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Value-based healthcare has been described as the sustainable, equitable and transparent use of healthcare resources to achieve improved experiences and outcomes for people and communities. It is supported by all levels of government in Australia, with recent initiatives championing a shift away from traditional, clinician-centric care delivery to a more contemporary, value-based approach. To date, however, efforts in Queensland have focused on smaller scale siloed models of care and have not extended to the transformational change required to create equitable and sustainable healthcare delivery. The Queensland Health Allied Health Framework for Value-Based Health Care (the Framework) builds on contemporary frameworks with reference to the local context in Queensland and provides a structure and starting point for clinicians and managers to work together with consumers to transform services to focus on preventative health and wellbeing, shifting the focus of care to the community and sustainably improving the quality of care delivered. The Framework outlines key considerations for the design and implementation of new services, including understanding the care pathway, supporting an outcome driven workplace culture, measuring what matters and designing for outcomes. Several key lessons were learnt during the development of the Framework, including the importance of early and sustained consumer partnerships, of establishing a shared definition of value-based healthcare that enables integration across the care pathway and the need for leadership at all levels to actively support the change management process. While developed for Queensland public allied health services, the Framework is intended to be a system-wide tool relevant to all health professionals and services. What is known about the topic? Value-based healthcare provides an approach to restructure healthcare systems to improve health outcomes and the holistic experience of care for people and communities. What does this paper add? This paper details the development of a framework to support health services to transition to a value-based approach. What are the implications for practitioners? By reflecting on the diversity of health practitioners, managers and consumer experiences and the unique opportunities and challenges of individual healthcare services, the framework provides a structure and starting point for services to transition to value-based healthcare. This article belongs to the Special Issue: Value-Based Healthcare. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate COVID-19 vaccine hesitancy, acceptance, and unmet informational needs in a cancer population during the first phase of the coronavirus disease 2019 (COVID-19) vaccination rollout in Australia. Methods: A cross-sectional survey was conducted in a large tertiary hospital in Queensland, Australia, between 10 May and 31 July 2021. The survey assessed health beliefs, experiences of the COVID-19 pandemic, COVID-19 vaccine hesitancy and informational needs. Results: COVID-19 was perceived to be a significant threat to both physical and mental health. While 57.9% (n = 110) of respondents believed the COVID-19 vaccines were safe and 64.2% (n = 122) believed they were effective, more than half (52.6%; n = 100) agreed that they worried about vaccine side effects. Most respondents (84.2%; n = 160) planned to receive the COVID-19 vaccine; however, feelings of hesitancy remained. There was a statistically significant association between those aged under 60 years (P = 0.003), those with previous vaccine hesitancy (P = 0.000), those who felt they had not received adequate information (P = 0.000) and vaccine hesitancy. Requested information pertained to interactions with cancer treatments, those with a history of blood clotting and information for those undergoing bone marrow transplantation. Conclusions: There is a need for tailored COVID-19 vaccine communication that is responsive to the concerns of people with cancer. This will be beneficial during current and future vaccination rollouts. What is known about topic? People with cancer are a COVID-19 vaccine priority group, as they are at increased risk of morbidity and mortality from this disease. There is currently a dearth of information regarding COVID-19 vaccine hesitancy, acceptance, or informational needs for this population. What does this paper add? This paper has shown that although vaccine refusal rates were low in this population, feelings of hesitancy remained. Women, those in younger age categories, those with previous vaccine hesitancy and those who felt they had not received adequate information had stronger vaccine hesitancy and higher refusal rates. What are the implications for practitioners? There is a need for tailored information and open communication regarding COVID-19 vaccines and people with cancer. There is an opportunity to build upon established relationships of trust between cancer patients and their clinicians. [ABSTRACT FROM AUTHOR]

A correction is presented to the article correcting errors in a previously published study titled "COVID-19 vaccine hesitancy, acceptance and informational needs in an Australian cancer population: a cross-sectional survey."

This paper describes the integration of a pharmacist into a perioperative environment and the ensuing quality and economic benefits. Deficiencies were identified in medication management in operating theatres (OT) at a large tertiary hospital. A perioperative pharmacist was employed for a 6-month pilot period, with permanent funding dependent on demonstration of agreed economic benefits. A multidisciplinary committee set goals, drove strategic initiatives and was accountable for delivery of outcomes. Pharmaceutical expenditure was analysed and high expenditure items targeted. Cost savings and staff satisfaction were measured at 6 months. Savings of A$63 884 were achieved during the pilot period, resulting from optimised pharmaceutical unit pricing, OT medication stock on hand (imprest) review and redesigned medication management strategies. Improvements in medication management included better access to medications in the OT, rationalising available products to minimise wastage and implementation of guidelines and protocols for high-cost and high-risk medications. At 6 months, 97% of theatre staff supported continuation of the role; the project was extended with demonstrated cost savings of A$157 265 at 12 months. The integration of a perioperative pharmacist resulted in cost savings and medication management improvements in the OT setting. A permanent position was funded. What is known about the topic?: Medication use in OTs involves high volumes of high-risk and high-cost medications. Historically, there has been little pharmacist involvement in OTs, even though evidence has shown that hospital pharmacists can reduce medication errors, improve patient safety and reduce costs. What does this paper add?: This paper provides an overview of the process of establishing a perioperative pharmacist role in an adult tertiary hospital. It takes readers through the journey from pre-implementation audit to trial development, stakeholder consultation and specific medication and process targets. What are the implications for practitioners?: Hospitals and practitioners are faced with the challenge of improving service delivery within the constraints of a finite budget. This paper allows readers to learn from our experience and apply these learnings to their local hospital setting, ultimately improving both patient care and staff satisfaction through the development of a perioperative pharmacist service. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has brought into focus obligations for health services to protect the health and safety of their staff, arising from Occupational, Health and Safety legislation and the duty of care owed by a health service as an employer. Health workers, by nature of their work, are a particularly at-risk population in the context of COVID-19. This article examines the legal standard of care that healthcare employers owe their staff in terms of reduction of risk exposure, both physically and psychologically, to COVID-19, the obligation to provide staff with personal protective equipment, adequate hygiene, cleaning and the consequences for breaching these standards. This article also explores the right to dismiss employees who are non-compliant with their obligations. What is known about the topic?: It is well known that health workers are an at-risk population for COVID-19, particularly those with direct exposure to affected patients. Since early 2020, healthcare services have faced substantial challenges in managing employee risk while complying with Occupational, Health and Safety law in Australia. What does this paper add?: This paper explores the standard of care that healthcare services owe their staff in terms of reduction of risk exposure within the current Australian legal framework, as well as the rights and obligations of healthcare service employees. What are the implications for practitioners?: Health services should be aware of the range of legal obligations to protect healthcare workers from the consequences of COVID-19 in order to minimise risk as much as reasonably practicable for employees. This includes ensuring access to adequate personal protective equipment, psychological support, adequate hygiene and cleaning of the physical workspace as well as the appropriate reporting of incidents and exposures. [ABSTRACT FROM AUTHOR]

Clinical engagement has supplemented clinical governance in healthcare to strengthen the contribution of medical professionals to the assessment of clinical outcomes for patients. Assessments of clinical engagement have, until now, been qualitative; this case study introduces the concept of quantitative assessment of clinical engagement by measuring the number of patients managed according to specialist society guidelines. Such an assessment engages all staff (medical, nursing, allied health and pharmacy) involved in patients receiving treatment according to such guidelines and provides an assessment of individual and organisational compliance with those guidelines. Clinical engagement is then quantified as the percentage of patients that have been documented to receive specialist society- or college-approved guideline-compliant treatment, relative to the total number who could receive such treatment, in any healthcare organisation. What is known about the topic?: Clinical engagement has emerged in recent years as a virtue to be encouraged in healthcare organisations because of its association with improved patient outcomes and employee satisfaction. Assessments have relied on repeated staff surveys in order to gauge engagement. What does this paper add?: This paper proposes a novel means of measuring clinical engagement in an organisational setting. The vision put forward is that adherence to clinical guidelines in an organisation measures clinician engagement across professional disciplines. What are the implications for practitioners?: The implications are that organisations will contribute to measuring the adherence of specialty groups of clinicians to guidelines that the clinicians select and use the data for individual and organisational accreditation. [ABSTRACT FROM AUTHOR]

