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Purpose: This study aims to compare the impact of Australian onshore and offshore immigration detention centres (IDCs) on detainees' health and health-care events. Design/methodology/approach: It uses data extracted from the Australian Government's quarterly health reports from 2014 to 2017. These reports contain a range of data about the health and well-being of detainees, including complaints/presenting symptoms and number of appointments and hospitalisations. To compare onshore and offshore data sets, the authors calculated the rate of health events per quarter against the estimated quarterly onshore and offshore detention population. They ran a series of two-proportion z-tests for each matched quarter to calculate median z- and p-values for all quarters. These were used as an indicator as to whether the observed differences between onshore and offshore events were statistically significant. Findings: The results suggest that adults detained onshore and offshore have substantial health needs, however, almost all rates were far higher in offshore detention, with people more likely to raise a health-related complaint, access health services and be prescribed medications, often at two to three times the rate of those onshore. Originality/value: This paper adds to a modest body of literature that explains the health of people detained in Australian IDCs. To the best of the authors' knowledge, this is the first paper to explore health service utilisation and a range of other variables found in the Australian Government's quarterly health reports. These findings bolster the evidence which suggests that detention, and particularly offshore detention is particularly harmful to health. [ABSTRACT FROM AUTHOR]

Aims: This work aims to explore staff perceptions of (1) the effectiveness of organizational communication during the COVID‐19 pandemic and (2) the impact of organizational communication on staff well‐being and ability to progress their work and patient care. Background: Effective coordination and communication are essential in a pandemic management response. However, the effectiveness of communication strategies used during the COVID‐19 pandemic is not well understood. Design: An exploratory cross‐sectional research design was used. A 33‐item survey tool was created for the study. Methods: The study was conducted at a tertiary teaching hospital in Western Australia. Convenience sampling was used to recruit participants from nursing, medical, allied health services, administrative and clerical, and personal support services (N = 325). Data were collected between December 2020 and May 2021. Results: Overall, all occupational groups found working during the COVID‐19 pandemic stressful, and all groups wanted accessible and accurate communication from management and new policies, procedures, and protocols for future outbreaks. Conclusions: The use of occupational group‐relevant strategies and COVID‐19 protocols, as well as the on‐going use of email, face‐to‐face meetings with debrief sessions, are needed to improve communication and support staff to fulfil their roles. Summary statement: What is already known about the topic? Effective coordination and communication that is timely and two‐way in nature, is an essential part of a pandemic management response. What this paper adds? All occupational groups found working during the COVID‐19 pandemic stressful; all groups wanted accessible and accurate communication from management and new policies, procedures, and protocols for future outbreaks. The implications of this paper: Managing a pandemic situation in health care settings is challenging for all levels of staff including management and all occupational work groups.The use of occupational group‐relevant strategies and COVID‐19 protocols, as well as the on‐going use of email, face‐to‐face meetings with debrief sessions, are needed to improve communication and support staff to fulfil their roles. [ABSTRACT FROM AUTHOR]

Introduction: People who inject drugs experience stigma across multiple settings, including when accessing health‐care services, however, comparatively little is known about experiences of stigma towards other groups of people who use illegal drugs. This paper examines experience of, and factors associated with, stigma among two samples of people who use illegal drugs when visiting both specialist alcohol and other drug (AOD) and general health‐care services. Methods: Australians who regularly (i.e., ≥monthly) inject drugs (n = 879; illicit drug reporting system [IDRS]) or use ecstasy and/or other illegal stimulants (n = 700; ecstasy and related drugs reporting system [EDRS]) were surveyed between April and July 2022 about past 6‐month experience of stigma in the above services. Multi‐variable regression analyses were performed to determine the socio‐demographic, drug use and health factors associated with stigma. Results: Experiences of stigma in general health‐care services were more common among IDRS (40%) than EDRS (24%; p < 0.001) participants, however, experiences were comparable in specialist AOD health‐care settings (22% and 20%, respectively; p = 0.687). Gender identity and experiencing high psychological distress were associated with experiencing stigma across both samples. Past‐year overdose was associated with experiencing stigma among the IDRS sample, while unstable housing and incomplete high school education were associated with experiencing stigma in the EDRS sample. Discussion and Conclusions: Experiences of stigma when accessing health‐care services are relatively common across different populations of people who use illegal drugs. Our findings highlight the multiple and intersecting dimensions of stigma and provide further support for recent calls for a universal precautions approach to stigma in health care. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to review the literature on the response and adaption to change of allied health professionals. Understanding how individuals respond and adapt to change is essential to assist leaders to manage transformational change effectively. Contemporary health-care environments are characterised by frequent and rapid change, often with unrealistic and challenging time frames. Individuals operate independently, but also as members of teams, professions and organisations. Therefore, having a sound understanding of individual response to change is important for change leaders. In the Australian context, allied health professionals represent a quarter of the health-care workforce. There is a significant gap in understanding how allied health professionals respond and adapt to change. Design/methodology/approach: A scoping review was designed to report on the nature and extent of the literature on the response and adaption to change in the context of allied health professionals. Change leaders in the health-care environment face a number of complex challenges when attempting to facilitate change. While this scoping review did not identify any specific literature on the response and adaption to change of allied health professionals, it did however provide information on change models and factors to take into consideration when implementing a change process. Findings: The results of this scoping review identified findings in two main areas with regard to response and adaptation of allied health to change: a review of change management literature at the organisation level and change management for allied health. Most of the literature described organisational level change management without providing a structural framework for change. At the professional individual level, the literature focused on specific clinical interventions, rather than on the response and adaption to change for allied health. Minimal literature was identified in regard to the response and adaption to change of allied health professionals. In an environment characterised by continuous change and policy reform, a greater understanding of the response and adaption to change by allied health is a priority for research, policy and practice. Research limitations/implications: This scoping review was undertaken to explore the response and adaption to change of allied health. It sought to identify the factors that may explain why certain disciplines within the allied health professional group responded to change differently. Scoping reviews do not set out to comprehensively source all relevant literature but rather to ascertain the nature and extent of the published literature in the field. Therefore, it is possible that a systematic review might uncover additional relevant papers. However, this scoping review provides a clear indication of the nature and extent of the literature in allied health. Practical implications: Social implications: This scoping review will assist change leaders to gain a better understanding of theoretical frameworks of individual, team and organisational change processes and the impacts these have individually and collectively on change processes. Originality/value: To the best of the authors' knowledge, this scoping review is the first of its kind to identify the minimal literature available on the way allied health professionals respond and adapt to change. [ABSTRACT FROM AUTHOR]

Objective: In 2018 the Australian Commission on Quality and Safety in Health Care released a new consumer driven Australian Hospital Patient Experience Question set. The objective was to explore the acceptability, adoption, appropriateness, feasibility, fidelity, penetration, resources and sustainability of implementing the AHPEQS, and to review which questions correlated with overall rating of care. Methods: Thirty-six Australian private hospitals participated in the AHPEQS implementation over an 18-month period. Results: Responses were analysed for 86 180 patient experience surveys. Positive patient experiences (Question 12) correlated most highly with Question 2 (My individual needs were met; correlation coefficient (CC) 0.45, P < 0.001), Question 4 (I felt cared for; CC 0.45, P < 0.001) and Question 9 (When I was in the hospital, I felt confident in the safety of my treatment and care; CC 0.44, P < 0.001). Day procedure patients rated their experience higher than overnight patients. Uptake was rapid across the 36 hospitals, with minimal resources and demonstrable acceptability, adoption, appropriateness, feasibility, fidelity, penetration and sustainability. Conclusion: Utilising a consumer-driven survey highlighting treatment and care, assisted in enhancing staff engagement and continuous improvement in patient experience in acute, day procedure and rehabilitation hospitals. What is known about the topic?: Patient experience in hospital is associated with healthcare quality, safety and outcomes. What does this paper add?: From a consumer perspective, feeling cared for, having needs met and confidence in the safety of care, correlated with a positive patient experience. What are the implications for practitioners?: Investing staff time and health service resources into a consumer-driven patient experience survey tool, which highlighted treatment and care, assisted in enhancing staff engagement and continuous improvement in patient experience in acute, day procedure and rehabilitation hospitals. [ABSTRACT FROM AUTHOR]

