Medicine & Health

Publication Search Results

Now showing 1 - 10 of 18
  • (2012) Olivier, Jake; Walter, Scott; Grzebieta, Raphael
    Journal Article
    Since the 1991 enactment of mandatory helmet legislation (MHL) for cyclists in New South Wales (NSW), Australia, there has been extensive debate as to its effect on head injury rates at a population level. Many previous studies have focused on the impact of MHL around the time of enactment, while little has been done to examine the ongoing effects. We aimed to extend prior work by investigating long-term trends in cyclist head and arm injuries over the period 1991–2010. The counts of cyclists hospitalised with head or arm injuries were jointly modelled with log-linear regression. The simultaneous modelling of related injury mechanisms avoids the need for actual exposure data and accounts for the effects of changes in the cycling environment, cycling behaviour and general safety improvements. Models were run separately with population counts, bicycle imports, the average weekday counts of cyclists in Sydney CBD and cycling estimates from survey data as proxy exposures. Overall, arm injuries were higher than head injuries throughout the study period, consistent with previous post-MHL observations. The trends in the two injury groups also significantly diverged, such that the gap between rates increased with time. The results suggest that the initial observed benefit of MHL has been maintained over the ensuing decades. There is a notable additional safety benefit after 2006 that is associated with an increase in cycling infrastructure spending. This implies that the effect of MHL is ongoing and progress in cycling safety in NSW has and will continue to benefit from focusing on broader issues such as increasing cycling infrastructure.

  • (2012) Georgiou, Andrew; Vecellio, Elia; Toouli, George; Eigenstetter, Alex; Li, Ling; Wilson, Roger; Westbrook, Johanna
    This project aimed to assess the impact of electronic ordering systems, on the quality use of pathology services across six hospital sites and different pathology departments, for the following areas:- the legibility and completeness of laboratory test orders and the impact on Central Specimen Reception work processes (Quality of test orders). - the volume and mix of tests ordered examined by such factors as Diagnosis-related Groups (DRGs), adjusted for clinical activity where appropriate, and the prevalence of add-on and repeat testing (Effectiveness). - the timeliness of the pathology laboratory process (Turnaround time). - the impact of pathology performance (e.g., laboratory test turnaround times) on the duration of patient stay in the emergency department (Patient outcome).The project also produced a benefits realisation framework, made up of performance indicators, that can be used to guide the assessment of electronic ordering in a pathology service and to monitor what works (or doesn’t work), where, and in what circumstances. The project was funded by an Australian Government Department of Health and Ageing, Quality Use of Pathology Program grant.

  • (2013) Walter, Scott; Olivier, Jake; Churches, Tim; Grzebieta, Raphael
    Journal Article
    This article responds to criticisms made in a rejoinder (Accident Analysis and Prevention 2012, 45: 107–109) questioning the validity of a study on the impact of mandatory helmet legislation (MHL) for cyclists in New South Wales, Australia. We systematically address the criticisms through clarification of our methods, extension of the original analysis and discussion of new evidence on the population-level effects of MHL. Extensions of our analysis confirm the original conclusions that MHL had a beneficial effect on head injury rates over and above background trends and changes in cycling participation. The ongoing debate around MHL draws attention away from important ways in which both safety and participation can be improved through investment in well-connected cycling infrastructure, fostering consideration between road users, and adequate legal protection for vulnerable road users. These are the essential elements for providing a cycling environment that encourages participation, with all its health, economic and environmental benefits, while maximising safety.

  • (2017) Falster, Michael
    Preventable hospitalisations are used in Australia as a high-level indicator of health system performance, specifically the accessibility and quality of primary care. However, there are key gaps in understanding of how preventable hospitalisations relate to characteristics of patients and features of the health system, and surprisingly little evidence validating their use in Australia. In this thesis, new approaches to analysing longitudinal health data were applied to gain insights into the properties of this health performance indicator. This thesis used linked questionnaire and longitudinal health data for a cohort of over 267,000 participants in the 45 and Up Study, Australia, containing detailed information on participants and their use of health services. Temporal patterns in use of primary care and other health services around preventable hospitalisation were explored using a visualisation of unit record health data. Predictors of preventable hospitalisation were identified using multilevel Poisson regression models, with variation partitioned between person- and geographic-levels. Through development of novel weighted-hospital service area networks , variation was further partitioned to the hospital-level. Many patients admitted for preventable hospitalisation were found to have high levels of engagement with the health care system, both around the time of admission and compared to similar non-admitted patients. The supply of general practitioners explained only a small amount of geographic variation in preventable hospitalisation, while over one-third of variation was contributed by the sociodemographic and health characteristics of the population. Hospitals differed in their propensity to admit patients, with the greatest variability in smaller community hospitals, which account for a small proportion of admissions but contribute greatly to regional variation. These findings show the preventable hospitalisation indicator in Australia should not be interpreted simply as a measure of the accessibility and quality of primary care. They suggest the most appropriate policy responses are long-term strategies to promote healthy living and targeted local interventions to efficiently manage the current burden of chronically ill patients. The findings demonstrate why caution should be used when adopting international health performance indicators, but also the benefits of using novel approaches to derive new information from linked and longitudinal data.