Objective: To explore the perceptions of rural health professionals who use telehealth services for cardiovascular health care, including the potential role of telehealth in enhancing services for this patient group. Methods: Semi-structured interviews were conducted with ten rural health professionals across a range of disciplines, including medicine, nursing and allied health. All study participants were based in the same rural region in New South Wales, Australia. Results: Participant responses emphasised the importance of including rural communities in ongoing dialogue to enhance telehealth services for cardiovascular care. Divergent expectations about the purpose of telehealth and unresolved technology issues were identified as factors to be addressed. Rural health professionals highlighted the importance of all stakeholders coming together to overcome barriers and enhance telehealth services in a collaborative manner. Conclusion: This study contributes to an evolving understanding of how health professionals based in regional Australia experience telehealth services. Future telehealth research should proceed in collaboration with rural communities, supported by policy that actively facilitates the meaningful inclusion of rural stakeholders in telehealth dialogue. What is known about the topic?: Telehealth is frequently discussed as a potential solution to overcome aspects of rural health, such as poor outcomes and limited access to services compared with metropolitan areas. In the context of telehealth and cardiovascular disease (CVD), research that focuses on rural communities is limited, particularly regarding the experiences of these communities with telehealth. What does this paper add?: This paper offers insight into how telehealth is experienced by rural health professionals. The paper highlights divergent expectations of telehealth's purpose and unresolved technological issues as barriers to telehealth service delivery. It suggests telehealth services may be enhanced by collaborative approaches that engage multiple stakeholder groups. What are the implications for practitioners?: The use and development of telehealth in rural communities requires a collaborative approach that considers the views of rural stakeholders in their specific contexts. To improve telehealth services for people living with CVD in rural communities, it is important that rural stakeholders have opportunities to engage with non-rural clinicians, telehealth developers and policy makers. [ABSTRACT FROM AUTHOR]

Objective: This study provides insights into the reported early impacts of the digital transformation of a large Australian hospital and healthcare service (HHS) by surveying staff perceptions of an integrated electronic medical record (ieMR). Methods: The information systems success model was used as a tool to evaluate perceptions of system quality, information quality, individual benefits and expected organisational benefits of the ieMR soon after its introduction at the HHS. A questionnaire was distributed to staff in all five hospitals in the HHS immediately after implementation. Overall staff perceptions were examined, in addition to how perceptions differed by site and profession. Results: Overall, staff held mildly positive early perceptions of system quality, information quality, individual benefits and expected organisational benefits. These views were largely consistent across sites. In terms of professions, allied health held more positive perceptions, followed by administrative and nursing professionals. Medical professionals held negative perceptions, but were neutral regarding their future expectations. Conclusion: On average, staff viewed the ieMR mildly positively immediately after implementation (despite significant changes to work practices), but differences exist across professional groups. What is known about the topic?: Hospitals globally are in the midst of a digital transformation. Yet, reported impacts are mixed and there have been few studies of the effects of comprehensive electronic medical record (EMR) implementations. What does this paper add?: This paper evaluates a comprehensive EMR immediately after go-live. We found positive early perceptions of system quality, information quality, individual benefits and expected organisational benefits. We also found that perceptions of medical professionals were largely negative, but they were neutral in terms of their future expectations. What are the implications for practitioners?: Health services may be unsure of the effect of implementing a comprehensive EMR because of conflicting reports in the literature, some touting major benefits, others stressing major costs. Our results paint a middle-ground picture immediately after implementation. Staff perceptions are mildly positive on average, which is reassuring given the results were obtained during the early disruptive period after implementation. [ABSTRACT FROM AUTHOR]

When addressing disparities in health status of Indigenous Australians, it is necessary to consult with Indigenous people to explore their health needs. The process of improving health outcomes is complex; it requires acknowledgement of underlying cultural and social determinants of health and active engagement of Indigenous people to define the issues and identify solutions. The aim of this study is to explore the most appropriate research methodologies to determine Australian Indigenous community members' perceptions of their health needs. A scoping review was conducted in BioMed Central, CINAHL, Informit Health, MEDLINE Ovid, ProQuest and Scopus databases and Google Scholar for all relevant literature published between 2009 and 2018. Extensive manual searches of reference lists were also undertaken. The limited number of articles relating to needs assessment with Indigenous community members prescribed broadening the scope of the review to include articles that describe methodologies to enhance Indigenous people's engagement in the research process. Twelve papers met the inclusion criteria. Three major themes emerged: (1) the imperative to develop and implement Indigenist research methodologies; (2) participatory action research (PAR) and community-based participatory research (CBPR) as appropriate methodologies to conduct research with Indigenous community members; and (3) yarning or storytelling as a culturally appropriate Indigenous method of data collection. [ABSTRACT FROM AUTHOR]

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

Objective: The aim of this study was to evaluate the prevalence of psychiatric morbidity, alcohol use, burnout and compassion satisfaction among physician trainees in New South Wales, Australia, and examine links between personal, demographic and lifestyle factors. Methods: A total of 67 physician trainees were recruited to the study. Fifty-nine completed the online survey (88% response rate). Outcome measures included the Depression Anxiety Stress Scale, Professional Quality of Life Scale and Alcohol Use Disorders Identification Test. Results: Approximately half the respondents met screening criteria for depression (53%), stress (51%) and anxiety (46%). Secondary traumatic stress was exceptionally high across the cohort, with higher scores in females (P = 0.001). The main reasons for not seeking help for depression or anxiety were lack of time (81%), fear of lack of confidentiality or privacy (41%), embarrassment (39%) and effect on registration (27%). Eighty-eight per cent of respondents agreed that doctors feel they need to portray a healthy image, but only 54% engaged in regular exercise and 24% slept ≤6 h each day. Conclusion: The results demonstrate high levels of non-psychotic psychiatric morbidity among physician trainees and a need to improve their well-being. Workplace systems need to promote healthy work environments and support physician trainees through good mentorship and supervision. What is known about the topic?: Doctors' health and patient care can be affected when doctors experience burnout and psychiatric morbidity. What does this paper add?: This paper adds to the evidence of psychiatric morbidity, burnout, secondary trauma and increased demographic data on a cohort of junior doctors undertaking speciality training. In addition, it provides reasons for not seeking help and positive and negative coping methods used by these junior doctors. What are the implications for practitioners?: The level of distress is high and requires system changes to support both individual health measures and structural change to work and study programs. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods: An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results: Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions: Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic?: Refugee health after resettlement is poor, yet health service use is low. What does this paper add?: Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals' knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners?: The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the experiences of communication for staff providing cardiac care for Aboriginal and Torres Strait Islander patients in hospital and discuss potential improvements. Methods: Focus group discussions were performed with 58 multidisciplinary staff who provide care for Aboriginal and Torres Strait Islander cardiac patients in two metropolitan and two regional hospitals in South Australia and Northern Territory. Inductive thematic analysis was undertaken to identify staff perceptions of communication challenges and strategies for improvement. Results: There were five key themes: (1) communication is central to good care; (2) communication within busy clinical environments; (3) supporting a strong Aboriginal workforce; (4) a cultural as well as clinical focus; and (5) particular challenges working with patients from remote areas. Conclusions: Providing effective communication that is both clinically and culturally appropriate is often challenging within a busy and non-adaptive hospital environment. Moving beyond clinical tasks, increased Aboriginal and Torres Strat Islander health workforce and cultural competency, supporting coordinated care and improved skills are required to meet the communication needs of Aboriginal and Torres Strait Islander patients. What is known about this topic?: Communication between patients, their families and hospital staff is crucial for health care quality and safety. There is little understanding of the challenges and opportunities for staff to meet the communication needs of Aboriginal and Torres Strait Islander cardiac patients to address disparities in acute care settings. What does this paper add?: This paper discusses the barriers and potential improvements, as identified by hospital staff providing care to Aboriginal and Torres Strait Islander cardiac patients in both metropolitan and regional settings. What are the implications for practitioners?: Practitioners should be trained and supported in providing both clinically and culturally safe care for Aboriginal and Torres Strait Islander patients. This requires adequate time, two-way communication and resources to support and facilitate effective communication. [ABSTRACT FROM AUTHOR]

The medical profession is fundamentally thought of as a vocation and calling, one that requires the translation of knowledge and skill into counselling, diagnosis and interventions that benefit the lives of patients. Physicians and healthcare professionals have the immense privilege to compassionately use their vocation to improve the health of communities. What does this commitment look like in an Indigenous health setting? Using the author's own experience as a participant–observer in the University of Hawaii's John A. Burns School of Medicine's Native Hawaiian Health elective, an example is provided of an educational curriculum that seeks to integrate community health in Native Hawaiian settings. This paper shows the ways that the author's understanding of health broadened to include environmental stewardship and healthcare professionals' compassion and involvement in the life of the community throughout the elective. By providing this example, the author seeks to shed light on how a medical education initiative can change the way students approach Indigenous health. [ABSTRACT FROM AUTHOR]

