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Watts C, Spillane A, Henderson MA, Cust A, Braithwaite J, Gyorki DE, Hong AM, Kelly JW, Long GV, Mar VJ, Menzies AM, Morton RL, Rapport F, Saw RPM, Schmid H, Scolyer RA, Smith AL, Winder A, Mann GJ. Sentinel lymph node biopsy rates in Victoria, 2018 and 2019. Med J Aust 2022. [DOI: 10.5694/mja2.51424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Caroline Watts
- Daffodil Centre University of Sydney and Cancer Council NSW Sydney NSW
- The Kirby Institute UNSW Sydney NSW
| | - Andrew Spillane
- Melanoma Institute Australia University of Sydney Sydney NSW
- Sydney Medical School University of Sydney Sydney NSW
- Royal North Shore Hospital Sydney NSW
- Mater Hospital Sydney NSW
| | - Michael A Henderson
- Peter MacCallum Cancer Centre Melbourne VIC
- The University of Melbourne Melbourne VIC
| | - Anne Cust
- Daffodil Centre University of Sydney and Cancer Council NSW Sydney NSW
- Melanoma Institute Australia University of Sydney Sydney NSW
| | - J Braithwaite
- Australian Institute of Health Innovation Macquarie University Sydney NSW
| | - DE Gyorki
- Peter MacCallum Cancer Centre Melbourne VIC
| | - AM Hong
- Melanoma Institute Australia University of Sydney Sydney NSW
| | - JW Kelly
- Victorian Melanoma Service Alfred Hospital Melbourne VIC
| | - GV Long
- Melanoma Institute Australia University of Sydney Sydney NSW
- Sydney Medical School University of Sydney Sydney NSW
- Royal North Shore Hospital Sydney NSW
- Mater Hospital Sydney NSW
| | - VJ Mar
- Victorian Melanoma Service Alfred Hospital Melbourne VIC
| | - AM Menzies
- Melanoma Institute Australia University of Sydney Sydney NSW
- Sydney Medical School University of Sydney Sydney NSW
- Royal North Shore Hospital Sydney NSW
- Mater Hospital Sydney NSW
| | - RL Morton
- Melanoma Institute Australia University of Sydney Sydney NSW
- NHMRC Clinical Trials Centre University of Sydney Sydney NSW
| | - F Rapport
- Australian Institute of Health Innovation Macquarie University Sydney NSW
| | - RPM Saw
- Melanoma Institute Australia University of Sydney Sydney NSW
- Sydney Medical School University of Sydney Sydney NSW
- Mater Hospital Sydney NSW
| | - H Schmid
- Daffodil Centre University of Sydney and Cancer Council NSW Sydney NSW
| | - RA Scolyer
- Melanoma Institute Australia University of Sydney Sydney NSW
- Sydney Medical School University of Sydney Sydney NSW
- Royal Prince Alfred Hospital and New South Wales Health Pathology Sydney NSW
| | - AL Smith
- Daffodil Centre University of Sydney and Cancer Council NSW Sydney NSW
| | - A Winder
- Melanoma Institute Australia University of Sydney Sydney NSW
| | - GJ Mann
- Melanoma Institute Australia University of Sydney Sydney NSW
- The John Curtin School of Medical Research Australian National University Canberra ACT
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Austin E, Blakely B, Salmon P, Braithwaite J, Clay-Williams R. The scope for adaptive capacity in emergency departments: modelling performance constraints using control task analysis and social organisational cooperation analysis. Ergonomics 2022; 65:467-484. [PMID: 34649471 DOI: 10.1080/00140139.2021.1992004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
Patient flow between the emergency department (ED) and hospital wards becomes problematic when bed availability is limited. To better understand the constraints that shape patient flow and everyday work in the ED, we applied Control Task Analysis (i.e. Contextual Activities Template, CAT) and Social Organisational Cooperation Analysis (SOCA) phases from the Cognitive Work Analysis framework to identify ways in which to optimise patient flow. The model and analysis were created through observations in the ED of clinicians (e.g. nurses, doctors), and professional staff (e.g. ward personnel, clerks). The CAT and SOCA-CAT models illustrate workspaces, patient journey phases, and patient volume within the department that are heavily loaded with tasks and human and non-human agents performing these tasks, while others are underutilised. The findings suggest that an ED's adaptive capacity could be strengthened through the integration of additional human and non-human agents allowing the redistribution of clinical and non-clinical tasks. Practitioner Summary: Workflow in EDs is constrained by uneven geographical distribution of activities, insufficient adaptive support during critical patient journey phases and periods of high patient volume. Adaptive capacity could be strengthened by additional human and non-human agents in combination with a redistribution of tasks, supporting seamless successful structural and behavioural adaptation in ED.
