134 results on '"Churruca, K."'
Search Results
2. The Quality of Care for Australian Children with Autism Spectrum Disorders
- Author
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Churruca, K., Ellis, L. A., Long, J. C., Pomare, C., Wiles, L. K., Arnolda, G., Ting, H. P., Woolfenden, S., Sarkozy, V., de Wet, C., Hibbert, P., and Braithwaite, J.
- Abstract
Knowledge about the quality of care delivered to children with autism spectrum disorders (ASD) in relation to that recommended by clinical practice guidelines (CPGs) is limited. ASD care quality indicators were developed from CPGs and validated by experts, then used to assess the quality of care delivered by general practitioners (GPs) and pediatricians in Australia. Data were retrospectively collected from the medical records of 228 children (= 15 years) with ASD for 2012-2013. Overall quality of care was high, but with considerable variation among indicators, and between GPs and pediatricians--e.g., GPs were less likely to complete the assessment care bundle (61%; 95% CI 21-92). Findings highlight potential areas for improvement in the need for standardized criteria for diagnosis. [The CareTrack Kids Investigation Team participated in writing this article.]
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- 2019
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3. Managers’ perceptions of the effects of a national mandatory accreditation program in Danish hospitals. A cross-sectional survey
- Author
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NICOLAISEN, A., BOGH, S.B., CHURRUCA, K., ELLIS, L. A., BRAITHWAITE, J., and VON PLESSEN, C.
- Published
- 2019
4. The Quality of Care for Australian Children with Autism Spectrum Disorders
- Author
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Churruca, K., Ellis, L.A., Long, J.C., Pomare, C., Wiles, L.K., Arnolda, G., and Ting, H.P.
- Subjects
Pervasive developmental disorders -- Care and treatment ,Medical care -- Quality management ,Autistic children -- Care and treatment ,Health - Abstract
Knowledge about the quality of care delivered to children with autism spectrum disorders (ASD) in relation to that recommended by clinical practice guidelines (CPGs) is limited. ASD care quality indicators were developed from CPGs and validated by experts, then used to assess the quality of care delivered by general practitioners (GPs) and pediatricians in Australia. Data were retrospectively collected from the medical records of 228 children ([less than or equal to] 15 years) with ASD for 2012-2013. Overall quality of care was high, but with considerable variation among indicators, and between GPs and pediatricians-e.g., GPs were less likely to complete the assessment care bundle (61%; 95% CI 21-92). Findings highlight potential areas for improvement in the need for standardized criteria for diagnosis., Author(s): K. Churruca [sup.1] , L. A. Ellis [sup.1] , J. C. Long [sup.1] , C. Pomare [sup.1] , L. K. Wiles [sup.1] [sup.2] , G. Arnolda [sup.1] , H. [...]
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- 2019
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- View/download PDF
5. The ‘goodness-of-fit’ of fit models: creating a multidimensional survey for person-organisation and person-group fit in health care
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Herkes, J., Ellis, L. A., Churruca, K., and Braithwaite, J.
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- 2020
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6. Guideline adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states
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Ellis, LA, Blakely, B, Hazell, P, Woolfenden, S, Hiscock, H, Sarkozy, V, Gould, B, Hibbert, PD, Arnolda, G, Ting, HP, Wiles, LK, Molloy, CJ, Churruca, K, Warwick, M, Braithwaite, J, Ellis, LA, Blakely, B, Hazell, P, Woolfenden, S, Hiscock, H, Sarkozy, V, Gould, B, Hibbert, PD, Arnolda, G, Ting, HP, Wiles, LK, Molloy, CJ, Churruca, K, Warwick, M, and Braithwaite, J
- Abstract
Objective To assess General Practitioner (GP) and pediatrician adherence to clinical practice guidelines (CPGs) for diagnosis, treatment and management of attention deficit hyperactivity disorder (ADHD). Method Medical records for 306 children aged ≤15 years from 46 GP clinics and 20 pediatric practices in Australia were reviewed against 34 indicators derived from CPG recommendations. At indicator level, adherence was estimated as the percentage of indicators with 'Yes' or 'No' responses for adherence, which were scored 'Yes'. This was done separately for GPs, pediatricians and overall; and weighted to adjust for sampling processes. Results Adherence with guidelines was high at 83.6% (95% CI: 77.7-88.5) with pediatricians (90.1%; 95% CI: 73.0-98.1) higher than GPs (68.3%; 95% CI: 46.0-85.8; p = 0.02). Appropriate assessment for children presenting with signs or symptoms of ADHD was undertaken with 95.2% adherence (95% CI: 76.6-99.9), however ongoing reviews for children with ADHD prescribed stimulant medication was markedly lower for both pediatricians (51.1%; 95% CI: 9.6-91.4) and GPs (18.7%; 95% CI: 4.1-45.5). Conclusion Adherence to CPGs for ADHD by pediatricians was generally high. Adherence by GPs was lower across most domains; timely recognition of medication side effects is a particular area for improvement. Copyright
- Published
- 2021
7. Guideline adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states
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Doering, S, Ellis, LA, Blakely, B, Hazell, P, Woolfenden, S, Hiscock, H, Sarkozy, V, Gould, B, Hibbert, PD, Arnolda, G, Ting, HP, Wiles, LK, Molloy, CJ, Churruca, K, Warwick, M, Braithwaite, J, Doering, S, Ellis, LA, Blakely, B, Hazell, P, Woolfenden, S, Hiscock, H, Sarkozy, V, Gould, B, Hibbert, PD, Arnolda, G, Ting, HP, Wiles, LK, Molloy, CJ, Churruca, K, Warwick, M, and Braithwaite, J
- Abstract
OBJECTIVE: To assess General Practitioner (GP) and pediatrician adherence to clinical practice guidelines (CPGs) for diagnosis, treatment and management of attention deficit hyperactivity disorder (ADHD). METHOD: Medical records for 306 children aged ≤15 years from 46 GP clinics and 20 pediatric practices in Australia were reviewed against 34 indicators derived from CPG recommendations. At indicator level, adherence was estimated as the percentage of indicators with 'Yes' or 'No' responses for adherence, which were scored 'Yes'. This was done separately for GPs, pediatricians and overall; and weighted to adjust for sampling processes. RESULTS: Adherence with guidelines was high at 83.6% (95% CI: 77.7-88.5) with pediatricians (90.1%; 95% CI: 73.0-98.1) higher than GPs (68.3%; 95% CI: 46.0-85.8; p = 0.02). Appropriate assessment for children presenting with signs or symptoms of ADHD was undertaken with 95.2% adherence (95% CI: 76.6-99.9), however ongoing reviews for children with ADHD prescribed stimulant medication was markedly lower for both pediatricians (51.1%; 95% CI: 9.6-91.4) and GPs (18.7%; 95% CI: 4.1-45.5). CONCLUSION: Adherence to CPGs for ADHD by pediatricians was generally high. Adherence by GPs was lower across most domains; timely recognition of medication side effects is a particular area for improvement.
- Published
- 2021
8. Guideline adherence in the management of head injury in Australian children: A population-based sample survey
- Author
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Long, JC, Dalton, S, Arnolda, G, Ting, HP, Molloy, CJ, Hibbert, PD, Wiles, LK, Craig, S, Warwick, M, Churruca, K, Ellis, LA, Braithwaite, J, Long, JC, Dalton, S, Arnolda, G, Ting, HP, Molloy, CJ, Hibbert, PD, Wiles, LK, Craig, S, Warwick, M, Churruca, K, Ellis, LA, and Braithwaite, J
- Abstract
Background Head injuries in children are a common and potentially devastating presentation. The CareTrack Kids (CTK) study assessed care of Australian children aged 0–15 years, in 2012 and 2013, to evaluate the proportion in line with guideline-based indicators for 17 common conditions. Overall adherence to guideline-based recommended practice occurred 59.8% of care encounters (95% CI: 57.5–62.0), and 78.3% (95% CI: 75.1–81.2) for head injury. This paper presents results for head injury, at indicator level. Methods A modified version of the RAND-UCLA method of indicator development was used. Indicators, measurable components of a standard or guideline, were developed from international and national guidelines relating to head injury in children and were ratified by clinical experts using a Delphi process. Paediatric nurses extracted data from medical records from general practitioners (GPs), emergency departments (EDs) and inpatient wards in Queensland, New South Wales and South Australia, for children under 15 years receiving care in 2012–13. Our purpose was to estimate the percentage adherent for each indicator. Results The medical records of 629 children with head injury were examined. Fifty-one percent of children were under 5 years old, with more males (61%) than females. Thirty-eight indicators were assessed. Avoidance of nasotracheal airways (100%; 95% CI: 99.4–100) or nasogastric tubes (99.7%; 95% CI: 98.5–100) for children with a head injury had the highest adherence. Indicators relating to primary and secondary assessment of head injuries were mostly adhered to. However, adherence to other indicators was poor (e.g., documentation of the past history of children (e.g., presence or absence of seizures) before the injury; 29.9% (95% CI: 24.5–35.7)), and for others was difficult to estimate with confidence due to small sample sizes (e.g., Children with a head injury who were intubated had PaO2 above 80mm Hg; 56.0% (95% CI: 28.6–80.9)). Indicators guiding clini
- Published
- 2020
9. Guideline adherence in the management of head injury in Australian children: A population-based sample survey.
- Author
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Ellis L.A., Wiles L.K., Craig S., Warwick M., Churruca K., Braithwaite J., Long J.C., Dalton S., Arnolda G., Ting H.P., Molloy C.J., Hibbert P.D., Ellis L.A., Wiles L.K., Craig S., Warwick M., Churruca K., Braithwaite J., Long J.C., Dalton S., Arnolda G., Ting H.P., Molloy C.J., and Hibbert P.D.