Objective: Allied health structures and leadership positions vary throughout Australia and New Zealand in their design and implementation. It is not clear which organisational factors support allied health leaders and professionals to enhance clinical outcomes. The aim of this project was to identify key organisational contexts and corresponding mechanisms that influenced effective outcomes for allied health professionals. Methods: A qualitative realist evaluation was chosen to describe key aspects of allied health organisational structures, identify positive outcomes and describe how context and processes are operationalised to influence outcomes for the allied health workforce and the populations they serve. Results: A purposive sample of nine allied health leaders, five executives and 49 allied health professionals were interviewed individually and in focus groups, representing nine Queensland Health services. Marked differences exist in the title and focus of senior allied health leaders' roles. The use of a qualitative realist evaluation methodology enabled identification of the mechanisms that work to achieve effective and efficient outcomes, within specific contexts. Conclusions: The initial middle range theory of allied health organisational structures in Queensland was supported and extended to better understand which contexts were important and which key mechanisms were activated to achieve effective outcomes. Executive allied health leadership roles enable allied health leaders to use their influence in organisational planning and decision-making to ensure allied health professionals deliver successful patient care services. Professional governance systems embed the management and support of the clinical workforce most efficiently within professional disciplines. With consistent data management systems, allied health professional staff can be integrated within clinical teams that provide high-quality care. Interprofessional learning opportunities can enhance collaborative teamwork and, when allied health professionals are supported to understand and use research, they can deliver positive patient and business outcomes for the health service. What is known about the topic?: A collective allied health organisational structure encourages engagement of allied health professionals within healthcare organisations. Organisational structures commonly include management and leadership strategies and service delivery models. Allied health leaders in Queensland work across a range of senior management levels to ensure adequate resources for sufficient suitably skilled professional staff to meet patient needs. What does this paper add?: Literature to date has described how allied health professionals operate within organisational structures. This paper examines key aspects of allied health management, governance and leadership, together with mechanisms that support allied health professionals to deliver effective clinical and business outcomes for their local community. What are the implications for practitioners?: Health service executives and allied health leaders should consider supporting executive allied health leadership roles to influence strategic planning and decision-making, as well as to deliver outcomes that are important to the health service. When allied health leaders implement integrated professional and operational governance systems, executives described allied health professionals as influential in supporting team-based models of care that add value to the business and improve outcomes for patients. When allied health leaders use consistent data management, executives reinforced the benefit of aligning activity data with financial costs to monitor, recognise and reimburse appropriate clinical interventions for patients. When allied health leaders support allied health workforce capability through educational and research opportunities, clinicians can use research to inform their clinical practice. [ABSTRACT FROM AUTHOR]

Objective: This article critically appraises the range of personal, professional and social factors that affect the choice of speciality across medical students, prevocational doctors, general practice registrars and general practitioners. Methods: This qualitative study applied constructs from the fields of decision theory and career theory to better understand the complex nature of choosing a speciality. In all, 47 in-depth interviews were conducted with participants at different stages of their career cycle. The data was codified and analysed using NVivo to identify key factors that influenced speciality choice. Results: The research identified 77 individual findings influencing general practice as a choice of medical speciality. These were distilled into a matrix to show that factors such as money, prestige and peer interaction did not have a compelling effect, whereas clinical and academic role models, flexibility, work–life balance, scope of practice, connection with patients, training environment and practical opportunities did. Conclusion: The findings indicate that the decision in relation to the choice of medical speciality is a complex cognitive process that is undertaken within a personal, social and professional context particular to each individual. What is known about the topic?: Current literature aims to quantify changes in attitudes towards choice of speciality or the effect of particular variables in isolation while ignoring the complexity of this decision process and how the numerous variables compare with each other. What does this paper add?: The present study is the first intergenerational research on this topic in the Australian context and the paper dismisses the role of prestige and remuneration as key drivers of choice in picking general practice as a speciality, noting that money is merely a 'hygiene factor'. What are the implications for policy makers?: A policy framework outlining 10 key principles is presented to assist policy makers seeking to affect workforce outcomes by applying policy levers to influence doctors' choice of speciality. [ABSTRACT FROM AUTHOR]

Adult women in Australia are more likely than men to have no teeth, more missing teeth or have a dental hospital admission. Experiences of war, family and domestic violence, mental health or alcohol and other drug use problems may also negatively affect women's oral health. Yet, oral health is often excluded from primary healthcare. Little is known about what helps or inhibits primary healthcare service workers to promote oral health to women in need. Identifying the perceptions and experiences of such workers is a step towards a strategy to develop resources to support them in raising oral health issues with disadvantaged clients. This paper presents findings from a qualitative study conducted at a community-based women's health service, which used focus groups to investigate workers' perceptions of promoting oral health and accessing services for their clients. Findings indicated how structural issues informed oral healthcare, where workers generally did not consider oral health their responsibility, were reluctant to raise the issue with clients and had limited oral health knowledge and resources. To overcome these barriers, workers identified the need for oral health resources and better linkages to the dental system to help support their clients. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to better understand senior medical directors' perceptions of public reporting of hospital performance data, how public reporting affects institutional behavioural change towards quality improvement and how it could be improved. Methods: Interviews were undertaken with 17 medical directors representing 26 metropolitan and regional public hospitals in Victoria, Australia, between June and August 2016. Data were analysed thematically. Results: Medical directors are well placed to comment on clinical and administrative aspects of quality, safety and performance monitoring in public hospitals. Their responses largely suggested that public reporting of hospital performance data in Australia is immature and not fulfilling its potential. There was little consensus among informants around what public reporting is, who it is for or its purpose. Although public reporting was considered to have important functions for hospitals and consumers, it was generally considered to lack robustness and have underutilised potential to inform consumers, build trust and drive quality and performance improvements within hospitals. Conclusions: The next steps needed to advance public reporting of hospital performance data in Australia include engaging clinicians and patients in selection and development of metrics, improving timeliness of reporting, and improving communication of information so that it is accessible and meaningful for different audiences. What is known about the topic?: Public reporting of hospital performance data is a mechanism increasingly used in the Australian health system, but it has attracted little research. What does this paper add?: This paper reveals a lack of shared understanding among medical directors in Victoria, Australia, on what public reporting of hospital performance data is, who it is for and its purpose. The paper highlights the potential importance of public reporting of hospital performance data for rural and regional healthcare consumers and how it may be strengthened. What are the implications for practitioners?: Stronger systems of public reporting of hospital performance data have the potential to increase consumer engagement and improve hospital performance, quality and safety. Awareness of the discourse around public reporting of hospital performance data can increase practitioners' engagement in debate and development of reporting systems. [ABSTRACT FROM AUTHOR]

Objective: To describe the perceptions of healthcare workers employed at a metropolitan public health service, with respect to how they identify, manage and care for refugee patients. Methods: This study surveyed healthcare workers using a cross-sectional, mixed methods descriptive design, which partially replicates a previous Australian study. A total of 215 responses to a brief online survey were received (n = 48 medical, n = 100 nursing and midwifery, n = 50 allied health, n = 4 other). Results: Nurses and allied health respondents were more likely to record working with refugees rarely or never (P = 0.00). Most respondents (70.3%) identified no negative effects from working with refugees, and perceived this patient group enhanced (71.3%) their work. Insufficient identification, interpreter availability, education, healthcare worker capacity and providing culturally specific treatment were all identified as potential service barriers. Allied health respondents were more likely to report low confidence about working with refugees in general (P = 0.04). Respondents with more than 10 years' experience with refugees (P = 0.02), and those with good self-perceived awareness of community services (P = 0.01), were more confident in their ability to manage social issues. Conclusions: This study suggests that contextual factors influence the perceptions of healthcare workers who provide care to refugee patients; however, communication, health literacy and healthcare worker capacity were consistently raised as key issues when working with refugees. What is known about the topic?: Refugee and asylum seeker patients may present with complex health needs to any part of the Australian health system. The majority of previous research has occurred in primary care settings. What does this paper add?: This study adds an acute and subacute perspective to the evidence base, and also includes medical respondents for the first time. Compared to previous research, respondents of this study saw refugee patients more frequently in their practice, and also reported fewer negative effects from working with them. Most demographic characteristics had no significant effect on worker-reported confidence in this study; however, greater experience of working with refugees and good self-perceived awareness of community services were both identified as positive influences. What are the implications for practitioners?: Practitioners should prioritise remedying barriers that are consistently identified as affecting the service provided to refugee patients (communication, health literacy and healthcare worker capacity) as part of their quality and service improvement efforts. [ABSTRACT FROM AUTHOR]

Definitions of clinical governance are varied and there is no one agreed model. This paper explored the perspectives of rural and remote primary healthcare services, located in North Queensland, Australia, on the meaning and goals of clinical governance. The study followed an embedded multiple case study design with semi-structured interviews, document analysis and non-participant observation. Participants included clinicians, non-clinical support staff, managers and executives. Similarities and differences in the understanding of clinical governance between health centre and committee case studies were evident. Almost one-third of participants were unfamiliar with the term or were unsure of its meaning; alongside limited documentation of a definition. Although most cases linked the concept of clinical governance to key terms, many lacked a comprehensive understanding. Similarities between cases included viewing clinical governance as a management and administrative function. Differences included committee members' alignment of clinical governance with corporate governance and frontline staff associating clinical governance with staff safety. Document analysis offered further insight into these perspectives. Clinical governance is well-documented as an expected organisational requirement, including in rural and remote areas where geographic, workforce and demographic factors pose additional challenges to quality and safety. However, in reality, it is not clearly, similarly or comprehensively understood by all participants. [ABSTRACT FROM AUTHOR]