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Affiliation(s)
- E Austin
- Macquarie University, Sydney, Australia
| | - B Blakely
- Macquarie University, Sydney, Australia
| | - P Salmon
- University of the Sunshine Coast, Maroochydore, Australia
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3
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Herkes J, Ellis LA, Churruca K, Braithwaite J. The 'goodness-of-fit' of fit models: creating a multidimensional survey for person-organisation and person-group fit in health care. BMC Med Res Methodol 2020; 20:144. [PMID: 32503435 PMCID: PMC7275356 DOI: 10.1186/s12874-020-01033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Person-environment fit, which examines the individual’s perceptions of if, and in what way, he or she is compatible with aspects of the work context, offers a promising conceptual model for understanding employees and their interactions in health care environments. There are numerous potential ways an individual feels they “fit” with their environment. The construct was first noted almost thirty years ago, yet still remains elusive. Feelings of fit with one’s environment are typically measured by surveys, but current surveys encompass only a subset of the different components of fit, which may limit the conclusions drawn. Further, these surveys have rarely been conducted in a focused way in health care settings. Method This article describes the development of a multidimensional survey tool to measure fit in relation to the person’s work group (termed person-group (P-G) fit) and their organisation (person-organisation (P-O) fit). The participants were mental health care employees, volunteers, and university interns (n = 213 for P-O fit; n = 194 for P-G fit). Confirmatory Factor Analyses (CFAs) were conducted using LISREL. Results Valid and reliable sub-scales were found. Conclusion This advanced multidimensional survey tool can be used to measure P-O and P-G fit, and illuminates new information about the theoretical structure of the fit construct.
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Affiliation(s)
- J Herkes
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, Australia.
| | - L A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, Australia
| | - K Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, Australia
| | - J Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, Australia
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Mitchell R, Draper B, Brodaty H, Close J, Ting HP, Lystad R, Harris I, Harvey L, Sherrington C, Cameron ID, Braithwaite J. An 11-year review of hip fracture hospitalisations, health outcomes, and predictors of access to in-hospital rehabilitation for adults ≥ 65 years living with and without dementia: a population-based cohort study. Osteoporos Int 2020; 31:465-474. [PMID: 31897545 DOI: 10.1007/s00198-019-05260-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/05/2019] [Indexed: 12/30/2022]
Abstract
UNLABELLED This study examined hip fracture hospitalisation trends and predictors of access to rehabilitation for adults aged ≥ 65 years living with and without dementia. The hospitalisation rate was 2.5 times higher for adults living with dementia and adults who lived in aged care were between 4.8 and 9.3 times less likely to receive rehabilitation. INTRODUCTION To examine hip fracture hospitalisation temporal trends, health outcomes, and predictors of access to in-hospital rehabilitation for older adults living with and without dementia. METHODS A population-based retrospective cohort study of adults aged ≥ 65 years hospitalised with a hip fracture during 2007-2017 in New South Wales, Australia. RESULTS Of the 69,370 hip fracture hospitalisations, 27.1% were adults living with dementia. The hip fracture hospitalisation rate was 2.5 times higher for adults living with dementia compared with adults with no dementia (1186.6 vs 492.9 per 100,000 population). The rate declined by 6.1% per year (95%CI - 6.6 to - 5.5) for adults living with dementia and increased by 1.0% per year (95%CI 0.5-1.5) for adults with no dementia. Multivariable associations identified that adults living with dementia who experienced high frailty and increasing age were between 1.6 and 1.8 times less likely to receive in-hospital rehabilitation. Adults who were living in long-term aged care facilities were between 4.8 and 9.3 times less likely to receive in-hospital rehabilitation which varied by the presence of dementia or delirium. CONCLUSION Consistent criteria should be applied to determine rehabilitation access, and rehabilitation services designed for older adults living with dementia or in aged care are needed. HIGHLIGHTS • Adults living with dementia were able to make functional gains following hip fracture rehabilitation. • Need to determine consistent criteria to determine access to hip fracture rehabilitation. • Rehabilitation services specifically designed for adults living with dementia or in aged care are needed.
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Affiliation(s)
- R Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - B Draper
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - H Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - J Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - H P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - R Lystad
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - I Harris
- Whitlam Orthopaedic Research Centre, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - L Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - C Sherrington
- School of Public Health, University of Sydney, Sydney, Australia
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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5
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Nicolaisen A, Bogh SB, Churruca K, Ellis LA, Braithwaite J, von Plessen C. Managers' perceptions of the effects of a national mandatory accreditation program in Danish hospitals. A cross-sectional survey. Int J Qual Health Care 2019; 31:331-337. [PMID: 30476098 DOI: 10.1093/intqhc/mzy174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/12/2018] [Accepted: 11/06/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to examine and compare middle and senior hospital managers' perceptions of the effects of a mandatory accreditation program in Denmark, the Danish Healthcare Quality Program (Den Danske Kvalitetsmodel [DDKM]) after it was terminated in 2015. DESIGN A cross-sectional online questionnaire survey. SETTING All 26 somatic and psychiatric public hospitals in Denmark. PARTICIPANTS All senior and middle managers. METHODS A questionnaire with open and closed response (five-point Likert scale) questions. Quantitative data were analyzed descriptively and through ordered logistic regression by management level. Qualitative data were subjected to a software-assisted content analysis. RESULTS The response rate was 49% (533/1059). In both the qualitative and quantitative data sets, participants perceived the DDKM as having: led to an increased focus on registration, documentation and additional and unnecessary procedures. While the DDKM was perceived as increasing a focus on quality, the time required for accreditation was at the expense of patient care. There were significant differences by management level, with middle managers having more negative perceptions of the DDKM related to time spent on documentation and registration. CONCLUSION While the DDKM had some perceived benefits for quality improvement, it was ultimately considered time-consuming and outdated or having served its purpose. Including managers, particularly middle managers, in refinements to the new quality improvement model could capitalize on the benefits while redressing the problems with the terminated accreditation program.