  • (2014) Prgomet, Mirela
    The mobile and information intensive nature of clinical work in hospital settings presents a critical challenge: how to provide clinicians with access to information at the time and place of need? This challenge is particularly pertinent to decision-makers responsible for the selection of computing devices. Mobile devices are often promoted as a means to meet this challenge, with existing literature tending to portray the mobility of devices as inherently beneficial. However, evidence to clearly demonstrate how mobile devices support clinical work is limited. This research aimed to generate new knowledge to contribute to answering two significant questions: (i) how do decision-makers select computing devices? and (ii) how do mobile devices support clinical work practices? The research was conducted in two stages. In stage one, interviews were conducted with 28 individuals involved in decisions regarding the selection of computing devices for hospital wards. Decision-makers reported a range of factors that influenced device selection. Role of the user, types of tasks, and location of tasks, for example, were deemed important. In stage two, a mixed methods design comprising structured observations, interviews, and field notes was employed. A sample of 38 clinicians, on two wards of a metropolitan hospital, was observed for 90 hours. In total 4,423 clinical tasks were recorded, capturing key information about tasks doctors and nurses undertake, where, and devices used. The findings provide evidence validating core assumptions about mobile devices: namely, that they support clinicians work by facilitating access to information at patients bedsides. Notably, mobile devices also supported work away from the bedside and whilst clinicians were in transit, allowing continuity in work processes. However, mobile devices did not provide the best fit for all tasks and additional factors, such as the temporal rhythms of the ward and structure of ward round teams, affected how mobile devices supported work. Integration of findings from the two stages resulted in the development of a detailed list of factors that influence the use of mobile devices on hospital wards. This new evidence provides valuable knowledge to guide the selection of computing devices to support, and potentially optimise, clinical work.

  • (2014) Debono, Deborah
    Background: Electronic medication management systems (EMMS) aim to reduce medication errors. Rather than use them as prescribed by policy, nurses commonly employ workarounds. EMMS-related workarounds have been attributed to a mismatch between introduced technology and nurses’ workflow. Comparatively little attention has been focused on examining nurses’ enactment, explanations and experiences of using workarounds. This is a significant lacuna because nurses’ contextual rationalisation is integral, I will argue, to understanding their use of workarounds. Aims: To improve our knowledge and understanding of nurses’ use of workarounds with EMMS in order to inform policy and technology development. Methods: A qualitative study was conducted in four phases: scoping and process mapping; data collection and analysis; explanatory framework generation and member checking; and interpretation of emergent findings using existing sociological theory. The study sampled EMMS implementation stakeholders and nurses across all shifts and days of the week, from six wards in two Australian hospitals, representing two EMMS types and two models of nursing care. Data collection methods included observations, interviews and focus groups. Data analysis used a general inductive approach in which data were coded for emerging themes, framed by the research questions. Results: While sometimes EMMS related problems offered the best explanation for workarounds, nurses used workarounds largely to circumvent perceived barriers to being, or being perceived to be, a ‘good nurse’ in the sense of being time-efficient, safe, patient-centred and/or a team player. Whether nurses used workarounds, and how they felt about doing so, was moderated by a number of contextual factors. The use of workarounds provoked a range of emotions, in particular, feelings of tension. Interpretation: Nurses were motivated to use workarounds, even when doing so made them professionally vulnerable, primarily by the desire to be, or be perceived to be, a ‘good nurse'. Bourdieu’s concepts of habitus, field and capital offered useful constructs to interpret the intensity and complexity of the drivers of workarounds. Conclusion: Technology and policy designers need to be cognisant of creating potential barriers to being a ‘good nurse'. Unless they do so, problematic workarounds will continue unabated, and potentially useful workarounds will remain ‘underground’.