Patients from racial/ethnic minority backgrounds can experience racism and race-based discrimination in the health system, enduring unfair and inferior treatment that negatively affects physical and mental health and well-being and may, in some cases, lead to premature and avoidable death. Racism within the health system also acts as a deterrent to health care access because individuals may choose to avoid healthcare settings for fear of repeated exposure to racism. Racism and its impacts in health are well documented and health care-related regulatory organisations and antidiscrimination commissions in Australia are the recipients of racism complaints that occur within the health system. However, the extent and nature of complaints of racism in healthcare settings (i.e. self-reported incidents of racism) and how they are managed by regulatory organisations and antidiscrimination commissions are not well understood. This paper provides a summary of existing approaches to complaints in the Australian health system related to healthcare regulatory organisations and antidiscrimination commissions. We offer recommendations for improvements to data collection and dissemination of racism complaints to better understand the nature and extent of racism and race-based discrimination in the health system, and thus inform changes to process and practices that will reduce the incidence of racism and improve health outcomes. [ABSTRACT FROM AUTHOR]

This paper reports the impact of a major life event–death–on the physical, psychological and social well-being of the deceased’s close friends. We utilised data from a large longitudinal survey covering a period of 14 years (2002–2015) consisting a cohort of 26,515 individuals in Australia, of whom 9,586 had experienced the death of at least one close friend. This longitudinal cohort dataset comprises responses to the SF-36 (health related quality of life measure) and allowed for analysis of the short and longer-term impacts of bereavement. In order to manage the heterogeneity of the socio-demographics of respondents who did/not experience a death event, we use a new and robust approach known as the Entropy Balancing method to construct a set of weights applied to the bereaved group and the control group (the group that did not experience death). This approach enables us to match the two groups so that the distribution of socio-demographic variables between the two groups are balanced. These variables included gender, age, marital status, ethnicity, personality traits, religion, relative socio-economic disadvantage, economic resources, and education and occupation and where they resided. The data show, for the first time, a range of negative and enduring consequences experienced by people following the death of a close friend. Significant adverse physical and psychological well-being, poorer mental health and social functioning occur up to four years following bereavement. Bereaved females experienced a sharper fall in vitality, suffered greater deterioration in mental health, impaired emotional and social functioning than the male counterparts up to four years after the death. The data show that the level of social connectedness plays an important role in bereavement outcomes. Specifically, we found that less socially active respondents experienced a longer deterioration in physical and psychological health. Finally, we found evidence that the death of a close friend lowered the respondent’s satisfaction with their health. Since death of friends is a universal phenomenon, we conclude the paper by reflecting on the need to recognise the death of a close friend as a substantial experience, and to offer support and services to address this disenfranchised grief. Recognising bereaved friends as a group experiencing adverse outcomes can be used internationally to prompt health and psychological services to assist this specific group, noting that there may be substantial longevity to the negative sequelae of the death of a friend. Facilitating bereaved people’s support networks may be a fruitful approach to minimising these negative outcomes. [ABSTRACT FROM AUTHOR]

Drawing on findings from a study of two social generations of gender and sexuality diverse Australians, this paper offers a critical analysis of expectations and experiences of inclusive health care for LGBTQ+ youth. Data were collected by means of individual and focus group interviews with people from two different social generations who grew up in regional or urban Australia: those born in the 1970s (n = 50) and those born in the 1990s (n = 71). Data were analysed inductively to develop insights into what inclusive health care meant, and what this revealed about the potential for fostering belonging in healthcare settings. Findings raise critical questions about how inclusiveness of care might best be understood in encounters between gender and sexual minorities and health professionals. In particular, forms of 'inclusivity labour' were observed across the social generations, both in terms of the work involved in seeking to locate supportive services, and in assessing the performance of clinicians in healthcare settings, with implications for the continued engagement of LGBTQ+ young people with essential forms of care. Mobilising contemporary forms of inclusivity labour, including attention to the affective dimensions of healthcare engagement, has the potential to promote both better health and more meaningful experiences of belonging for gender and sexual minorities. [ABSTRACT FROM AUTHOR]

Background: Middle ear disease (otitis media) is endemic among Aboriginal and Torres Strait Islander children in Australia and represents an important cause of hearing loss. The disease is the result of a mix of biological, environmental and host risk factors that interact in complex, non-linear ways along a dynamic continuum. As such, it is generally recognised that a holistic, systems approach is required to reverse the high rates of otitis media in Aboriginal and Torres Strait Islander children. The objective of this paper is to examine the alignment between efforts designed to address otitis media in Aboriginal and Torres Strait Islander children in Queensland, Australia and core concepts of systems thinking. This paper’s overall purpose is to identify which combination of activities, and at which level, hold the potential to facilitate systems changes to better support ear health among Aboriginal and Torres Strait Islander children. Methods: We began with a review of documents identified in consultation with stakeholders and an online search. In addition, key informants were invited to participate in an online survey and a face-to-face or phone interview. Qualitative interviews using a semi-structured interview guide were used to explore survey responses in more depth. We also undertook interviews at the community level to elicit a diverse range of views. Ideas, statements or activities reported in the documents and interviews as being performed under the Intervention Level Framework were identified using qualitative thematic and content analysis. A quantitative descriptive analysis was also undertaken, whereby data was extracted into an Excel spreadsheet and coded under the relevant strategic directions and performance indicators of the Framework. Subsequently, we coded activities against the five-level intervention framework developed by Malhi and colleagues, that is: 1) paradigm; 2) goals; 3) system structure; 4) feedback and delays; and 5) structural elements. Results: Overall, twenty documents were reviewed. We examined surveys and interviews with six key informants. Twenty-four individual and 3 group interviews were conducted across central and community level informants. One hundred and four items were coded from the 20 documents and 156 items from interview data. For both data sets, the majority of activities were coded at the structural elements level. The results suggested three key areas where further work is needed to drive sustained improvements: 1) build the governance structures needed for paradigm shift to achieve a multi-sectoral approach; 2) develop shared system level goals; 3) develop system-wide feedback processes. Conclusions: Sustained progress in improving ear health within Aboriginal and Torres Strait Islander children requires a holistic, system-wide approach. To advance such work, governance structures for multi-sectoral collaboration including the development of joint goals and monitoring and feedback are required. Intervening at these higher leverage points could have a profound effect on persistent public health issues. [ABSTRACT FROM AUTHOR]