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Affiliation(s)
- A Nicolaisen
- Centre for Quality, Region of Southern Denmark, P.V. Tuxensvej 5.1, Middelfart, Denmark
| | - S B Bogh
- Centre for Quality, Region of Southern Denmark, P.V. Tuxensvej 5.1, Middelfart, Denmark
| | - K Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - L A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - J Braithwaite
- Institute of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, Odense C DK-5000, Denmark.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - C von Plessen
- Centre for Quality, Region of Southern Denmark, P.V. Tuxensvej 5.1, Middelfart, Denmark.,Institute of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, Odense C DK-5000, Denmark
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Mitchell R, Draper B, Close J, Harvey L, Brodaty H, Do V, Driscoll TR, Braithwaite J. Future hospital service utilisation in older adults living in long-term residential aged care or the community hospitalised with a fall-related injury. Osteoporos Int 2019; 30:1995-2008. [PMID: 31342137 DOI: 10.1007/s00198-019-05096-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED This study identified group-based trajectories of hospitalisation for older adults who were living in residential aged care facilities (RACF) or the community for up to 4 years after an index fall injury hospitalisation. Greater than 3 subsequent fall injury hospitalisations and time until move to a RACF were key predictors of RACF and community-living trajectory group memberships, respectively. INTRODUCTION To examine hospital service use trajectories of people aged ≥ 65 years who had a fall injury hospitalisation and were either living in a residential aged care facility (RACF) or the community at the time of the index fall and to identify factors predictive of their trajectory group membership. METHOD A group-based trajectory analysis of hospitalisations of people aged ≥ 65 years who had a fall injury hospitalisation during 2008-2009 in New South Wales, Australia, was conducted. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived based on number of subsequent hospital admissions following the index fall injury hospitalisation. Multinominal logistic regression examined predictors of trajectory group membership. RESULTS There were 24,729 fall injury hospitalisations; 78.8% of fallers were living in the community and 21.2% in a RACF. Five distinct trajectory groups were identified for community-living and four trajectory groups for RACF residents. Key predictors of trajectory group membership for both community-living and RACF residents were age group, number of comorbidities and dementia status. For RACF residents, depression, assistance with activities of daily living and number of subsequent fall injury admissions were also predictors of group membership, with time to move to a RACF a predictor of group membership for community living. CONCLUSIONS Identifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living individuals to remain as long as possible within their own residence.
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Affiliation(s)
- R Mitchell
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia.
| | - B Draper
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - J Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - L Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - H Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - V Do
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - T R Driscoll
- School of Public Health, University of Sydney, Camperdown, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia
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Churruca K, Ellis LA, Long JC, Pomare C, Wiles LK, Arnolda G, Ting HP, Woolfenden S, Sarkozy V, de Wet C, Hibbert P, Braithwaite J. The Quality of Care for Australian Children with Autism Spectrum Disorders. J Autism Dev Disord 2019; 49:4919-4928. [PMID: 31473948 DOI: 10.1007/s10803-019-04195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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.
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Affiliation(s)
- K Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.
| | - L A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - J C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - C Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - L K Wiles
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.,Australian Centre for Precision Health, School of Health Sciences, University of South Australia Cancer Research Institute, University of South Australia, Level 8, North Terrace, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - G Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - H P Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - S Woolfenden
- Department of Community Child Health, Sydney Children's Hospitals Network, School of Women and Children's Health, University of New South Wales, Sydney Children's Hospital, Level 3, High Street, Randwick, NSW, 2031, Australia
| | - V Sarkozy
- Tumbatin Developmental Clinic, Sydney Children's Hospital Network, School of Women and Children's Health, University of New South Wales, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia
| | - C de Wet
- Healthcare Improvement Unit, Clinical Excellence Division, Queensland Health, Brisbane, Australia.,School of Medicine, Griffith University, Gold Coast, Gold Coast Campus, Brisbane, QLD, 4222, Australia
| | - P Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.,Australian Centre for Precision Health, School of Health Sciences, University of South Australia Cancer Research Institute, University of South Australia, Level 8, North Terrace, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - J Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
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Testa L, Seah R, Ludlow K, Braithwaite J, Mitchell RJ. Models of care that avoid or improve transitions to hospital services for residential aged care facility residents: An integrative review. Geriatr Nurs 2019; 41:360-372. [PMID: 30876676 DOI: 10.1016/j.gerinurse.2019.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/18/2019] [Accepted: 02/22/2019] [Indexed: 11/26/2022]
Abstract
Care transitions for older people moving from residential aged care facilities (RACFs) to hospital services are associated with greater challenges and poorer outcomes. An integrative review was conducted to investigate models of care designed to avoid or improve transitions for older people residing in RACFs to hospital settings. Twenty-one studies were included in the final analysis. Models of care aimed to either improve or avoid transitions of residents through enhanced primary care in RACFs, promoting quality improvement in RACFs, instilling comprehensive hospital care, conducting outreach services, transferring information, or involved a combination of outreach services and comprehensive hospital care. As standalone interventions, standardised communication tools may improve information transfer between RACFs and hospital services. For more complex models, providing quality improvement and outreach to RACFs may prevent some types of hospital admissions.
