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Objective: This study explored the experiences, concerns and perceptions of hospital clinical staff returning to work after parental leave during the COVID-19 pandemic. Methods: An exploratory mixed-methods study was performed. Eligible staff employed at a large metropolitan tertiary health service in Melbourne, Australia, completed an ethics-approved anonymous online cross-sectional survey and/or participated in an interview between February and June 2021. Results: Ninety-six staff completed a survey and four participated in an interview. Staff reported both positive and negative aspects of being on parental leave during the COVID-19 pandemic including disappointment their leave had not gone as planned; feeling isolated from family and friends; wanting greater communication from their health service; appreciating the increased opportunities for them and their partner to be at home and bond with their baby; and concerns about returning to work such as limited knowledge of COVID-19 workplace policies and potentially infecting their baby and family. Conclusions: The COVID-19 pandemic had a unique impact on the parental leave and return to work experiences of hospital clinical staff. The findings suggest that staff would benefit from formal return to work policies and programs including regular contact with their manager while on parental leave and workplace reorientation on their return, especially during events such as a pandemic. What is known about the topic? Healthcare workers often experience additional challenges and stressors returning to work after parental leave compared to other workers. What does this paper add? The COVID-19 pandemic had a unique impact on the parental leave and return to work experiences of healthcare workers who reported positive and negative aspects including isolation, limited workplace communication and increased opportunities for bonding with their baby. What are the implications for practitioners? Appropriate organisational initiatives may alleviate staff distress and support their return to work and could include formal return to work programs, regular managerial contact and workplace reorientation. [ABSTRACT FROM AUTHOR]

Objective: This study gathered information from public hospital chief medical officers to better understand underlying mechanisms through which public reporting affects institutional behavioural change and decision making towards quality improvement. Methods: This qualitative study used thematic analysis of 17 semistructured, in-depth interviews among a peak group of medical directors representing 26 health services in Victoria, Australia. Results: The medical directors indicated a high level of in-principle support for public reporting of identifiable, individual clinician-level data. However, they also described varying conceptual understanding of what public reporting of performance data is. Overall, they considered public reporting of individual clinicians' performance data a means to improve health care quality, increase transparency and inform consumer healthcare decision making. Most identified caveats that would need to be met before such data should be publicly released, in particular the need to resolve issues around data quality and timeliness, context and interpretation and ethics. Acknowledgement of the public's right to access individual clinician-level data was at odds with some medical directors' belief that such reporting may diminish trust between clinicians and their employers, thus eroding rather than motivating quality improvement. Conclusions: Public reporting of identifiable individual healthcare clinicians' performance data is an issue that merits robust research and debate given the effects such reporting may have on doctors and on hospital quality and safety. What is known about the topic?: The public reporting of individual clinician-level data is a mechanism used in some countries, but not in Australia, for increasing health care transparency and quality. Clinician-level public reporting of doctors' performance attracts contention and debate in Australia. What does this paper add?: This paper informs debate around the public reporting of individual clinician-level performance data. Among a discrete cohort of senior hospital administrators in Victoria, Australia, there was strong in-principle support for such public reporting as a means to improve hospital quality and safety. What are the implications for practitioners?: Before public reporting of individual clinician performance data could occur in Australia, resolution of issues would be required relating to legality and ethics, data context and interpretation, data quality and timeliness. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the acceptability of a novel, integrated general practitioner (GP)–paediatrician model of care, aiming to reduce referrals to hospitals and improve primary care quality. Methods: A pre-post study was conducted with five general practice clinics in north-west Melbourne. Over 12 months, 49 GPs and 896 families participated in the intervention that included weekly to fortnightly paediatrician–GP co-consultation sessions at the general practice, monthly case discussions and telephone or email clinical support for GPs. GPs and families completed surveys or interviews at three time points (before the intervention, after running the model for 4 months and at the end of the implementation). Non-identifiable consultation data were extracted from general practice medical records. Results: All GPs found the model acceptable. Although not significant, there was a trend towards a lower proportion of referrals to private paediatricians after the intervention (from 34% to 20%) and emergency departments (from 19% to 12%). Outpatient clinic referrals remained steady, and then increased as the paediatrician left the clinics (31% vs 47% before and after the intervention respectively). Unnecessary prescribing of acid suppression medications decreased by 20% (from 29% to 9%). GPs reported improved confidence in paediatric care (88% vs 100% before and after the intervention respectively). Families reported increased confidence in GP care (78% vs 94% before and after the intervention respectively). Model cost estimates were A$172 above usual care per child seen in the co-consultations. Conclusions: This novel model of care is acceptable to GPs and families and may improve access and quality of paediatric care. What is known about the topic?: A GP–paediatrician integrated model of care appears effective in reducing hospital burden in England, but has not been implemented in Australia. What does this paper add?: This pilot, an Australian first, found that a GP–paediatrician integrated model of care is feasible and acceptable in Australia's primary healthcare system, improves GP confidence and quality of paediatric care, may reduce paediatric referrals to outpatient clinics and emergency departments and improves family confidence in, and preference for, GP care. What are the implications for practitioners?: This model may reduce hospital burden and improve quality in GP paediatric care while potentially producing cost savings for families and the healthcare system. [ABSTRACT FROM AUTHOR]

Objective. The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma. Methods. A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews. Results. Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients' requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer. Conclusions. The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to present the views of four stakeholder groups, namely general practitioners (GP), employers (EMP), injured workers (IW) and compensation agents (CA), about the content and usability of the draft of thenew Victorian sickness certificate. Methods. A cross-sectional mixed-methods qualitative study was conducted in GP clinics and community settings in Melbourne, Australia. Interviews were conducted with GPs, EMPs and IWs and one focus group discussion was completed with CAs (n = 29). Data were collected between October and December 2013. Thematic analysis was performed. Results. All stakeholders viewed the new draft certificate as an improvement on the old one. GPs saw the certificate as a form of communication, whereas EMPs and CAs saw it as a therapeutic device. GPs continued to certify based on incapacity and provided little information about what IWs could do on return to work. All groups said that assessments for mental health needed more clarity and specificity. GPs, EMPs and CAs also said that the new certificates must be electronically available and integrated into existing medical software to streamline uptake. Conclusions. To ensure appropriate use of the new certificate, stakeholders must share a common understanding about its purpose and the certificate must be incorporated into existing medical software. Content on mental health assessment, an area of continued difficulty, needs additional refinement. Thenewcertificate replaced the old certificate inMarch 2015; after it has been established in clinical practice, an impact evaluation should be completed to determine whether GPs are certifying capacity and earlier return to work. [ABSTRACT FROM AUTHOR]