Louise A Ellis

• PhD (Psychology)
• Research Associate at Macquarie University

Objectives Quality Improvement (QI) and Implementation Science (IS) are both frequently utilised in health research. Little is known about how they are integrated within studies, and whether combined they add value. This systematic review sought to investigate how QI and IS theories and strategies are integrated within healthcare-based studies. Me...

Introduction Continuous quality improvement (CQI) initiatives are commonly used to enhance patient safety and quality of care. A novel South Australian Local Health Network (SALHN) Continuous Improvement Program (CIP009) has integrated a top-down model of executive-directed change initiatives, with a bottom-up approach of clinician designed interve...

Introduction Since being introduced by the Institute of Medicine (IoM) in 2007, the learning health system (LHS) concept has gained traction as a promising solution for achieving systems‐level healthcare transformation. This review of the LHS literature consolidates current understanding of LHS definitions, models, frameworks, and underlying theory...

Health systems must solve two climate-related problems simultaneously: mitigate their greenhouse gas emissions and adapt to additional patient loads associated with climate-induced demands for care from weather sequalae and vector-borne diseases. We aimed to benchmark the mitigation and adaptive efforts of OECD member countries compared with their...

Background Commercially run direct-to-consumer (DTC) telemedicine services are on the rise in countries such as Australia and the United States. These include DTC services that are web-based, largely asynchronous, and offer targeted treatment pathways for specific health issues (eg, weight loss or sexual function). It has been argued that DTC telem...

The workplace is an important setting for improving population psychological health. This study aimed to identify priority industries and populations in Australia with highest adverse effects of psychological distress. The study included 5834 workers aged 18 to 64 years who participated in the 2020 to 2021 National Health Survey. Logistic regressio...

Rationale Telehealth has been consistently viewed as a viable solution for addressing healthcare inaccessibility and mitigating the impact of health workforce shortages in rural areas. However, despite high utilisation in rural areas, little is known about the unintended consequences of telehealth in terms of unexpected benefits and drawbacks. Aim...

Background Though an important component of high‐quality healthcare, the routine collection of patient experience data is limited in primary care, as is the evidence for how this data is being used for quality improvement. This study used a learning health system (LHS) framework to describe how a university‐affiliated community general practice is...

The involvement of service–users, clinicians, and other health service end–users is recognised as an essential part of health and medical research. This collaborative approach can significantly contribute to methodological advancements including the development of research instruments and measures that ensure their suitability for research particip...

Background Applied research using co‐creation methods is rarely described or evaluated in detail. Practical evidence of co‐creation processes and collaboration effectiveness is needed to better understand its complex and dynamic nature. Methods Using a case study design and survey method, we assessed processes of co‐implementation and co‐evaluatio...

Background and objectives: This study comprehensively reviews the contemporary empirical literature on direct-to-consumer (DTC) telemedicine services within primary care. Method: MEDLINE, Embase and SCOPUS were strategically searched and screened. Data on the modality of consultations, population of focus, condition of focus and treatment of foc...

Introduction Implementation science focuses on improving the dissemination, uptake and adoption of evidence into practice. Over the last decade, implementation science research has proliferated, particularly in healthcare and social science. The key synthesis of implementation frameworks conducted by Meyers and colleagues in 2012, and the resulting...

Background Staff in health systems everywhere have exhibited flexibility and a capacity for improvisations during, and in response to, the COVID-19 pandemic. Looking to other examples of such resilient behaviours outside of those induced by the pandemic is instructive for those involved with researching or understanding change, or making health sys...

Introduction The COVID‐19 pandemic challenged primary care to rapidly innovate. In response, the Western Victorian Primary Health Network (WVPHN) developed a COVID‐19 online Community of Practice comprising general practitioners (GPs), practice nurses, pharmacists, aged care and disability workers, health administrators, public health experts, medi...

Introduction The quality and safety of care within residential aged care facilities (RACFs) have been linked to their organisational culture. However, evidence for understanding and improving culture in this setting is limited. This research programme aims to validate a survey to measure organisational culture and determine the relationship of cult...

Background Despite more than 2 decades of telehealth use in Australia and the rapid uptake during the COVID-19 pandemic, little is known about its unintended consequences beyond its planned and intended outcomes. Objective The aim of this review was to synthesize evidence on the unintended consequences of telehealth use in Australia to clarify its...

Background An essential component of future-proofing health systems against future pandemics and climate change is strengthening the front lines of care: principally, emergency departments and primary care settings. To achieve this, these settings can adopt learning health system (LHS) principles, integrating data, evidence, and experience to conti...