Purpose The Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on general practices, and examine the feasibility of implementing an ICS, within a predominantly fee-for-service delivery model.Design/methodology/approach Mixed methods were used to analyse the implementation of the ICS, including practice-level patient data on changes in service provision. This includes unit-record data on 130 enroled patients across three rural sites, as well as qualitative data collection from providers.Findings There were significant increases in both revenue-generating and non-revenue-generating activities (primarily care coordination activities) associated with implementing the ICS. Each occasion of service involved greater contact time with practice staff other than GPs, as well as greater administration time. There is evidence that ICS activities such as case conferencing and team care planning substitute for traditional GP consultations. Overall, the study found that a significant investment of resources – namely staff time devoted to a range of activities – was required to support the implementation of the ICS. Such an investment was supported both externally and through revenue-generating practice-level activities.Research limitations/implications The data collection and evaluation project is ongoing, with analysis based on the first wave of data from three sites.Practical implications At the practice level, a substantial commitment of resources is required to invest in, and sustain, a new model of integrated care (IC). This commitment can currently be supported both through higher revenue generation at the practice level, and externally by health system stakeholders, but changes in financial settings could impact on financial viability.Originality/value This paper provides evidence on the role of blended payment mechanisms in facilitating the implementation of IC in a rural setting where there are medical workforce constraints. [ABSTRACT FROM AUTHOR]

Purpose: Whistleblowing is a procedure where an existing or past participant of an establishment reveals actions and practices believed to be illegal, immoral or corrupt, by individuals who can influence change. Whistleblowing is an important means of recognising quality and safety matters in the health-care system. The aim of this study is to undergo a literature review exploring perceived barriers of whistleblowing in health care among health-care professionals of all grades and the possible influences on the whistleblower. Design/methodology/approach: An integrative review of both quantitative and qualitative studies published between 2000 and 2020 was undertaken using the following databases: CINAHL Plus, Embase, Google Scholar, Medline and Scopus. The primary search terms were "whistleblowing" and "barriers to whistleblowing". The quality of the included studies was appraised using the Critical Appraisal Skills Programme criteria. The authors followed preferred reporting items for systematic review and meta-analysis (Prisma) in designing the research and also reporting. Findings: A total of 11 peer-reviewed articles were included. Included papers were analysed using constant comparative analysis. The review identified three broad themes (cultural, organisational and individual) factors as having a significant influence on whistleblowing reporting among health-care professionals. Originality/value: This study points out that fear is predominantly an existing barrier causing individuals to hesitate to report wrongdoing in care and further highlights the significance of increasing an ethos of trust and honesty within health care. [ABSTRACT FROM AUTHOR]

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Purpose – This paper seeks to provide an overview of the concept of training needs analysis (TNA), current practice, models and the impact that training needs analysis currently has on nurses in public hospitals in Australia. Thus, the paper should aid future research in the area of TNA of nurses through helping researchers to clarify the conceptual boundaries of training needs of nurses; providing a theoretical framework that could help researchers in framing their research efforts in the area; and establishing a research agenda and identifying the impact this research will potentially have on Human Resource managers in hospitals across Australia. Design/methodology/approach – This paper examines the TNA process by examining literature regarding the importance and benefits of TNA, issues relating to TNA and current practice and models. This paper then looks at how TNA applies to, and is currently practised within, the healthcare industry, specifically amongst a group of nurses. This paper also addresses how TNA tools relate to healthcare workers, particularly nurses, within Australia and how it may be able to improve the current TNA process for nurses in Australia. Findings – The specific contribution of the current paper is in developing a logical model of TNA for nurses employed in healthcare organizations in Australia. In so doing insights are drawn from a number of discreet literature bases. Originality/value – Research in this area has been carried out primarily in the UK, in the USA, and in other countries. Unfortunately, TNA for nurses in Australia is very much an under-researched topic. Equally, there is scant research available into the importance and benefits of conducting appropriate TNA for nurses in Australia. The research that has been conducted involving training needs of nurses in Australia has not been focused on a TNA using a psychometrically valid tool, nor has the research considered the factors that may influence the training needs of particular nurses or organizations. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to use current stroke care guidelines to identify and discuss current stroke care challenges in rural Australian health care and potential solutions for delivery of evidence‐based practice. Design and setting: A review of national guidelines since 2002 for organised stroke care was undertaken to determine best practice for delivering primary stroke care. We then employed a narrative literature review strategy looking at relevant articles, based on keywords, outlining current stroke service availability in Australia, highlighting the challenges of implementing evidence‐based stroke care in rural areas in Australia based on the current guidelines. Results: Delivery of evidence‐based stroke care in rural Australia is fraught with challenges. Although national best‐practice guidelines for stroke care are well established, the recommendations made in these guidelines do not always reflect the resource availability in rural Australia. Redesigning processes and utilising available resources, such as telemedicine or local clinical pathways, can achieve an evidence‐based standard; however, ultimately better resourcing of these areas is required. Conclusion: Evidence‐based stroke care, aligned with current national standards is the key to providing adequate stroke services in rural Australia. Improved health service resourcing and better utilisation of currently available resources are options for achieving elements of evidence‐based stroke care. Implications for public health: Availability of adequate services for stroke patients directly impacts public health as it determines health outcomes for these patients. Indirect implications for public health include the effects on health professionals and the general public. [ABSTRACT FROM AUTHOR]

Errors-in-variables (EIV) regression is widely used in econometric models. The statistical analysis becomes challenging when the regression function is discontinuous and the distribution of measurement error is unknown. In the literature, most existing jump regression methods either assume that there is no measurement error involved or require that jumps are explicitly detected before the regression function can be estimated. In some applications, however, the ultimate goal is to estimate the regression function and to preserve the jumps in the process of estimation. In this paper, we are concerned with reconstructing jump regression curve from data that involve measurement error. We propose a direct jump-preserving method that does not explicitly detect jumps. The challenge of restoring jump structure masked by measurement error is handled by local clustering. Theoretical analysis shows that the proposed curve estimator is statistically consistent. A numerical comparison with an existing jump regression method highlights its jump-preserving property. Finally, we demonstrate our method by an application to a health tax policy study in Australia. [ABSTRACT FROM AUTHOR]

Increased waste in health care is a widespread problem. Currently, modern clinical practices favour single-use products and pre-packaged supply kits. Many of these consist of various types of plastics. By weight, up to 25 per cent of total hospital waste is plastics. Common plastics used are polyethylene terephthalate, polypropylene, polyethylene, polyvinylchloride and polyurethane. Polyethylene terephthalate represents the highest volume, and accounts for 40 per cent of the plastics used in operating rooms. Health care has an enormous ecological footprint. Around the world, health care waste management strategies and clinician activities are starting to address how health care affects our planet and public health. Recovery of valuable waste, or product stewardship, is one of these strategies. In many countries, product stewardship in health care is still non-existent or unregulated. Clinicians and health service organisations must make product stewardship in health care an integral part of sustainable procurement and health care business activities. In addition, sustainable solutions require the engagement of suppliers of plastic packaging who can contribute to reducing waste in health care and minimising the impact of plastics on the environment and public health. [ABSTRACT FROM AUTHOR]

