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Objective: To evaluate the suitability and acceptability of virtual training post accreditation visits conducted online for medical specialist training in ophthalmology in Australia and New Zealand. Methods: A two-phase study (pilot and implementation) was conducted. In the pilot phase, an open-ended observation proforma was used by the authors to independently record their observations, which were later compared and discussed until consensus was achieved. All participants were asked to complete an online survey. A document analysis of accreditation documents was conducted. Observation data were broken down into themes and triangulated with online survey and document analysis results. In the implementation phase, the inspections were observed by one of the authors (SK) and the observation notes were discussed with other authors to obtain a contextual and consensual view. A document analysis of all accreditation-related documentation was undertaken. The documents included in the document analysis were planning and scheduling records, interview and inspection notes, training post inspection fact and document notices and accreditation reports. Finally, a post-inspection focus group of all inspectors was conducted. Results: The accreditation interviews adequately addressed all relevant issues with high levels of robustness and reliability. Participants found it more difficult to discuss complex issues virtually compared with onsite visits. The virtual accreditation reports were not any different to what would be expected if a face-to-face accreditation visit had been conducted; however, it was not possible using the virtual inspection to determine the appropriateness of facilities and clinic layout to support and facilitate trainee learning and supervision. Conclusions: Virtual accreditation of training posts in medical specialist training is viable in limited circumstances where there are no known complex training post-related issues and the site has not made substantial changes to clinic and theatre layout, equipment and facilities since the previous accreditation. What is known about the topic? All medical specialist colleges in Australia and New Zealand accredit the sites where training is delivered, usually by conducting periodic face‐to‐face visits. What does this paper add? This paper provides evidence that in limited circumstances, it is possible to accredit training posts virtually. What are the implications for practitioners? This paper provides an outline of issues to consider when planning virtual accreditation of training posts in medical specialist education. [ABSTRACT FROM AUTHOR]

Objective: The climate crisis necessitates urgent decarbonisation. The health sector must address its large carbon footprint. In the present study, we sought healthcare thought leaders' views about a future environmentally sustainable health system. Methods: The present study was a qualitative exploratory study consisting of semistructured, in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the US and New Zealand. Audio recordings of the interviews were transcribed and analysed by matrix display and thematic analysis. Results: Overall, healthcare thought leaders believe that to reduce the carbon footprint of healthcare we need to look beyond traditional 'green' initiatives towards a more fundamental and longer-term redesign. Five main themes and one 'key enabler' (information communication technology) were identified. In this paper we draw on other relevant findings, but chiefly focus on the fifth theme about reshaping the role of healthcare within society and using the size and influence of the health sector to leverage wider health, environmental and societal benefits. Conclusions: These ideas represent potentially low-carbon models of care. The next step would be to pilot and measure the outcomes (health, environmental, financial) of these models. What is known about the topic?: The health sector needs to reduce its large carbon footprint. Traditional 'green' initiatives, such as recycling and improving energy efficiency, are insufficient to achieve the scale of decarbonisation required. What does this paper add?: Healthcare thought leaders surveyed in the present study suggested that we also consider other, non-traditional ways to achieve environmental sustainability. In this paper we discuss their ideas about adopting an anticipatory approach to healthcare using predictive analytics, and using the size and influence of the health sector to effect wider health and environmental benefits. What are the implications for practitioners?: Achieving an environmentally sustainable healthcare system is likely to require broad and fundamental (i.e. transformational) change to the current service model. Health practitioners throughout the sector must be closely engaged in this process. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to evaluate the short-term outcomes of two health science academies established by a district health board in South Auckland, New Zealand, to create a health workforce pipeline for local Māori and Pasifika students. Methods: A mixed-methods approach was used, involving background discussions with key informants to generate an initial logic model of how the academies work, followed by secondary analysis of students' records relating to retention and academic achievement, a survey of senior academy students' interest in particular health careers and face-to-face interviews and focus groups with students, families and teachers. Results: Academy students are collectively achieving better academic results than their contemporaries, although selection decisions are likely to contribute to these results. Academies are retaining students, with over 70% of students transitioning from Year 11 to Years 12 and 13. Senior students are expressing long-term ambitions to work in the health sector. Conclusions: Health science academies show promise as an innovative approach to supporting Māori and Pasifika students prepare for a career in the health professions. Evaluating the long-term outcomes of the academies is required to determine their contribution to addressing inequities in the local health workforce. What is known about the topic?: Despite progress in health workforce participation for underrepresented indigenous and ethnic minority groups in New Zealand, significant disparities persist. Within this context, a workforce development pipeline that targets preparation of secondary school students is recommended to address identified barriers in the pursuit of health careers. What does this paper add?: We provide an evaluation of an innovative district health board initiative supporting high school students that is designed to ensure their future workforce is responsive to the needs of the local community. What are the implications for practitioners?: The findings have implications for decision makers in health workforce planning regarding the benefits of investing at an early stage of the workforce development pipeline in order to build an equitable and diverse health professions workforce. [ABSTRACT FROM AUTHOR]

