Australian health review: a publication of the Australian Hospital Association (AUST HEALTH REV )

Publisher: Australian Hospital Association

Journal description

Current impact factor: 1.00

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 1
2012 Impact Factor 0.698
2011 Impact Factor 0.545
2010 Impact Factor 0.803
2009 Impact Factor 0.584

Impact factor over time

Impact factor
Year

Additional details

5-year impact 0.92
Cited half-life 5.60
Immediacy index 0.10
Eigenfactor 0.00
Article influence 0.26
Website Australian Health Review website
Other titles Australian health review (Online)
ISSN 0156-5788
OCLC 60624483
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Clinical supervision is widely recognised as a mechanism for providing professional support, professional development and clinical governance for healthcare workers. There have been limited studies about the effectiveness of clinical supervision for allied health and minimal studies conducted within the Australian health context. The aim of the present study was to identify whether clinical supervision was perceived to be effective by allied health professionals and to identify components that contributed to effectiveness. Participants completed an anonymous online questionnaire, administered through the health service's intranet. Methods A cross-sectional study was conducted with community allied health workers (n=82) 8 months after implementation of structured clinical supervision. Demographic data (age, gender), work-related history (profession employment level, years of experience), and supervision practice (number and length of supervision sessions) were collected through an online survey. The outcome measure, clinical supervision effectiveness, was operationalised using the Manchester Clinical Supervision Scale-26 (MCSS-26©). Data were analysed with Pearson correlation (r) and independent sample t-tests (t) with significance set at 0.05 (ie the probability of significant difference set at Prs ?0.44), the number of sessions (rs?0.35) and the total period supervision had been received (rs?0.42) were all significantly positively correlated with the MCSS-26© domains of clinical supervision effectiveness. Three individual variables, namely 'receiving clinical supervision', 'having some choice in the allocation of clinical supervisor' and 'having a completed clinical supervision agreement', were also significantly associated with higher total MCSS-26© scores (Ps<0.014). Conclusion The results of the study demonstrate that when clinical supervision uses best practice principles, it can provide professional support for allied health workers, even during times of rapid organisational change. What is known about the topic? The provision of clinical supervision for allied health staff is being increasingly adopted within the Australian health context. However, current approaches to clinical supervision for allied health are fragmented and poorly coordinated. There have been limited clinical supervision studies undertaken in Australian allied health populations, and little is known about the evidence for outcomes in this cohort. What does this paper add? The findings of the present study indicate that clinical supervision, when based on best practice principles, can provide professional support and guidance to allied health workers, even when staff are experiencing significant change in the workplace. The article describes specific elements of the clinical supervision infrastructure that appear to be critical for effective professional support outcomes. What are the implications for practitioners? Effective clinical supervision can provide professional support to the allied health workforce. Healthcare organisations can facilitate effective clinical supervision delivery by ensuring that evidence-based principles are embedded in the infrastructure of the clinical supervision practice.
    Australian health review: a publication of the Australian Hospital Association 03/2015;
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    ABSTRACT: Traditional overnight rehabilitation payment models in the private sector are not based on a rigorous classification system and vary greatly between contracts with no consideration of patient complexity. The payment rates are not based on relative cost and the length-of-stay (LOS) point at which a reduced rate applies (step downs) varies markedly. The rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model (RAM), which has been in place for over 2 years in some private hospitals, bases payment on a rigorous classification system, relative cost and industry LOS. RAM is in the process of being rolled out more widely. This paper compares and contrasts RAM with traditional overnight rehabilitation payment models. It considers the advantages of RAM for hospitals and Australian Health Service Alliance. It also considers payment model changes in the context of maintaining industry consistency with Electronic Claims Lodgement and Information Processing System Environment (ECLIPSE) and health reform generally. What is known about this topic? The Australian Health Service Alliance is unaware of any recent studies comparing and contrasting current Australian private sector rehabilitation models with AN-SNAP-based models. What does this paper add? This paper outlines the advantages of an AN-SNAP payment model with regard to paying for services in relation to relative cost and avoiding perverse incentives in relation to rehabilitation patient admission and LOS. What are the implications for practitioners? Basing private sector rehabilitation payment models on AN-SNAP can address deficiencies of traditional payment models.