Background: Home visiting programs are implemented in high income countries to improve outcomes for families with young children. Significant resources are invested in such programs and high quality evaluations are important. In the context of research trials, implementation quality is often poorly reported and, when reported, is variable. This paper presents the quality of implementation of the right@home program, a sustained nurse home visiting intervention trialled in Australia, and delivered in a ‘real world’ context through usual child and family health services. right@home is structured around the core Maternal Early Childhood Sustained Home-visiting (MECSH) program, which is a salutogenic, child focused prevention model. Method: At each visit right@home practitioners completed a checklist detailing the client unique identifier, date of contact and activities undertaken. These checklists were collated to provide data on intervention dose, retention to program completion at child age 2 years, and visit content, which were compared with the program schedule. Quality of family-provider relationship was measured using the Session Rating Scale. Exploratory factor analysis was conducted to identify clusters of activities and allow qualitative assessment of concordance between program aims and program delivery. Results: Of 363 intervention families offered the program, 352 (97·0%) commenced the program and 304 (87·3%) completed the program to child age 2 years. 253 of 352 (71·9%) families who commenced the program received more than 75 percent of scheduled visits including at least one antenatal visit. Families rated the participant-practitioner relationship highly (mean 39.4/40). The factor analysis identified six antenatal and six postnatal components which were concordant with the program aims. Conclusions: The right@home program was delivered with higher adherence to program dose, schedule and content, and retention than usually reported in other home visiting research. Program compliance may have resulted from program design (visit schedule, dose, content and delivery flexibility) that was consistent with family aims. [ABSTRACT FROM AUTHOR]

Background: Rural Australian populations experience an increased burden of ischaemic heart disease (IHD) compared to their metropolitan counterparts, similar to other developed countries, globally. Policy and other efforts need to address and acknowledge these differences in order to reduce inequalities in health burden. This paper examines rural health policy makers’ perceptions and use of evidence in efforts to reduce the burden of IHD in rural areas. Methods: Policy makers and government advisors (n = 21) who worked with, or advised on, rural health policy at local, state and federal government levels, with specific focus on the state of Victoria (n = 9) were identified from publicly available documents and subsequent snowball sample. Semi-structured qualitative interviews were conducted in regards to the use of evidence in policy to prevent IHD and thematic analysis undertaken applying two theoretical perspectives: context-based evidence-based policy making and the conceptual framework for understanding rural and remote health. Results: The rural context, particularly low resourcing, was seen as limiting potential for evidence based policy at local government (LG) level. Lower levels of political pressure and education were seen as constraints to evidence-based policy in rural communities. Participants described the potential for policy to have a greater impact on reducing heart disease in rural areas though they felt under-resourced and out of touch with the scientific evidence. Scientific studies were less valued than local anecdote to prioritise specific policy. At all levels (local, state and federal) low self-efficacy in interpreting evidence and perceived lack of relevance inhibited development of evidence informed policy. Conclusion: The rural context constrains the use of scientific evidence in policy making for the prevention of heart disease in rural areas in Australia with multiple factors influencing the capacity for evidenced based health policy. This is similar to findings at the international scale and is for consideration across other developed countries that experience inequalities in IHD disease burden between rural and urban populations. [ABSTRACT FROM AUTHOR]

Sexual minority young people use licit and illicit substances at disproportionate levels. However, little is known about the perceptions of substance use among members of LGBT communities. This paper reports the results of a content analysis of 45 semi-structured interviews about substance use in LGBT communities with sexual minority young people (n = 31) and community stakeholders (n = 14). Results indicated both sexual minority youth and community stakeholders perceived the use and acceptance of substances to be higher in LGBT communities compared to the general population. Participants identified a range of characteristics potentially leading to higher levels of substance use including peer pressure, high exposure to substance use, and the high concentrations of licensed venues in LGBT communities. Marginalisation, discrimination and mental health were also perceived as important reasons for these disparities. Community stakeholders identified a range of potential interventions including legislation to address discrimination and substance use, increased services and activities, advertising in commercial LGBT venues and social media, and reinvigorating community cohesion. [ABSTRACT FROM AUTHOR]

This paper estimates the cost-effectiveness of a 20% price discount on healthy food and beverages with and without consumer nutrition education, as trialled in remote Northern Australia. Changes in actual store sales, from the pre-discount baseline period, were analysed for population impact on consumption of fruit and vegetables, water and artificially sweetened soft drinks, in addition with total dietary weight (grams), energy (Mega Joules), and sodium (milligrams). Disability Adjusted Life Years (DALYs), arising from changes in dietary risk factor prevalence in the population, were estimated as the primary health outcome in a multi health-state Markov model. The costs of the strategies were sourced from paid invoices and time estimates of staff providing store-based discount promotion and consumer education. The incremental cost-effectiveness ratio adopted a partial societal perspective, (including health and retail sector costs), as cost per DALY averted and was presented in 2011 Australian dollars. The price discount, helped address a gap in food price equity for residents of remote communities. However, the discount strategy, with or without consumer education led to a net loss of population health –36 95%CI (-47,-25) or -21(-28, -15) DALYs respectively, at increased cost to the retail and health sectors, of AUD860000 95%CI (710000, 1million) or AUD500000 (410000, 590000). The strategies trialled were thereby categorised as dominated by current practice while acknowledging considerable uncertainty surrounding the health outcome estimates. The 20% discount on limited targeted products appeared to need to be considered in conjunction with other marketing strategies to support healthy food choices, if remote Australian Indigenous population health is to be improved. [ABSTRACT FROM AUTHOR]

This paper estimates the influence of inadequate access to healthcare services on the rate of Emergency Room (ER) hospital visits in Australia. We take micro-data on different types of healthcare shortfalls from the 2012 Australian Survey of Disability, Aging and Carers, and employ Propensity Score Matching (PSM) techniques to identify their effects on ER visits. We find that shortfalls in access to various medical services increases ER visits for individuals with mental and physical conditions by about the same degree. Conversely, inadequate community care services significantly predict ER visits for individuals with physical conditions, but not for persons with mental conditions. The lack of predictive power for inadequate community care for persons with mental health problems is surprising, as “acopia” is thought to be a significant driver of crises that require emergency treatment. We discuss some of the mechanisms that may underpin this finding and address the policy implications of our results. Lastly a number of robustness checks and diagnostics tests are presented which confirm that our modelling assumptions are not violated and that our results are insensitive to the choice of matching algorithms. [ABSTRACT FROM AUTHOR]

This paper examines the mediating effects of social identification on the relationship between high performance work systems (HPWS) and psychological empowerment and the direct relationship between psychological empowerment and clinician perceptions of quality of patient care. We use structural equation modelling on a sample of 254 health professionals from a large regional hospital in Australia. Results demonstrate, first, a strong effect of HPWS on social identification. Second, social identification mediates the relationship between HPWS and psychological empowerment and, third, psychological empowerment has a strong effect on clinician perceptions of quality of patient care. Implications are drawn for management theory and hospital managers. [ABSTRACT FROM PUBLISHER]

General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system. [ABSTRACT FROM AUTHOR]

Mental health can affect young people’s sense of wellbeing and life satisfaction, their ability to participate in employment and education, and their onward opportunities in life. This paper offers a rare opportunity to longitudinally examine mental health in a population-representative study of children aged 4–5 years to 14–15 years. Using data from the Longitudinal Study of Australian Children (LSAC), this study examined maternally-reported child mental health over a 10 year period, in order to understand their initial mental health status early in life and its change over time, as measured by the Strengths and Difficulties Questionnaire. Longitudinal models were fitted from ages 4–5 to 14–15 years. Results showed that child sex, maternal mental health, socio-economic status (family income, maternal education, neighbourhood disadvantage), maternal hostility, and child temperament (persistence, sociability, reactivity) are all independent contributors to child mental health at age 4. These effects largely persist over time, with the effects of maternal mental health increasing slightly over time. Persistence of these effects suggests the need for early intervention and supports. The independent contribution of these factors to child mental health suggests that multi-faceted approaches to child and maternal mental health are needed. [ABSTRACT FROM AUTHOR]

