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This paper aims to contribute to growing literature on the intensification of work. It traces the changing role of Nursing Unit Managers (NUMs) in NSW public hospitals since the creation of this position in 1986, using a combination of statewide data and more disaggregated data from a case study of the Division of Medicine in a large public hospital. Empirically, the paper shows that the responsibilities passed to NUMs have steadily expanded and that the amount of work they are required to do is causing many NUMs great distress. Theoretically, the paper confirms the value of Green's distinction between ‘extensive’ and ‘intensive’ work effort and demonstrates the value of Beynon et al. ‘s three-fold classification of the processes leading to work intensification. It is suggested, however, that there is a need to modify the latter classifications to give greater recognition of the fairly obvious fact that much work intensification comes from simple increases in the volume of work—doing more of the ...

Importance Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. Objective To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. Design, Setting, and Participants This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. Main Outcomes and Measures Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). Results A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89 in the endovascular group and 4.84 in the open repair group ( P = .68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group ( P = .82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, −$10 788; 95% CI, −$29 796 to $5825; P = .25). Costs related to AAA, including the initial repair, constituted nearly 40% of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, −$393; 95% CI, −$12 071 to $7928; P = .94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs. Conclusions and Relevance In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA. Trial Registration clinicaltrials.gov Identifier:NCT00094575

Foreword by Luigi Cabrini, UN World Tourism Organization Part I: Sustainability, Climate Change and Tourism: Conceptual Issues 1. Tourism and Sustainability: Transition to a Green Economy Maharaj Vijay Reddy and Keith Wilkes 2. Social Representations of Climate Change: Exploring the Perceived Links between Climate Change, the Drive for Sustainability and Tourism Gianna Moscardo 3. Facilitating Sustainable Innovations for SMEs in the Tourism Industry: Identifying Factors of Success and Barriers to Adoption in Australia Robyn Bushell and Bruce Simmons 4. Tourism Industry Responses to Climate Change in Hawaii: An Exploratory Analysis of Knowledge and Responses Shelly Rowell and Harold Richins Part II: Responses and Initiatives of Regional, National and International Agencies 5. Sustainable Tourism Development and Climate Change: Opportunities in UNESCO Biosphere Reserves Natarajan Ishwaran 6. Interpreting Climate Projections for Tourism Planning in South-West England Emma Whittlesea and Bas Amelung 7 Climate Change Policy Responses of Australian and New Zealand National Governments: Implications for Sustainable Tourism Nadine Elizabeth White and Jeremy Buultjens 8. Key Players in the Environmental Performance of Tourism Enterprises David Leslie Part III: Emerging Techniques and Research Implications 9. Tourism Sensitivity to Climate Change Mitigation Policies: Lessons from Recent Surveys Ghislain Dubois, Jean-Paul Ceron and Paul Peeters 10. The Importance of Visitor Perceptions in Estimating how Climate Change will Affect Future Tourist Flows to the Great Barrier Reef Marine Ramis and Bruce Prideaux 11. Tourism Adaptation to Climate Change in the South Pacific Min Jiang, Terry Delacy, Louise Munk Klint and Emma Wong 12. Scenarios of Climate Change and Impacts on Brazilian Tourism: A Case Study of the Brazilian North Coast Tourism Region Gilson Zehetmeyer Borda, Elimar Pinheiro Do Nascimento, Helena Araujo Costa, Joao Paulo Faria Tasso and Leticia Ramos 13. The Role of Climate Change in Tourism Development Strategies: A Sustainability Perspective In Tourism Strategies in the Nordic Countries Kaarina Tervo-Kankare and Jarkko Saarinen 14. Tourism and Climate Change in Southern Africa: Sustainability and Perceived Impacts and Adaptation Strategies of the Tourism Industry to Changing Climate and Environment in Botswana Jarkko Saarinen, Wame Hambira, Julius Atlhopheng and Haretsebe Manwa 15. Contradictions in Climate Concern: Performances at Home and Away Scott A. Cohen and James E. S. Higham Index