- Abstract
Background Head injuries in children are a common and potentially devastating presentation. The CareTrack Kids (CTK) study assessed care of Australian children aged 0-15 years, in 2012 and 2013, to evaluate the proportion in line with guideline-based indicators for 17 common conditions. Overall adherence to guideline-based recommended practice occurred 59.8% of care encounters (95% CI: 57.5-62.0), and 78.3% (95% CI: 75.1-81.2) for head injury. This paper presents results for head injury, at indicator level. Methods A modified version of the RAND-UCLA method of indicator development was used. Indicators, measurable components of a standard or guideline, were developed from international and national guidelines relating to head injury in children and were ratified by clinical experts using a Delphi process. Paediatric nurses extracted data from medical records from general practitioners (GPs), emergency departments (EDs) and inpatient wards in Queensland, New South Wales and South Australia, for children under 15 years receiving care in 2012-13. Our purpose was to estimate the percentage adherent for each indicator. Results The medical records of 629 children with head injury were examined. Fifty-one percent of children were under 5 years old, with more males (61%) than females. Thirty-eight indicators were assessed. Avoidance of nasotracheal airways (100%; 95% CI: 99.4-100) or nasogastric tubes (99.7%; 95% CI: 98.5-100) for children with a head injury had the highest adherence. Indicators relating to primary and secondary assessment of head injuries were mostly adhered to. However, adherence to other indicators was poor (e.g., documentation of the past history of children (e.g., presence or absence of seizures) before the injury; 29.9% (95% CI: 24.5-35.7)), and for others was difficult to estimate with confidence due to small sample sizes (e.g., Children with a head injury who were intubated had PaO2 above 80mm Hg; 56.0% (95% CI: 28.6-80.9)). Indicators guiding clini
- Published
- 2020
10. What methods are used to promote patient and family involvement in healthcare regulation?
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Wiig, S. (Siri), Rutz, S.I. (Suzanne), Boyd, A. (Alan), Churruca, K. (Kate), Kleefstra, S. (Sophia), Haraldseid-Driftland, C. (Cecilie), Braithwaite, J. (Jeffrey), O'Hara, J. (Jane), Bovenkamp, H.M. (Hester) van de, Wiig, S. (Siri), Rutz, S.I. (Suzanne), Boyd, A. (Alan), Churruca, K. (Kate), Kleefstra, S. (Sophia), Haraldseid-Driftland, C. (Cecilie), Braithwaite, J. (Jeffrey), O'Hara, J. (Jane), and Bovenkamp, H.M. (Hester) van de
- Abstract
BACKGROUND: In the regulation of healthcare, the subject of patient and family involvement figures increasingly prominently on the agenda. However, the literature on involving patients and families in regulation is still in its infancy. A systematic analysis of how patient and family involvement in regulation is accomplished across different health systems is lacking. We provide such an overview by mapping and classifying methods of patient and family involvement in regulatory practice in four countries; Norway, England, the Netherlands, and Australia. We thus provide a knowledge base that enables d
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- 2020
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11. What methods are used to promote patient and family involvement in healthcare regulation? A case study across four countries
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Wiig, S (Siri), Rutz, S, Boyd, A, Churruca, K, Kleefstra, S, Haraldseid-Driftla, C, Braithwaite, J, O'Hara, J, van de Bovenkamp, Hester, Wiig, S (Siri), Rutz, S, Boyd, A, Churruca, K, Kleefstra, S, Haraldseid-Driftla, C, Braithwaite, J, O'Hara, J, and van de Bovenkamp, Hester
- Abstract
Background In healthcare regulation, the subject of patient and family involvement figures increasingly prominently on the agenda. However, the literature on involving patient and families in regulation is still in its infancy. A systematic analysis of how patient and family involvement in regulation is accomplished across different health systems is lacking. We provide such an overview by mapping and classifying methods of patient and family involvement in regulatory practice in four countries; Norway, England, the Netherlands, and Australia. We thus provide a knowledge base that enables discussions about possible types of involvement, and advantages and difficulties of involvement encountered in practice. Methods The research design was a multiple case study of patient and family involvement in regulation in four countries. The authors collected 1) academic literature if available and 2) documents of regulators that describe user involvement. Based on the data collected, the authors from each country completed a pre-agreed template to describe the involvement methods. The following information was extracted and included if available: 1) Method of involvement, 2) Type of regulatory activity, 3) Purpose of involvement, 4) Who is involved and 5) Lessons learnt. Results Our mapping of involvement methods showed a range of methods being used in regulation, which we classified into four categories: individual proactive, individual reactive, collective proactive, and collective reactive methods. Reported advantages include: increased quality of regulation, increased legitimacy, perceived justice for those affected, and empowerment. Difficulties were also reported concerning: how to incorporate the input of users in decisions, the fact that not all users want to be involved, time and costs required, organizational procedures standing in the way of involvement, and dealing with emotions. Conclusions Our mapping of user involvement methods found a broad variety of involveme
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- 2020
12. Building a learning community of Australian clinical genomics: a social network study of the Australian Genomic Health Alliance
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Long, JC, Pomare, C, Best, S, Boughtwood, T, North, K, Ellis, LA, Churruca, K, Braithwaite, J, Long, JC, Pomare, C, Best, S, Boughtwood, T, North, K, Ellis, LA, Churruca, K, and Braithwaite, J
- Abstract
BACKGROUND: Adopting clinical genomics represents a major systems-level intervention requiring diverse expertise and collective learning. The Australian Genomic Health Alliance (Australian Genomics) is strategically linking members and partner organisations to lead the integration of genomic medicine into healthcare across Australia. This study aimed to map and analyse interconnections between members-a key feature of complexity-to capture the collaborations among the genomic community, document learning, assess Australian Genomics' influence and identify key players. METHODS: An online, whole network study collected relational data from members asking them about two time points: baseline, before Australian Genomics started operation in 2016 and current in 2018. Likert style questions assessed the influence of various sources of knowledge on the respondents' genomic practice. A secure link to the online questionnaire was distributed to all members of Australian Genomics during May 2018. Social network data was analysed and visually constructed using Gephi 0.9.2 software, and Likert questions were analysed using chi-squared computations in SPSS. The project was given ethical approval. RESULTS: Response rate was 57.81% (222/384). The genomic learning community within Australian Genomics was constructed from the responses of participants. There was a growth in ties from pre-2016 (2925 ties) to 2018 (6381 ties) and an increase in density (0.020 to 0.043) suggesting the strong influence of Australian Genomics in creating this community. Respondents nominated 355 collaborative partners from 24 different countries outside of Australia and 328 partners from within Australia but outside the alliance. Key players were the Australian Genomics Manager, two clinical geneticists and four Operational staff members. Most influential sources of learning were hands on learning, shared decision making, journal articles and conference presentations in contrast to formal courses. CONCLU
- Published
- 2019
13. Managers’ perceptions of the effects of a national mandatory accreditation program in Danish hospitals. A cross-sectional survey
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Nicolaisen, A, primary, Bogh, S B, additional, Churruca, K, additional, Ellis, L A, additional, Braithwaite, J, additional, and von Plessen, C, additional
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- 2018
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14. ISQUA18-1699Complexity Science: The Next Frontier for Improving Quality and Safety in Healthcare
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Churruca, K, primary, Ellis, L, additional, Long, J, additional, and Braithwaite, J, additional
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- 2018
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15. ISQUA17-1548BROKEN WINDOWS THEORY AND ITS APPLICATION TO HEALTHCARE
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Ellis, L, primary, Churruca, K, additional, Braithwaite, J, additional, and Long, J, additional
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- 2017
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16. ISQUA16-2496CARE ACROSS THE CONTINUUM: SUPPORTING WOMEN CONCERNED ABOUT BREAST CANCER IN GENETICS AND ONCOLOGY SETTINGS
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Rapport, F., primary, Shih, P., additional, and Churruca, K., additional
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- 2016
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17. The quality of care for Australian children with autism spectrum disorders
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Hsuen Pei Ting, Chiara Pomare, Louise Wiles, Peter Hibbert, Susan Woolfenden, Kate Churruca, Louise A. Ellis, C. de Wet, Janet C. Long, Jeffrey Braithwaite, Gaston Arnolda, Vanessa Sarkozy, Churruca, K, Ellis, LA, Long, JC, Pomare, C, Wiles, LK, Arnolda, G, Ting, HP, Woolfenden, S, Sarkozy, V, de Wet, C, Hibbert, P, and Braithwaite, J
- Subjects
Male ,medicine.medical_specialty ,pediatrics ,Autism Spectrum Disorder ,media_common.quotation_subject ,General Practice ,autism spectrum disorder ,Medical Records ,03 medical and health sciences ,0302 clinical medicine ,quality of health care ,Developmental and Educational Psychology ,medicine ,Humans ,0501 psychology and cognitive sciences ,Quality (business) ,Care bundle ,Quality of care ,Child ,guideline adherence ,media_common ,Quality of Health Care ,general practice ,Medical record ,Public health ,05 social sciences ,Australia ,medicine.disease ,Clinical Practice ,Autism spectrum disorder ,Family medicine ,Child, Preschool ,Autism ,Female ,Psychology ,030217 neurology & neurosurgery ,clinical practice guideline ,050104 developmental & child psychology - Abstract
Knowledge about the quality of care delivered to children with autism spectrum disorders (ASD) in relation to that recommended by clinical practice guidelines (CPGs) is limited. ASD care quality indicators were developed from CPGs and validated by experts, then used to assess the quality of care delivered by general practitioners (GPs) and pediatricians in Australia. Data were retrospectively collected from the medical records of 228 children (≤ 15 years) with ASD for 2012–2013.Overall quality of care was high, but with considerable variation among indicators, and between GPs and pediatricians—e.g., GPs were less likely to complete the assessment care bundle (61%; 95% CI 21–92). Findings highlight potential areas for improvement in the need for standardized criteria for diagnosis. Refereed/Peer-reviewed
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- 2019
18. Building a culture of safety in Australian residential aged care facilities: protocol for a longitudinal mixed methods research programme.