Aim To illuminate ways that avoidant leadership can be enacted in contemporary clinical settings. Background Avoidance is identified in relation to laissez-faire leadership and passive avoidant leadership. However, the nature and characteristics of avoidance and how it can be enacted in a clinical environment are not detailed. Methods This paper applied secondary analysis to data from two qualitative studies. Results We have identified three forms of avoidant leader response: placating avoidance, where leaders affirmed concerns but abstained from action; equivocal avoidance, where leaders were ambivalent in their response; and hostile avoidance, where the failure of leaders to address concerns escalated hostility towards the complainant. Conclusions Through secondary analysis of two existing sets of data, we have shed new light on avoidant leaderships and how it can be enacted in contemporary clinical settings. Further work needs to be undertaken to better understand this leadership style. Implications for nursing management We recommend that organizations ensure that all nurse leaders are aware of how best to respond to concerns of wrongdoing and that mechanisms are created to ensure timely feedback is provided about the actions taken. [ABSTRACT FROM AUTHOR]

Purpose |!|#8211; The purpose of this paper is to investigate the regulator|!|#39;s attempt at redesigning the patient care process (PCP) |!|#8211; a core business process in public hospitals |!|#8211; by introducing dichotomous process performance indicators as an innovative management tool intended to align the State health care policy with the everyday management of operations at a hospital ward. Design/methodology/approach |!|#8211; The paper presents an ethnographic case study of redesigning the PCP according to the strategy originating outside the organization. The study employs competing theories that represent alternative epistemological and ontological views of the world in order to produce a tentative explanation of why the intended redesign of the PCP has not fully eventuated. Observational data and opportunistic interviewing are used to answer the research question of whether and how the information and operational flows on the ward were affected by introduction of process performance indicators. A business process redesign framework was employed for data analysis since it better reflects the objectives of the State-wide initiative and offers a convenient tool in dealing with data complexity. Findings |!|#8211; Introduction of the process performance indicators did not result in redesigning of the PCP as intended by health care authorities. Out of four process performance indicators, only one was consistently implemented, which merely produced a duplication of the previously collected information, therefore adding no value to the PCP. On a theoretical level, the results indicate that the emergent theory rather than the rational agent theory demonstrated a greater fidelity to the empirical observations. Originality/value |!|#8211; The paper assessed the feasibility of using innovative dichotomous process performance indicators as a tool for redesigning the business process at the ward level, in order to achieve macro-level policy objectives. The failure to successfully implement a top-down universal approach to redesigning business processes in health care is likely to reflect a lack of appreciation of emergent rationality that characterizes essential aspects of the PCP. [ABSTRACT FROM AUTHOR]

Nurse practitioners were introduced into Australia in 1990 to improve access to health care in isolated communities where medical doctors are scarce. The slow uptake of nurse practitioners in these areas has largely been the result of legislation not affording them access to provider numbers through the Medicare Australia Act 1973. This has denied nurse practitioners the opportunity to become primary care providers because they cannot prescribe medications and order diagnostic tests at rebated costs. Recently this Act changed, making provision for nurse practitioners. Ironically the enactment of the new legislation still prevents nurse practitioners from practicing effectively. This paper describes the discursive practices in legislation, driven by traditional power brokers, which perpetuate the traditional role of nurses as care givers and fails to support the evolution of nurse practitioners as care providers. These continued practices effectively prevent nurse practitioners from working to their potential, despite government reassurance under recent health care reform in Australia. [ABSTRACT FROM AUTHOR]

The term ‘workforce development’ is increasingly popular in the health-care field. It appears to encompass a range of human and organizational development activity. However, there has been limited explication of the concept of workforce development in Australian health care at area health service levels. It is timely to develop a framework for workforce development and processes to guide any evaluation of the implementation of workforce development strategies. This paper presents a framework that has been developed through consultative processes in an area health service and an associated review of literature. [ABSTRACT FROM AUTHOR]

Pen pals: correspondence as a method for data generation in qualitative research The study aimed to understand the impact of chronic illness on the lives of midlife women and explore and share the ways in which women adapt to and/or tolerate chronic illness in their lives. In 1998, 80 women participated in a study in which data were generated by corresponding with the researcher. Guided by feminist principles of collaboration, reciprocity and disclosure, we created rich stories about what it is like to live with a chronic illness. In this paper we will discuss the first phase of this inquiry which utilized correspondence between the researcher and the women. The issues posed by the use of correspondence as an innovative data generation process will be analysed. Correspondence, at first glance, may appear to be a rather impersonal communication medium. However, we are committed to this method of data generation and believe we have unlocked the doors to a viable qualitative research process. The literature to guide this process is scarce so we are keen to share work in progress. We will describe the preparation phase in setting up the study; discuss some practical issues, share some of the researcher’s experiences in generating narratives from dialogues and hear from the women themselves what they consider to be significant about this research process. [ABSTRACT FROM AUTHOR]

In recent years policy makers and social scientists have devoted considerable attention to wellbeing, a concept that refers to people’s capacity to live healthy, creative and fulfilling lives. Two conceptual approaches dominate wellbeing research. The objective approach examines the objective components of a good life. The subjective approach examines people’s subjective evaluations of their lives. In the objective approach how subjective wellbeing relates to objective wellbeing is not a relevant research question. The subjective approach does investigate how objective wellbeing relates to subjective wellbeing, but has focused primarily on one objective wellbeing indicator, income, rather than the comprehensive indicator set implied by the objective approach. This paper attempts to contribute by examining relationships between a comprehensive set of objective wellbeing measures and subjective wellbeing, and by linking wellbeing research to inequality research by also investigating how subjective and objective wellbeing relate to class, gender, age and ethnicity. We use three waves of a representative state-level household panel study from Queensland, Australia, undertaken from 2008 to 2010, to investigate how objective measures of wellbeing are socially distributed by gender, class, age, and ethnicity. We also examine relationships between objective wellbeing and overall life satisfaction, providing one of the first longitudinal analyses linking objective wellbeing with subjective evaluations. Objective aspects of wellbeing are unequally distributed by gender, age, class and ethnicity and are strongly associated with life satisfaction. Moreover, associations between gender, ethnicity, class and life satisfaction persist after controlling for objective wellbeing, suggesting that mechanisms in addition to objective wellbeing link structural dimensions of inequality to life satisfaction. [ABSTRACT FROM AUTHOR]

Objective This paper analyses an organisational development project that aimed to change the organisational culture and improve people management systems and processes. The questions addressed were: was the change process a success; how was success defined; and what were the barriers to its progress? Methods We examined the process of change over a 3-year period. The organisational development intervention is described and analysed. Qualitative methods, including document review, in-depth interviews and focus groups, participant observation, newsletters and diary entries were used to gather the data. A variant of competing values was used to analyse the data. Results We sought to build trust with all managers and encouraged reflection by conducting feedback sessions, presentations, workshops and one-on-one and group discussions. A cross-site action group was established to encourage organisation-wide participation in the project. However, it was clear that stakeholders had different understandings and perceptions of the problems facing the organisation. The project faltered when a leadership development intervention was organised. Conclusions The existence of at least four different organisational 'worlds' and identities, according to different professional groupings with different goals, languages and values, was evident. The relationship between the researcher and subjects was key in terms of whether the researcher is seen as an 'expert' or as a 'facilitator'. In bringing about change, we need to work with the Chief Executive Officer in empowering others. Hence, the researchers need to engage in continual dialogue across boundaries and within groups as well as at individual levels to provide support for organisational change. [ABSTRACT FROM AUTHOR]

