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Objective: To demonstrate how decision-making can be made more efficacious in healthcare contexts, such as cancer care networks, by adopting relational leadership practices. Design: Empirical material was collected through video-recordings over a 12-month period of fifty-three meetings of seven cancer networks in Australia. Using an interpretive approach, analysis was conducted on the meeting conversations of service improvement subcommittees of the networks. Only one sub-committee was described as 'narrative rich' meaning, personal narratives or stories were evident in their conversations. The sub-committee is characterised as displaying elements of multi-ontology sense making. Drawing on the Cynefin framework, conversations were classified as simple, complicated, complex or crisis-based depending on the nature of their decisions and the contextual constraints. This allowed conversations to be tagged as examples of either single or multi-ontology sense making. Setting: Cancer networks in Australia tasked with the dilemma of enhancing multi-disciplinary cancer care. Main outcome: Relational leadership practices can generate narrative rich conversations in decisionmaking through enabling multi-ontology sense making. Results: Sufficient evidence was found to demonstrate that narrative rich conversations offered potentially new and innovative ideas for service improvement but lacking relational leadership practices, networks simply produced interventions that amounted to 'more of the same'. Conclusions: The ability to skilfully relate helps create contexts in which multi-ontology sense making can flourish. Skilful relating, as a leadership practice, is essential to making healthcare professionals more innovative and creative in how they deal with organisational dilemmas, allowing them to engage in robust, informed and inclusive decision-making processes. [ABSTRACT FROM AUTHOR]

Objective: To review the background of accreditation in healthcare. We examine the National Safety Quality Health Service (NSQHS) standards development and the perceptions of some of the NSQHS accredited accreditation providers in Australia. Design: An exploratory qualitative study in which the researchers use interviews and content comparison analysis to examine the Australian NSQHS standards (the Standards), the approving accrediting agencies and the perceived impact of the changes on the healthcare system. Setting: The researchers focus on providers' accreditation products and services, and how the Standards will impact on the Australian Healthcare system. Australia is not alone in undergoing reforms in accreditation and performance in healthcare. Other countries and international organisations have recently revised and renewed their interest in how healthcare systems perform. Outcome: This has led to the development of revised standards; quality and safety review frameworks; performance indicators for monitoring, assessing and managing healthcare systems to achieve effectiveness, equity, efficiency and quality. Measures: Analysis of qualitative data using the constant comparison method. Findings: Five major themes are found from in-depth interviews with accreditation program providers: the multiple levels of accreditation that are offered; the importance of assessor recruitment and training; the aspiration of service excellence; improved processes; and the importance of value versus price to those who are accredited by the participants of this study. Conclusions: The findings focus on optimisation of the regulatory environment to drive performance and quality in health facilities and the importance of the assessors, in what is expected to continue to be, a valuedriven accreditation market. [ABSTRACT FROM AUTHOR]

Increased scrutiny of healthcare in advanced economies has created an emphasis on the need to understand factors influencing quality and efficiency within the sector. In response to this situation, the Australian Council on Healthcare Standards' (ACHS) Evaluation and Quality Improvement Program (EQuIP) was established to foster quality and efficiency improvements through the identification and publicising of outstanding achievements in healthcare accreditation standards. A recent, major investigation has independently demonstrated that these outstanding achievements contribute to healthcare outcomes. Through conducting a qualitative content analysis of ACHS' EQuIP case studies presenting outstanding achievement, this research identified common factors that act as managerial and organisational drivers for achieving excellence. Four major relevant and overarching themes emerged - leadership, communication and culture; management, organisation and human resources; information and knowledge management; and outcomes - along with various sub-themes. This deeper level of analysis provides additional criteria and understanding for indicating outstanding achievement thereby providing stronger insight to EQuIP evaluation criteria and previous research. The findings demonstrate both the value of using an exploratory methodology and the inherent flexibility of EQuIP. Insights from this approach provide recognition of unanticipated and valuable healthcare innovations, offer initial guidance for healthcare organisations aiming to enhance their performance, and form the basis for future research and publications on outstanding achievement in healthcare [ABSTRACT FROM AUTHOR]

The motivation behind having brilliance as a focus for a project in healthcare is about trying to understand it, and from that, trying to find ways of spreading such understanding widely so that brilliance is more pervasive in health services. One member of the team commented that they had been referred to as running a brilliant team, and responded 'that if that was the case, how bad must the rest have been?' Sometimes it is not easy to see brilliance in what we do, let alone measure it, but on reflection we can remember times when the teamwork was just right, although we did not know it at the time, but now see it as having been a special time. Hugh B MacLeod of the Canadian Patient Safety Institute (CPSI) has been pivotal in inspiring this work, and some of his input is outlined. This paper describes more of the background and motivation behind the project as well as some of the potential ways in which the Health Management Research Alliance (HMRA) is investigating and going about this project. [ABSTRACT FROM AUTHOR]

This article focuses on a study related to the effect of experimental gonadectomy and reverse hormone substitution on hemorheological factors. Altered or lost gonad function may cause severe problems in hemostasis as well as in blood rheological factors. Gonadectomy and the consequential sex-hormone less state differentially affect the hemostaseological and hemorheological factors. Reverse hormone substitution causes larger disturbing effect on certain parameters, but not equivalently in males and females.