Introduction Industry-based intermediaries (including trade associations, peak bodies, professional associations, and unions), play a key role in improving occupational health and safety standards. While action from these groups to improve mental health has accelerated, these activities have not been systematically collated or evaluated. We aim to...

Background The learning health system (LHS) concept is a potential solution to the challenges currently faced by primary care. There are few descriptions of the barriers and facilitators to achieving an LHS in general practice, and even fewer that are underpinned by implementation science. This study aimed to describe the barriers and facilitators...

Introduction Continuous quality improvement (CQI) initiatives are commonly used to enhance patient safety and quality of care. A novel South Australian Local Health Network (SALHN) Continuous Improvement Program (CIP009) has integrated a top-down model of executive-directed change initiatives, with a bottom-up approach of clinician designed interve...

Background Gestational diabetes mellitus (GDM) affects a significant and growing proportion of pregnant women each year. The condition entails additional monitoring, self‐management and healthcare use during pregnancy, and some women also join GDM support groups on Facebook. Little is known about the practices inside these groups, but examining the...

Background In the past, evidence-based medicine (EBM) and shared decision-making (SDM) have been taught separately in health sciences and medical education. However, recognition is increasing of the importance of EBM training that includes SDM, whereby practitioners incorporate all steps of EBM, including person-centered decision-making using SDM....

Background Keeping best practice guidelines up-to-date with rapidly emerging research evidence is challenging. ‘Living guidelines’ approaches enable continual incorporation of new research, assisting healthcare professionals to apply the latest evidence to their clinical practice. However, information about how living guidelines are developed, main...

Background Pandemics and climate change each challenge health systems through increasing numbers and new types of patients. To adapt to these challenges, leading health systems have embraced a Learning Health System (LHS) approach, aiming to increase the efficiency with which data is translated into actionable knowledge. This rapid review sought to...

A resilient healthcare system is key to responding to sudden crises, such as the coronavirus disease 2019 (COVID‐19) pandemic. Homecare services have been an important platform of healthcare delivery during the pandemic, and healthcare staff on the frontlines of homecare have been confronted with major challenges requiring adaptation to sustain hig...

Objective Clinician’s experiences of providing care are identified as a key outcome associated with value-based healthcare (VBHC). In contrast to patient-reported experience measures, measurement tools to capture clinician’s experiences in relation to VBHC initiatives have received limited attention to date. Progressing from an initial 18-item clin...

Background Care delivery for the increasing number of people presenting at hospital emergency departments (EDs) with mental illness is a challenging issue. This review aimed to synthesise the research evidence associated with strategies used to improve ED care delivery outcomes, experience, and performance for adults presenting with mental illness....

BACKGROUND Despite more than 2 decades of telehealth use in Australia and the rapid uptake during the COVID-19 pandemic, little is known about its unintended consequences beyond its planned and intended outcomes. OBJECTIVE The aim of this review was to synthesize evidence on the unintended consequences of telehealth use in Australia to clarify its...

Background The prevalence of gestational diabetes mellitus (GDM) has drastically risen in recent years. For some, self-management includes the use of GDM online communities on Facebook. Such communities can fill gaps in information and support that participants are not able to access elsewhere to address unmet needs. Given the popularity of sharing...

Background As global CO 2 emissions continue to rise and the ‘era of global boiling’ takes hold, the health workforce must cope with the challenge of providing care to increasing numbers of patients affected by climate change‐related events (e.g., hurricanes, wildfires, floods). In this review, we describe the impacts of these events on the health...

Background Health care professionals play a central role in offering reproductive genetic carrier screening but face challenges when integrating the offer into practice. The aim of this study was to design, execute, and evaluate theory-informed implementation strategies to support health care professionals in offering carrier screening. Methods An...

As an alternative model of delivery to standard care, telehealth offers a promising solution to health access issues faced by rural and remote communities in Australia and worldwide. However, research typically focuses on its expected benefits and pitfalls, with little to no consideration of its unintended consequences and factors influencing its b...

Objective To identify barriers and facilitators associated with the sustainability of implemented and evaluated improvement programs in healthcare delivery systems. Data sources and study setting Six academic databases were searched to identify relevant peer-reviewed journal articles published in English between July 2011 and June 2022. Studies we...

Objective This research uses Australian survey data to identify industries with high rates of psychological distress, and to estimate productivity impacts in the form of work loss and cutback days. Methods Analyzing cross‐sectional data from the 2017/2018 National Health Survey, industry prevalence of psychological distress (Kessler Screening Scal...