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Affiliation(s)
- L Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, Australia.
| | - R Seah
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, Australia
| | - K Ludlow
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, Australia
| | - R J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, Australia
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Rapport F, Hibbert P, Baysari M, Long JC, Seah R, Zheng WY, Jones C, Preece K, Braithwaite J. What do patients really want? An in-depth examination of patient experience in four Australian hospitals. BMC Health Serv Res 2019; 19:38. [PMID: 30646962 PMCID: PMC6332615 DOI: 10.1186/s12913-019-3881-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/07/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient satisfaction is an important outcome measure guiding quality improvement in the healthcare setting while the patient-centred care movement places increasing importance on patient engagement in clinical decision-making. However, the concept of patient satisfaction is not clearly defined, and beliefs of patients are not always evident in health surveys. Researchers rarely follow up on surveys to explore patient views and what they mean in greater depth. This study set out to examine perceptions of hospital care, through in-depth, qualitative data capture and as a result, to gather rich, patient-driven information on user experience and satisfaction in the Australian healthcare setting; and identify influencing factors. METHODS Focus groups were undertaken in four St Vincent's Health Australia (SVHA) hospitals in 2017 where participants discussed responses to eight questions from the Press Ganey Patient Experience Survey. Thirty people who were inpatients at SVHA. RESULTS Good communication and high-quality information at arrival and discharge were found to be important to patients. Communication breakdown was also evident, further exacerbated by a range of environmental factors such as sharing a room with others. Overall, patients' felt that while their spiritual needs were well-supported by the hospital staff at all SVHA hospitals, it was the clinical teams prioritised their emotional needs. Good communication and environments can improve patient experience and follow-up at home is vital. CONCLUSIONS Patient-centred care needs careful planning with patients involved at entry and exit from hospital. Focused communication, environmental changes, attending to complaints, and clearer discharge strategies are recommended.
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Affiliation(s)
- F Rapport
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW, 2113, Australia.
| | - P Hibbert
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW, 2113, Australia
| | - M Baysari
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW, 2113, Australia
| | - J C Long
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW, 2113, Australia
| | - R Seah
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW, 2113, Australia
| | - W Y Zheng
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW, 2113, Australia
| | - C Jones
- St. Vincent's Health Australia, 340 Albert Street, East Melbourne, VIC, 3002, Australia
| | - K Preece
- St. Vincent's Health Australia, 340 Albert Street, East Melbourne, VIC, 3002, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW, 2113, Australia
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Clay-Williams R, Taylor N, Hsuen PT, Braithwaite J. ISQUA18-2317The Clinician View: The Relationship Between Clinicians Leadership and Culture and Quality Management in 32 Australian Hospitals. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Clay-Williams
- Australian Institute of Health Innovation, MACQUARIE UNIVERSITY, Macquarie University
| | - N Taylor
- Cancer Research Division, Cancer Council NSW, Syndey, Australia
| | - P T Hsuen
- Australian Institute of Health Innovation, MACQUARIE UNIVERSITY, Macquarie University
| | - J Braithwaite
- Australian Institute of Health Innovation, MACQUARIE UNIVERSITY, Macquarie University
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11
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Churruca K, Ellis L, Long J, Braithwaite J. ISQUA18-1699Complexity Science: The Next Frontier for Improving Quality and Safety in Healthcare. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K Churruca
- Australian Institute of Health Innovation, MACQUARIE UNIVERSITY, Macquarie University, Australia
| | - L Ellis
- Australian Institute of Health Innovation, MACQUARIE UNIVERSITY, Macquarie University, Australia
| | - J Long
- Australian Institute of Health Innovation, MACQUARIE UNIVERSITY, Macquarie University, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, MACQUARIE UNIVERSITY, Macquarie University, Australia
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Best S, Long JC, Taylor N, Braithwaite J. ISQUA18-2411Implementation of Genomics: A New Frontier in Clinical Practice. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Best
- Australian Institute of Health Innovation, Macquarie University, North Ryde
| | - J C Long
- Australian Institute of Health Innovation, Macquarie University, North Ryde
| | - N Taylor
- Cancer Council New South Wales, Sydney, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde