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Churruca K, Graham J, Ellis LA, Westbrook J, Wabe N, Hibbert PD, Ludlow K, Urwin R, Meulenbroeks I, Thanigasalam J, Svaleng I, Sardellis JA, and Braithwaite J
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- Humans, Australia, Longitudinal Studies, Cross-Sectional Studies, Research Design, Quality of Health Care, Aged, Nursing Homes organization & administration, Surveys and Questionnaires, Organizational Culture, Homes for the Aged organization & administration, Patient Safety
- Abstract
Introduction: The quality and safety of care within residential aged care facilities (RACFs) have been linked to their organisational culture. However, evidence for understanding and improving culture in this setting is limited. This research programme aims to validate a survey to measure organisational culture and determine the relationship of culture with safety and quality of care, then to evaluate an organisational culture change programme in Australian RACFs., Methods and Analysis: This is a longitudinal mixed methods programme of research conducted across four studies in collaboration with a national aged care provider that cares for more than 5000 residents:Study 1: Cross-sectional staff survey of organisational culture in >50 RACFs with concurrent collection of data on quality and safety of care, and staff outcomes, to explore their associations with culture.Study 2: Ethnographic fieldwork in eight RACFs sampled to achieve maximum variation. Data from interviews, observations and documents will be analysed to identify the underlying assumptions and how cultural assumptions influence the enactment of safety and quality.Study 3: Evaluation of the implementation of the Speak Up for Safety culture change programme, focusing on its contextualisation for RACFs, implementation determinants and outcomes. Data will be collected through semistructured interviews, complimented with secondary data from program training and feedback system usage.Study 4: Evaluation of the effectiveness of the culture change programme using baseline data from study 1 and a follow-up survey of organisational culture postimplementation to assess changes in organisational culture and staff behaviour., Ethics and Dissemination: The study has received approval from the Macquarie University Human Research Ethics Committee. Informed consent will be sought from all participants. Findings will be disseminated through journal articles, conference presentations and reports to the collaborating provider and RACFs. Survey data will be deposited into a data repository for use by others working on related research., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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19. The Unintended Consequences of Telehealth in Australia: Critical Interpretive Synthesis.
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Osman S, Churruca K, Ellis LA, Luo D, and Braithwaite J
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- Humans, Australia, Pandemics, SARS-CoV-2, Telemedicine statistics & numerical data, COVID-19 epidemiology
- Abstract
Background: Despite more than 2 decades of telehealth use in Australia and the rapid uptake during the COVID-19 pandemic, little is known about its unintended consequences beyond its planned and intended outcomes., Objective: The aim of this review was to synthesize evidence on the unintended consequences of telehealth use in Australia to clarify its impact beyond its planned and intended outcomes., Methods: We conducted a search of 4 electronic databases: Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, and Scopus. A critical interpretive synthesis approach was adopted for its flexibility and interpretive nature. We extracted data about study characteristics and the types and models of telehealth services. The extracted unintended consequences were coded and mapped into the domains and dimensions of the Australian Health Performance Framework., Results: Of the 4241 records identified by the search, 94 (2.22%) studies were eligible for data extraction and analysis. Of these 94 studies, 23 (24%) reported largely positive unintended consequences of telehealth associated with health status, while 6 (6%) noted a potential negative impact of telehealth on socioeconomic status. The findings of 4 (4%) of the 94 studies highlighted societal and financial consequences of telehealth beyond the health system. Almost all studies (93/94, 99%) reported unintended consequences under the 5 dimensions of the Australian Health Performance Framework., Conclusions: Our synthesis offers a framework for understanding the unintended consequences of the use of telehealth as an alternative to in-person care in Australia. While we have documented many unintended benefits of telehealth use, our findings also shed light on many challenges of delivering care via telehealth across different domains and dimensions. These findings hold significant practice and policy-making implications for ensuring safe and high-quality care delivery via telehealth., (©Sagda Osman, Kate Churruca, Louise A Ellis, Dan Luo, Jeffrey Braithwaite. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.08.2024.)
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- 2024
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20. Barriers and facilitators to learning health systems in primary care: a framework analysis.
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Fisher G, Saba M, Dammery G, Ellis LA, Churruca K, Mahadeva J, Foo D, Wilcock S, and Braithwaite J
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- Humans, Interviews as Topic, Australia, General Practice, Attitude of Health Personnel, Primary Health Care, Learning Health System, Qualitative Research
- Abstract
Background: The learning health system (LHS) concept is a potential solution to the challenges currently faced by primary care. There are few descriptions of the barriers and facilitators to achieving an LHS in general practice, and even fewer that are underpinned by implementation science. This study aimed to describe the barriers and facilitators to achieving an LHS in primary care and provide practical recommendations for general practices on their journey towards an LHS., Methods: This study is a secondary data analysis from a qualitative investigation of an LHS in a university-based general practice in Sydney, Australia. A framework analysis was conducted using transcripts from semistructured interviews with clinic staff. Data were coded according to the theoretical domains framework, and then to an LHS framework., Results: 91% (n=32) of practice staff were interviewed, comprising general practitioners (n=15), practice nurses (n=3), administrative staff (n=13) and a psychologist. Participants reported that the practice alignment with LHS principles was influenced by many behavioural determinants, some of which were applicable to healthcare in general, for example, some staff lacked knowledge about practice policies and skills in using software. However, many were specific to the general practice environment, for example, the environmental context of general practice meant that administrative staff were an integral part of the LHS, particularly in facilitating partnerships with patients., Conclusions: The LHS journey in general practice is influenced by several factors. Mapping the LHS domains in relation to the theoretical domains framework can be used to generate a roadmap to hasten the journey towards LHS in primary care settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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21. Evaluation of a culture change program to reduce unprofessional behaviours by hospital co-workers in Australian hospitals.
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Westbrook JI, Urwin R, McMullan R, Badgery-Parker T, Pavithra A, Churruca K, Cunningham N, Loh E, Hibbert P, Maddern G, Braithwaite J, and Li L
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- Humans, Australia, Female, Male, Adult, Personnel, Hospital psychology, Surveys and Questionnaires, Program Evaluation, Professional Misconduct statistics & numerical data, Professional Misconduct psychology, Sexual Harassment statistics & numerical data, Sexual Harassment psychology, Middle Aged, Bullying statistics & numerical data, Bullying prevention & control, Organizational Culture
- Abstract
Background: Unprofessional behaviours between healthcare workers are highly prevalent. Evaluations of large-scale culture change programs are rare resulting in limited evidence of intervention effectiveness. We conducted a multi-method evaluation of a professional accountability and culture change program "Ethos" implemented across eight Australian hospitals. The Ethos program incorporates training for staff in speaking-up; an online system for reporting co-worker behaviours; and a tiered accountability pathway, including peer-messengers who deliver feedback to staff for 'reflection' or 'recognition'. Here we report the final evaluation component which aimed to measure changes in the prevalence of unprofessional behaviours before and after Ethos., Methods: A survey of staff (clinical and non-clinical) experiences of 26 unprofessional behaviours across five hospitals at baseline before (2018) and 2.5-3 years after (2021/2022) Ethos implementation. Five of the 26 behaviours were classified as 'extreme' (e.g., assault) and 21 as incivility/bullying (e.g., being spoken to rudely). Our analysis assessed changes in four dimensions: work-related bullying; person-related bullying; physical bullying and sexual harassment. Change in experience of incivility/bullying was compared using multivariable ordinal logistic regression. Change in extreme behaviours was assessed using multivariable binary logistic regression. All models were adjusted for respondent characteristics., Results: In total, 3975 surveys were completed. Staff reporting frequent incivility/bullying significantly declined from 41.7% (n = 1064; 95% CI 39.7,43.9) at baseline to 35.5% (n = 505; 95% CI 32.8,38.3; χ
2 (1) = 14.3; P < 0.001) post-Ethos. The odds of experiencing incivility/bullying declined by 24% (adjusted odds ratio [aOR] 0.76; 95% CI 0.66,0.87; P < 0.001) and odds of experiencing extreme behaviours by 32% (aOR 0.68; 95% CI 0.54,0.85; P < 0.001) following Ethos. All four dimensions showed a reduction of 32-41% in prevalence post-Ethos. Non-clinical staff reported the greatest decrease in their experience of unprofessional behaviour (aOR 0.41; 95% CI 0.29, 0.61). Staff attitudes and reported skills to speak-up were significantly more positive at follow-up. Awareness of the program was high (82.1%; 95% CI 80.0, 84.0%); 33% of respondents had sent or received an Ethos message., Conclusion: The Ethos program was associated with significant reductions in the prevalence of reported unprofessional behaviours and improved capacity of hospital staff to speak-up. These results add to evidence that staff will actively engage with a system that supports informal feedback to co-workers about their behaviours and is facilitated by trained peer messengers., (© 2024. The Author(s).)- Published
- 2024
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22. Beyond the planned and expected: the unintended consequences of telehealth in rural and remote Australia through a complexity lens.
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Osman S, Churruca K, Ellis LA, and Braithwaite J
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- Humans, Australia, Rural Population, Health Services Accessibility, Telemedicine, Rural Health Services organization & administration
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- 2024
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23. 'No matter what time of day': The value of joining Facebook groups supporting women's self-management of gestational diabetes mellitus.
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Pham S, Churruca K, Ellis LA, and Braithwaite J
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- Humans, Female, Pregnancy, Adult, Cross-Sectional Studies, Surveys and Questionnaires, Social Support, Motivation, Self-Help Groups, Diabetes, Gestational therapy, Diabetes, Gestational psychology, Self-Management, Social Media
- Abstract
Background: Gestational diabetes mellitus (GDM) affects a significant and growing proportion of pregnant women each year. The condition entails additional monitoring, self-management and healthcare use during pregnancy, and some women also join GDM support groups on Facebook. Little is known about the practices inside these groups, but examining them may elucidate support needs, women's experience of healthcare and improve overall outcomes. The aims of this study were to explore motivations for joining GDM Facebook groups and the perceived value and benefits of such spaces., Design: A cross-sectional design using a web-based survey collected data from two peer-led GDM Facebook groups; relevant quantitative and qualitative data were extracted from open and closed questions, and analysed using descriptive statistics and content analysis., Results: A total of 340 women responded to the survey, with 306 (90%) tendering their motivations to join a GDM Facebook group. Their answers were classified into six categories: peer support; information and practical advice; lived experiences; community; a safe place to ask questions and being recommended. The most commonly reported benefits of membership were 'reading about food ideas' and 'finding helpful information and tips'. Respondents reported finding their group strongly sympathetic, sincere, compassionate, heart-felt, tolerant, sensitive, warm and supportive., Discussion and Conclusions: GDM Facebook groups are valuable for informational and emotional support, and the sharing and perusal of lived experiences; another key benefit for women is feeling belonging to a community. GDM Facebook groups provide women with access to more tailored and readily available support, filling gaps not addressed by healthcare providers., Patient Contribution: This study was led by a person with lived experience of GDM, and the survey was pilot tested with women who had also experienced GDM, which contributed to its development., (© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.)
