A call for conceptual clarity: a soft systems view of performance measurement in public service delivery

Performance measurement systems and the publication of performance data are fundamental to the New Public Management, with its emphasis on decentralised service provision through a variety of agencies. There seem to be four reasons for this performance measurement: to see what works, to identify competences, to support public accountability and to allow control of decentralised service provision. Each of these is examined, using the root definitions that form part of soft systems methodology, which highlights the importance of different worldviews that provide justifications for different approaches to this measurement. If performance measurement systems are to be beneficial, their design should be based on a conceptualisations that recognises these different worldviews and purposes

Emergency and on-demand health care: modelling a large complex system

This paper describes how system dynamics was used as a central part of a whole-system review of emergency and on-demand health care in Nottingham, England. Based on interviews with 30 key individuals across health and social care, a 'conceptual map' of the system was developed, showing potential patient pathways through the system. This was used to construct a stock-flow model, populated with current activity data, in order to simulate patient flows and to identify system bottle-necks. Without intervention, assuming current trends continue, Nottingham hospitals are unlikely to reach elective admission targets or achieve the government target of 82% bed occupancy. Admissions from general practice had the greatest influence on occupancy rates. Preventing a small number of emergency admissions in elderly patients showed a substantial effect, reducing bed occupancy by 1% per annum over 5 years. Modelling indicated a range of undesirable outcomes associated with continued growth in demand for emergency care, but also considerable potential to intervene to alleviate these problems, in particular by increasing the care options available in the community

The Seven Words of the Virgin: Identifying Change in the Discourse Context of the Concept of Virginity in Early Modern English

No abstract available

Hazardous alcohol use interventions with emergency patients: Self-reported practices of nurses, and predictors of behaviour

This is the peer reviewed version of the following article: [Freeman, T., Roche, A.M., Williamson, P., & Pidd, K. (2011) Hazardous alcohol use interventions with emergency patients: Self-reported practices of nurses, and predictors of behaviour. Emergency Medicine Australasia, 23, 479-489.], which has been published in final form at [DOI:10.1111/j.1742-6723.2011.01416.x]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Objectives. This study examined Australian Emergency Department (ED) nurses’ practices in asking patients about alcohol and assisting them to manage their alcohol consumption. It also investigated strategies to support ED nurses in these interventions. Methods. A two stage survey was administered to ED nurses. The first questionnaire measured theoretical and organisational predictors of behaviour, and underlying beliefs, and the subsequent questionnaire explored rates of asking and assisting patients. Results. A total of 125 nurses returned the first questionnaire. Participants held generally positive attitudes, perceived norms, feelings of legitimacy, and perceived ability to ask about and intervene for alcohol, but lower role adequacy. The 71 ED nurses who completed the second questionnaire had intervened with almost 500 patients concerning alcohol in the previous week. Participants asked approximately one in four patients about alcohol (median = 26.3% of patients, 1095/4279 total patients asked). The Theory of Planned Behaviour did not predict rates of asking or assisting patients. Several strategies were identified that may increase rates: identify environmental factors that prevent nurses acting on their intentions to ask and intervene, raise confidence and skills, make asking about alcohol part of routine assessment, make supports such as drug and alcohol units or nurses available, and implement organisational policies on alcohol. Conclusions. Nurses appear positively disposed to engage with patients in regard to alcohol. However, greater support is needed to achieve the considerable significant public health benefits from this engagement. The findings point to several practical strategies that could be pursued to provide this support

What Factors Need to be Addressed to Support Dental Hygienists to Assist Their Patients to Quit Smoking?

This is a pre-copyedited, author-produced PDF of an article accepted for publication in NICOTINE AND TOBACCO following peer review. The version of record [Freeman, T., Roche, A.M., Williamson, P., & Pidd K (2012). What factors need to be addressed to support dental hygienists to assist their patients to quit smoking? Nicotine & Tobacco Research, 14, 1040-1047.] is available online at: http://ntr.oxfordjournals.org/content/early/2012/02/16/ntr.ntr329Dental hygienists are well placed to assist their patients to quit smoking. Smoking affects oral health and dental treatments, and hygienists report greater time with patients than dentists with more focus on prevention. However, there has been little research into the extent to which hygienists assist patients to quit smoking, and strategies to support them in this role. Methods. A two stage survey of Australian dental hygienists was conducted. The first survey measured potential predictors of asking patients about smoking and assisting patients to quit smoking using the Theory of Planned Behaviour as a framework. The second survey measured these behaviours in the past week. Structural equation modelling was used to examine predictors of the two behaviours. Results. A total of 362 hygienists returned the first questionnaire. Intentions to ask and assist patients were high. The 273 hygienists who returned the second questionnaire assisted an estimated total of 1,394 patients to quit smoking in one week. Predictors within the Theory of Planned Behaviour framework explained significant variance in asking (11%) and assisting (29%) behaviours, with self-efficacy the most critical predictor in both cases (β =.27, .32 respectively). Conclusions. Dental hygienists may be a viable and willing avenue for addressing smoking. Hygienists may be best supported in this role through increasing skills and confidence around asking sensitively about smoking, building rapport, and assisting patients to quit smoking. . Incorporation of smoking status into general history taking and adoption of organisational policies on assisting patients to quit smoking could also be encouraged

The born-digital in future digital scholarly editing and publishing

Editorial scholarship is once again in a state of upheaval. Digital scholarly editing, for all it has achieved, has not accommodated the increasingly digital nature of cultural production and consumption. The theories and practices of digital scholarly editing need to better account for born-digital cultural materials like social media content, digital fiction, and video games. This paper discusses the state-of-the-art in digital scholarly editing, and advocates for future forms of digital scholarly editing and publishing suited to the born-digital

Australia’s Alcohol and Other Drug Telephone Information, Referral, and Counselling Services: A Guide to Quality Service Provision.

Ann Roche, Keith Evans, Tania Steenson, Ken Pidd, Nicole Lee, Lynette Cusack