    Australian health review: a publication of the Australian Hospital Association 03/2015;
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    ABSTRACT: Objective Pressure injuries (PI) are largely preventable and can be viewed as an adverse outcome of a healthcare admission, yet they affect millions of people and consume billions of dollars in healthcare spending. The existing literature in Australia presents a patchy picture of the economic burden of PI on society and the health system. The aim of the present study was to provide a more comprehensive and updated picture of PI by state and severity using publicly available data. Methods A cost-of-illness analysis was conducted using a prevalence approach and a 1-year time horizon based on data from the existing literature extrapolated using simulation methods to estimate the costs by PI severity and state subgroups. Results The treatment cost across all states and severity in 2012-13 was estimated to be A$983million per annum, representing approximately 1.9% of all public hospital expenditure or 0.6% of the public recurrent health expenditure. The opportunity cost was valued at an additional A$820million per annum. These estimates were associated with a total number of 121645 PI cases in 2012-13 and a total number of 524661 bed days lost. Conclusions The costs estimated in the present study highlight the economic waste for the Australian health system associated with a largely avoidable injury. Wastage can also be reduced by preventing moderate injuries (Stage I and II) from developing into severe cases (Stage III and IV), because the severe cases, accounting for 12% of cases, mounted to 30% of the total cost.
    Australian health review: a publication of the Australian Hospital Association 03/2015;
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    ABSTRACT: Objective The aim of the present study was to assess whether the outdoor areas of residential aged care facilities used for a sunlight intervention trial had the design features that encouraged participants' use of these spaces. Methods The design principles recommended in the 'Vitamin D and the Built Environment in Victoria' guidelines were used to assess the outdoor spaces of residential aged care facilities that were used in a randomised controlled trial (RCT) of sunlight exposure. Attendance rates in the sunlight RCT were analysed in relation to global impression scores of the facilities using one-way analysis of variance. Results Thirty-six outdoor areas of 31 facilities were assessed. The facilities met the guidelines for sun exposure, and were generally safe and accessible. However, many lacked privacy, security and aesthetic appeal. Most of the outdoor spaces were not used for regularly scheduled activities. Attendance rates were higher in those facilities with the highest global impression scores compared with those with the lowest scores (F(2,367)=3.262, P=0.039). Conclusions The physical environment of the outdoor areas of residential aged care facilities was associated with their use for sunlight exposure. Suitably designed or modified spaces have the potential to encourage their greater use, and residential aged care facilities should also plan regular activities in those areas. These measures can facilitate safe sun exposure, as well as physical activity and social interaction in older people. What is known about the topic? Older people living in aged care facilities have inadequate outdoor sun exposure and vitamin D deficiency. The outdoor spaces of aged care facilities are not well used by residents. Design features that encourage greater use of outdoor spaces have been identified. What does this paper add? Participation rates in a trial of outdoor sun exposure in residents of aged care facilities were found to be higher in those facilities with better design features in their outdoor spaces. Most facilities do not schedule their regular activities outdoors. What are the implications for practitioners? Suitable design or modification of outdoor spaces of residential aged care facilities can encourage their greater use. Regular scheduling of leisure and social activities can further promote their utilisation.
    Australian health review: a publication of the Australian Hospital Association 03/2015;
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    ABSTRACT: Objective The aim of the present study was to investigate Medicare rebate claim trends under the Australian Chronic Disease Dental Scheme (CDDS) over time, region and type of service. Methods CDDS data obtained from the Department of Human Services reflected all Medicare item claims lodged under the CDDS by dental practitioners and processed by Medicare. Retrospective analysis of CDDS rebate claims was conducted. Results The CDDS rebates for the period 2008-13 totalled A$2.8 billion. Just under 81% of claims were from dental practitioners working in major cities. The most frequent rebates were for crown, bridge and implant (32.4%), removable prostheses (22.4%) and restorative services (21.3%). The rebate claims of restorative services, crown and bridge, and removable prostheses per dentist in all regional areas increased over the time of the CDDS. Per capita, the rebates for every type of dental service were lower in the more remote regions. Conclusions Rebate claims increased in each of the last 3 full years of the CDDS across all areas. The majority of Medicare rebate claims were from major city areas and for crown and bridge, removable prostheses and restorative services. The service mix varied between regions. What is known about the topic? The CDDS was described as 'unsustainable' from the governmental budgetary perspective, being controversial around the value of the program, 'poorly targeted' and having implementation and administrative requirement shortfalls. What does this paper add? The CDDS rebates for the period 2008-13 totalled A$2.8 billion, with just under 81% of claims from dental practitioners working in major cities. The services with the highest rebate claims were crown and bridge, removable prostheses and restorative services. What are the implications for practitioners? In future such schemes, the type of services offered could be reviewed regularly by policymakers in order to control item expenses. The take-up of Government dental schemes may be slow to start, but will tend to increase rapidly over the life of the scheme.