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- 2024
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24. Co-worker unprofessional behaviour and patient safety risks: an analysis of co-worker reports across eight Australian hospitals.
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McMullan RD, Churruca K, Hibbert P, Li L, Ash R, Urwin R, Pavithra A, and Westbrook JI
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- Humans, Australia, Hospitals, Professional Misconduct, Patient Safety, Physicians
- Abstract
A key component of professional accountability programmes is online reporting tools that allow hospital staff to report co-worker unprofessional behaviour. Few studies have analysed data from these systems to further understand the nature or impact of unprofessional behaviour amongst staff. Ethos is a whole-of-hospital professional accountability programme that includes an online messaging system. Ethos has now been implemented across multiple Australian hospitals. This study examined reported unprofessional behaviour that staff indicated created a risk to patient safety. This study included 1310 Ethos submissions reporting co-worker unprofessional behaviour between 2017 and 2020 across eight Australian hospitals. Submissions that indicated the behaviour increased the risk to patient safety were identified. Descriptive summary statistics were presented for reporters and subjects of submissions about unprofessional behaviour. Logistic regression was applied to examine the association between each unprofessional behaviour (of the six most frequently reported in the Ethos submissions) and patient safety risk reported in the submissions. The descriptions in the reports were reviewed and the patient safety risks were coded using a framework aligned with the World Health Organization's International Classification for Patient Safety. Of 1310 submissions about unprofessional behaviour, 395 (30.2%) indicated that there was a risk to patient safety. Nurses made the highest number of submissions that included a patient safety risk [3.47 submissions per 100 nursing staff, 95% confidence interval (CI): 3.09-3.9] compared to other professional groups. Medical professionals had the highest rate as subjects of submissions for unprofessional behaviour with a patient safety risk (5.19 submissions per 100 medical staff, 95% CI: 4.44-6.05). 'Opinions being ignored' (odds ratio: 1.68; 95% CI: 1.23-2.22; P < .001) and 'someone withholding information which affects work performance' were behaviours strongly associated with patient safety risk in the submissions (odds ratio: 2.50; 95% CI: 1.73-3.62; P < .001) compared to submissions without a patient safety risk. The two main types of risks to patient safety described were related to clinical process/procedure and clinical administration. Commonly reported events included staff not following policy or protocol; doctors refusing to review a patient; and interruptions and inadequate information during handover. Our findings indicate that unprofessional behaviour was associated with risks to patient safety. Co-worker reports about unprofessional behaviour have significant value as they can be used by organizations to better understand how unprofessional behaviour can disrupt work practices and lead to risks to patient safety., (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Quality in Health Care.)
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- 2024
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25. Correction: Strategies to improve care for older adults who present to the emergency department: a systematic review.
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Testa L, Richardson L, Cheek C, Hensel T, Austin E, Safi M, Ransolin N, Carrigan A, Long J, Hutchinson K, Goirand M, Bierbaum M, Bleckly F, Hibbert P, Churruca K, and Clay-Williams R
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- 2024
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26. Implementation of large, multi-site hospital interventions: a realist evaluation of strategies for developing capability.
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Long JC, Roberts N, Francis-Auton E, Sarkies MN, Nguyen HM, Westbrook JI, Levesque JF, Watson DE, Hardwick R, Churruca K, Hibbert P, and Braithwaite J
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- Humans, Australia, Health Personnel, Investments, Hospitals, Data Analysis
- Abstract
Background: This study presents guidelines for implementation distilled from the findings of a realist evaluation. The setting was local health districts in New South Wales, Australia that implemented three clinical improvement initiatives as part of a state-wide program. We focussed on implementation strategies designed to develop health professionals' capability to deliver value-based care initiatives for multisite programs. Capability, which increases implementers' ability to cope with unexpected scenarios is key to managing change., Methods: We used a mixed methods realist evaluation which tested and refined program theories elucidating the complex dynamic between context (C), mechanism (M) and outcome (O) to determine what works, for whom, under what circumstances. Data was drawn from program documents, a realist synthesis, informal discussions with implementation designers, and interviews with 10 key informants (out of 37 identified) from seven sites. Data analysis employed a retroductive approach to interrogate the causal factors identified as contributors to outcomes., Results: CMO statements were refined for four initial program theories: Making it Relevant- where participation in activities was increased when targeted to the needs of the staff; Investment in Quality Improvement- where engagement in capability development was enhanced when it was valued by all levels of the organisation; Turnover and Capability Loss- where the effects of staff turnover were mitigated; and Community-Wide Priority- where there was a strategy of spanning sites. From these data five guiding principles for implementers were distilled: (1) Involve all levels of the health system to effectively implement large-scale capability development, (2) Design capability development activities in a way that supports a learning culture, (3) Plan capability development activities with staff turnover in mind, (4) Increased capability should be distributed across teams to avoid bottlenecks in workflows and the risk of losing key staff, (5) Foster cross-site collaboration to focus effort, reduce variation in practice and promote greater cohesion in patient care., Conclusions: A key implementation strategy for interventions to standardise high quality practice is development of clinical capability. We illustrate how leadership support, attention to staff turnover patterns, and making activities relevant to current issues, can lead to an emergent learning culture., (© 2024. The Author(s).)
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- 2024
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27. Systems archetypes to investigate the unintended consequences of telehealth in rural Australia: A systems thinking approach to telehealth evaluation and policymaking.
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Osman S, Churruca K, Ellis LA, and Braithwaite J
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- Australia, Systems Analysis, Policy Making, Telemedicine
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As an alternative model of delivery to standard care, telehealth offers a promising solution to health access issues faced by rural and remote communities in Australia and worldwide. However, research typically focuses on its expected benefits and pitfalls, with little to no consideration of its unintended consequences and factors influencing its better utilisation. Drawing on systems thinking and informed by complexity science, we propose using systems archetypes-systems thinking tools - as a magnifying lens to investigate potential telehealth unintended consequences or outcomes. We conceptualise telehealth implementation in rural and remote Australia as a sociotechnical system whereby the interactions between its various agents shape telehealth implementation and, in turn, are shaped by it. When introducing new policies or interventions to any system, these interactions often lead to outcomes other than those initially planned or intended. Although systems archetypes cannot necessarily predict these outcomes, they are valuable for helping anticipate unintended, unforeseen outcomes and facilitating discussions about them to mitigate their negative impact and maximise their benefits. Outcomes are not necessarily adverse; they can also be positive. So, investigating such outcomes will minimise their negative impact and maximise their benefit. Our method was to review existing research and a selection of complexity and systems informed frameworks. Then, we assessed systems archetypes. And how they can be utilised to investigate unintended consequences. A worked example of what an unintended consequence in the implementation of telehealth in rural and remote Australia is presented., (© 2023 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)
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- 2024
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28. Help-Seeking, Support, and Engagement in Gestational Diabetes Mellitus Online Communities on Facebook: Content Analysis.
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Pham S, Churruca K, Ellis LA, and Braithwaite J
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Background: The prevalence of gestational diabetes mellitus (GDM) has drastically risen in recent years. For some, self-management includes the use of GDM online communities on Facebook. Such communities can fill gaps in information and support that participants are not able to access elsewhere to address unmet needs. Given the popularity of sharing information about pregnancy on Facebook and the documented benefits of diabetes online communities, the same may be true of GDM online communities., Objective: This study aimed to categorize and quantify what is being discussed in GDM Facebook groups, including informational and emotional help-seeking behavior, and how this support and engagement may be demonstrated by peers through comments and reactions., Methods: We sourced the data from the 2 largest Facebook groups focused on GDM in Australia. A summative content analysis was conducted on original posts across the 2 groups and coded for topics as well as help-seeking types. The coding scheme was based on the previous work of Liang and Scammon. Visible indicators of engagement, including the number of comments and "reactions," were tabled and manually evaluated., Results: There were 388 original posts, and the analysis produced 6 topics: GDM self-management (199/388, 51.3%), GDM clinical management (120/388, 30.9%), preparing for birth (40/388, 10.3%), mental distress (35/388, 9%), birth announcement (29/388, 7.5%), and GDM journey reflections (21/388, 5.4%). Secondary coding of help-seeking type revealed more than half of the posts were informational help-seeking (224/388, 57.7%), while a small proportion were both informational and emotional help-seeking (44/388, 11.3%), and some (12/388, 3.1%) were emotional help-seeking only. Self-disclosure was identified as a fourth category, comprising almost a quarter of all posts (90/388, 23.2%). A total of 6022 comments were posted in response to the original posts, and there were 4452 reactions across all posts. Emotional help-seeking attracted the most comments per thread (mean 21.5, SD 19.8), followed by informational and emotional help-seeking (mean 20.2, SD 14.7), informational help-seeking (mean 15.6, SD 14.6), and self-disclosure (mean 14.3, SD 21.8). Across all help-seeking categories, few reactions occurred compared to comments; in contrast, self-disclosure attracted a large number of reactions (mean 9.4, SD 45.3)., Conclusions: This is one of the first studies to examine peer support in a GDM online community on Facebook. Our findings suggest that active participants' needs around information and support in relation to GDM are being somewhat met by peer-led online communities. Given the practical limitations of formal health care, including the provision of ongoing social support, it is important to recognize how GDM online communities can complement formal health care and help address unmet needs., (©Sheila Pham, Kate Churruca, Louise A Ellis, Jeffrey Braithwaite. Originally published in JMIR Formative Research (https://formative.jmir.org), 26.02.2024.)
