examine whether collaborative learning can be supported in this environment and what form the collaborative learning embodies. We report briefly on a set of trials and pilot studies were tuition through collaboration is practised. The model we have developed provides a collaborative environment in a way that is not normally available in a conventional setting. We have found that a distributed educational process naturally supports collaborative learning environments in which students and tutors interact and provide essential support for students studying at a distance. We have found that tutor’s feedback to students has improved and that tutors are happy to work in the new environment