    Australian health review: a publication of the Australian Hospital Association 02/2015;
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    ABSTRACT: Abstract Objective. The aim of the present study was to investigate changes in stroke survival among Indigenous and non-Indigenous patients in the Northern Territory (NT). Methods. A longitudinal study was undertaken of stroke patients admitted to NT public hospitals between 1992 and 2013. The Kaplan–Meier method and proportional hazards regression were used for survival analysis. A marginal structural model was applied to adjust for time-dependent confounders and informative censoring. Results. There were 4754 stroke in-patients over the period, with 3540 new cases and 837 stroke deaths. Mean age of onset for Indigenous patients (51.7 years) was 12.3 years younger than that for non-Indigenous patients. After adjustments for confounders and loss to follow-up, in-hospital deaths were more likely among Indigenous patients (hazard ratio (HR) = 1.56; P < 0.01) and less likely among males (HR = 0.86; P < 0.05) and patients from remote areas (HR = 0.72; P < 0.01). There was a 3% decrease annually in mortality hazard from 1992 to 2013. Renal disease, cancer and chronic obstructive pulmonary disease had deleterious effects on stroke survival. Conclusions. Stroke survival has improved in the NT over the past two decades. The marginal structural models provide a powerful methodological tool that can be applied to hospital administrative data to assess changes in quality of care and the impact of interventions.
    Australian health review: a publication of the Australian Hospital Association 02/2015;
  • Australian health review: a publication of the Australian Hospital Association 02/2015;
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    ABSTRACT: Objective The aim of the present study was to assess the effect of an inter-hospital transfer on efficiency and quality of in-patient care. Methods A retrospective cohort study from 2010 to 2012 inclusive was conducted in two tertiary-referral urban hospitals within a single area healthcare network. The study included 14571 acutely unwell patients admitted to a general medical service. The main outcome measures were length of in-patient stay, relative stay index, readmission rate within 7 and 28 days of discharge and in-hospital mortality rate. Results Compared with patients who were transferred to a long-stay ward within the original hospital (n=3465), transferred patients (n=1531) were older (71 vs 80 years, respectively; PPPPP<0.001) than patients who were not transferred. Mortality was lower in the transferred patients (1.1% vs 4.1%). Conclusion Appropriate patients for inter-hospital transfer can be selected within 24h of arrival at an index hospital. The efficiency of their care at the receiving hospital appears not to be compromised. The present study provides support for inter-hospital transfer as a strategy to optimise regional bed capacity. What is known about the topic? Little has been written about lateral inter-hospital transfers; it was first labelled a 'sideways transfer' in a publication about hospital reimbursement published in the Medical Journal of Australia in 1998. What does this paper add? This paper adds quality and safety data to what little is known about lateral transfers. 'Lateral transfer' better describes the process than 'sideways transfer'. What are the implications for practitioners? Our data helped us understand that a lateral transfer does not by itself increase the cost of the hospital stay, nor does it increase readmission rate or mortality. It also means that if a patient is hospitalised in a hospital with limited capacity and the patient's acute medical problem has improved, but not resolved, that patient can be safely transferred to a hospital with available beds to continue receiving acute services.