Background: There is a worldwide concern regarding young people’s mental health and the complexities of designing mental health services to meet these challenges. By integrating user knowledge in the design of mental health services, the services will be better suited to meet the distinctive requirements of youth, as well as uphold their entitlemen...

Background Evidence suggests that the culture of healthcare organisations, including residential aged care facilities (RACFs), is linked to the quality of care offered. The number of people living in RACFs has increased globally, and in turn, attention has been placed on care quality. This review aimed to identify how organisational culture is stud...

Background The COVID-19 pandemic has presented many multi-faceted challenges to the maintenance of service quality and safety, highlighting the need for resilient and responsive healthcare systems more than ever before. This review examined empirical investigations of Resilient Health Care (RHC) in response to the COVID-19 pandemic with the aim to:...

Introduction Addressing clinical variation in elective surgery is challenging. A key issue is how to gain consensus between largely autonomous clinicians. Understanding how the consensus process works to develop and implement perioperative pathways and the impact of these pathways on reducing clinical variation can provide important insights into t...

Background: One of the most difficult challenges in healthcare involves equitable allocation of resources. Our review aimed to identify international funding models in Organisation for Economic Co-operation and Development (OECD) countries for government-funded public hospitals and evidence underpinning their efficacy, via review of the peer-revie...

Background Resilience, the capacity to adapt and respond to challenges and disturbances, is now considered fundamental to understanding how healthcare systems maintain required levels of performance across varying conditions. Limited research has examined healthcare resilience in the context of implementing healthcare improvement programs across mu...

Background: Widespread adoption of digital tools and technologies now support the delivery of virtual healthcare. Although, consumer engagement is central to care processes in virtual care models, there is paucity of evidence regarding the nature and outcomes of consumer engagement. This study aimed to determine the nature of consumer engagement u...

Background Digital triage tools such as telephone advice and online symptom checkers are now commonplace in health systems internationally. Research has focused on consumers’ adherence to advice, health outcomes, satisfaction, and the degree to which these services manage demand for general practice or emergency departments. Such studies have had m...

Background Theories of learning are of clear importance to resilience in healthcare since the ability to successfully adapt and improve patient care is closely linked to the ability to understand what happens and why. Learning from both positive and negative events is crucial. While several tools and approaches for learning from adverse events have...

RECEIVED May ACCEPTED May PUBLISHED June CITATION Ellis LA, Falkland E, Hibbert P, Wiig S, Ree E, Schultz TJ, Pirone C and Braithwaite J () Issues and complexities in safety culture assessment in healthcare.

The concept of safety culture in healthcare—a culture that enables staff and patients to be free from harm—is characterized by complexity, multifacetedness, and indefinability. Over the years, disparate and unclear definitions have resulted in a proliferation of measurement tools, with lack of consensus on how safety culture can be best measured an...

Background: NHS 111 online offers 24-hour access to health assessment and triage. Objectives: This study examined pathways to care, differential access and use, and workforce impacts of NHS 111 online. This study compared NHS 111 with Healthdirect (Haymarket, Australia) virtual triage. Design: Interviews with 80 staff and stakeholders in Engli...

BACKGROUND The prevalence of gestational diabetes mellitus (GDM) has drastically risen in recent years. For some, self-management includes the use of GDM online communities on Facebook. Such communities can fill gaps in information and support that participants are not able to access elsewhere to address unmet needs. Given the popularity of sharing...

Background Evidence suggests that the culture of healthcare organisations, including residential aged care facilities (RACFs), is linked to the quality of care offered. The number of people living in RACFs has increased globally, and in turn, attention has been placed on the quality of care provided. This review aimed to identify how organisational...

Objectives: Organisational culture is increasingly recognised as influencing the quality of care provided to patients and residents of aged care, both in research and in policy. For example, investigations into quality and safety issues in health care frequently highlight cultural problems, but often without adequate theorisation of culture. This...

Objective To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals. Design Umbrella review. Setting Interventions delivered inside and outside of acute care settings. Participants Children and adults with one or more identified acute or chronic health conditions. Data sou...

Background Preventative healthcare is crucial for improving individual patient outcomes and is integral to sustainable health systems. The effectiveness of prevention programs is enhanced by activated populations who are capable of managing their own health and are proactive to keep themselves well. However, little is known about the level of activ...