Background Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving highquality health care. Aims This paper outlines health inequalities experienced by people with intellectual disability and focuses on the opportunities medical education provides to address these. Strategies to ensure that health professional education is inclusive of and relevant to people with disabilities are highlighted. Conclusions The barriers experienced by people with intellectual disabilities to the receipt of high-quality health care include the attitudes, knowledge and skills of doctors. Improving medical education to ensure doctors are better equipped is one strategy to address these barriers. Improving health enhances quality of life, enables engagement and optimizes opportunities to participate in and contribute to the social and economic life of communities. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to develop an understanding of the nature of collaborative arrangements that partners in Australian hospital supply chains use to manage inventories. Design/methodology/approach – A case study involving a supply chain network of ten healthcare organisations (three pharmaceutical manufacturers, two wholesalers/distributors and five public hospitals) was studied. Data included 40 semi-structured interviews, site visits and examination of documents. Findings – This study highlights the existence of a variety of collaborative arrangements amongst supply chain partners such as the "Ward Box" system (a variant of the vender managed inventory system) between wholesalers/distributors and hospitals. The materials management departments were more willing than their pharmacy counterparts to participate in a variety of partial and complete outsourcing arrangements with wholesalers/distributors and other hospitals. Several contingent factors were identified that influenced development of collaborative arrangements. Research limitations/implications – This study is limited to the Australian healthcare sector. To improve generalisability, this study could be replicated in other industry sectors and countries. Practical implications – Application of collaborative arrangements between manufacturers and wholesalers/distributors would improve inventory management practices across the supply chains. Also, learning from materials management departments could be transferable to pharmacy departments. Originality/value – Several contingent variables for the implementation of collaborative inventory management arrangements between healthcare supply chain partners have been identified. Methodologically, data across three echelons in the supply chains (manufacturers, wholesalers/distributors and hospitals) were collected and analysed. [ABSTRACT FROM AUTHOR]

The research questions, "As an Australian, can we expect fully Mobile Technology integrated health care services in Australia? Is it possible everywhere in Australia?" A healthcare system whether private or public should provide comprehensive health care services all over in Australia including countryside and CBD. In addition, the term 'Mobile Technology integrated health care' refers to a healthcare system designed for electronic and smart devices which can be used anytime and anywhere in the world. This research paper examines 'how patients can access GPs, specialists, private and public hospitals in Australia', which provide interactive Mobile Technology based health services. The research has mainly used secondary research data analysis and methods to provide a broad investigation of the issues relevant to interactive Mobile Technology and health care system in Australia, the problems, problem factors, benefits and opportunities in the health care industry. The research is subject to academic journal articles, conference proceedings, academic text books, project reports, online media articles, corporation-based documents and other appropriate information, including a technology adoption or acceptance research model for Mobile Technology integrated health care system. The preliminary stage of the research findings show that the proposed integrated Mobile Technology model can be applied to the current health care system in Australia, particularly improving patients' smooth access to GPs, specialists, public and private hospitals. Finally, the Mobile Technology integrated health care system will ensure that the framework is user and environmentally friendly including positive and active interactions with all system functions. [ABSTRACT FROM AUTHOR]

With the arrival of another wave of “boat people” to Australian waters in late 2009, issues of human rights of asylum seekers and refugees once again became a major feature of the political landscape. Claims of “queue jumping” were made, particularly by some sections of the media, and they may seem populist, but they are also ironic, given the protracted efforts on the part of the federal government to stymie any orderly appeals process, largely through resort to “privative clauses”. Such clauses demonstrate the many ways in which human rights of those seeking asylum in far-off lands and are potential future immigrants, who often lack much-touted needed papers, yet who are for the most part genuine refugees, are subject to the slings and arrows of political fortune (and misfortune). Approaching the courts if treated unfairly or seeking a further decision as to your fate would seem one of the fundamental premises of human rights. Yet privative clauses—or attempts to ouster the jurisdiction of the courts and to insulate decisions from appeal—have become an increasingly frequent feature of the Australian migration legislation. With a seemingly watertight federal constitutional power set in stone since 1901, to deal with migration and aliens, and without the tempered contemporary update of a federal Bill of Rights, the Australian federal government has been able to narrow the grounds of judicial review in those contexts. We argue that the concerted efforts to deny such fundamental rights of appeal to those most in need of the full armoury of the protection of the law in a modern, affluent democracy, constitutes both a breach of their human rights and a breach of core constitutional principles such as separation of powers. Those principles may not be formally articulated in the text of the Australian Constitution, but in our view they are implicit in the constitutional arrangements, and hence we can conclude with the arguments of former Justice of the High Court of Australia, Michael Kirby, who asked—to whom does sovereignty truly belong? [ABSTRACT FROM AUTHOR]

Background: Value-based healthcare provider reimbursement models have been proposed as an alternative to traditional fee-for-service arrangements that can align financial reimbursement more closely to the outcomes of value to patients and society. This study aimed to investigate stakeholder perceptions and experiences of different reimbursement systems for healthcare providers in high-performance sport, with a focus on fee-for-service versus salaried provider models. Methods: Three in-depth semi-structured focus group discussions and one individual interview were conducted with key stakeholders across the Australian high-performance sport system. Participants included healthcare providers, health managers, sports managers and executive personnel. An interview guide was developed using the Exploration, Preparation, Implementation, Sustainment framework, with key themes deductively mapped to the innovation, inner context and outer context domains. A total of 16 stakeholders participated in a focus group discussion or interview. Results: Participants identified several key advantages of salaried provider models over fee-for-service arrangements, including: the potential for more proactive and preventive models of care; enhanced inter-disciplinary collaboration; and the ability for providers to have a deeper understanding of context and how their role aligns with a broader set of priorities for an athlete and the organisation. Noted challenges of salaried provider models included the potential for providers to revert to reactive care delivery when not afforded adequate capacity to provide services, and difficulties for providers in demonstrating and quantifying the value of their work. Conclusions: Our findings suggest that high-performance sporting organisations seeking to improve primary prevention and multidisciplinary care should consider salaried provider arrangements. Further research to confirm these findings using prospective, experimental study designs remains a priority. [ABSTRACT FROM AUTHOR]

Objective: We describe a research program to advance youth mental health service research in Australia, addressing two core knowledge gaps: the lack of available routine outcome measures and lack of understanding of how to assess and monitor complexity and heterogeneity in illness presentation and trajectory. Conclusions: Our research identifies better routine outcome measures (ROM) that are: designed specifically for the developmental nuances of the 12–25-year age range; multidimensional; and meaningful to young people, their carers, and service providers. Alongside much-needed new measures of complexity and heterogeneity, these tools will inform service providers to better meet the needs of young people presenting with mental health problems. [ABSTRACT FROM AUTHOR]