    Australian health review: a publication of the Australian Hospital Association 02/2015;
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    ABSTRACT: Objective Advancing quality in health services requires structures and processes that are informed by consumer input. Although this agenda is well recognised, few researchers have focussed on the establishment and maintenance of customer input throughout the structures and processes used to produce high-quality, safe care. We present an analysis of literature outlining the barriers and enablers involved in community representation in hospital governance. The review aimed to explore how community representation in hospital governance is achieved. Methods Studies spanning 1997-2012 were analysed using Donabedian's model of quality systems as a guide for categories of interest: structure, in relation to administration of quality; process, which is particularly concerned with cooperation and culture; and outcome, considered, in this case, to be the achievement of effective community representation on quality of care. Results There are limited published studies on community representation in hospital governance in Australia. What can be gleaned from the literature is: 1) quality subcommittees set up to assist Hospital Boards are a key structure for involving community representation in decision making around quality of care, and 2) there are a number of challenges to effectively developing the process of community representation in hospital governance: ambiguity and the potential for escalated indecision; inadequate value and consideration given to it by decision makers resulting in a lack of time and resources needed to support the community engagement strategy (time, facilitation, budgets); poor support and attitude amongst staff; and consumer issues, such as feeling isolated and intimidated by expert opinion. Conclusions The analysis indicates that: quality subcommittees set up to assist boards are a key structure for involving community representation in decision making around quality of care. There are clearly a number of challenges to effectively developing the process of community representation in hospital governance, associated with ambiguity, organisational and consumer issues. For an inclusive agenda to real life, work must be done on understanding the representatives' role and the decision making process, adequately supporting the representational process, and developing organisational cooperation and culture regarding community representation. What is known about the topic? Partnering community is recognised as a fundamental element of hospital quality improvement strategies and the implementation of the Australian agenda for advancing the quality of health service standards. It is also known that developing collaborative environments and partnerships can be a challenging process, and that it is good practice to consider the factors that will influence their success and develop an approach built on the identification of potential challenges and the incorporation of facilitators. What does this paper add? This paper draws out key obstacles that can challenge the process of involving community representation into hospital governance structures. What are the implications for practitioners? There is little published on the challenges to community engagement in the hospital governance setting. By doing this, this paper encourages the recognition that although partnering with the community is an essential aspect of achieving quality of care, it requires significant effort and support to be an effective aspect. The paper highlights challenges and facilitators that practitioners should consider if planning for successful community representation on hospital committees.
    Australian health review: a publication of the Australian Hospital Association 02/2015;
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    ABSTRACT: Objectives The aim of the present study was to provide descriptive planning data for a hospital-based Aboriginal Health Liaison Officer (AHLO) program, specifically quantifying episodes of care and outcomes within 28 days after discharge. Methods A follow-up study of Aboriginal in-patient hospital episodes was undertaken using person-based linked administrative data from four South Metropolitan hospitals in Perth, Western Australia (2006-11). Outcomes included 28-day deaths, emergency department (ED) presentations and in-patient re-admissions. Results There were 8041 eligible index admissions among 5113 individuals, with episode volumes increasing by 31% over the study period. Among patients 25 years and older, the highest ranking comorbidities included injury (47%), drug and alcohol disorders (41%), heart disease (40%), infection (40%), mental illness (31%) and diabetes (31%). Most events (96%) ended in a regular discharge. Within 28 days, 24% of events resulted in ED presentations and 20% resulted in hospital re-admissions. Emergency readmissions (13%) were twice as likely as booked re-admissions (7%). Stratified analyses showed poorer outcomes for older people, and for emergency and tertiary hospital admissions. Conclusions Future planning must address the greater service volumes anticipated. The high prevalence of comorbidities requires intensive case management to address case complexity. These data will inform the refinement of the AHLO program to improve in-patient experiences and outcomes. What is known about the topic? The health gap between Aboriginal and non-Aboriginal Australians is well documented. Aboriginal people have significantly higher hospital utilisation rates, as well as higher rates of complications, comorbidities and discharges against medical advice (DAMA). Aboriginal patients receive most of their specialist services in hospital; however, detailed person-based analyses are limited and planning is often based on crude data. What does this paper add? This is the first analysis of linked data focusing on Aboriginal patient flows and volume and 28-day health system outcomes following hospital admission for all causes in a large metropolitan setting. Because the data were linked, admissions belonging to a single episode of care were combined, ensuring that transfers were not counted as re-admissions. Linkage also allowed follow up across time. The results highlight the main disease groups for which Aboriginal patients are admitted, how this varies by age and the high proportion of patients returning to (any) hospital within 28 days, either through EDs or as booked (pre-arranged) admissions. These data aid in the planning of hospital-based Aboriginal health liaison services. What are the implications for practitioners? The paper outlines the complexity with which many Aboriginal patients present to hospital and the risk of DAMA and re-admission. Clinical and organisational strategies can be put in place in hospitals to address these risks and ensure improved continuity of care with community-based primary health services. The Western Australian South Metropolitan Health Service is reviewing these data and will monitor the impact of the hospital-based AHLO program.