Optimal primary care sector performance is vital for ensuring the delivery of quality health services and effective clinical management of populations. The Primary Care Practice Improvement Tool (PC-PIT) incorporates subjective staff input and objective indicators to measure 13 elements of organisational performance. This study aimed to measure change in organisational performance for general practices using the PC-PIT with Primary Health Network (PHN) support. A pre-post design was used for changes in PC-PIT subjective and objective scores. Practices used results with PHN support to complete two Plan Do Study Act initiatives and were reassessed 9-months later. PC-PIT scales were dichotomised into lower and higher scores, with odds ratios used to determine effect size. Staff survey response rates were 55.4% at baseline and 50.1% at follow up. There were modest increases in the likelihood of staff rating several elements higher at follow up. When implemented with PHN support staff, the PC-PIT has the potential for effective, focussed and sustained quality improvement, with capacity to support Health Care Home model transition and implementation. Optimising primary care practice performance presents an important national challenge. This paper demonstrates the positive effect of the Primary Care Practice Improvement Tool (PC-PIT), supported by a Primary Health Network practice support team, in building practice quality and performance. [ABSTRACT FROM AUTHOR]

Objective. In 2015, the Australian Government introduced several mental health reforms, including the requirement that Primary Health Networks (PHNs) provide stepped care services for Australians with mental health needs such as anxiety and depression. This paper reports on the development and feasibility study of StepCare, an online stepped mental healthcare service in general practice that screens patients, provides immediate feedback to patients and general practitioners (GPs), transmits stepped treatment recommendations to GPs and monitors patients' progress, including notification of deterioration. Methods. The present codesign and feasibility study in one PHN examined: (1) the acceptability and feasibility of StepCare to GPs, practice staff and patients; (2) the impact of StepCare on clinical practice; and (3) the barriers to and facilitators of implementation. Results. Thirty-two GPs, 22 practice staff and 418 patients participated in the study. Overall, patients, practice staff and GPs found StepCare acceptable and feasible, commending its privacy, the mental health screening, monitoring and feedback. They also made suggestions for service improvements. GPs reported that StepCare helped with their identification and management of patients with common mental health issues. Conclusions. Preliminary data suggest that StepCare may be acceptable and feasible in Australian general practice, helping GPs identify and manage common mental health problems in their patients. The study provides implications for policy and practice, and points the way to future translational research into stepped mental health care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the hepatitis C treatment intentions of Aboriginal people living with hepatitis C virus (HCV) in Western Australia. Methods: This study used a mixed-methods design. In the cross-sectional survey, 123 Aboriginal people who inject drugs and self-report as living with hepatitis C completed a purpose-designed questionnaire. In the qualitative phase, 10 participants were interviewed about the factors influencing their future intentions to undertake hepatitis C treatment. Results: Analysis of the survey data revealed significant associations between an intention to undertake hepatitis C treatment and support, community attachment, stable housing and stigma. In addition, there was a high overall level of expressed intention to undertake HCV treatment, with 54% of participants responding positively. Analysis of the qualitative data supported quantitative findings, revealing concerns about stigma, lack of social support and unstable housing as factors affecting the intention to undertake hepatitis C treatment. Conclusion: This mixed methods study with Aboriginal people living with self-reported HCV indicates interventions focused on reducing stigma and unstable housing could positively affect hepatitis C treatment intentions. These findings have implications for developing holistic programs to promote and support people on hepatitis C treatment. What is known about the topic?: Substantial knowledge gaps need to be resolved if HCV elimination among Aboriginal Australians is to be achieved. Current research has prioritised non-Aboriginal communities. What does this paper add?: This study found that stigma and unstable housing require attention if Aboriginal Australians are to obtain the full benefits of direct acting antiviral (DAA) hepatitis C treatment. What are the implications for practitioners?: Reducing stigma (in the primary healthcare setting) and providing access to stable housing are vital components of supportive, non-judgemental and culturally appropriate care for Aboriginal people. This study highlights the importance of education for nurses and other primary care providers to increase engagement in the hepatitis cascade of care. To achieve this, scaling-up of HCV treatment engagement, trained Aboriginal community healthcare workers and HCV treatment advocates must mobilise and support Aboriginal people to avoid the negative effects of stigma, build positive and enabling relationships and reinforce positive attitudes towards DAA hepatitis C treatment. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assist hospitals contemplating digital transformation by assessing the reported qualitative effects of rapidly implementing an integrated eHealth system in a large Australian hospital and determining whether existing literature offers a reliable framework to assess the effects of digitisation. Methods: A qualitative, single-site case study was performed using semistructured interviews supplemented by focus groups, observations and documentation. In all, 92 individuals across medical, nursing, allied health, administrative and executive roles provided insights into the eHealth system, which consisted of an electronic medical record, computerised decision support, computerised physician order entry, ePrescribing systems and wireless device integration. These results were compared against a known framework of the effects of hospital digitisation. Results: Diverse, mostly positive, effects were reported, largely consistent with existing literature. Several new effects not reported in literature were reported, namely: (1) improvements in accountability for care, individual career development and time management; (2) mixed findings for the availability of real-time data; and (3) positive findings for the secondary use of data. Conclusions: The overall positive perceptions of the effects of digitisation should give confidence to health services contemplating rapid digital transformation. Although existing literature provides a reliable framework for impact assessment, new effects are still emerging, and research and practice need to shift towards understanding how clinicians and hospitals can maximise the benefits of digital transformation. What is known about the topic?: Hospitals outside the US are increasingly becoming engaged in eHealth transformations. Yet, the reported effects of these technologies are diverse and mixed with qualitative effects rarely reported. What does this paper add?: This study provides a qualitative assessment of the effects of an eHealth transformation at a large Australian tertiary hospital. The results provide renewed confidence in the literature because the findings are largely consistent with expectations from prior systematic reviews of impacts. The qualitative approach followed also resulted in the identification of new effects, which included improvements in accountability, time management and individual development, as well as mixed results for real-time data. In addition, substantial improvements in patient outcomes and clinician productivity were reported from the secondary use of data within the eHealth systems. What are the implications for practitioners?: The overall positive findings in this large case study should give confidence to other health services contemplating rapid digital transformation. To achieve substantial benefits, hospitals need to understand how they can best leverage the data within these systems to improve the quality and efficiency of patient care. As such, both research and practice need to shift towards understanding how these systems can be used more effectively. [ABSTRACT FROM AUTHOR]

Objectives: HealthPathways, pioneered in Canterbury, New Zealand, in 2008, is a web-based tool designed to promote health care integration and patient management in primary care and to reduce fragmentation in the delivery of health services. This cross-sectional study evaluated the utilisation and perceptions of this tool among health professionals in Australia and New Zealand. Methods: A cross-sectional survey was administered online through Research Electronic Data Capture (REDCap) to general practitioners (GPs), practice nurses and managers, nurse practitioners, specialist and community nurses, hospital clinicians, nurses, managers, and allied health professionals between April and September 2018. The frequency of HealthPathways use in the previous month was modelled as an ordered response using an ordered logistic regression model after adjusting for the possible effects of sex, age, years in clinical practice, location and time spent in practice. Results: Health professionals perceived HealthPathways to be useful in primary care management and referral, as well as in the prereferral treatment of patients. GPs in New Zealand, New South Wales and Victoria were 73%, 47% and 27% more likely to have used HealthPathways ≥10 times in the previous month respectively. Conclusion: The results suggest that HealthPathways is having a positive effect on healthcare systems in New Zealand and Australia. However, differences in uptake suggests the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. What is known about the topic?: Early evaluations suggest that HealthPathways is a useful tool for health professionals, although uptake and utilisation may be limited. However, there is no comparative evidence regarding uptake and implementation of the tool. What does the paper add?: This study is among the first to provide a comparative narrative of the literature assessing the implementation and uptake of HealthPathways across Australia and New Zealand. It is also among the first to compare the perceptions of allied health professionals in the use of HealthPathways across Australia and New Zealand. What are the implications for practitioners?: The results of this study suggest the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. [ABSTRACT FROM AUTHOR]