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Mumford V, Kulh MA, Westbrook J, Braithwaite J. ISQUA17-1772IMPROVING CARE FOR OLDER ACUTE INPATIENTS: AN ECONOMIC EVALUATION OF THE DELIRIUM CLINICAL CARE STANDARD. Int J Qual Health Care 2017. [DOI: 10.1093/intqhc/mzx125.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Braithwaite J, Von Plessen C, Nicolaisen A, Clay-Williams R. ISQUA17-2582THE RELATIONSHIP BETWEEN QUALITY IMPROVEMENT AND RESILIENT HEALTHCARE; NUANCES, COMPLEXITIES AND TRADE-OFFS. Int J Qual Health Care 2017. [DOI: 10.1093/intqhc/mzx125.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ellis L, Churruca K, Braithwaite J, Long J. ISQUA17-1548BROKEN WINDOWS THEORY AND ITS APPLICATION TO HEALTHCARE. Int J Qual Health Care 2017. [DOI: 10.1093/intqhc/mzx125.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lamprell G, Braithwaite J. Mainstreaming gender and promoting intersectionality in Papua New Guinea's health policy: a triangulated analysis applying data-mining and content analytic techniques. Int J Equity Health 2017; 16:65. [PMID: 28427479 PMCID: PMC5397822 DOI: 10.1186/s12939-017-0555-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Gender mainstreaming is an approach to policy and planning that emphasizes equality between the sexes. It is the stated policy for gender equity in Papua New Guinea’s (PNG) health sector, as well as all other sectors, and is enshrined in the policies of its biggest aid givers. However, there is criticism that gender mainstreaming’s application has too often been technocratic and lacking in conceptual clarity not only in PNG but elsewhere. In the health sector this is further exacerbated by a traditional bio-medical approach, which is often paternalistic and insufficiently patient- and family-centered. Methods This study analyses the policy attitudes toward gender in PNG’s health sector using both data-mining and a traditional, summative content analysis. Results Our results show that gender is rarely mentioned. When it is, it is most often mentioned in relation to programs such as maternity and childcare for women, and elsewhere is applied technocratically. Conclusion For PNG to promote greater levels of equity, the focus should first be on conceptualizing gender in a way that is meaningful for Papuans, taking into account the diversity of experiences and setting. Second, there should be greater focus on activists and civil society groups as the stakeholders most likely to make a difference in gender equity.
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Affiliation(s)
- G Lamprell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie, NSW, 2109, Australia
| | - J Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie, NSW, 2109, Australia.
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Braithwaite J, Westbrook J, Coiera E, Runciman WB, Day R, Hillman K, Herkes J. A systems science perspective on the capacity for change in public hospitals. Isr J Health Policy Res 2017; 6:16. [PMID: 28352457 PMCID: PMC5366102 DOI: 10.1186/s13584-017-0143-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/20/2017] [Indexed: 11/16/2022] Open
Abstract
Many types of organisation are difficult to change, mainly due to structural, cultural and contextual barriers. Change in public hospitals is arguably even more problematic than in other types of hospitals, due to features such as structural dysfunctionalities and bureaucracy stemming from being publicly-run institutions. The main goals of this commentary are to bring into focus and highlight the "3 + 3 Decision Framework" proposed by Edwards and Saltman. This aims to help guide policymakers and managers implementing productive change in public hospitals. However, while change from the top is popular, there are powerful front-line clinicians, especially doctors, who can act to counterbalance top-down efforts. Front-line clinicians have cultural characteristics and power that allows them to influence or reject managerial decisions. Clinicians in various lower-level roles can also influence other clinicians to resist or ignore management requirements. The context is further complicated by multi-stakeholder agendas, differing goals, and accumulated inertia. The special status of clinicians, along with other system features of public hospitals, should be factored into efforts to realise major system improvements and progressive change.
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Affiliation(s)
- J. Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109 Australia
| | - J. Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - E. Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - W. B. Runciman
- Centre for Population Health Research, School of Health Sciences, The University of South Australia, Adelaide, Australia
| | - R. Day
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - K. Hillman
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
- Intensive Care Unit, Liverpool Hospital, Sydney, Australia
| | - J. Herkes
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109 Australia
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Braithwaite J, Herkes J, Ludlow K, Lamprell G, Testa L. Association between organisational and workplace cultures, and patient outcomes: systematic review protocol. BMJ Open 2016; 6:e013758. [PMID: 27909040 PMCID: PMC5168669 DOI: 10.1136/bmjopen-2016-013758] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite widespread interest in the topic, no current synthesis of research is available analysing the linkages between organisational or workplace cultures on the one hand, and patient outcomes on the other. This protocol proposes a systematic review to analyse and synthesise the literature to date on this topic. The resulting review will discuss characteristics of included studies in terms of the type of healthcare settings researched, the measurements of organisational and workplace culture, patient outcomes measured and the influence of these cultures on patient outcomes. METHODS AND ANALYSIS A systematic review will be conducted aiming to examine the associations between organisational and workplace cultures, and patient outcomes, guided by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement. An English language search of abstracts will be executed using the following academic databases: CINAHL, EMBASE, Ovid MEDLINE, Web of Science and PsycINFO. The review will include relevant peer-reviewed articles from randomised controlled trials (RCTs), non-RCTs, controlled before and after studies, interrupted time series studies, cross-sectional analyses, qualitative studies and mixed-method studies. Multiple researchers will be involved in assessing the quality of articles for inclusion in the review. This protocol documents a detailed search strategy, including terms and inclusion criteria, which will form the basis of the subsequent systematic review. ETHICS AND DISSEMINATION Ethics approval is not required as no primary data will be collected. Results will be disseminated through a peer-reviewed publication and conference presentations.