    Australian health review: a publication of the Australian Hospital Association 02/2015;
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    ABSTRACT: Objective The aim of the present study was to investigate how midwives are responding to the changed re-registration requirements; specifically the Recency of Practice (RoP) Standard. Methods A qualitative longitudinal case study used conversational interviews conducted annually at two time phases after the introduction of national registration. Results Findings reveal that confusion has created challenges in demonstration of the RoP standard. This confusion was evident at individual and organisational levels. Conclusions Professional bodies need to support staff in this transition by providing clearer guidance that exemplifies the Nursing and Midwifery Board of Australia expectations. What is known about the topic? Impact subsequent to Australian legislative and regulatory changes affecting midwifery and nursing registration has not been examined. What does this paper add? The findings of this study provide an insight into midwives' responses to the changed re-registration standard in Australia. What are the implications for practitioners? There appears to be a problem in the way tensions and challenges are being met; misinterpretation of the requirements has generated questions about the relationship between skills and work areas and demonstration of RoP. This may influence individual career planning and have broader workforce planning implications.
    Australian health review: a publication of the Australian Hospital Association 01/2015;
  • Australian health review: a publication of the Australian Hospital Association 01/2015; 39(1).
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    ABSTRACT: Objective To identify the attitudes, knowledge and practices regarding advance care planning (ACP) in palliative care. Methods A nationwide online survey was distributed to Australian palliative care services associated with the Palliative Care Outcomes Collaboration (n=105). Seventy-three health professionals (HPs) and 59 service managers completed the survey. Results Regarding ACP, 51% of service managers reported relevant policies and procedures were in place in their service and 44% included ACP in job descriptions. Most HPs were confident in undertaking ACP, including initiating discussions with patients and complying with documents; however, only 44% reported receiving ACP specific training. Although 58% of HPs reported having conversations about ACP with more than 11 patients in the past 6 months, only 44% of managers report that it is offered to most patients. Thirty per cent of HPs were aware of others not adhering to patient wishes in the past 6 months and only 43% of HPs (and 37% of managers) believed ACP is done well within their service. Conclusions This first national survey examining ACP in palliative care services demonstrates there is a need to improve systems to support ACP and to understand circumstances in which ACP wishes are not followed. What is known about the topic? ACP is increasingly recognised as an important part of care of people in hospital and community settings. However, currently there is no empirical evidence about the national uptake and quality of ACP in palliative care settings specifically. What does this paper add? This nationwide survey shows improvements on past small-scale research showing that ACP is supported by palliative care health professionals; however, the organisational ACP processes and systems did not support best practice in this regard. What are the implications for practitioners? Palliative care organisations should incorporate ACP systems (including greater access to ACP policies and guidelines) that support health professionals to complete ACP with clients who want to. Greater access to support, such as ACP training and resources, would assist with development of ACP documentation and adherence.
