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Objectives: Integrated respiratory and palliative care services for people with advanced lung disease provide disease-orientated care until the end of life, alongside symptom management and discussions about future care. This study aimed to explore patient, caregiver and general practitioner perspectives of an integrated respiratory and palliative care service, to understand which components of the service were considered valued and effective. Methods: We approached patients, caregivers and general practitioners, to participate in semi-structured phone interviews. A grounded theory approach guided data collection and qualitative analysis. Results: Between July and December 2019, 10 patients, eight caregivers and five general practitioners completed interviews. The overarching theme was that of valuing integrated care – the provision of disease-orientated care along with palliative care. Four other major themes emerged: Valuing communication and engagement between patient, caregiver and healthcare professionals – who spoke of 'growing this plan together'; the delivery of person-centred care – where physicians 'actually listen and you are not treated like a number'; the reality of action plan use in serious illness – while many found plans 'certainly' do help, others described when they were simply 'too ill to do the action plan'; and finally, divergent preferences for discussions about future care – while some patients felt this subject was 'better left alone', caregivers consistently reported their preference was to 'make a plan.' Conclusion: Consumer perspectives highlight the service was valued for delivering personalised care with high communication standards. Similar services should appreciate the usefulness and limitations of action plan use in advanced lung disease, and be sensitive to potential diverging preferences of the patient and caregiver when discussing future care. What is known about the topic? Integrated respiratory and palliative care services for people with advanced lung disease may improve quality of life and decrease acute healthcare utilisation and cost. What does this paper add? This paper adds to our understanding of patients', caregivers' and general practitioners' perspectives of this integrated care model. Participants highly valued this integrated service for providing person-centred care. Participants outlined both the effectiveness and limitations of action plan use in advanced lung disease, and of diverging preferences between patients and caregivers for discussions about future care. What are the implications for practitioners? The integration of disease-orientated care along with the provision of palliative care is highly valued from a consumer perspective. [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]

Objectives. The purpose of this study was to describe preparations for extreme hot weather at Victorian public sector residential aged care services for the 2010-11 summer, and to examine the role of the Residential Aged Care Services Heatwave Ready Resource in this process. Method. Qualitative data was collected through semi-structured interviews of senior staff of Victorian public sector residential aged care services. Interviews were conducted at monthly intervals from November 2010 to March 2011, and data were analysed thematically. Results. All interviewees described pre-summer preparations for hot weather undertaken at the health services they represented. Staff awareness and experience, and having a heatwave plan, were reported to have facilitated heat preparedness, whereas challenges to preparations mainly concerned air conditioning. The Residential Aged Care Services Heatwave Ready Resource was used to inform heatwave plans, for staff and family education, and as an audit tool. Conclusions. An extensive and well-considered approach to minimisation of harm from extreme heat by a sample of residential aged care services is described, and the Residential Aged Care Services Heatwave Ready Resource is reported to have supported the heatwave preparedness process. What is known about the topic? Heatwaves cause illness and death and are likely to become more frequent and severe in the future. Residents of aged care services are particularly vulnerable to harm from heatwaves. The Residential Aged Care Services Heatwave Ready Resource has been developed to support staff of residential aged care services in Victoria to prepare for heatwaves. What does this paper add? This exploratory study provides insight into the types of preparations for extreme hot weather that are undertaken at Victorian residential aged care services before and during summer. What are the implications for practitioners? A combination of staff knowledge and experience, and having a heatwave plan, supported by a publication that includes educational resources and a checklist is reported to facilitate the preparedness of Victorian residential aged care services for extreme hot weather. [ABSTRACT FROM AUTHOR]