Objectives: The use of robotic-assisted surgery (RAS) remains predominantly in the private sector. In the public sector, the effect of the implementation of RAS on theatre staff is unknown. The aim of this study was to examine the knowledge and attitudes of theatre staff before and after implementation of RAS in the public sector. Methods: In all, 250 theatre staff, including nursing, medical and support staff, were invited to participate in the study. A survey investigating the benefits of RAS for patients and staff, concerns towards the workplace environment and facilitators towards the implementation of new technology was administered before (June 2016) and after (February 2019) the implementation of a comprehensive RAS program. Results: The survey was completed by 164 (65.6%) staff before and 200 (80.0%) staff after the implementation of RAS. With time, most nursing (P = 0.002) and medical staff (P = 0.003) indicated that RAS may benefit patients by reducing intraoperative complications, whereas support staff remained uncertain about this benefit (P = 0.594). Before the implementation, most medical staff indicated that RAS would benefit staff, although after they were unsure about this benefit. Overall, before RAS implementation, theatre staff were mostly concerned about workplace safety, but this concern was significantly reduced after RAS implementation (P < 0.010). Conclusions: With time, operating theatre staff considered their RAS program to be associated with enhanced benefits to patients, and their concerns regarding workplace safety were significantly reduced. Conversely, theatre staff were unsure about the benefits of RAS to themselves. It is important for organisations to consider the evolving impact of new technology on their staff and to refine ongoing education and training programs in line with these changes. What is known about the topic?: The implementation of RAS is rapidly evolving in major hospitals. Therefore, it is important to investigate the knowledge, attitudes and experiences of operating theatre staff before and after the implementation of RAS, especially in the public sector. What does this paper add?: This study found that with time theatre staff considered RAS to be beneficial to patients, and their initial concerns about the effect on workplace safety were significantly reduced. What are the implications for practitioners?: It is important for organisations to consider the evolving impact of the implementation of new technology on operating theatre staff and to refine ongoing education and training programs as required. [ABSTRACT FROM AUTHOR]

Dementia is now a global health priority. With no known cure, the best way to reduce the number of people who will be living with dementia is by promoting dementia risk reduction (DRR). However, despite evidence-based guidelines, DRR is not yet routinely promoted in Australian general practice. Previously, we proposed a preliminary conceptual model for implementing DRR in primary care based on our scoping review of practitioners' views. The present study aimed to refine this model for the Australian context by incorporating the current perspectives of Australian general practitioners (GPs) and general practice nurses (GPNs) about DRR. Interviews with 17 GPs and GPNs were analysed using the framework method, underpinned by the Consolidated Framework for Implementation Research (CFIR). We identified 12 barriers to promoting DRR in Australian general practice, along with five facilitators. Using the CFIR–Expert Recommendations for Implementing Change (ERIC) Matching Tool to select prioritised implementation strategies from the ERIC project, the findings were incorporated into a refined conceptual model. The refined model points to an implementation intervention that uses educational materials and meetings to reach consensus with GPs and GPNs on the importance of promoting DRR and an appropriate approach. Champion GPs and GPNs should be prepared to drive the agreed implementation forward, and general practices should share successes and lessons learned. This model is a crucial step in bridging the gap between DRR guidelines and routine practice. Dementia is a global health priority, demanding a dementia risk reduction (DRR) approach. To implement new DRR guidelines in Australian general practice, we need to better understand the barriers and facilitators to promoting DRR and the implementation strategies to match. This paper presents a practitioner-informed conceptual model in which educational materials and meetings, consensus discussions, champions and knowledge sharing could help overcome 12 identified barriers and capitalise on five identified facilitators. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore the features of sustainable antimicrobial stewardship (AMS) programs in Australian rural hospitals and develop recommendations on incorporating these features into rural hospitals' AMS programs. Methods: Lead AMS clinicians with knowledge of at least one AMS program sustained for >2 years in a health service in rural Australia were recruited to the study. A series of interviews was conducted and the transcripts analysed thematically using a framework method. Results: Fifteen participants from various professional disciplines were interviewed. Key features that positively affected the sustainability of AMS programs in rural hospitals included a hospital executive who provided strong governance and accountability, dedicated resources, passionate local champions, area-wide arrangements and adaptability to engage in new partnerships. Challenges to building AMS programs with these features were identified, particularly in engaging hospital executive to allocate AMS resources, managing the burn out of passionate champions and formalising network arrangements. Conclusions: Strategies to increase the sustainability of AMS programs in rural hospitals include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop formal network arrangements and a framework for integrated AMS programs across primary, aged and acute care. What is known about the topic?: AMS programs facilitate the responsible use of antimicrobials. Implementation challenges have been identified for rural hospitals, but the sustainability of AMS programs has not been explored. What does this paper add?: Factors that positively affected the sustainability of AMS programs in rural hospitals were a hospital executive that provided strong governance and accountability, dedicated resources, network or area-wide arrangements and adaptability. Challenges to building AMS programs with these features were identified. What are the implications for practitioners?: Recommended actions to boost the sustainability of AMS programs in rural hospitals are required. These include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop network arrangements and support to create integrated AMS programs across acute, aged and primary care. [ABSTRACT FROM AUTHOR]

Objective.: The aim of this study was to summarise the process and outcomes of complaints from five regulated health professions in Australia, and to compare these between the national and New South Wales (NSW) systems. Methods.: This is a retrospective cohort study of all complaints lodged from 1 July 2012 to 31 December 2013 for medicine, nursing and midwifery, dentistry, psychology and pharmacy registered practitioners. Data were extracted from the Australian Health Practitioner Regulation Agency, the NSW Health Professional Councils' Authority and the NSW Health Care Complaints Commission databases. The main outcome measures were frequencies and percentages of process decisions and outcomes. Results.: Systems differed in classification of complaints as conduct (national 47%; NSW 22%) and performance (national 45%; NSW 71%). Thirty-eight per cent of complaints were investigated or managed through a health or performance stream (national 40%; NSW 34%), but the national system investigated more matters (national 35%; NSW 6%). Over 50% of complaints resulted in 'no further action' (national 60%; NSW 70%). The most common action was caution or counsel (national 12%; NSW 15%), followed by conditions, (national 10%; NSW 5%). Practitioner registration surrender was more common with the NSW than national system (national 0.1%; NSW 1.3%), but registration suspensions or cancellations were similar (national 0.6%; NSW 1.0%). Conclusion.: The main difference between the two systems is the administrative decision as to how complaints are assessed. In NSW, a classification of a complaint as 'performance' usually means the complaint is not investigated; rather, the practitioner is assessed by peers and may be required to undergo further education and training. Reaching agreement and understanding of complaints that should be investigated and those appropriate for performance review would strengthen a national approach to health complaint regulation. What is known about the topic?: The national system of managing healthcare complaints is relatively new (since 2010) compared with the NSW system (since 1993). Annual reports of the regulatory authorities provide summaries of types and outcomes of complaints separately for each profession, and separately for NSW and the national system, but we do not know how the two systems directly compare in terms of complaint management or their outcomes. What does this paper add?: This study examined how different types of complaints are managed between the two systems and whether there are any differences in outcomes. The types of complaints are almost identical between the two systems, but classification of complaints as 'performance' or 'conduct' differed. Immediate action is more common in the national than NSW system, especially for health impairment and boundary crossing. Health impairment complaints are much less likely to be discontinued at the assessment stage in NSW compared with the national system. The NSW and national systems are similar in terms of complaints proceeding to either an investigation or performance or health assessment, but the national system investigates more than the NSW system. For many types of complaints the outcomes were similar between systems, but there were clear differences for some types of complaints, such as health impairment and boundary crossing. What are the implications for practitioners?: An efficient and fair regulatory system is crucial for maintaining practitioner trust, as well as trust of the public. This study shows that there are many similarities between the national and NSW systems in terms of process and outcomes, but there are differences in the way some types of complaints are assessed between the two systems. This knowledge may assist regulatory authorities in their efforts to achieve a nationally consistent approach to complaints. [ABSTRACT FROM AUTHOR]

This study evaluated a program arising from the Commonwealth policy of regionalised training for general practice with regard to the outcomes for the region investing in the training program. A complete operational audit was performed of the outcomes of a training provider of the Commonwealth program, evaluating workforce contribution and retention in the region during and after training, stratified for the effects of locally contextualising, advanced skill training and origin of trainee. The local regional workforce contribution during training peaked at 130 full-time equivalents in 2015. Cumulatively, 53% of alumni remained in the region, but over 40% moved to practice in metropolitan south-east Queensland and other Australian capital cities. Local contextualising of training, completing additional advanced skills training and being an Australian graduate were associated with increased retention in the region. A regional training program is a significant local asset introducing potential general practitioners (GPs) to the region. However, this regional area has become a 'rural' training ground for GPs into metropolitan practice rather than local investment translating as comprehensively as possible into long-term local workforce. The Commonwealth program should focus on local workforce outcomes as an evaluation metric rather than the proportion of trainees in rural training. What is known about the topic?: Retention in regional areas following the Australian General Practice Training (AGPT) program measured on a national basis is greater following regional-based training. What does this paper add?: Local workforce return on investment for training providers in GP is substantial. Contextualised local rural training, Australian graduates and trainees completing advanced rural training improve local return on training investment. A significant proportion of this rural local training program investment provides GPs for metropolitan southeast Queensland. What are the implications for practitioners?: National and regional investment in the AGPT should recognise that despite the lesser supervisory medical workforce and resources, regional training still supports metropolitan GP workforce development. Australian graduates are more likely to remain in a region following local training, as are those who have additionally completed advanced rural skill training. [ABSTRACT FROM AUTHOR]