Background: Studies related to clinical quality indicators (CQIs) in dementia have focused on hospitalizations, medication management, and safety. Less attention has been paid to indicators related to primary and secondary care.Objective: To evaluate the incidence of primary and secondary care CQIs for Australians with dementia using government-subsidized aged care. The examined CQIs were: comprehensive medication reviews, 75+ health assessments, comprehensive geriatric assessments, chronic disease management plans, general practitioner (GP) mental health treatment plans, and psychiatrist attendances.Methods: Retrospective cohort study (2011-2016) of 255,458 individuals. National trend analyses estimated incidence rates and 95% confidence intervals (CI) using Poisson or negative binomial regression. Associations were assessed using backward stepwise multivariate Poisson or negative binomial regression model, as appropriate. Funnel plots examined geographic and permanent residential aged care (PRAC) facility variation.Results: CQI incidence increased in all CQIs but medication reviews. For the overall cohort, 75+ health assessments increased from 1.07/1000 person-days to 1.16/1000 person-days (adjusted incidence rate ratio (aIRR) = 1.03, 95% CI 1.02-1.03).Comprehensive geriatric assessments increased from 0.24 to 0.37/1000 person-days (aIRR = 1.12, 95% CI 1.10-1.14). GP mental health treatment plans increased from 0.04 to 0.07/1000 person-days (aIRR = 1.13, 95% CI 1.12-1.15). Psychiatric attendances increased from 0.09 to 0.11/1000 person-days (aIRR = 1.05, 95% CI 1.03-1.07). Being female, older, having fewer comorbidities, and living outside a major city were associated with lower likelihood of using the services. Large geographical and PRAC facility variation was observed (0-92%).Conclusion: Better use of primary and secondary care services to address needs of individuals with dementia is urgently needed. [ABSTRACT FROM AUTHOR]

In 2020 Coronavirus disease (COVID-19) was identified in Australia. During the pandemic, as essential workers, hospital-based social workers have been on the frontline. This cross-sectional study examines the resilience of social workers during the COVID-19 pandemic, how the pandemic impacted on social work and lessons learnt. Hospital social workers working in three states, namely Victoria, Queensland, and New South Wales were invited to participate in an online web-based survey, providing non-identifiable demographic details and information a) relating to their proximity to COVID-19, b) their degree of resilience (CD-RISC-2), c) professional quality of life, d) perceived social support, e) physical health, f) professional and personal growth during the pandemic, and g) impacts of COVID-19 on their practice. Basic descriptive statistics were computed for variables of interest. Within group, comparisons were made using paired t-tests or one-way ANOVAs for continuous variables as appropriate to investigate possible interstate differences. Regression analyses were conducted to determine which factors contribute to resilience. Social workers, during the pandemic, whether working under the constraints of lockdown or not, demonstrated high levels of resilience. These levels were similar across the three states, unaffected by the degree of infection in the community, indicating that as a group, social workers have high innate levels of resilience. This study provides an in-depth understanding of the impact of COVID-19 on hospital social workers, the long-term impact of the pandemic on social work practice, and potentially useful lessons learnt for the future. [ABSTRACT FROM AUTHOR]

Background: Severe maternal morbidity or maternal near miss (MNM) events can have significant consequences for individuals, their families and society and the study of these events may inform practices to reduce future adverse pregnancy outcomes. Aims: To review the scope of MNM studies undertaken in Australia, New Zealand, South‐East Asia and the South Pacific region. Materials and Methods: A systematic search of four online databases (MEDLINE, EMBASE, SCOPUS and CINAHL) and the World Health Organization Library was conducted to identify all relevant studies published between 1 January 2011 and 31 December 2020. The studies were reviewed and included if they assessed MNM using a composite outcome or a predefined set of indicators. Results: The literature search yielded 143 articles of which 49 are included in this review. There were substantial differences in the monitoring approach to MNM in the Australasian region. Overall rates of MNM in the region ranged from two to 100/1000 births and the most common aetiologies identified were direct obstetric causes such as postpartum haemorrhage, pre‐eclampsia and sepsis. Multidisciplinary review indicated a substantial number of MNM cases were preventable or amenable to improved management, mostly from a provider perspective. Conclusions: Assessment of MNM is an important part of the evaluation of maternity care provision. Reaching a consensus on indicators and how best to collect information will allow a more discerning assessment of MNM including longer‐term health outcomes, aspects of preventability and financial implications for health services. [ABSTRACT FROM AUTHOR]

Across the globe, people are not equitably included or respected by health services. This results in some people being 'hardly reached' and having less access to safe and appropriate care. While some health services have adopted specific agendas to increase inclusion, these services can struggle to implement such strategies because the underlying reasons for exclusion have not been addressed. This calls for preparation prior to implementation of inclusion approaches that deconstructs discourses and practices of exclusion. This paper presents a pre-inclusion framework that seeks to deconstruct exclusion in health services. Authors developed this framework from action research in four 'mainstream' regional health services in southeast Australia over five years. Research identified dominant discourses of exclusion among staff in these services. The study also identified common experiences of residents hardly reached by these services. Following, a range of change activities were undertaken within these services to deconstruct exclusion. Researchers also kept journals, reflected on their impact, and identified lessons learned from trying to deconstruct exclusion. Triangulating these analyses, researchers developed an interdisciplinary framework that weaves together Foucauldian theory on power/discourse with continuous quality improvement processes to embed cultural humility and voices of the hardly reached in health care. The framework outlines five foundational concepts (power as productive, deconstruction, use of continuous quality improvement processes, cultural humility and voices of service users), followed by six principles (a journey, expect resistance, whole of service approach, make visible the reasons for change, we are all cultural beings and people centred care) and six actions undertaken within health services (commitment, assessment of exclusion, action plans, structural change, reflective discussions and engagement). Until such approaches to deconstruct exclusion are implemented, inclusive agendas are likely to be ineffective. • Before inclusion can be achieved, reasons for exclusion must be challenged. • Pre-inclusion readies a health service for engagement with those hardly reached. • This framework weaves Foucault, cultural humility, those hardly reached and CQI. • The framework aims to rupture power relations to privilege discourses of service users. • Health practitioners learn about their privilege and actions of exclusion. [ABSTRACT FROM AUTHOR]

Objective: To determine the financial and non-financial costs of Attention-Deficit/Hyperactivity Disorder (ADHD) across the lifespan. Method: The population costs of ADHD in Australia were estimated for the financial year 2018 to 2019 using a prevalence approach to cost estimation across all ages. Financial (healthcare, productivity, education and justice systems, and deadweight losses) and non-financial costs were measured (Disability Adjusted Life Years (DALYs)). Results: The total social and economic cost of ADHD in 2018 to 2019 were US$12.76 billion (range US$8.40 billion to US$17.44 billion, with per person costs of US$15,664 per year). Productivity costs made up 81% of the total financial costs, followed by deadweight losses (11%), and health system costs (4%). Loss in terms of wellbeing was significant (US$5.31 billion). Conclusion: There is a need to raise public awareness of the considerable socioeconomic impact and burden of ADHD in order to drive investment and policy decisions that improve identification and treatment of ADHD. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of medication‐related hospitalisations preceded by potentially suboptimal processes of care in aged care residents. Method: We conducted a retrospective analysis of administrative claims data from the Australian Government Department of Veterans' Affairs (DVA). We identified all hospital admissions for aged care residents between 1 July 2014 and 30 June 2019. The proportion of hospital admissions preceded by potentially suboptimal medication‐related processes of care was determined. Results: A total of 18 874 hospitalisations were included, and 46% were preceded by potentially suboptimal medication‐related care. One‐quarter of fracture admissions occurred in residents at risk of fracture who were not using a medicine to prevent fracture, and 87% occurred in residents using falls‐risk medicines. Thirty per cent of heart failure admissions occurred in patients who were not using an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker. Conclusion: Nearly half of hospital admissions were preceded by potentially suboptimal medication‐related processes of care. Interventions to improve use of medicines for aged care residents in these areas are warranted. [ABSTRACT FROM AUTHOR]