    Australian health review: a publication of the Australian Hospital Association 01/2015;
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    ABSTRACT: Objective To explore the health professionals' (HPs) perceptions and experiences of advance care directives (ACDs) and advance care planning in Australian palliative care services. Methods A nationwide survey of 105 palliative care services was conducted, with two HPs from each service invited to participate. A qualitative analysis of open responses about advance care planning was undertaken. Results Sixty questionnaires were returned with open responses. Most responders were nurses (75%), aged ?40 years (80%) and with a mean of 12 years palliative care experience. Data were grouped into four key themes: (1) the ACD; (2) the process of developing ACDs; (3) the process of using ACDs; and (4) the consequences of having ACDs. Participants were positive about advance care planning, commenting that ongoing communication about end-of-life care ensures mutual understanding between patients, family and HPs. Provision of care was considered easier and more efficient with an ACD in place. ACDs were perceived to reduce distrust and conflict between family, friends and HPs, and promote communication. Suboptimal documentation, clarity and explicitness limited the usefulness of ACDs when they were available. Conclusions Advance care planning benefits HPs, patients and their family. To maximise these benefits, ACDs need to be clear, comprehensive, medically relevant and transportable documents. What is known about the topic? Ideally, advance care planning encompasses the identification and documentation of a person's preferences for future medical treatments and care in preparation for an occasion when the person cannot express their values and wishes. The uptake and practice of advance care planning is inconsistent, and the extent to which it is used by health professionals and patients is variable. Many people are cared for at the end of life in specialist palliative care services, but the intersection between palliative care and advance care planning remains under-researched. What does this paper adds? ACDs facilitate communication and advance care planning; help establish trust between health professionals, patients and their families; and make multiple aspects of care easier for HPs. Processes surrounding ACDs, particularly inadequate documentation, limit adherence and application. What are the implications for practitioners? Clear communication is necessary for effective ACD development and application. The presence of an ACD makes communication and advance care planning easier, and improves trust between HPs, patients and their family. To be useful, ACDs must be clear, comprehensive, medically relevant, transportable documents.
    Australian health review: a publication of the Australian Hospital Association 01/2015;
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    ABSTRACT: Objective This paper analyses an organisational development project that aimed to change the organisational culture and improve people management systems and processes. The questions addressed were: was the change process a success; how was success defined; and what were the barriers to its progress? Methods We examined the process of change over a 3-year period. The organisational development intervention is described and analysed. Qualitative methods, including document review, in-depth interviews and focus groups, participant observation, newsletters and diary entries were used to gather the data. A variant of competing values was used to analyse the data. Results We sought to build trust with all managers and encouraged reflection by conducting feedback sessions, presentations, workshops and one-on-one and group discussions. A cross-site action group was established to encourage organisation-wide participation in the project. However, it was clear that stakeholders had different understandings and perceptions of the problems facing the organisation. The project faltered when a leadership development intervention was organised. Conclusions The existence of at least four different organisational 'worlds' and identities, according to different professional groupings with different goals, languages and values, was evident. The relationship between the researcher and subjects was key in terms of whether the researcher is seen as an 'expert' or as a 'facilitator'. In bringing about change, we need to work with the Chief Executive Officer in empowering others. Hence, the researchers need to engage in continual dialogue across boundaries and within groups as well as at individual levels to provide support for organisational change. What is known about the topic? Evidence suggests that change processes often fail, that success in one part of the organisation may not translate into organisation-level performance and that change may fail to deliver expected organisation-wide results. Fluctuating organisational expectations may render managers unable to understand the shifting world and the confusion, anxiety and stress that middle managers experience as part of the change process may impede decision making. What does this paper add? This paper reports on a single case study of an organisational development project in a rural health service in Australia. The contribution of this paper is in demonstrating the different worlds of each of the actors involved. Moreover, it shows that building relationships is key. What are the implications for practitioners? The relationship between the researcher and subjects is key in terms of whether the researcher is seen as an 'expert' or as a 'facilitator'. The researchers need to engage in continual dialogue across boundaries and within groups, as well as at individual levels, to provide support for organisational change. The research also demonstrates the importance of middle managers in facilitating communication between senior management and employees.
    Australian health review: a publication of the Australian Hospital Association 01/2015;
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    ABSTRACT: This paper describes the development and outcomes from 'joint working' between Prince of Wales Hospital and BD (Becton, Dickinson and Company) in Australia. 'Joint working' is a term used within the English National Health Service to describe health system and industry partners working together to create novel service models which benefit patients. The joint working process broadened the perspective of both parties through learning from each other and so enhanced the range of tools they each bring to their work. What is known about the topic? Collaboration between industry - specifically the pharmaceutical industry - and English National Health Service providers under the rubric "joint working" has been used successfully to pool skills, experience and/or resources for the joint development and implementation of patient centred projects. This process has required identification of the common interest of both parties and care to ensure the public interest is maintained. What does this paper add? Descriptions of collaboration between public hospital and private industry to deliver improved health outcomes have not been widely published. Joint working has not previously been described in the Australian context. This paper describes an experiment which addresses both of the gaps. What are the implications for practitioners? Opportunities may exist to improve patient outcomes through collaboration between public health providers and industry.