Introduction. From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between rural and urban COVID-19 vaccination coverage have been found. Aim. To gain insight into factors contributing to the urban-rural COVID-19 vaccination disparity by exploring NZ rural health providers' experiences of the vaccine rollout and pandemic response in rural Māori and Pasifika communities. Methods. Rural health providers at four sites participated in individual or focus group semi-structured interviews exploring their views of the COVID-19 vaccine rollout. Thematic analysis was undertaken using a framework-guided rapid analysis method. Results. Twenty interviews with 42 participants were conducted. Five themes were identified: Pre COVID-19 rural situation, fragile yet resilient; Centrally imposed structures, policies and solutions - urban-centric and Pakehā focused; Multiple logistical challenges - poor/no consideration of rural context in planning stages resulting in wasted resource and time; Taking ownership - rural providers found geographically tailored, culturally anchored and locally driven solutions; Future directions - sustained investment in rural health services, including funding long-term integrated (rather than 'by activity') health services, would ensure success in future vaccine rollouts and other health initiatives for rural communities. Discussion. In providing rural health provider perspectives from rural areas serving Māori and Pasifika communities during the NZ COVID-19 vaccine rollout, the importance of the rural context is highlighted. Findings provide a platform on which to build further research regarding models of rural health care to ensure services are designed for rural NZ contexts and capable of meeting the needs of diverse rural communities. [ABSTRACT FROM AUTHOR]

Objective: Continuing education (CE) is essential for a healthcare workforce, but in regional areas of Australia there are challenges to providing and accessing relevant, reliable and low-cost opportunities. The aim of the present study was to collaborate with the local regional healthcare workforce to design, deliver and evaluate an interdisciplinary CE (ICE) program. Methods: A participatory action research (PAR) model combined with an appreciative inquiry (AI) framework was used to design, deliver and evaluate an ICE program. A focus group of 11 health professionals developed an initial program. Evaluation data from 410 program participants were analysed using AI. Results: The ICE program addressed the CE barriers for the regional healthcare workforce because the locally derived content was delivered at a reasonable cost and in a convenient location. Program participants identified that they most valued shared experiences and opportunities enabling them to acquire and confirm relevant knowledge. Conclusion: ICE programs enhance interdisciplinary collaboration. However, attendance constraints for regional healthcare workforce include location, cost, workplace and personal factors. Through community engagement, resource sharing and cooperation, a local university and the interdisciplinary focus group members successfully designed and delivered the local education and research nexus program to address a CE problem for a regional healthcare workforce. What is known about the topic?: Participation in CE is mandatory for most health professionals. However, various barriers exist for regional health workers to attending CE. Innovative programs, such as webinars and travelling workshops, address some of the issues but create others. Bringing various health workers together for the simultaneous education of multiple disciplines is beneficial. Collectively, this is called ICE. What does this paper add?: Using PAR combined with AI to design an ICE program will focus attention on the enablers of the program and meet the diverse educational needs of the healthcare workforce in regional areas. Engaging regional health professionals with a local university to design and deliver CE is one way to increase access to quality, cost-effective education. What are the implications for practitioners?: Regional healthcare workers' CE needs are more likely to be met when education programs are designed by them and developed for them. ICE raises awareness of the roles of multiple healthcare disciplines. Learning together strengthens healthcare networks by bolstering relationships through a greater understanding of each other's roles. Enriching communication between local health workers has the potential to enhance patient care. [ABSTRACT FROM AUTHOR]

Objectives: To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction. Methods: A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses. Results: With the exception of polypharmacy, commonly collected negative clinical outcomes were rare events. Compared with care homes with <25% of residents having high-level care needs (high ACFI), homes with 25<75% high-ACFI residents had more occurrences of all negative clinical outcomes except pressure injury. Homes with ≥75% high-ACFI residents reported the highest rates of polypharmacy (odds ratio 1.48, 95% confidence interval 1.39 – 1.57). Falls, unplanned weight loss and pressure injury were inversely associated with satisfaction scores adjusted for residents' level of care needs. Conclusions: This first Australian study of multistate clinical indicator data suggests interpretation of clinical indicators of aged-care home quality requires consideration of the level of residents' care needs. What is known about the topic?: Many Australian aged-care providers use quality indicators (QI) through benchmarking companies or in-house programs. The five most widely used aged-care clinical QIs in Australia are falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy. Prevalence and incidence of these QIs are highly variable among Australian studies. A consistent message in the international literature is that residents' clinical characteristics influence QI outcomes at baseline and may continue to influence outcomes over time. Study of associations between Australian aged-care home characteristics and QI outcomes has been limited. What does this paper add?: This is the first Australian study of multistate clinical QI data. It is also the first to consider the level of resident care needs in the interpretation of clinical QI outcomes and exploration of the association between level of consumer and staff satisfaction and QI outcomes. What are the implications for practitioners?: Understanding the connections between aged-care home characteristics, consumer and staff perceptions and clinical QIs is crucial in the meaningful interpretation of QI outcomes in context. With the recent introduction of the National Aged Care Quality Indicator Program, it is timely to review national policy, to gauge current quality of care and the measure of care quality in the sector, and to develop directions for possible research to inform and resolve debates regarding the potential influence and unplanned effects that such a program may have. [ABSTRACT FROM AUTHOR]

Objective: Despite the recognition that refugees should have equitable access to healthcare services, this presents considerable challenges, particularly in rural and regional areas. Because general practitioners (GPs) are critical to resettlement for refugees and play a crucial role in understanding their specific health and social issues, it is important to know more about the needs of GPs. Methods: In-depth interviews were conducted with 14 GPs and GP registrars who trained with a New South Wales regional training provider with the aim of assessing the needs and attitudes of GPs in treating refugees and the perceived effect that refugees have on their practice. Results: The interviews, while acknowledging well-recognised issues such as language and culture, also highlighted particular issues for rural and regional areas, such as employment and community support. International medical graduates identified with resettlement problems faced by refugees and are a potential resource for these patients. A need for greater information for GPs regarding services available to help manage refugees in rural and regional areas and greater access to those services was demonstrated. Conclusions: Issues such as time, costs, language and culture were recognised as challenges in providing services for refugees. GPs highlighted particular issues for rural and regional areas in addressing refugee health, such as finding jobs, problems with isolation and the effect of lack of anonymity in such communities. These social factors have implications for the health of the refugees, especially psychological health, which is also challenged by poor resources. What is known about the topic?: Providing refugees equitable access to healthcare services presents considerable challenges, particularly in rural and regional areas. Time, language and culture are commonly reported barriers in providing services for this population group. What does this paper add?: There are particular issues for rural and regional areas in addressing refugee health, including finding jobs, problems with isolation and the effect of lack of anonymity in rural communities. These social factors have implications for the health of refugees, especially psychological health, which is also challenged by a paucity of services. The findings of this study suggest that international medical graduate doctors identified with resettlement problems faced by refugees and may be an important resource for these patients. This study highlights the awareness, empathy and positive attitudes of GPs in regional and rural areas in their approach to treating patients with a refugee background. What are the implications for practitioners?: International medical graduates often identify with resettlement problems faced by refugees and are an important resource for these patients. A need for greater information for GPs regarding services available to help manage refugees in rural and regional areas and greater access to those services was demonstrated. [ABSTRACT FROM AUTHOR]

Objective. To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia. Methods. A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals. Results. Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful. Conclusion. Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia. What is known about the topic? Clinicians working in hospitals in the US, Canada and UK have access to ethics expertise to help them manage ethical issues that arise in patient care. How Australian clinicians currently manage the ethical issues they face has not been investigated. What does this paper add? This paper describes the types of ethical issues faced by Australian clinicians, how they manage these issues and whether they think ethics support would be helpful. What are the implications for practitioners? Clinicians frequently encounter ethically and legally difficult decisions and want additional ethics support. Helping clinicians to provide ethically sound patient care should be a priority of public hospitals in NSW and elsewhere in Australia. [ABSTRACT FROM AUTHOR]

Objective To explore service availability and accessibility for people with advanced chronic obstructive pulmonary disease (COPD) and their carers and strategies for improvement, including the potential role of a COPD care co-ordinator in ensuring best-practice care in the Australian context. Methods This qualitative study used focus groups and interviews with health professionals, carers and consumers to explore gaps and restrictions in services, barriers to access and the functioning of services. Data were analysed deductively. Results Key themes arising from the data included difficulties around access to care, lack of continuity of care, poor care co-ordination, the need for active disease management as well as supportive care, and poor communication. A COPD care co-ordinator was suggested as an effective strategy for ensuring best-practice care. Conclusions People with advanced COPD often have difficulty navigating the acute, primary and community care systems to deal with the multiple services that they may require. Lack of communication between health professionals and services is frequently a significant issue. A COPD care co-ordinator, encompassing advanced nursing skills, could ensure that care is centred on the needs of the person and their carer and that they receive continuing, appropriate and accessible care as they approach the end of their life. What is known about the topic? The importance of care co-ordination as a quality care indicator in chronic disease is growing, and the care co-ordinator role as a facilitator of quality care is increasingly being recognised in the UK and US. There is currently little information in the Australian context about how a COPD care co-ordinator role could be implemented, where it could be situated and the level of skill required. What does this paper add? This paper explores the specific issues in developing a COPD care co-ordinator role and provides a detailed model of care for the introduction of care co-ordinators into the Australian setting. What are the implications for practitioners? The proposed COPD care co-ordinator role has the potential to improve quality, continuing care for people with advanced COPD. It could facilitate the linkage of multidisciplinary teams across acute, primary and community care settings and promote timely and effective communication. The role would provide a clear point of contact for all practitioners and the opportunity for nurses to develop an advanced practice role in COPD care co-ordination, combining a palliative care approach with a chronic disease management framework. [ABSTRACT FROM AUTHOR]