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Affiliation(s)
- J Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - J Herkes
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - K Ludlow
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - G Lamprell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - L Testa
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
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Mumford V, Greenfield D, Parkinson B, Braithwaite J. ISQUA16-2548WHAT WOULD IT TAKE FOR ACCREDITATION TO BE COST-EFFECTIVE? A THRESHOLD ANALYSIS CASE STUDY. Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Clay-Williams R, Taylor N, Hogden E, Braithwaite J. ISQUA16-2861UNDERTAKING LARGE-SCALE RESEARCH IN AUSTRALIA: ENCOUNTERING THE COMPLEX WEB OF ETHICS AND GOVERNANCE IN HOSPITALS AND HEALTH SERVICES. Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Debono D, Greenfield D, Mumford V, Braithwaite J. ISQUA16-3062IMPROVEMENTS IDENTIFIED, BUT FUTURE SUSTAINABILITY IS NOT ASSURED: STAKEHOLDERS’ VIEWS ON ACCREDITATION IN AUSTRALIAN GENERAL PRACTICES. Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cardona-Morrell M, Prgomet M, Lake R, Nicholson M, Harrison R, Long J, Westbrook J, Braithwaite J, Hillman K. Vital signs monitoring and nurse-patient interaction: A qualitative observational study of hospital practice. Int J Nurs Stud 2015; 56:9-16. [PMID: 26775214 DOI: 10.1016/j.ijnurstu.2015.12.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/06/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND High profile safety failures have demonstrated that recognising early warning signs of clinical and physiological deterioration can prevent or reduce harm resulting from serious adverse events. Early warning scoring systems are now routinely used in many places to detect and escalate deteriorating patients. Timely and accurate vital signs monitoring are critical for ensuring patient safety through providing data for early warning scoring systems, but little is known about current monitoring practices. OBJECTIVE To establish a profile of nurses' vital signs monitoring practices, related dialogue, and adherence to health service protocol in New South Wales, Australia. METHODS Direct observations of nurses' working practices were conducted in two wards. The observations focused on times of the day when vital signs were generally measured. Patient interactions were recorded if occurring any time during the observation periods. Participants (n=42) included nursing staff on one chronic disease medical and one acute surgical ward in a large urban teaching hospital in New South Wales. RESULTS We observed 441 patient interactions. Measurement of vital signs occurred in 52% of interactions. The minimum five vital signs measures required by New South Wales Health policy were taken in only 6-21% of instances of vital signs monitoring. Vital signs were documented immediately on 93% of vitals-taking occasions and documented according to the policy in the patient's chart on 89% of these occasions. Nurse-patient interactions were initiated for the purpose of taking vital signs in 49% of interactions, with nurse-patient discourse observed during 88% of all interactions. Nurse-patient dialogue led to additional care being provided to patients in 12% of interactions. CONCLUSION The selection of appropriate vital signs measured and responses to these appears to rely on nurses' clinical judgement or time availability rather than on policy-mandated frequency. The prevalence of incomplete sets of vital signs may limit identification of deteriorating patients. The findings from this study present an important baseline profile against which to evaluate the impact of introducing continuous monitoring approaches on current hospital practice.
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Affiliation(s)
- M Cardona-Morrell
- South Western Sydney Clinical School, The University of New South Wales, Australia.
| | - M Prgomet
- Australian Institute of Health Innovation, Macquarie University, Australia
| | - R Lake
- Australian Institute of Health Innovation, Macquarie University, Australia
| | - M Nicholson
- Intensive Care Unit, Liverpool Hospital, Australia
| | - R Harrison
- School of Public Health, Sydney Medical School, The University of Sydney, Australia
| | - J Long
- Australian Institute of Health Innovation, Macquarie University, Australia
| | - J Westbrook
- Australian Institute of Health Innovation, Macquarie University, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Australia
| | - K Hillman
- South Western Sydney Clinical School, The University of New South Wales, Australia; Intensive Care Unit, Liverpool Hospital, Australia
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Braithwaite J, Marks D, Taylor N. Harnessing implementation science to improve care quality and patient safety: a systematic review of targeted literature. Int J Qual Health Care 2014; 26:321-9. [DOI: 10.1093/intqhc/mzu047] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Hinchcliff R, Greenfield D, Braithwaite J. Is it worth engaging in multi-stakeholder health services research collaborations? Reflections on key benefits, challenges and enabling mechanisms. Int J Qual Health Care 2014; 26:124-8. [DOI: 10.1093/intqhc/mzu009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mannion R, Braithwaite J. Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service. Intern Med J 2013; 42:569-74. [PMID: 22616961 DOI: 10.1111/j.1445-5994.2012.02766.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of the study is to review the evidence on the consequences associated with the introduction of national performance measurement systems in the National Health Service (NHS), with the aim of informing the development of similar national performance measurement programmes proposed for Australia. Narrative review of the published evidence on the unintended and adverse consequences of performance measurement systems in the NHS is the data source. We identified 20 different dysfunctional consequences of national performance measurement systems in the NHS in four headings. These are poor measurement (measurement fixation, tunnel vision, myopia, ossification, anachronism and quantification privileging), misplaced incentives and sanctions (complacency, silo-creation, overcompensation, undercompensation, insensitivity and increased inequality), breach of trust (misrepresentation, gaming, misinterpretation, bullying, erosion of trust and reduced staff morale), and politicisation of performance systems (political grandstanding and creating a diversion). Performance measurement programmes can contribute to systems improvement, delivering benefits to health services and patients, as evidenced by the dramatic reduction in waiting times in the NHS following the incorporation of targets and indicators for waiting times. Nevertheless, experience from the NHS shows that in addition to generating desired improvements, performance measures can induce a range of unintended and dysfunctional consequences. We recommend Australia to heed the lessons of the NHS, and strive to balance effective performance measurement and management against the potential drawbacks and adverse consequences. Any national performance measures need to be piloted and carefully evaluated to assess potential benefits and pitfalls.