Objective Prior analysis in the Open vs Endovascular Repair Veterans Affairs (VA) Cooperative Study (CSP #498) demonstrated that survival, quality of life, and total health care costs are not significantly different between the open and endovascular methods of repair of abdominal aortic aneurysm. The device is a major cost of this method of repair, and the objective of this study was to evaluate the costs of the device, abdominal aortic aneurysm repair, and total health care costs when different endograft systems are selected for the endovascular repair (EVR). Within each selected system, EVR costs are compared with open repair costs. Methods The study randomized 881 patients to open (n = 437) or EVR (n = 444). Device selection was recorded before randomization; therefore, open repair controls were matched to each device cohort. Data were excluded for two low-volume devices, implanted in only 13 individuals, leaving 423 control and 431 endovascular patients: 166 Zenith (Cook Medical, Bloomington, Ind), 177 Excluder (W. L. Gore & Associates, Flagstaff, Ariz), and 88 AneuRx (Medtronic, Minneapolis, Minn). Mean device, hospitalization, and total health care costs from randomization to 2 years were compared. Health care utilization data were obtained from patients and national VA and Medicare data sources. VA costs were determined using methods previously developed by the VA Health Economics Resource Center. Non-VA costs were obtained from Medicare claims data and billing data from the patient's health care providers. Results Implant costs were 38% of initial hospitalization costs. Mean device (range, $13,600-$14,400), initial hospitalization (range, $34,800-$38,900), and total health care costs at 2 years in the endovascular (range, $72,400-$78,200) and open repair groups (range, $75,600-$82,100) were not significantly different among device systems. Differences between endovascular and corresponding open repair cohorts showed lower mean costs for EVR (range, $3200-$8300), but these were not statistically different. Conclusions The implant costs of endovascular aneurysm repair are substantial. When evaluating total health care system expenditures, there is large individual variability in costs, and there is no significant difference at 2 years among systems or when an individual system is compared with open repair.

Over the last two decades, public hospitals in New South Wales have seen huge workplace changes that have been caused by two main imperatives: increasingly neo-liberal solutions to public sector management by governments of both political complexions, which have led to great pressure for increasing efficiency and reductions in costs; and health sector-specific cost increases associated with new medical technologies and procedures. The cumulative effect of these two imperatives has been transmitted through strict limitations on funding and new hospital budgeting regimes that have forced hospital managers to seek new and cheaper ways to deliver patient care (Bray and White, 2002).

The Australian health care system has changed considerably over recent years – for patients and workers alike. This paper examines one part – albeit a very important part – of that changing system; namely, the public hospitals in New South Wales. This is the most populous of the Australian states, providing 6 1/2 million of the country’s total population of around 19 million. The public health system in New South Wales annually accounts over $7 billion in expenditure, which represents almost one quarter of the state government’s budget, and employs around 100,000 staff, approximately 90 percent of whom work in public hospitals operated by NSW Health.

Over the last decade most of the debate regarding workplace reforms in the health sector has tended to centre on funding and activity levels and their impact on outcomes. Yet there has been little analysis of either the mechanisms by which these reforms have been introduced or their impact on the work life of employees. It is the intention of this paper to analyse the mechanism used to implement workplace change and the impact of that change on employees using a case study method. The paper will firstly identify the various mechanisms by which workplace change may be introduced and provide a brief background on the case study unit. The following sections will discuss the development and implementation of a performance management system, using an informal workplace consultation and negotiation mechanism. The final section will explore the impact of the change mechanism by analysing the objectives of the organisation. The paper, in conclusion, will argue that while the mechanism and the introduction of this instance of workplace change did not in the long term achieve the desired objectives as a specific management tool it has had an ongoing impact on managers, employees and the workplace. The paper draws on evidence from related literature, analysis of primary documents and 10 semi-structured interviews. Data collection, including the interviews with employees and managers, was conducted primarily during the second half of 2001, as part of a broader research project on bargaining structures and workplace change.

This chapter concerns employment relations in the public hospitals of New South Wales, Victoria and South Australia. The main aim of the chapter is to describe and then compare trends in the structure of bargaining in the public hospitals of three Australian states; the ‘structure of bargaining’ being defined as ‘the institutionalized arrangements by which employers and employees determine the terms and conditions of the employment relationship’ (Bray and Waring, 1998). In this context, the focus is mostly on union-management relations and collective bargaining, but at the same time there is a broader subject because these collective forms of regulation in which employees are represented by unions operate alongside individual bargaining, managerial prerogative and state regulation to determine the conditions of employment of public hospital workers.