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- 2024
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29. Strategies to improve care for older adults who present to the emergency department: a systematic review.
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Testa L, Richardson L, Cheek C, Hensel T, Austin E, Safi M, Ransolin N, Carrigan A, Long J, Hutchinson K, Goirand M, Bierbaum M, Bleckly F, Hibbert P, Churruca K, and Clay-Williams R
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- Humans, Aged, Aged, 80 and over, Female, Emergency Service, Hospital, Quality Improvement
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Background: The aim of this systematic review was to examine the relationship between strategies to improve care delivery for older adults in ED and evaluation measures of patient outcomes, patient experience, staff experience, and system performance., Methods: A systematic review of English language studies published since inception to December 2022, available from CINAHL, Embase, Medline, and Scopus was conducted. Studies were reviewed by pairs of independent reviewers and included if they met the following criteria: participant mean age of ≥ 65 years; ED setting or directly influenced provision of care in the ED; reported on improvement interventions and strategies; reported patient outcomes, patient experience, staff experience, or system performance. The methodological quality of the studies was assessed by pairs of independent reviewers using The Joanna Briggs Institute critical appraisal tools. Data were synthesised using a hermeneutic approach., Results: Seventy-six studies were included in the review, incorporating strategies for comprehensive assessment and multi-faceted care (n = 32), targeted care such as management of falls risk, functional decline, or pain management (n = 27), medication safety (n = 5), and trauma care (n = 12). We found a misalignment between comprehensive care delivered in ED for older adults and ED performance measures oriented to rapid assessment and referral. Eight (10.4%) studies reported patient experience and five (6.5%) reported staff experience., Conclusion: It is crucial that future strategies to improve care delivery in ED align the needs of older adults with the purpose of the ED system to ensure sustainable improvement effort and critical functioning of the ED as an interdependent component of the health system. Staff and patient input at the design stage may advance prioritisation of higher-impact interventions aligned with the pace of change and illuminate experience measures. More consistent reporting of interventions would inform important contextual factors and allow for replication., (© 2024. The Author(s).)
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- 2024
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30. Rates of adherence to cancer treatment guidelines in Australia and the factors associated with adherence: A systematic review.
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Bierbaum M, Rapport F, Arnolda G, Tran Y, Nic Giolla Easpaig B, Ludlow K, Clay-Williams R, Austin E, Laginha B, Lo CY, Churruca K, van Baar L, Hutchinson K, Chittajallu R, Owais SS, Nullwala R, Hibbert P, Fajardo Pulido D, and Braithwaite J
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- Female, Humans, Male, Australasian People, Australia, Breast Neoplasms, Colonic Neoplasms, Lung Neoplasms pathology, Guideline Adherence, Practice Guidelines as Topic, Neoplasms therapy, Social Determinants of Health statistics & numerical data
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Adherence to cancer treatment clinical practice guidelines (CPGs) varies enormously across Australia, despite being associated with improved patient outcomes. This systematic review aims to characterize adherence rates to active-cancer treatment CPGs in Australia and related factors to inform future implementation strategies. Five databases were systematically searched, abstracts were screened for eligibility, a full-text review and critical appraisal of eligible studies performed, and data extracted. A narrative synthesis of factors associated with adherence was conducted, and the median adherence rates within cancer streams calculated. A total of 21,031 abstracts were identified. After duplicates were removed, abstracts screened, and full texts reviewed, 20 studies focused on adherence to active-cancer treatment CPGs were included. Overall adherence rates ranged from 29% to 100%. Receipt of guideline recommended treatments was higher for patients who were younger (diffuse large B-cell lymphoma [DLBCL], colorectal, lung, and breast cancer); female (breast and lung cancer), and male (DLBCL and colorectal cancer); never smokers (DLBCL and lung cancer); non-Indigenous Australians (cervical and lung cancer); with less advanced stage disease (colorectal, lung, and cervical cancer), without comorbidities (DLBCL, colorectal, and lung cancer); with good-excellent Eastern Cooperative Oncology Group performance status (lung cancer); living in moderately accessible places (colon cancer); and; treated in metropolitan facilities (DLBLC, breast and colon cancer). This review characterized active-cancer treatment CPG adherence rates and associated factors in Australia. Future targeted CPG implementation strategies should account for these factors, to redress unwarranted variation particularly in vulnerable populations, and improve patient outcomes (Prospero number: CRD42020222962)., (© 2023 The Authors. Asia-Pacific Journal of Clinical Oncology published by John Wiley & Sons Australia, Ltd.)
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- 2023
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31. Editorial: Occupational health and organizational culture within a healthcare setting: challenges, complexities, and dynamics.
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Tran Y, Ellis LA, Clay-Williams R, Churruca K, and Wiig S
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- Humans, Health Personnel, Mental Health, Delivery of Health Care, Organizational Culture, Occupational Health
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Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
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- 2023
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32. Hospital staff reports of coworker positive and unprofessional behaviours across eight hospitals: who reports what about whom?
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Urwin R, Pavithra A, McMullan RD, Churruca K, Loh E, Moore C, Li L, and Westbrook JI
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- Humans, Delivery of Health Care, Patient Safety, Professional Misconduct, Hospitals, Personnel, Hospital
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Background: Workplace behaviours of healthcare staff impact patient safety, staff well-being and organisational outcomes. A whole-of-hospital culture change programme, Ethos, was implemented by St. Vincent's Health Australia across eight hospitals. Ethos includes a secure online submission system that allows staff across all professional groups to report positive (Feedback for Recognition) and negative (Feedback for Reflection) coworker behaviours. We analysed these submissions to determine patterns and rates of submissions and identify the coworker behaviours reported., Method: All Ethos submissions between 2017 and 2020 were deidentified and analysed. Submissions include structured data elements (eg, professional role of the reporter and subjects, event and report dates) and a narrative account of the event and coworker behaviours. Descriptive statistics were calculated to assess use and reporting patterns. Coding of the content of submissions was performed to classify types of reported coworker behaviours., Results: There were a total of 2504 Ethos submissions, including 1194 (47.7%) Recognition and 1310 (52.3%) Reflection submissions. Use of the submission tool was highest among nurses (20.14 submissions/100 nursing staff) and lowest among non-clinical services staff (5.07/100 non-clinical services staff). Nurses were most frequently the subject of Recognition submissions (7.56/100 nurses) while management and administrative staff were the least (4.25/100 staff). Frequently reported positive coworker behaviours were non-technical skills (79.3%, N=947); values-driven behaviours (72.5%, N=866); and actions that enhanced patient care (51.3%, N=612). Medical staff were the most frequent subjects of Reflection submissions (12.59/100 medical staff), and non-clinical services staff the least (4.53/100 staff). Overall, the most frequently reported unprofessional behaviours were being rude (53.8%, N=705); humiliating or ridiculing others (26%, N=346); and ignoring others' opinions (24.6%, N=322)., Conclusion: Hospital staff across all professional groups used the Ethos messaging system to report both positive and negative coworker behaviours. High rates of Recognition submissions demonstrate a strong desire of staff to reward and encourage positive workplace behaviours, highlighting the importance of culture change programmes which emphasise these behaviours. The unprofessional behaviours identified in submissions are consistent with behaviours previously reported in surveys of hospital staff, suggesting that submissions are a reliable indicator of staff experiences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
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- 2023
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33. An integrative review of research evaluating organisational culture in residential aged care facilities.
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Churruca K, Falkland E, Saba M, Ellis LA, and Braithwaite J
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- Aged, Humans, Delivery of Health Care, Quality of Health Care, Organizational Culture, Homes for the Aged
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Background: Evidence suggests that the culture of healthcare organisations, including residential aged care facilities (RACFs), is linked to the quality of care offered. The number of people living in RACFs has increased globally, and in turn, attention has been placed on care quality. This review aimed to identify how organisational culture is studied, sought to elucidate the results of previous studies, and aimed to establish what interventions are being used to improve organisational culture in RACFs., Methods: We employed an integrative review design to provide a comprehensive understanding of organisational culture. Five academic data bases were searched (Ovid Medline, Scopus, PsycInfo, CINAHL, Embase). Articles were included if they were empirical studies, published in peer reviewed journals in English, conducted in a RACF setting, and were focused on organisational culture/climate., Results: Ninety-two articles were included. Fifty-nine studies (64.1%) utilised a quantitative approach, while 24 (26.0%) were qualitative, and nine used mixed methods (9.8%). Twenty-two (23.9%) aimed to describe the culture within RACFs, while 65 (70.7%) attempted to understand the relationship between culture and other variables, demonstrating mixed and indeterminate associations. Only five (5.4%) evaluated an intervention., Conclusions: This review highlights the heterogenous nature of this research area, whereby differences in how culture is demarcated, conceptualised, and operationalised, has likely contributed to mixed findings. Future research which is underpinned by a sound theoretical basis is needed to increase the availability of empirical evidence on which culture change interventions can be based., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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34. The rise of resilient healthcare research during COVID-19: scoping review of empirical research.