    Australian health review: a publication of the Australian Hospital Association 01/2015;
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    ABSTRACT: Objective The aim of the present study was to document the financial and psychosocial impact of relocation for specialist haematology treatment in Queensland. Methods This study was a qualitative exploratory study comprising 45 in-depth interviews with haematology patients supported by the Leukaemia Foundation of Queensland. Results The findings indicate that decentralisation of treatment is assisting haematology patients to overcome the profound difficulties associated with travelling to the metropolitan area for treatment. Conclusion Fostering specialist outreach and building capacity in regional cancer centres are service delivery strategies that are greatly appreciated by regional, rural and remote haematology patients who are stressed by the many challenges associated with leaving home to travel distances for specialist treatment. It is the hope and expectation that these findings will make a contribution to informing future health policy and service delivery planning. What is known about the topic? Internationally, there is evidence of the benefits of visiting specialists and the development of local specialist services for cancer patients in regional and rural areas, but there is limited research on the topic in Australia. What does this paper add? The findings herein make a contribution to this area of research through an up-to-date, in-depth consumer perspective on non-metropolitan oncology hospital services for haematology patients in Queensland. The evidence indicates that the opportunity to avoid travel to the metropolitan treating hospitals for regional, rural and remote haematology patients is increasingly an option in Queensland and greatly appreciated by many of those who have this option. What are the implications for practitioners? The findings applaud the work of the health professionals providing the opportunity for regional specialist care for haematology patients. With regard to service delivery and health policy decision making, it is important to note that for patients positive about access to local treatment, psychosocial concerns (e.g. remaining at home, connection with family, avoidance of financial hardship) predominate in their reasoning about benefit. Thus, it is important that regional, rural and remote patients are offered greater choice in treatment options and have more involvement in decision making about specialist care.
    Australian health review: a publication of the Australian Hospital Association 01/2015;
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    ABSTRACT: Objective Many of Australia's rural hospitals operate without an on-site pharmacist. In some, community pharmacists have sessional contracts to provide medication management services to inpatients. This paper discusses the funding arrangements of identified sessional employment models to raise awareness of options for other rural hospitals. Methods Semistructured one-on-one interviews were conducted with rural pharmacists with experience in a sessional employment role (n=8) or who were seeking sessional arrangements (n=4). Participants were identified via publicity and referrals. Interviews were conducted via telephone or Skype for ~40-55min each, recorded and analysed descriptively. Results A shortage of state funding and reliance on federal funding was reported. Pharmacists accredited to provide medication reviews claimed remuneration via these federal schemes; however, restrictive criteria limited their scope of services. Funds pooling to subsidise remuneration for the pharmacists was evident and arrangements with local community pharmacies provided business frameworks to support sessional services. Conclusion Participants were unaware of each other's models of practice, highlighting the need to share information and these findings. Several similarities existed, namely, pooling funds and use of federal medication review remuneration. Findings highlighted the need for a stable remuneration pathway and business model to enable wider implementation of sessional pharmacist models. What is known about the topic? Many rural hospitals lack an optimal workforce to provide comprehensive health services, including pharmaceutical services. One solution to address medication management shortfalls is employment of a local community pharmacist or consultant pharmacist on a sessional basis in the hospital. There is no known research into remuneration options for pharmacists providing sessional hospital services. What does this paper add? Viability of services and financial sustainability are paramount in rural healthcare. This paper describes and compares the mechanisms initiated independently by hospitals or pharmacists to meet the medication needs of rural hospital patients. Awareness of the funding arrangements provides options for health service providers to extend services to other rural communities. What are the implications for practitioners? Rural practitioners who identify unmet service needs may be inspired to explore funding arrangements successfully implemented by our participants. Innovative use of existing funding schemes has potential to create employment options for rural practitioners and increase provision of services in rural areas.