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Affiliation(s)
- R Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK.
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Braithwaite J, Shaw CD, Moldovan M, Greenfield D, Hinchcliff R, Mumford V, Kristensen MB, Westbrook J, Nicklin W, Fortune T, Whittaker S. Comparison of health service accreditation programs in low- and middle-income countries with those in higher income countries: a cross-sectional study. Int J Qual Health Care 2012; 24:568-77. [DOI: 10.1093/intqhc/mzs064] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Gallego B, Westbrook MT, Dunn AG, Braithwaite J. Investigating patient safety culture across a health system: multilevel modelling of differences associated with service types and staff demographics. Int J Qual Health Care 2012; 24:311-20. [DOI: 10.1093/intqhc/mzs028] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Abstract
A new model is proposed for enhancing patient safety using market-based control (MBC), inspired by successful approaches to environmental governance. Emissions trading, enshrined in the Kyoto protocol, set a carbon price and created a carbon market--is it possible to set a patient safety price and let the marketplace find ways of reducing clinically adverse events? To "cap and trade," a regulator would need to establish system-wide and organisation-specific targets, based on the cost of adverse events, create a safety market for trading safety credits and then police the market. Organisations are given a clear policy signal to reduce adverse event rates, are told by how much, but are free to find mechanisms best suited to their local needs. The market would inevitably generate novel ways of creating safety credits, and accountability becomes hard to evade when adverse events are explicitly measured and accounted for in an organisation's bottom line.
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Affiliation(s)
- E Coiera
- Centre for Health Informatics, Institute of Health Innovation, University of New South Wales, Australia.
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Braithwaite J, Westbrook MT, Robinson M, Michael S, Pirone C, Robinson P. Improving patient safety: the comparative views of patient-safety specialists, workforce staff and managers. BMJ Qual Saf 2011; 20:424-31. [DOI: 10.1136/bmjqs.2010.047605] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Greenfield D, Nugus P, Travaglia J, Braithwaite J. Factors that shape the development of interprofessional improvement initiatives in health organisations. BMJ Qual Saf 2011; 20:332-7. [DOI: 10.1136/bmjqs.2010.044545] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dent K, Braithwaite J, Allen H, Humphreys G. Selective conjunctive suppression in visual search for motion - form conjunctions. J Vis 2010. [DOI: 10.1167/10.7.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Shaw CD, Kutryba B, Braithwaite J, Bedlicki M, Warunek A. Sustainable healthcare accreditation: messages from Europe in 2009. Int J Qual Health Care 2010; 22:341-50. [DOI: 10.1093/intqhc/mzq043] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Braithwaite J, Westbrook MT, Travaglia JF, Hughes C. Cultural and associated enablers of, and barriers to, adverse incident reporting. Qual Saf Health Care 2010; 19:229-33. [DOI: 10.1136/qshc.2008.030213] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Cross-fertilisation of ideas across industries, settings and contexts potentially improves learning by providing fresh insights into error pathways. OBJECTIVES AND HYPOTHESES: To investigate six cases of human error drawn from disasters in the space, shipping, aviation, mining, rail and nuclear industries, and to apprehend similarities and differences in the antecedents to errors, the way they manifest, the course of events and the way they are tackled. The extent to which human intervention can exacerbate the problems by introducing new errors, how the cases are resolved and the lessons learnt were examined. DESIGN, SETTING AND PARTICIPANTS Exemplar disaster events drawn from a very large sample of human errors. RESULTS It is possible to identify and model a generic disaster pathway that applies across several industries, including healthcare. CONCLUSIONS Despite differences between industries, it is clear that learning from disasters in other industries may provide important insights on how to prevent or ameliorate them in healthcare.