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Ellis LA, Saba M, Long JC, Lyng HB, Haraldseid-Driftland C, Churruca K, Wiig S, Austin E, Clay-Williams R, Carrigan A, and Braithwaite J
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- Humans, Pandemics, Health Personnel psychology, Empirical Research, Health Services Research, COVID-19 epidemiology
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Background: The COVID-19 pandemic has presented many multi-faceted challenges to the maintenance of service quality and safety, highlighting the need for resilient and responsive healthcare systems more than ever before. This review examined empirical investigations of Resilient Health Care (RHC) in response to the COVID-19 pandemic with the aim to: identify key areas of research; synthesise findings on capacities that develop RHC across system levels (micro, meso, macro); and identify reported adverse consequences of the effort of maintaining system performance on system agents (healthcare workers, patients)., Methods: Three academic databases were searched (Medline, EMBASE, Scopus) from 1st January 2020 to 30th August 2022 using keywords pertaining to: systems resilience and related concepts; healthcare and healthcare settings; and COVID-19. Capacities that developed and enhanced systems resilience were synthesised using a hybrid inductive-deductive thematic analysis., Results: Fifty publications were included in this review. Consistent with previous research, studies from high-income countries and the use of qualitative methods within the context of hospitals, dominated the included studies. However, promising developments have been made, with an emergence of studies conducted at the macro-system level, including the development of quantitative tools and indicator-based modelling approaches, and the increased involvement of low- and middle-income countries in research (LMIC). Concordant with previous research, eight key resilience capacities were identified that can support, develop or enhance resilient performance, namely: structure, alignment, coordination, learning, involvement, risk awareness, leadership, and communication. The need for healthcare workers to constantly learn and make adaptations, however, had potentially adverse physical and emotional consequences for healthcare workers, in addition to adverse effects on routine patient care., Conclusions: This review identified an upsurge in new empirical studies on health system resilience associated with COVID-19. The pandemic provided a unique opportunity to examine RHC in practice, and uncovered emerging new evidence on RHC theory and system factors that contribute to resilient performance at micro, meso and macro levels. These findings will enable leaders and other stakeholders to strengthen health system resilience when responding to future challenges and unexpected events., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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35. Implementation of consensus-based perioperative care pathways to reduce clinical variation for elective surgery in an Australian private hospital: a mixed-methods pre-post study protocol.
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Pagano L, Hemmert C, Hirschhorn A, Francis-Auton E, Arnolda G, Long JC, Braithwaite J, Gumley G, Hibbert PD, Churruca K, Hutchinson K, Partington A, Hughes C, Gillatt D, Ellis LA, Testa L, Patel R, and Sarkies MN
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- Male, Humans, Consensus, Australia, Perioperative Care, Delivery of Health Care, Elective Surgical Procedures
- Abstract
Introduction: Addressing clinical variation in elective surgery is challenging. A key issue is how to gain consensus between largely autonomous clinicians. Understanding how the consensus process works to develop and implement perioperative pathways and the impact of these pathways on reducing clinical variation can provide important insights into the effectiveness of the consensus process. The primary objective of this study is to understand the implementation of an organisationally supported, consensus approach to implement perioperative care pathways in a private healthcare facility and to determine its impact., Methods: A mixed-methods Effectiveness-Implementation Hybrid (type III) pre-post study will be conducted in one Australian private hospital. Five new consensus-based perioperative care pathways will be developed and implemented for specific patient cohorts: spinal surgery, radical prostatectomy, cardiac surgery, bariatric surgery and total hip and knee replacement. The individual components of these pathways will be confirmed as part of a consensus-building approach and will follow a four-stage implementation process using the Exploration, Preparation, Implementation and Sustainment framework. The process of implementation, as well as barriers and facilitators, will be evaluated through semistructured interviews and focus groups with key clinical and non-clinical staff, and participant observation. We anticipate completing 30 interviews and 15-20 meeting observations. Administrative and clinical end-points for at least 152 participants will be analysed to assess the effectiveness of the pathways., Ethics and Dissemination: This study received ethical approval from Macquarie University Human Research Ethics Medical Sciences Committee (Reference No: 520221219542374). The findings of this study will be disseminated through peer-reviewed publications, conference presentations and reports for key stakeholders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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36. Systems resilience in the implementation of a large-scale suicide prevention intervention: a qualitative study using a multilevel theoretical approach.
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Ellis LA, Zurynski Y, Long JC, Clay-Williams R, Ree E, Sarkies M, Churruca K, Shand F, Pomare C, Saba M, Haraldseid-Driftland C, and Braithwaite J
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- Humans, Qualitative Research, Burnout, Psychological, Health Facilities, Suicide Prevention, Suicide
- Abstract
Background: Resilience, the capacity to adapt and respond to challenges and disturbances, is now considered fundamental to understanding how healthcare systems maintain required levels of performance across varying conditions. Limited research has examined healthcare resilience in the context of implementing healthcare improvement programs across multiple system levels, particularly within community-based mental health settings or systems. In this study, we explored resilient characteristics across varying system levels (individual, team, management) during the implementation of a large-scale community-based suicide prevention intervention., Methods: Semi-structured interviews (n=53) were conducted with coordinating teams from the four intervention regions and the central implementation management team. Data were audio-recorded, transcribed, and imported into NVivo for analysis. A thematic analysis of eight transcripts involving thirteen key personnel was conducted using a deductive approach to identify characteristics of resilience across multiple system levels and an inductive approach to uncover both impediments to, and strategies that supported, resilient performance during the implementation of the suicide prevention intervention., Results: Numerous impediments to resilient performance were identified (e.g., complexity of the intervention, and incompatible goals and priorities between system levels). Consistent with the adopted theoretical framework, indicators of resilient performance relating to anticipation, sensemaking, adaptation and tradeoffs were identified at multiple system levels. At each of the system levels, distinctive strategies were identified that promoted resilience. At the individual and team levels, several key strategies were used by the project coordinators to promote resilience, such as building relationships and networks and carefully prioritising available resources. At the management level, strategies included teambuilding, collaborative learning, building relationships with external stakeholders, monitoring progress and providing feedback. The results also suggested that resilience at one level can shape resilience at other levels in complex ways; most notably we identified that there can be a downside to resilience, with negative consequences including stress and burnout, among individuals enacting resilience., Conclusions: The importance of considering resilience from a multilevel systems perspective, as well as implications for theory and future research, are discussed., (© 2023. The Author(s).)
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- 2023
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37. Experience-based codesign approach to improve care in Australian emergency departments for complex consumer cohorts: the MyED project protocol, Stages 1.1-1.3.
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Cheek C, Hayba N, Richardson L, Austin EE, Francis Auton E, Safi M, Ransolin N, Vukasovic M, De Los Santos A, Murphy M, Harrison R, Churruca K, Long JC, Hibbert PD, Carrigan A, Newman B, Hutchinson K, Mitchell R, Cutler H, Holt L, Braithwaite J, Gillies D, Salmon PM, Walpola RL, Zurynski Y, Ellis LA, Smith K, Brown A, Ali R, Gwynne K, and Clay-Williams R
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- Humans, Aged, Australia, New South Wales, Hospitals, Emergency Service, Hospital, Emergency Medical Services
- Abstract
Introduction: Emergency department (ED) care must adapt to meet current and future demands. In Australia, ED quality measures (eg, prolonged length of stay, re-presentations or patient experience) are worse for older adults with multiple comorbidities, people who have a disability, those who present with a mental health condition, Indigenous Australians, and those with a culturally and linguistically diverse (CALD) background. Strengthened ED performance relies on understanding the social and systemic barriers and preferences for care of these different cohorts, and identifying viable solutions that may result in sustained improvement by service providers. A collaborative 5-year project (MyED) aims to codesign, with ED users and providers, new or adapted models of care that improve ED performance, improve patient outcomes and improve patient experience for these five cohorts., Methods and Analysis: Experience-based codesign using mixed methods, set in three hospitals in one health district in Australia. This protocol introduces the staged and incremental approach to the whole project, and details the first research elements: ethnographic observations at the ED care interface, interviews with providers and interviews with two patient cohorts-older adults and adults with a CALD background. We aim to sample a diverse range of participants, carefully tailoring recruitment and support., Ethics and Dissemination: Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee (2022/PID02749-2022/ETH02447). Prior informed written consent will be obtained from all research participants. Findings from each stage of the project will be submitted for peer-reviewed publication. Project outputs will be disseminated for implementation more widely across New South Wales, Australia., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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38. The place of digital triage in a complex healthcare system: An interview study with key stakeholders in Australia's national provider.
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Churruca K, Ellis LA, Pope C, MacLellan J, Zurynski Y, and Braithwaite J
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Background: Digital triage tools such as telephone advice and online symptom checkers are now commonplace in health systems internationally. Research has focused on consumers' adherence to advice, health outcomes, satisfaction, and the degree to which these services manage demand for general practice or emergency departments. Such studies have had mixed findings, leaving equivocal the role of these services in healthcare., Objective: We examined stakeholders' perspectives on Healthdirect, Australia's national digital triage provider, focusing on its role in the health system, and barriers to operation, in the context of the COVID-19 pandemic., Methods: Key stakeholders took part in semi-structured interviews conducted online in the third quarter of 2021. Transcripts were coded and thematically analysed., Results: Participants (n = 41) were Healthdirect staff (n = 13), employees of Primary Health Networks (PHNs; n = 12), clinicians (n = 9), shareholder representatives (n = 4), consumer representatives (n = 2) and other policymakers (n = 1). Eight themes emerged from the analysis: (1) information and guidance in navigating the system, (2) efficiency through appropriate care, (3) value for consumers? (4) the difficulties in triage at a distance, (5) competition and the unfulfilled promise of integration, (6) challenges in promoting Healthdirect, (7) monitoring and evaluating digital triage services and (8) rapid change, challenge and opportunity from COVID-19., Conclusion: Stakeholders varied in their views of the purpose of Healthdirect's digital triage services. They identified challenges in lack of integration, competition, and the limited public profile of the services, issues largely reflective of the complexity of the policy and health system landscape. There was acknowledgement of the value of the services during the COVID-19 pandemic, and an expectation of them realising greater potential in the wake of the rapid uptake of telehealth., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2023.)
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- 2023
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39. Retrospective analysis of factors influencing the implementation of a program to address unprofessional behaviour and improve culture in Australian hospitals.