    Australian health review: a publication of the Australian Hospital Association 01/2015;
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    ABSTRACT: Objective To explore organisational factors and barriers contributing to limited uptake of antimicrobial stewardship (AMS) in Australian private hospitals and to determine solutions for AMS implementation. Methods A qualitative study using a series of focus group discussions was conducted in a large private hospital making use of a semistructured interview guide to facilitate discussion among clinical and non-clinical stakeholders. A thematic analysis using five sequential components that mapped and interpreted emergent themes surrounding AMS implementation was undertaken by a multidisciplinary team of researchers. Results Analysis revealed that autonomy of consultant specialists was perceived as being of greater significance in private hospitals compared with public hospitals. Use of an expert team providing antimicrobial prescribing advice and education without intruding on existing patient-specialist relationships was proposed by participants as an acceptable method of introducing AMS in private hospitals. There was more opportunity for nursing and pharmacist involvement, as well as empowering patients. Opportunities were identified for the hospital executive to market an AMS service as a feature that promoted excellence in patient care. Conclusions Provision of advice from experts, championing by clinical leaders, marketing by hospital executives and involving nurses, pharmacists and patients should be considered during implementation of AMS in private hospitals. What is known about the topic? Hospital-wide AMS programs have been shown to be an effective means to address the problem of accelerating antimicrobial resistance. However, current literature predominantly focuses on evaluation of AMS activities rather than on improving implementation success. In addition, most research on hospital AMS programs is from the public hospital sector. AMS is now part of new National Safety and Quality Health Service accreditation standards mandatory for all Australian hospitals; however, uptake of AMS in private hospitals lags behind public hospitals. Australian private hospitals are fundamentally different to public hospitals and there is more information needed to determine how AMS can best be introduced in these hospitals. What does this paper add? Further investigation on how AMS can be implemented into private hospitals is urgently required. The qualitative work detailed in the present study provides a means of tailoring AMS strategies on the basis of organisational factors that may be considered unique to Australian private hospitals. What are the implications for practitioners? Clinical and hospital executive stakeholders in the private hospital sector will be able to use solutions presented herein as a blueprint for designing sustainable AMS programs within their private healthcare facilities.
    Australian health review: a publication of the Australian Hospital Association 01/2015;
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    ABSTRACT: Objective To examine personal and social demographics, and rehabilitation discharge outcomes of dysvascular and non-vascular lower limb amputees. Methods In total, 425 lower limb amputation inpatient rehabilitation admissions (335 individuals) from 2005 to 2011 were examined. Admission and discharge descriptive statistics (frequency, percentages) were calculated and compared by aetiology. Results Participants were male (74%), aged 65 years (s.d. 14), born in Australia (72%), had predominantly dysvascular aetiology (80%) and a median length of stay 48 days (interquartile range (IQR): 25-76). Following amputation, 56% received prostheses for mobility, 21% (n=89) changed residence and 28% (n=116) required community services. Dysvascular amputees were older (mean 67 years, s.d. 12 vs 54 years, s.d. 16; Pz=3.61, Pz=4.52, Pvs 11%; Pvs 52%; P<0.001) and had a shorter length of stay (7 days, 95% confidence interval: -3 to 17), although this was not statistically significant. Conclusions Differences exist in social and demographic outcomes between dysvascular and non-vascular lower limb amputees. What is known about the topic? Lower limb amputation occurs due to various aetiologies. What does this paper add? Lower limb amputee rehabilitation over 7 years was investigated, comprising 425 admissions, 80% due to dysvascular aetiology. Personal and social demographics, and discharge outcomes are compared by aetiology. What are the implications for practitioners? Demographic and discharge outcome differences exist between dysvascular and non-vascular lower limb amputees. Twenty-one percent were required to change residence and 28% required additional social supports. Discharge planning should begin as soon as possible to limit time spent waiting for new accommodation or major modifications for current homes. Lower limb amputees are not homogeneous, so care should be taken if extrapolating from combined amputee aetiologies or from one aetiology to another.
    Australian health review: a publication of the Australian Hospital Association 01/2015;