Background: Evidence‐based practice requires health professionals to recognise situations of uncertainty in their practice, translate that uncertainty into answerable questions, and find and appraise information relevant to those questions. No research to date has explored the research‐based information needs of allied health professionals (AHPs) in regional and rural Australia. Objective: To examine the information‐seeking experiences and needs of AHPs in regional and rural Australia. Methods: A total of 80 AHPs, predominantly occupational therapists and physiotherapists, practising in regional and rural areas of Australia completed an online survey. Results: Almost all respondents reported having questions requiring research evidence, but most of their questions were worded non‐specifically. Respondents practising in rural areas had greater perceived difficulty in obtaining relevant evidence than their regional counterparts. Many respondents reported wanting additional support to find relevant research evidence. Discussion: The findings offer insights regarding information‐seeking challenges AHPs face and potential solutions, including improved training and increased health librarian support. However, due to sampling limitations, the results cannot be generalised to all allied health professions. Conclusion: Allied health professionals may require more training and support to engage in efficient and effective information‐seeking behaviours. Health librarians have a valuable role to play in providing this training and support. [ABSTRACT FROM AUTHOR]

Objectives: Literature on dermatology outpatient demographic and clinical data is limited, and the few studies on this topic are mainly conducted overseas, with medical systems and case mix different to Australia. This study presents demographic data relating to dermatology public outpatient referrals to a tertiary hospital in Brisbane, Australia, and determines what additional structured data should be collected to formulate and evaluate initiatives to address service issues such as referral quality, triage process and wait times. Methods: A four‐year retrospective audit was undertaken, summarising all referrals (n = 7140) and clinical dermatology encounters (n = 53 844) between January 2016 and December 2019 at Princess Alexandra Hospital (PAH), the largest hospital in Metro South Health (MSH), serving a population of one million. PAH has one of the two largest public dermatology clinics in Queensland and is the only dermatology service within MSH. Results: Patient demographic data, wait time by triage category, referral rates over time and encounter durations were collected. Structured diagnostic data (e.g. ICD‐10 coding) of the provisional diagnosis, comorbidities, medications and the final diagnosis are not collected in a structured format and would be a valuable addition. Conclusions: The clinical burden of public dermatology is increasing. Both collection and analysis of structured data pertaining to the referrals and encounters are important to help formulate, implement and evaluate initiatives that aim to improve health service provision in this area. [ABSTRACT FROM AUTHOR]

Transition Care (TC) is a new program for older adults in Australia. At present, program quality is assessed using provider reports of compliance with key requirements established by the Australian Government Department of Health and Ageing. As part of the National Evaluation of the Transition Care Program, the authors developed a questionnaire to measure recipient experience of TC. Validity and reliability were assessed via interviews with 582 recipients or proxies 3 months after discharge from TC. Concordance between test-retest observations was high. Principal component analysis suggested three subscales were important: restoration, continuity of care and patient involvement. Recipients of TC in a residential care setting had lower mean scores on the restoration subscale compared to those who received services in the community. This study found that a standardised measure of recipient experience could inform quality improvement in TC and is feasible to administer via questionnaire. [ABSTRACT FROM AUTHOR]

The challenges and opportunities for provision of, and access to, reliable chronic cardiovascular health care for Indigenous people were addressed by expert speakers from New Zealand and Australia. It is well recognised that cardiovascular disease is a life-long concern, requiring reliable follow-up, early transition of clinical research into practice and ongoing support of patients. The clinical outcomes and long-term prognosis of individuals with cardiovascular disease are critically dependent upon the quality and availability of follow-up and chronic care facilities. This paper summarises the principal issues identified by the expert speakers for the provision of chronic cardiovascular health care to Indigenous peoples in Australia and New Zealand; identifies common challenges and describes important initiatives which the Cardiac Society of Australia and New Zealand (CSANZ), in partnership with health care professionals, communities and governments, can undertake in order to achieve the goals of uniform and equitable health care for chronic cardiovascular disease in all the Indigenous peoples, relevant to the needs of these peoples, in New Zealand and Australia. The issues addressed by the meeting include: [(1)] Determination of appropriate models for effective delivery of cardiovascular health care. [(2)] Who should deliver cardiovascular health care and what are the workforce requirements. [(3)] What support systems and infrastructure are required. [(4)] How can primary care and secondary specialist services be effectively integrated. [Copyright &y& Elsevier]

Interest in values work – the purposeful effort of actors to create, maintain and disrupt the values of organizations, professions and other institutions – is growing among scholars. We ask: How do frontline professionals engage in values work while enacting managerialist practices inside organizations? We investigate this question using a case study of nurses enacting managerialist practices associated with time-efficient work flow in a hospital emergency department in Australia. Our findings show that professionals engage in values work by categorizing the values of the profession and taking actions within the managerialist practice to (1) defend a superordinate value category, (2) contain erosion of a subordinate value category, and (3) integrate a basic value category. Our study brings attention to how multiple values complicate the processes of values work when particular values become implicated in organizational practices. Frontline professionals become motivated and take actions to accomplish values within a relational system of multiple values according to relative importance and relevance to the local context. Our study offers a way forward for understanding the performance of values work within the 'new normal' for professions in contemporary organizational contexts. [ABSTRACT FROM AUTHOR]

Aim and objectives: To evaluate and examine the utility of the Violence Prevention Climate scale by generalist healthcare professionals. Background: Workplace violence in general hospital settings remains a challenge for healthcare organisations. High rates of violence are still being reported towards healthcare workers, despite organisational violence prevention strategies being implemented. There is a major challenge to healthcare organisation in the measurement of the effectiveness of these interventions, traditionally completed via the reporting and monitoring of workplace violent incidents. A novel approach to measuring workplace violence is by studying hospital atmosphere or climate. Design: A cross‐sectional survey using the STARD guidelines was used. Methods: The Violence Prevention Climate scale was completed by 194 healthcare staff working in the emergency department, medical/surgical wards, respiratory/infectious disease, spinal care, renal unit, corrections health, and rehabilitation and community services of a major Australian tertiary referral hospital. The Violence Prevention Climate scale has previously been validated and used in mental health settings, but not general hospital settings. A content analysis of an open‐ended question on violence prevention management strategies was also conducted. Results: Comprising of 14 items with two factors (patients and staff), the study revealed a 9‐item staff factor scale that can be used in the general hospital setting, the patient factor did not show adequate reliability. The content analysis revealed seven categories of staff identified violence prevention and management strategies. Conclusions: The use of the 9‐item scale across an organisation annually, or added to existing organisational workforce surveys, could prove to be practical way of measuring the social climate of violence in a general hospital setting. Relevance to clinical practice: The results of which could guide clinical practice, workplace safety, policy and educational initiatives for the prevention and management of workplace violence. [ABSTRACT FROM AUTHOR]

Vulnerability during the coronavirus disease 2019 (COVID-19) pandemic is an emotional state that affects all of us globally. The Italian experience shows that our general practitioners (GPs) seem to have a higher rate of death due to COVID-19 infection than other physicians. This article discusses clinical ethics questions related to the vulnerability of GPs and the communityduringthepandemic inItaly: the total lackof, or the inadequateprotectionofpersonal protective equipment, the increased use of virtual medicine, and the value of a solid synergy between hospitals and territorial systems. We provide a few examples of experiences in other affected countries and populations (Indigenous communities in Brazil, Australia and Germany). In conclusion, we offer some reflections on the crucial role of communication in dealing with vulnerability issues during this COVID-19 pandemic period. [ABSTRACT FROM AUTHOR]