Medical photography illustrates what people would prefer to keep private, is practiced when people are vulnerable, and has the power to freeze a moment in time. Given it is a sensitive area of health, lawful and ethical practice is paramount. This paper recognises and seeks to clarify the possibility of widespread clinician-taken medical photography in a tertiary hospital in northern Australia, examining the legal and ethical implications of this practice. A framework of Northern Territory law, state Department of Health policy and human rights theory were used to argue the thesis. Clinicians from 13 purposively chosen wards were asked to participate in an anonymous survey and confidential in-depth interviews. Questions were generated from the literature and local knowledge on the topics of 'occurrence', 'image use', 'quality of consent', 'cameras and technology', 'confidentiality', 'data storage and security', 'hospital policy and law' and 'cultural issues'. One hundred and seventy surveys and eight interviews were analysed using descriptive statistics and theme and content analysis, then triangulated for similarity, difference and unique responses. Forty-eight percent of clinicians surveyed take medical photographs, with the majority using hospital-owned cameras. However, one-fifth of clinicians reported photographing with personal mobile phones. Non-compliance with written consent requirements articulated in policy was endemic, with most clinicians surveyed obtaining only verbal consent. Labelling, storage, copyright and cultural issues were generally misunderstood, with a significant number of clinicians risking the security of patient information by storing images on personal devices. If this tertiary hospital does not develop a clinical photography action plan to address staff lack of knowledge, and non-compliance with policy and mobile phone use, patients' data is at risk of being distributed into the public domain where unauthorised publication may cause psychological harm and have legal ramifications for the hospital, its patients, and staff. What is known about the topic? While professional medical photography has been widely used for recording patient condition, evidencing care and teaching, little is known about the use of digital photographs taken by clinicians in Australian hospitals. Our research demonstrates that the ubiquitous nature of personal camera phones is encouraging clinicians to practice medical photography on personal devices. Clinicians who take photographs of patients have practical, legal and ethical issues to negotiate. Without careful management of these images, especially on personal devices, accidental and deliberate misuse is possible. What does this paper add? This paper adds to knowledge of clinician-performed medical photography practice: no other study has reported on the subject across multiple wards in an Australian tertiary hospital. This paper defines key areas of inquiry relevant to the topic, documents poor knowledge and compliance with hospital policy and highlights areas of risk to patients, staff and hospital. What are the implications for practitioners? It is likely that the behaviours and knowledge of digital photography documented in our research site are similar to that in other hospitals. Practitioners, managers and policy makers need to be aware of the ethics and regulations regarding consent, use, storage, disposal and ownership of patients' digital images to ensure the practice follows ethical and legislated guidelines. [ABSTRACT FROM AUTHOR]

Background A trial of a new model of triage (Specific and Timely Appointments for Triage: STAT) at a community rehabilitation program (CRP) reduced the mean time to first appointment from 17.5 to 10.0 days. However, quantitative findings reveal little about the impact of the system on those who used it. We aimed to explore the experiences of patients and clinicians following the introduction of STAT. Method Qualitative study within a convergent mixed-methods design applied to a controlled before and after trial at a CRP. Semi-structured interviews (n = 32) were conducted with clinicians who experienced the change to STAT, patients admitted to the CRP using STAT and patients who attended rehabilitation via a triaged wait list at another site. Results Clinicians reported shorter waiting times, more flexibility and increased efficiency with STAT, and noted the importance of effective change management. Patients reported a more efficient and consistent pathway to rehabilitation with STAT. Waiting had negative consequences for some patients at the triaged wait list site. Conclusions The qualitative data provide context to the quantitative results by showing that the changes that reduced waiting times were also well accepted and perceived to be beneficial by both patients and clinicians. What is known about the topic? Triage systems are widely used but can contribute to inefficiencies in health care. An alternative method of triage (STAT) using early allocation to face-to-face appointments has been shown to reduce waiting times in a community rehabilitation service. What does this paper add? This paper explains and adds important context to the quantitative findings by exploring the perceptions of the staff and patients who experienced both the existing and alternative models of triage. What are the implications for practitioners? The STAT model was well received by staff and patients, suggesting that this simple intervention was a feasible and effective method of reducing waiting times for community rehabilitation, and may be applicable to other services that share similar features. [ABSTRACT FROM AUTHOR]

Objectives. To determine the preferences of multidisciplinary stroke clinicians for models of inpatient stroke unit care and perceived barriers to establishing a comprehensive stroke unit (CSU) model (acute and rehabilitation care in the same ward). Methods. Written questionnaires distributed and completed at multidisciplinary stroke unit case conferences in NSW, Australia. Results. Twenty hospitals with 22 stroke units were surveyed, 13 acute stroke units, 7 rehabilitation stroke units, 2 CSUs. Two hundred and twenty-eight respondents: 99 (43.4%) allied health, 72 (31.6%) nurses and 57 (25.0%) doctors. One hundred and fifty-one respondents (67.0%) thought CSU to be the best model. Seventy-three % of doctors and 79% of allied health preferred CSU v. 57% of nurses (P = 0.041). Of doctors, rehabilitation specialists were most likely to favour comprehensive model (84.2%) and neurologists least (57.0%). The main perceived advantages of CSU were reduced cost and improved functional outcomes; perceived disadvantages were increased workload and unwell patients unable to participate in rehabilitation. Main perceived barriers to establishing CSU were lack of space, money, staffing and time. Conclusion. Although most current stroke unit care in NSW is based on the traditional model of acute and rehabilitation components in separate wards or hospitals, the majority of multidisciplinary stroke team clinicians believe CSU is the optimum model. What is known about the topic? Stroke unit care is known to improve survival and dependency but the optimum model of care is unproven, despite some small studies suggesting that the CSU model may result in better outcomes. What does this paper add? This paper is the first to survey stroke clinicians from various disciplines and types of unit, to determine their preferences for stroke unit model. What are the implications for practitioners? A majority of clinicians expressed a preference for the CSU model, suggesting that most would be comfortable caring for patients in both acute and rehabilitation phases of stroke care if further such units are established. [ABSTRACT FROM AUTHOR]

Objective. In Australia, 25% of international medical graduates (IMGs) make up the medical workforce. Concern is expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs' education. Although there is literature alluding to difficulties IMGs face with undertaking the Australian Medical Council (AMC) examination, there is little research detailing this experience. We therefore explored IMGs' reflections on facilitators and barriers in undertaking the AMC examination. Methods. After ethics approval, in-depth telephone interviews were conducted with 30 IMGs selected from a hospital in Queensland. Data were coded and analysed using thematic analysis principles. Results. Two facilitating themes were identified: ability to sit for the first part of the examination in country of origin; and having access to resources such as bridging courses and study groups. Three themes represented barriers: not understanding procedural steps; financial issues; and lack of information on examination content and standards. Conclusion. The themes provide new insights and add depth to existing literature that can be used to improve procedural processes and education for IMGs towards successful outcomes in the AMC examination. What is known about the topic? There is concern expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs education. The Australian work that is available only depicts educational experience of fellowships or education and training strategies after IMGs have passed their AMC examination. What does this paper add? The findings indicate that the process of sitting for the AMC examination is perceived as one of the major difficulties associated with entering and integrating into the Australian health system. The findings indicate a range of practical, financial and resource problems faced by IMGs attempting to sit for the AMC examination. What are the implications for practitioners? The detailed accounts from IMGs about their experience with undertaking the AMC examination will provide up-skilling program coordinators with the information they need to better assist IMGs to prepare for the examination. The provision of appropriate medical training and educational support will contribute to more effective integration of IMGs into the healthcare system. [ABSTRACT FROM AUTHOR]

Little is known about the environmental and organisational determinants of workplace violence in correctional health settings. This paper describes the views of health professionals working in these settings on the factors influencing workplace violence risk. All employees of a large correctional health service in New South Wales, Australia, were invited to complete an online survey. The survey included an open-ended question seeking the views of participants about the factors influencing workplace violence in correctional health settings. Responses to this question were analysed using qualitative thematic analysis. Participants identified several factors that they felt reduced the risk of violence in their workplace, including: appropriate workplace health and safety policies and procedures; professionalism among health staff; the presence of prison guards and the quality of security provided; and physical barriers within clinics. Conversely, participants perceived workplace violence risk to be increased by: low health staff-to-patient and correctional officer-topatient ratios; high workloads; insufficient or underperforming security staff; and poor management of violence, especially horizontal violence. The views of these participants should inform efforts to prevent workplace violence among correctional health professionals. [ABSTRACT FROM AUTHOR]