  • (2012) Low, Lena
    This thesis examines the role of medical clinician surveyors (MC surveyors) working in the hospital-based health care accreditation arena. The thesis examines their motivations for participating in accreditation, the issues that influence them during the survey process, and the ways in which they deal with the influences to facilitate a reliable and credible survey outcome. The study is an evidence-based examination of MC surveyors working for the Australian Council on Healthcare Standards (ACHS), the dominant accreditation agency for public and private hospitals in Australia. There is limited research and empirical evidence as to the benefits of accreditation and improved service quality, despite the significance of accreditation for hospitals and the resources expended on it. The research consisted of three distinct stages: a questionnaire which examined the motivations for MC surveyors participating in accreditation; interviews which looked at the scale and scope of influences on MC surveyors during the accreditation survey process; and a case study approach which assessed how MCs and other surveyors dealt with the influences. The large amount of data generated was analysed utilising a range of social science methods. The findings corroborate and augment past research into the motivations for MC surveyors participating in accreditation, and extend existing knowledge considerably. These motivations included participants perceptions that accreditation facilitated improvement of quality in the health system and within their own organisation, and provided an external perspective and the opportunity to benchmark and share ideas. Furthermore, participants considered accreditation assisted in their professional development, supported professional networking, augmented their prestige, and increased their influence and respect whilst being an enjoyable experience. The research identified fourteen interrelated factors that influence the survey process and potentially, the accreditation outcome. It found that MC surveyors were acutely aware of the need to be objective in their surveying and furthermore were conscious of the difficulty in attaining objectivity. It also provided evidence supporting MC involvement in the accreditation process and reported a positive view of accreditation. In addition, it highlighted the characteristics of the accreditation process that MC surveyors consider benefits health care as well as leading to a more reliable and credible accreditation outcome.

  • (2012) Milne, Jacqueline
    This study explored Junior Medical Officers' (JMOs), particularly international medical graduates' (IMGs) understanding of interprofessional practice (IPP) and its links to patient safety. It investigated their willingness to practise interprofessionally and identified factors inhibiting collaborative IPP. The links between IPP and patient safety are established. Evidence supports the benefits of health professionals working collaboratively for enhanced patient outcomes. Hospital environments are complex with proliferating professional and departmental cultures. Patients are managed by a multiplicity of health professionals. We know that to practise interprofessionally challenges the territorial traditions of health professionals. An understanding of IPP and a preparedness to put patient interests before professional self interests are fundamental to realising improved patient safety. There are difficulties associated with transformation to a collaborative approach to patient care. Paradoxically, overcoming cultural boundaries between interdependent health professionals is one prerequisite for practising interprofessionally. This thesis contributes to our knowledge about junior doctors' perceptions of IPP in teaching hospitals and organisational factors challenging their interprofessional functioning. It reveals compromised intraprofessional practice linked to the hierarchical culture of hospital doctors. A triangulated method comprising semi-structured interviews, a survey questionnaire and ethnographic observations was employed for the research. Thirty two international and Australian medical graduates (IMGs and AMGs) from three Australian teaching hospitals participated. Four themes framed the study: culture, communication, collaboration and competency. The findings highlight diversity in the cultures and medical training of JMOs. Participants' experience of shared learning was minimal, limiting their proclivity to IPP in postgraduate training. JMOs' willingness to embrace IPP is overshadowed by the challenges of adapting to different cultures within hospitals, understanding other health professionals' roles, and working with inadequate support and supervision. Mutual respect and communication are lacking, both intraprofessionally and interprofessionally. Excessive demands, bounded professional cultures and uncompromising hospital organisational cultures impede IPP. The findings can be applied to other comparable settings and individual issues such as supervision, explored in further research.