Background Hospital organizational change can be a challenging time, especially when staff do not feel informed and ready for the change to come. A supportive workplace culture can mitigate the negative effects allowing for a smooth transition during hospital organizational change. In this paper, we test an exploratory path model by which teamwork...

Background: Social media platforms are frequently used by the general public to access health information, including information relating to complementary and alternative medicine (CAM). The aim of this study was to measure how often naturopathic influencers make evidence-informed recommendations on Instagram, and to examine associations between th...

Background Changes to hospital infrastructure are inevitable in ever-evolving healthcare systems. The redevelopment of hospitals and opening of new buildings can be a complex and challenging time for staff as they must find ways to deliver safe and high-quality care while navigating the complexities and uncertainties of change. This study explores...

Objectives To explore a macrolevel Learning Health System (LHS) and examine if an intentionally designed network can foster a collaborative learning community over time. The secondary aim was to demonstrate the application of social network research to the field of LHS. Design Two longitudinal online questionnaires of the Australian Genomics learn...

Introduction Safe spaces are an alternative to emergency departments, which are often unable to provide optimum care for people experiencing emotional distress and/or suicidal crisis. At present, there are several different safe space models being trialled in Australia. However, research examining the effectiveness of safe space models, especially...

Objectives Safety culture questionnaires are widely used in healthcare to understand how staff feel at work, their attitudes and views, and the influence this has on safe and high-quality patient care. A known challenge of safety culture questionnaires is achieving high response rates to enhance reliability and validity. This review examines predic...

Background Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study ai...

Background Gestational diabetes mellitus (GDM) is a condition associated with pregnancy that engenders additional healthcare demand. A growing body of research includes empirical studies focused on pregnant women’s GDM healthcare experiences. The aim of this scoping review is to map findings, highlight gaps and investigate the way research has been...

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Background Signs of disorder in neighbourhoods (e.g., litter, graffiti) are thought to influence the behaviour of residents, potentially leading to violations of rules and petty criminal behaviour. Recently, these premises have been applied to the hospital context, with physical and social disorder found to have a negative association with patient...

Background: Gestational diabetes mellitus (GDM) is a condition associated with pregnancy that engenders additional healthcare demand. A growing body of research includes empirical studies focused on pregnant women’s GDM healthcare experiences. The aim of this scoping review is to map findings, highlight gaps and investigate the way research has bee...

The Australian Health Consumer Sentiment Survey is a population-based study of health consumer sentiment and provides an important barometer of satisfaction and opinions about the Australian health system. The survey was co-designed by academics and researchers from Macquarie University together with health consumer advocates and consumer-researche...

Introduction Mental health services are fragmented in Australia leading to a priority being placed on whole-of-community approaches and integration. We describe the LifeSpan suicide prevention intervention developed by the Black Dog Institute that draws upon nine evidence-based community-wide strategies. We examined the suicide prevention Collabora...

Background Emerging adulthood is a distinct segment of an individual’s life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comp...

Background: The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, el...

Background Hospitals are perceived as fast-paced and complex environments in which a missed or incorrect diagnosis or misread chart has the potential to lead to patient harm. However, to date, limited attention has been paid to studying how hospital sociotemporal norms may be associated with staff wellbeing or patient safety. The aim of this study...

BACKGROUND The development and adoption of a Learning Health System (LHS) has been proposed as a means to address key challenges facing current and future healthcare systems. The first review of the LHS literature was conducted five years ago, identifying only a small number of published articles had empirically examined the implementation or testi...

Background: The development and adoption of a learning health system (LHS) has been proposed as a means to address key challenges facing current and future health care systems. The first review of the LHS literature was conducted 5 years ago, identifying only a small number of published papers that had empirically examined the implementation or te...

Objective The aim of this study is to examine the pathways by which work–life balance influences safety climate in hospital settings. Design A national cross-sectional survey on patient safety culture. Settings Healthcare workers from 56 hospitals in Taiwan, covering three work settings: intensive care units, operation rooms and emergency departm...

Assessments of organisational cultures in Australian public hospitals are required by national standards. However, detailed guidance on how to evaluate organisational cultures is currently lacking. Here, Churruca et al. examine public sector surveys used in public hospitals to assess organisational cultures. A thematic analysis of 597 items from se...

Pomare et al. take the theoretical lens of “work-as-imagined” versus “work-as-done” to examine the misalignment between policy and staff experiences during an Australian multimillion-dollar hospital redevelopment. Despite the “good news story” of allocating billions of dollars to redeveloping and modernising health services in Australia, this chapt...