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Churruca K, Westbrook J, Bagot KL, McMullan RD, Urwin R, Cunningham N, Mitchell R, Hibbert P, Sunderland N, Loh E, and Taylor N
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- Humans, Australia, Retrospective Studies, Hospitals
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Background: Unprofessional behaviour among hospital staff is common. Such behaviour negatively impacts on staff wellbeing and patient outcomes. Professional accountability programs collect information about unprofessional staff behaviour from colleagues or patients, providing this as informal feedback to raise awareness, promote reflection, and change behaviour. Despite increased adoption, studies have not assessed the implementation of these programs utilising implementation theory. This study aims to (1) identify factors influencing the implementation of a whole-of-hospital professional accountability and culture change program, Ethos, implemented in eight hospitals within a large healthcare provider group, and (2) examine whether expert recommended implementation strategies were intuitively used during implementation, and the degree to which they were operationalised to address identified barriers., Method: Data relating to implementation of Ethos from organisational documents, interviews with senior and middle management, and surveys of hospital staff and peer messengers were obtained and coded in NVivo using the Consolidated Framework for Implementation Research (CFIR). Implementation strategies to address identified barriers were generated using Expert Recommendations for Implementing Change (ERIC) strategies and used in a second round of targeted coding, then assessed for degree of alignment to contextual barriers., Results: Four enablers, seven barriers, and three mixed factors were found, including perceived limitations in the confidential nature of the online messaging tool ('Design quality and packaging'), which had downstream challenges for the capacity to provide feedback about utilisation of Ethos ('Goals and Feedback', 'Access to Knowledge and Information'). Fourteen recommended implementation strategies were used, however, only four of these were operationalised to completely address contextual barriers., Conclusion: Aspects of the inner setting (e.g., 'Leadership Engagement', 'Tension for Change') had the greatest influence on implementation and should be considered prior to the implementation of future professional accountability programs. Theory can improve understanding of factors affecting implementation, and support strategies to address them., (© 2023. The Author(s).)
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- 2023
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40. A multimethod study of NHS 111 online.
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Turnbull J, MacLellan J, Churruca K, Ellis LA, Prichard J, Browne D, Braithwaite J, Petter E, Chisambi M, and Pope C
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- Humans, Aged, Surveys and Questionnaires, Self Report, Triage, State Medicine, Telemedicine
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Background: NHS 111 online offers 24-hour access to health assessment and triage., Objectives: This study examined pathways to care, differential access and use, and workforce impacts of NHS 111 online. This study compared NHS 111 with Healthdirect (Haymarket, Australia) virtual triage., Design: Interviews with 80 staff and stakeholders in English primary, urgent and emergency care, and 41 staff and stakeholders associated with Healthdirect. A survey of 2754 respondents, of whom 1137 (41.3%) had used NHS 111 online and 1617 (58.7%) had not., Results: NHS 111 online is one of several digital health-care technologies and was not differentiated from the NHS 111 telephone service or well understood. There is a similar lack of awareness of Healthdirect virtual triage. NHS 111 and Healthdirect virtual triage are perceived as creating additional work for health-care staff and inappropriate demand for some health services, especially emergency care. One-third of survey respondents reported that they had not used any NHS 111 service (telephone or online). Older people and those with less educational qualifications are less likely to use NHS 111 online. Respondents who had used NHS 111 online reported more use of other urgent care services and make more cumulative use of services than those who had not used NHS 111 online. Users of NHS 111 online had higher levels of self-reported eHealth literacy. There were differences in reported preferences for using NHS 111 online for different symptom presentations., Conclusions: Greater clarity about what the NHS 111 online service offers would allow better signposting and reduce confusion. Generic NHS 111 services are perceived as creating additional work in the primary, urgent and emergency care system. There are differences in eHealth literacy between users and those who have not used NHS 111 online, and this suggests that 'digital first' policies may increase health inequalities., Limitations: This research bridged the pandemic from 2020 to 2021; therefore, findings may change as services adjust going forward. Surveys used a digital platform so there is probably bias towards some level of e-Literacy, but this also means that our data may underestimate the digital divide., Future Work: Further investigation of access to digital services could address concerns about digital exclusion. Research comparing the affordances and cost-benefits of different triage and assessment systems for users and health-care providers is needed. Research about trust in virtual assessments may show how duplication can be reduced. Mixed-methods studies looking at outcomes, impacts on work and costs, and ways to measure eHealth literacy, can inform the development NHS 111 online and opportunities for further international shared learning could be pursued., Study Registration: This study is registered at the research registry (UIN 5392)., Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme and will be published in full in Health and Social Care Delivery Research ; Vol. 11, No. 5. See the NIHR Journals Library website for further project information.
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- 2023
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41. Cultures of aged care delivery: Qualitative content analysis of Australia's Royal Commission into Aged Care Quality and Safety.
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Churruca K, Long JC, Ellis LA, Saba M, and Braithwaite J
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- Aged, Humans, Quality of Health Care, Delivery of Health Care, Australia, Nursing Homes, Homes for the Aged
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Objectives: Organisational culture is increasingly recognised as influencing the quality of care provided to patients and residents of aged care, both in research and in policy. For example, investigations into quality and safety issues in health care frequently highlight cultural problems, but often without adequate theorisation of culture. This study aimed at identifying how cultures of care delivery are considered in the final report of the Royal Commission into Aged Care Quality and Safety, and its subsequent implications., Methods: A documentary analysis was performed on the five volumes of the final report using qualitative content analysis., Results: Of 211 references to culture, the majority focussed on organisational culture (n = 155), followed by the sector's culture (n = 26), the culture of the agencies involved in managing aged care (n = 21) and the national culture relating to the treatment of older people (n = 8). These cultures were discussed in five ways: (1) highlighting poor culture as a problem (n = 56); (2) showcasing the style of culture that should be aspired to (n = 45); (3) reinforcing the importance of culture (n = 38); (4) making attributions about factors contributing to culture (n = 33); and (5) discussing the need for culture change (n = 30)., Conclusions: The Royal Commission's findings emphasise the importance of care culture and the need for change but provided limited guidance on how this should be achieved, or culture conceptualised., (© 2023 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)
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- 2023
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42. Experiences of peer messengers as part of a professional accountability culture change program to reduce unprofessional behaviour: a cross-sectional study across eight hospitals.
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McMullan RD, Urwin R, Sunderland N, Churruca K, Cunningham N, and Westbrook J
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- Humans, Cross-Sectional Studies, Australia, Professional Misconduct, Hospitals, Social Responsibility
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Objective Professional accountability programs are designed to promote professional behaviours between co-workers and improve organisational culture. Peer messengers play a key role in professional accountability programs by providing informal feedback to hospital staff about their behaviour. Little is known about the experiences of messengers. This study examined the experiences of staff who delivered messages to peers as part of a whole-of-hospital professional accountability program called 'Ethos'. Methods Ethos messengers (EMs) across eight Australian hospitals were invited to complete an online survey. The survey consisted of 17 close-ended questions asking respondents about their experiences delivering messages to peers and their perceptions of the Ethos program. Four open-ended questions asked respondents about rewarding and challenging aspects of being a peer messenger and what they would change about the program. Results Sixty EMs provided responses to the survey (response rate, 41.4%). The majority were from nursing and medical groups (53.4%) and had delivered 1-5 messages to staff (57.7%). Time as an EM ranged from less than 3 months to more than 12 months. A majority had been an EM for more than 12 months (80%; n = 40). Most agreed they had received sufficient training for the role (90.1%; n = 48) and had the skills (90.1%; n = 48), access to support (84.9%; n = 45) and time to fulfil their responsibilities (70.0%; n = 30). Approximately a third (34.9%; n = 15) of respondents indicated that recipients were 'sometimes' or 'never' receptive to messages. Challenging aspects of the role included organising a time to talk with staff, delivering feedback effectively and communicating with peers who lacked insight and were unable to reflect on their behaviour. Conclusions Skills development for peer messengers is key to ensuring the effectiveness and sustainability of professional accountability programs. Training in how to deliver difficult information and respond to negative reactions to feedback was identified by EMs as essential to support their ongoing effectiveness in their role.
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- 2023
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43. International approaches for implementing accreditation programmes in different healthcare facilities: a comparative case study in Australia, Botswana, Denmark, and Jordan.
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van Vliet EJ, Soethout J, Churruca K, Braithwaite J, Luxford K, Stewart J, Jaouni S, Engel C, and Sarkies MN
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- Humans, Jordan, Botswana, Denmark, Accreditation, Delivery of Health Care
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Healthcare accreditation programmes have been adopted internationally to maintain the quality and safety of services. Accreditation assesses the compliance of organizations to a series of standards. The evidence base supporting the benefits of accreditation is mixed, potentially influenced by differences in local implementation and operationalization of standards. Successful implementation is associated with optimizing regulation, funding, and government commitment. Implementation of accreditation is a complex intervention that needs to be tailored to meet contextual differences across settings. Comparing why and how accreditation is implemented across countries supports the effective implementation of new programmes and refinements to existing systems. This article presents four case studies from Australia, Botswana, Denmark, and Jordan to consider a geographic spread and mix of high- and upper-middle-income countries. The data were derived from a review of accreditation programme documents and follow-up discussions with directors of the accrediting bodies in the countries of interest. Each case study was summarized according to a standardized framework for comparison: (i) goals (why), (ii) programme implementation (how), (iii) outcomes based on pre-post measures (what), and (iv) lessons learned (enablers and barriers). The accreditation programmes were all introduced in the 2000s to improve quality and safety. Documents from each country outlined motivations for introducing an accreditation programme, which was predominantly initiated by the government. The programmes were adopted in demarcated healthcare sectors (e.g. primary care and hospital settings), with a mix of mandatory and voluntary approaches. Implementation support centred on the interpretation and operationalization of standards and follow-up on variation in compliance with standards, after announced surveys. Most standards focused on patient safety, patient centredness, and governance but differed between using standard sets on quality management or supportive processes for patient care. Methods for evaluation of programme success and outcomes measured varied. Frequently reported enablers of successful implementation included strong leadership and ownership of the process. A lack of awareness of quality and safety, insufficient training in quality improvement methods, and transfer of staff represented the most common challenges. This case analysis of accreditation programmes in a variety of countries highlights consistent strategies utilized, key enabling factors, barriers, and the influence of contextual differences. Our framework for describing why, how, what, and lessons learned demonstrates innovation and experimentation in approaches used across high- and upper-middle-income countries, hospital and primary care, and specialist clinics., (© The Author(s) 2023. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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44. Innovative models of healthcare delivery: an umbrella review of reviews.