Introduction. In 2009, the Royal New Zealand College of General Practitioners commissioned the development of a framework to facilitate quality-improvement activity in primary care settings. This paper outlines the development of the framework, which integrates concepts of quality with the reality of practice-based clinical care, and discusses its value for primary care quality improvement. Method. Framework development involved: (1) literature review of theoretical approaches to healthcare quality; (2) field work utilising a mixed methods approach to obtain empirical data; and (3) model design. Results. Primary care practitioners are juggling competing priorities. Models and tools that promote quality-related activity at practice level need to take into account, and incorporate by design, day-to-day clinical and practice functions. Conclusions. The quality framework identifies the components of primary care practice and locates this model within the concepts and activities necessary for quality improvement. It may be used by primary care organisations and practices to facilitate focussed quality-improvement activity and self-directed process review. The framework was developed for, and within a New Zealand primary care setting, and is applicable internationally and within other healthcare settings. [ABSTRACT FROM AUTHOR]

Objective. To ensure New Zealand's health workforce was fit for purpose, Health Workforce New Zealand (HWNZ) funded Workforce Service Reviews (WSRs) to develop visions for service reconfiguration and workforce for 2020. This paper describes what makes the WSR processes work, for whom, and in what circumstances. Method. Semi-structured interviews informed by a realist evaluation approach were conducted to obtain perceptions and experiences of WSR participants from four WSRs: eye health, palliative care, anaesthesia and aged care. Results. The WSR process was a successful means of bringing together professionals from across the health disciplines and building sector capacity to develop new ways of thinking about service and workforce planning. WSRs were constrained by: mixed signals about process and outcomes; being challenged not milestone focussed; lacking clarity about ownership of visions; and variable clarity about next steps. WSRs were optimised by having: a lead clinician with policy know-how, ability to inspire, bring people together, distil ideas into coherent frameworks; and a project manager with project enablement skill sets and expertise in complex systems, implementation, change management. Conclusions. Evidence now exists at a point in time about what makes the WSR processes work. Implications for HWNZ are presented using a capacity-building framework to inform future decision making regarding WSRs. What is known about the topic? More appropriate workforce planning is required to meet the challenges facing the health workforce, from both the demand and the workforce side. To ensure New Zealand's healthcare workforce was fit for purpose, HWNZ initiated an iterative WSR process in topic specific areas. The WSRs process was designed to develop a vision of the relevant health service and workforce for 2020, and models of care that were patient-centred and team-based. What does this paper add? The paper provides evidence that the WSR process was a successful means for bringing together professionals from across the health disciplines and building sector capacity to develop new ways of thinking about service and workforce planning. The paper presents key enablers of, and barriers to, the WSR iterative process. What are the implications for practitioners? The evaluation revealed that a multitude of factors can influence the capacity of the WSR process at the individual (workforce skills and abilities), organisational (leadership and interactions) and systems (infrastructure) levels. Implications for HWNZ on ways to build the capacity of the WSRs according to three capacity-building dimensions are presented to inform future decision making. [ABSTRACT FROM AUTHOR]

Objective. To investigate the adoption and impact of quality improvement measures in New Zealand hospitals. Method. Structured interviews with quality and safety managers of District Health Boards (DHBs). Correlation of use of measures with adjusted 30-day mortality data. Results. Eighteen of New Zealand's 21 DHBs participated in the survey. Structural or policy measures to improve patient safety, such as credentialing and event reporting procedures, had been introduced into all DHBs, whereas changes to general clinical processes such as medicine reconciliation, falls prevention interventions and disease-specific management guidelines were less consistently used. There was no meaningful correlation between risk-adjusted mortality rates for three common medical conditions and related quality measures. Conclusion. Widespread variation exists among New Zealand DHBs in their adoption of quality and safety practices, especially in relation to clinical processes of care. What is known about the topic? There are a significant number of adverse events which may affect hospital inpatients. Many of these are preventable. In response, quality and safety processes and measures are being adopted across the sector. What does this paper add? The paper provides a description of the frequency with which a range of processes and measures have been adopted and demonstrates that adoption of these by New Zealand hospitals is patchy and monitoring is uneven. It suggests that the measures implemented do not appear to have impacted common mortality outcomes, though the findings may reflect the limits of feasible measurement of a probabilistic system. What are the implications for practitioners? Managers should monitor the implementation of quality and safety measures and evaluate them in terms of their direct effects. [ABSTRACT FROM AUTHOR]