  • (2013) Hogden, Anne
    Motor neurone disease (MND), also known as amyotrophic lateral sclerosis, presents many challenges to patient and carer engagement in decision-making. A progressive and terminal multisystem disorder without a cure, MND care focuses on symptom management and quality of life, as patients and families attempt to come to terms with the diagnosis. In addition to physical deterioration, the cognitive, communication and behavioural abilities of many patients are affected. Care is delivered in specialised multidisciplinary clinic settings, creating decision-rich environments in which to test normative models of patient-centric decision-making. As patients continually face care decisions, few options are available to slow disease progression or extend survival time. Family carers are extensively involved in patient care, yet the decision-making relationships between MND health professionals, patients and their carers are undefined. Models of decision-making used in cancer and chronic disease care have limited applicability to MND care. Patients use a cyclic process of adaptation to their rapidly changing needs. The available treatment choices are often ethically and culturally complex, and may be time-constrained. While patient choices are well documented, little is known about the underlying factors influencing their decisions. This study addresses two research questions. The first asks: what are the influences on patient decision-making in MND multidisciplinary care? The second question is: how is patient-centred decision-making is delivered in MND multidisciplinary care? The thesis contributes insight into the underlying aspects of decision-making, and their implications for delivering patient-centred, collaborative and evidence-based care. Qualitative methods were used to examine factors influencing patient-centred decision-making. Fifty-four respondents from two specialised MND multidisciplinary clinics participated in semi-structured interviews. These were 32 health professionals, 14 patients and eight carers. The views of each group were analysed separately, and then combined to provide a comprehensive picture of MND patient-centred decision-making. Thematic analysis revealed broad agreement between the groups on key factors influencing patient-centred decision-making. These were: the decision-making process; patient-centred focus; timing and planning; information sources; engagement with specialised ALS services; and access to non-specialised services. Specialised MND multidisciplinary clinics offered an optimal setting for decision-making. The roles and expectations of stakeholders influenced the decision-making process, while psychosocial factors and continually changing symptoms impacted on patients capacity to participate. Issues of timing of evidence-based care delivery and the role of carers were contentious. Patient-centred decision-making is a complex and cyclical process, with health professionals, patients and carers collaborating to form a decision-making triad. A four-stage triadic model, embedded in the specialised MND multidisciplinary clinic environment, was derived from the data. The first stage, Patient Engagement , identifies the participants and establishes their values, preferences and expectations. In stage two, Option Information , information and guidelines on the available management options are determined, including the optimal timing for implementation of each choice. During the third stage, Deliberation , patients weigh up the risks and benefits, and decide between proceeding with an option, deferring their decision, or choosing to do nothing. The final stage, Implementation , results once an option is chosen. The model captures the complexities of MND patient-centred decision-making and offers a framework for health professionals, researchers and policy makers in this challenging environment.

  • (2013) Pereira, David Joseph
    How does Human Resource Management (HRM) contribute to organisations and their functioning? What is the relationship between HRM, teamwork and clinical performance? We know that organisations deploy Human Resources (HR) departments and initiate HRM with the express purpose of improving performance, yet little is known about their associations, especially in the healthcare setting. HRM is essentially a black box which needs to be understood, thereby informing organisations on how to maximise the benefits of the HR function. This thesis contributes to this deficit in knowledge, examining team characteristics, job satisfaction and clinical performance and how these relate to HRM policy and practice. Specifically, it investigates the links between aspects of HRM with teamwork and performance. A mixed method cross sectional study was conducted focusing on full service category rehabilitation services from public hospitals in Australia. This setting was selected for investigation because of the strong teamwork orientation and the lack of research comprehensively evaluating the contribution of HRM in this medical field. A total of 163 participants, comprising 152 rehabilitation clinicians and 11 managerial staff from seven hospitals were enrolled. A semi-structured questionnaire was administered to clinicians to determine their individual and team characteristics. Two measures of team performance were employed, namely: self reported job satisfaction, and compliance with clinical indicators defined by the Australian Council of Healthcare Standards. Twenty four focus groups and 18 interviews were conducted with clinicians and HR managers to investigate HRM policy and practice. Quantitative input from survey and clinical indicator data were analysed using descriptive and inferential statistics while qualitative data from focus groups and interviews were thematically analysed. The results show that a holistic approach to HRM is related to teamwork and facets of performance. Influenced by local context, HRM has the potential to either positively or negatively affect teamwork, job satisfaction and clinical performance. HRM s links to teamwork and performance were found to be significantly mediated by elements of efficiency, effectiveness, change, structure, service constraints, leadership, staffing, specialisation and research. The tailoring of HRM approaches to take account of local organisational circumstances could contribute positively to desirable teamwork and performance outcomes.