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Roberts N, Carrigan A, Clay-Williams R, Hibbert PD, Mahmoud Z, Pomare C, Fajardo Pulido D, Meulenbroeks I, Knaggs GT, Austin EE, Churruca K, Ellis LA, Long JC, Hutchinson K, Best S, Nic Giolla Easpaig B, Sarkies MN, Francis Auton E, Hatem S, Dammery G, Nguyen MT, Nguyen HM, Arnolda G, Rapport F, Zurynski Y, Maka K, and Braithwaite J
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- Adult, Child, Humans, Chronic Disease, Self Care, Quality of Life, Patient Acceptance of Health Care
- Abstract
Objective: To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals., Design: Umbrella review., Setting: Interventions delivered inside and outside of acute care settings., Participants: Children and adults with one or more identified acute or chronic health conditions., Data Sources: PsycINFO, Ovid MEDLINE and CINAHL., Primary and Secondary Outcome Measures: Clinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge., Results: A total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care., Conclusions: A consideration of local infrastructure and individual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems., Trial Registration Number: 10.17605/OSF.IO/PS6ZU., Competing Interests: Competing interests: There are no competing interests to declare between the authors and Health Infrastructure. The project was commissioned by Health Infrastructure NSW and Western Sydney LHD (WSLHD). KM works for WSLHD; however, this did not inform the evaluation of evidence or conclusions of the review., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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45. Hospital organizational change: The importance of teamwork culture, communication, and change readiness.
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Ellis LA, Tran Y, Pomare C, Long JC, Churruca K, Saba M, and Braithwaite J
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- Humans, Cross-Sectional Studies, Communication, Organizational Innovation, Hospitals, Burnout, Professional
- Abstract
Background: Hospital organizational change can be a challenging time, especially when staff do not feel informed and ready for the change to come. A supportive workplace culture can mitigate the negative effects allowing for a smooth transition during hospital organizational change. In this paper, we test an exploratory path model by which teamwork culture influences staff attitudes in feeling informed and ready for change, and which are ultimately related to reduced staff burnout. We also examined different types of change communication, identifying the channels that were perceived as most useful for communicating organizational change., Methods: In 2019, a cross-sectional online and paper-based survey of all staff (clinical and non-clinical) was conducted at a hospital undergoing major organizational change in Sydney, Australia. The survey included items regarding teamwork culture, communication (feeling informed, communication channels), change readiness (appropriateness, change efficacy), and burnout. With a sample size of 153 (62% clinical staff), regression and path analyses were used to examine relationships between variables., Results: The total effects between teamwork culture and burnout was significant [β (Total) = -0.37, p < 0.001) and explained through a serial mediation. This relationship was found to be mediated by three factors (feeling informed, appropriateness of change and change efficacy) in a full mediation. Further, change readiness (appropriateness of change and change efficacy) mediated the relationship between feeling informed and burnout. The most useful channels of change communication included face-to-face informal communication, emails, and a newsletter specifically about the change., Conclusion: Overall, the results supported the predicted hypotheses and were consistent with past research. In the context of large hospital change, staff with a positive teamwork culture who feel informed are more likely to feel change-ready, heightening the chances of successful organizational change and potentially reducing staff burnout. Understanding the pathways on how culture and communication related to burnout during organizational change provides an explanatory pathway that can be used to heighten the chances of a smooth change transition with minimal disruption to staff and patient care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ellis, Tran, Pomare, Long, Churruca, Saba and Braithwaite.)
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- 2023
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46. The journey to a learning health system in primary care: a qualitative case study utilising an embedded research approach.
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Dammery G, Ellis LA, Churruca K, Mahadeva J, Lopez F, Carrigan A, Halim N, Willcock S, and Braithwaite J
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- Humans, Qualitative Research, Primary Health Care, Learning Health System, General Practitioners, General Practice
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Background: Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to establish which elements of the learning health system were being realised within a university-based general practice and determine acceptability from staff to embrace further the transition towards a learning health system., Methods: Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the learning health system model. Interviews were transcribed and thematically analysed based on the National Academy of Medicine's framework of learning health systems., Results: In total, 32 (91%) practice staff were interviewed, comprising general practitioners (n = 15), nurses (n = 3), administrative staff (n = 13), and a psychologist (n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system (e.g., emphasising science and informatics; focusing on patient-clinician partnerships; applying incentives; supporting a continuous learning culture; and establishing structures and governance for learning). These measures were supported by the university-based setting, and resultant culture of learning. Nevertheless, there were areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice., Conclusion: Although the idea of a learning health system has been gaining traction in recent years, there are comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework., (© 2023. The Author(s).)
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- 2023
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47. High-performing primary care: reinvigorating general practice as a learning health system.
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Foo D, Mahadeva J, Lopez F, Ellis LA, Churruca K, Dammery G, Willcock S, and Braithwaite J
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- Humans, Family Practice, Primary Health Care, Learning Health System, General Practice
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- 2022
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48. Too much theory and not enough practice? The challenge of implementation science application in healthcare practice.
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Rapport F, Smith J, Hutchinson K, Clay-Williams R, Churruca K, Bierbaum M, and Braithwaite J
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- Humans, Health Services, Research Personnel, Learning, Implementation Science, Delivery of Health Care
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Background: Implementation science (IS) should contribute to maintaining high standards of care across healthcare systems and enhancing care practices. However, despite the evident need for greater and more rapid uptake and integration of evidence in practice, IS design and methodology fall short of the needs of effective translation., Aim: In this paper we examine what it is about IS that makes it so appealing for effective uptake of interventions in routine practice, and yet so difficult to achieve. We propose a number of ways that implementation scientists could build mutual relationships with healthcare practitioners and other stakeholders including public members to ensure greater shared care practices, and highlight the value of IS training, collaborative educational events, and co-designed research., Discussion: More consideration should be given to IS applications in healthcare contexts. Implementation scientists can make a valuable contribution by mobilizing theory and improving practice. However, goals for an evidence-based system may be more appropriately achieved through greater outreach and collaboration, with methods that are flexible to support rapid implementation in complex adaptive systems. Collective learning and mutual trust can be cultivated by embedding researchers into healthcare services while offering greater opportunities for practitioners to learn about, and engage in, implementation research., Conclusion: To bridge the worlds of healthcare practice and IS, researchers could be more consistent in the relationships they build with professionals and the public, communicating through a shared language and co-joining practical approaches to effective implementation. This will build capacity for improved collaboration and foster respectful, interdisciplinary relationships., (© 2021 John Wiley & Sons Ltd.)
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- 2022
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49. "The times they are a-changin'": A longitudinal, mixed methods case study of a hospital transformation.
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Pomare C, Gardiner B, Ellis LA, Long JC, Churruca K, and Braithwaite J
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- Humans, Organizational Innovation, Surveys and Questionnaires, Delivery of Health Care, Hospitals, Public, Quality of Health Care
- Abstract
Background: Changes to hospital infrastructure are inevitable in ever-evolving healthcare systems. The redevelopment of hospitals and opening of new buildings can be a complex and challenging time for staff as they must find ways to deliver safe and high-quality care while navigating the complexities and uncertainties of change. This study explores the perspectives and experiences of staff and patients before and after the opening of a new hospital building as part of a large public hospital redevelopment in Sydney, Australia., Methods: The study comprised a longitudinal mixed methods case study design. Methods included two rounds of staff surveys (n = 292 participants), two rounds of staff interviews (n = 66), six rounds of patient surveys (n = 255), and analysis of hospital data at tri-monthly intervals over two years. Data were compared before (2019) and after (2020) a new hospital building opened at a publicly funded hospital in Sydney, Australia., Results: Four key themes and perspectives emerged from the interviews including change uncertainty, communication effectiveness, staffing adequacy and staff resilience. Significant differences in staff perceptions of change readiness over time was identified. Specifically, perceptions that the organisational change was appropriate significantly decreased (2019: 15.93 ± 3.86; 2020: 14.13 ± 3.62; p < .001) and perceptions that staff could deal with the change significantly increased (2019: 17.30 ± 4.77; 2020: 19.16 ± 4.36; p = .001) after the building opened compared to before. Global satisfaction scores from patient survey data showed that patient experience significantly declined after the building opened compared to before (2020: 81.70 ± 21.52; 2019: 84.43 ± 18.46)), t(254) = -64.55, p < 0.05, and improved a few months after opening of the new facilities. This coincided with the improvement in staff perceptions in dealing with the change., Conclusions: Moving into a new hospital building can be a challenging time for staff and patients. Staff experienced uncertainty and stress, and displayed practices of resilience to deliver patient care during a difficult period of change. Policy makers, hospital managers, staff and patients must work together to minimise disruption to patient care and experience. Key recommendations for future hospital redevelopment projects outline the importance of supporting and informing staff and patients during the opening of a new hospital building., Competing Interests: The authors declare that they have no competing interests.
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- 2022
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50. Changes in unprofessional behaviour, teamwork and co-operation among hospital staff during the COVID-19 pandemic.
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Westbrook JI, McMullan R, Urwin R, Churruca K, Metri J, Loh E, and Li L
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- Humans, Pandemics, Professional Misconduct, Personnel, Hospital, Hospitals, COVID-19
- Abstract
A survey administered to staff at five hospitals investigated changes in unprofessional behaviour, teamwork and co-operation during the COVID-19 pandemic. From 1583 responses, 76.1% (95% confidence interval (CI): 74.0-78.2%) reported no change or a decrease in unprofessional behaviours. Across all professional groups, 43.6% (n = 579, 95% CI: 41.0-46.3%) reported improvements in teamwork and co-operation. Findings suggest that intensifying work demands, such as those resulting from the pandemic, are not a major trigger for unprofessional behaviour, and root causes lie elsewhere., (© 2022 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)
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- 2022
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