This paper presents the findings from a qualitative study, which sought to investigate the barriers and enablers to implementation of a continuous quality improvement (CQI) program by health-care professionals in Aboriginal primary health-care services in South Australia. Eighteen semi-structured interviews across 11 participating services were conducted alongside CQI implementation activities. Multiple barriers exist, from staff perspectives, which can be categorised according to different levels of the primary health-care system. At the macro level, barriers related to resource constraints (workforce issues) and access to project support (CQI coordinator). At the meso level, barriers related to senior level management and leadership for quality improvement and the level of organisational readiness. At the micro level, knowledge and attitudes of staff (such as resistance to change; lack of awareness of CQI) and lack of team tenure were cited as the main barriers to implementation. Staff identified that successful and sustained implementation of CQI requires both organisational systems and individual behaviour change. Improvements through continuing regional level collaborations and using a systems approach to develop an integrated regional level CQI framework, which includes building organisational and clinic team CQI capacity at the health centre level, are recommended. Ideally, this should be supported at the broader national level with dedicated funding. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Gout remains a health equity issue; Māori and Pacific peoples are disproportionately afflicted, with increased burden and loss of quality of life, yet are less likely to receive appropriate management, which mainly occurs in primary care. AIM: This study aims to understand the perspectives of the mainly Māori and Pacific clinicians and staff at an urban marae practice about barriers and challenges to delivering effective care to a Māori and Pacific community with high burden of gout. METHODS: Semi-structured interviews were conducted with 10 staff members delivering health care to a mostly Indigenous community. Interviews sought to ascertain staff views of enablers and barriers to optimal gout management and analyse them thematically. RESULTS: Three themes were identified: community disadvantage; demands unique to Indigenous providers; and challenges and opportunities for optimising gout management. High prevalence and heavy impact of gout on wellbeing in the community was intertwined with socioeconomic disadvantage, precariousness of employment and entrenched inaccurate (yet pliable) patient views on gout, to the detriment of focused, effective care. Structural and funding demands on providers inhibited staff focus on the clear community need. Providers saw the culturally safe and competent approach necessary for improvement as requiring community empowerment with appropriate clinical tools and adequate resourcing. DISCUSSION: Despite provider intent to deliver culturally appropriate and safe care and equitable health outcomes for patients suffering from gout, general practice initiatives without aligned resourcing or incentives are inhibited when inequity is pervasive. Simply asking Māori providers to do more for the same amount of resource may not be effective. [ABSTRACT FROM AUTHOR]

Introduction: The Department of General Practice and Primary Health Care at the University of Auckland is considering developing a Master of Primary Health Care (MPHC) programme. Masters level study entails considerable investment of both university and student time and money. Aim: To explore the views of potential students and possible employers of future graduates to discover whether there is a market for such a programme and to inform the development of the programme. Methods: Semi-structured interviews were conducted with 30 primary health care stakeholders. Interviews were digitally recorded, transcribed and analysed using a general inductive approach to identify themes. Findings: Primary care practitioners might embark on MPHC studies to develop health management and leadership skills, to develop and/or enhance clinical skills, to enhance teaching and research skills, or for reasons of personal interest. Barriers to MPHC study were identified as cost and a lack of funding, time constraints and clinical workload. Study participants favoured inter-professional learning and a flexible delivery format. Pre-existing courses may already satisfy the post-graduate educational needs of primary care practitioners. Masters level study may be superfluous to the needs of the primary care workforce. Conclusions: Any successful MPHC programme would need to provide value for PHC practitioner students and be unique. The postgraduate educational needs of New Zealand primary care practitioners may be already catered for. The international market for a MPHC programme is yet to be explored. [ABSTRACT FROM AUTHOR]

This case study describes the process of selecting the most appropriate state-wide hospital system to manage COVID-19 cases in a setting of low community transmission of COVID-19 infection. A rapid review of the literature was conducted of the advantages and disadvantages of having designated COVID hospitals. This led to three different options being presented for discussion. Following consultation, the option chosen was for all hospital facilities to remain prepared to care for COVID-19 patients where they present rather than having specified designated hospitals because this was considered the most practical option currently. [ABSTRACT FROM AUTHOR]

Objective. To explore the health professionals' (HPs) perceptions and experiences of advance care directives (ACDs) and advance care planning in Australian palliative care services. Methods. A nationwide survey of 105 palliative care services was conducted, with two HPs from each service invited to participate. A qualitative analysis of open responses about advance care planning was undertaken. Results. Sixty questionnaires were returned with open responses. Most responders were nurses (75%), aged ≥40 years (80%) and with a mean of 12 years palliative care experience. Data were grouped into four key themes: (1) the ACD; (2) the process of developing ACDs; (3) the process of using ACDs; and (4) the consequences of having ACDs. Participants were positive about advance care planning, commenting that ongoing communication about end-of-life care ensures mutual understanding between patients, family and HPs. Provision of care was considered easier and more efficient with an ACD in place. ACDs were perceived to reduce distrust and conflict between family, friends and HPs, and promote communication. Suboptimal documentation, clarity and explicitness limited the usefulness of ACDs when they were available. Conclusions. Advance care planning benefits HPs, patients and their family. To maximise these benefits, ACDs need to be clear, comprehensive, medically relevant and transportable documents. What is known about the topic? Ideally, advance care planning encompasses the identification and documentation of a person's preferences for future medical treatments and care in preparation for an occasion when the person cannot express their values and wishes. The uptake and practice of advance care planning is inconsistent, and the extent to which it is used by health professionals and patients is variable. Many people are cared for at the end of life in specialist palliative care services, but the intersection between palliative care and advance care planning remains under-researched. What does this paper adds? ACDs facilitate communication and advance care planning; help establish trust between health professionals, patients and their families; and make multiple aspects of care easier for HPs. Processes surrounding ACDs, particularly inadequate documentation, limit adherence and application. What are the implications for practitioners? Clear communication is necessary for effective ACD development and application. The presence of an ACD makes communication and advance care planning easier, and improves trust between HPs, patients and their family. To be useful, ACDs must be clear, comprehensive, medically relevant, transportable documents. [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]

Objectives. The Baume Report (1994) on Australia's surgical workforce had the potential to impact upon the health and educational sectors. This paper analyses the recommendations of this report and their impact at the time and 15 years later (2009). Methods. A questionnaire-based study was performed with the 18 senior Fellows and the Royal Australasian College of Surgeons (RACS) solicitor who had been instrumental in facilitating responses to the review. Results. The 19 respondents were asked to evaluate 22 areas from the Baume Report. The most highly ranked areas identified as being reasonable in 1994 were: additional funding being made available for more training positions, identifying workforce deficits, moving towards compulsory continuing professional development and having evidence of competence before introducing new technology. In 2009, the most highly ranked areas were: funding for more training positions; compulsory continuing professional development, involving the profession in improvements and broadening the training environment beyond public hospitals. Areas considered to be substantially addressed were: the selection process and encouragement of diversity, workforce numbers and deficits, confirming the educational merit of the training program and the role of professional colleges. Conclusions. The Baume Report highlighted many issues including workforce planning, the role of professional organisations in society and the complex interface between health and education. Issues of ongoing standards through a surgical career, access for patients to surgical services, funding for more training posts to provide the appropriate workforce level and distribution, and the assessment and introduction of technology remain priorities. Time has not diminished the relevance of these issues. [ABSTRACT FROM AUTHOR]

Objective. Non-government organisations make a substantial contribution to the provision of mental health services; despite this, there has been little research and evaluation targeted at understanding the role played by these services within the community mental health sector. The aim of the present study was to examine the depth and breadth of services offered by these organisations in south-east Queensland, Australia, across five key aspects of reach and delivery. Methods. Representatives from 52 purposively targeted non-government organisations providing mental health services to individuals with significant mental health challenges were interviewed regarding their approach to mental health service provision. Results. The findings indicated a diverse pattern of service frameworks across the sector. The results also suggested a positive approach to the inclusion of consumer participation within the organisations, with most services reporting, at the very least, some form of consumer advocacy within their processes and as part of their services. Conclusions. This paper offers an important first look at the nature of non-government service provision within the mental health sector and highlights the importance of these organisations within the community sector. [ABSTRACT FROM AUTHOR]

A 'health-literate organisation' recognises that miscommunication is very common and can negatively affect consumer care and outcomes, and makes it easier for people to navigate, understand, and use health information and services. This paper reports on the First Impressions Activities conducted by consumers to assess aspects of the literacy environment of a rural health service. The First Impressions Activities consists of three tools to assist health services to begin to consider some of the characteristics of their organisation that help and hinder a consumer's ability to physically navigate their way to and about the health service. The results show that navigation to and within the rural health service was made more complex due to lack of information, difficulty finding information, inconsistent terminology used in signage, missing signage, signage obscured by foliage, and incorrect signage. [ABSTRACT FROM AUTHOR]