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Affiliation(s)
- C Hughes
- Centre for Clinical Governance Research in Health, Institute of Health Innovation, Faculty of Medicine, University of New South Wales, 10 Arthur Street, Randwick, NSW 2052, Australia
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Braithwaite J, Greenfield D, Westbrook J, Pawsey M, Westbrook M, Gibberd R, Naylor J, Nathan S, Robinson M, Runciman B, Jackson M, Travaglia J, Johnston B, Yen D, McDonald H, Low L, Redman S, Johnson B, Corbett A, Hennessy D, Clark J, Lancaster J. Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study. Qual Saf Health Care 2010; 19:14-21. [DOI: 10.1136/qshc.2009.033928] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
OBJECTIVES To sustain an argument that harnessing the natural properties of sociotechnical systems is necessary to promote safer, better healthcare. METHODS Triangulated analyses of discrete literature sources, particularly drawing on those from mathematics, sociology, marketing science and psychology. RESULTS Progress involves the use of natural networks and exploiting features such as their scale-free and small world nature, as well as characteristics of group dynamics like natural appeal (stickiness) and propagation (tipping points). The agenda for change should be set by prioritising problems in natural categories, addressed by groups who self select on the basis of their natural interest in the areas in question, and who set clinical standards and develop tools, the use of which should be monitored by peers. This approach will facilitate the evidence-based practice that most agree is now overdue, but which has not yet been realised by the application of conventional methods. CONCLUSION A key to health system transformation may lie under-recognised under our noses, and involves exploiting the naturally-occurring characteristics of complex systems. Current strategies to address healthcare problems are insufficient. Clinicians work best when their expertise is mobilised, and they flourish in groupings of their own interests and preference. Being invited, empowered and nurtured rather than directed, micro-managed and controlled through a hierarchy is preferable.
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Affiliation(s)
- J Braithwaite
- Faculty of Medicine, Centre for Clinical Governance Research, Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia.
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Greenfield D, Braithwaite J. Developing the evidence base for accreditation of healthcare organisations: a call for transparency and innovation. Qual Saf Health Care 2009; 18:162-3. [DOI: 10.1136/qshc.2009.032359] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Coiera E, Braithwaite J. Debating market-based control for patient safety: response to commentaries. Qual Health Care 2009. [DOI: 10.1136/qshc.2009.032581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Callen J, Braithwaite J, Westbrook JI. The importance of medical and nursing sub-cultures in the implementation of clinical information systems. Methods Inf Med 2009; 48:196-202. [PMID: 19283319 DOI: 10.3414/me9212] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To measure doctors' and nurses' perceptions of organisational culture and relate this to their attitudes to, and satisfaction with, a hospital-wide mandatory computerised provider order entry (CPOE) system in order to illuminate cultural compositions in CPOE use. METHODS A cross-sectional survey design was employed. Data were collected by administering an organisational culture survey (Organisational Culture Inventory, OCI) along with a user-satisfaction survey to a population of 103 doctors and nurses from two clinical units in an Australian metropolitan teaching hospital. Clinicians from the hospital had used the CPOE system since 1991 to order and view clinical laboratory and radiology tests electronically for all patients. The OCI provides a measure of culture in terms of three general styles which distinguish between: constructive; passive/defensive, and aggressive/defensive cultures. The cluster which best describes the overall culture is the one that has the highest percentile score when the percentile scores of the four cultural norms included in the cluster are averaged. The user satisfaction survey asked questions relating to satisfaction with, and attitudes to, the system. RESULTS We found identifiable sub-cultures based on professional divisions where doctors perceived an aggressive-defensive culture (mean percentile score = 43.8) while nurses perceived a constructive culture (mean percentile score = 61.5). There were significant differences between doctors and nurses on three of the attitude variables with nurses expressing more positive views towards CPOE than doctors. CONCLUSION The manifestation of sub-cultures within hospitals and the impact this has on attitudes towards clinical information systems should be recognized and addressed when planning for system implementation. Identification and management of the cultural characteristics of different groups of health professionals may facilitate the successful implementation and use of clinical information systems.
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Affiliation(s)
- Joanne Callen
- The University of Sydney, Lidcombe, NSW 1825, Australia.
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Nugus P, Braithwaite J, Iedema R, Holdgate A, Travaglia J, McCarthy S, Fry M, Daly B. El Impacto del Conocimiento Clinico, su Estructura e Interaccion en la Experiencia del Paciente: El Recorrido Organizacional del Clinico de Emergencias. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2006.10.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Braithwaite J. Caring about carepaths: on locus of control, holons and weltanschauung. AUST HEALTH REV 2002; 24:18-20. [PMID: 11842708 DOI: 10.1071/ah010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Stakeholders in acute care experience problems at various levels and in many places. Numerous critics have pointed to flaws in the system such as fragmentation, structural deficiencies, lack of clinical governance, insufficient resources, serendipitous rather than planned outcomes, poor systems and neglect of health promotion, prevention and education, to mention only some.
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Affiliation(s)
- J Braithwaite
- Graduate Management Programs, Faculty of Medicine, University of New South Wales
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Affiliation(s)
- J Braithwaite
- Research School of Social Sciences, Australian National University, Canberra, ACT 0200, Australia.
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Abstract
BACKGROUND The primary objective of this study is to provide objective, empirical, evidence-based practice management information. This is a hitherto under-researched area of considerable interest for both the practitioner and educator. METHODS A questionnaire eliciting a mix of structured and free text responses was administered to a random sample of 480 practitioners who are members of the American Academy of Periodontology. Potential respondents not in private practice were excluded and the next listed person substituted. RESULTS The results provide demographic and descriptive information about some of the main issues and problems facing practice managers, central to which are information technology (IT), financial, people management, and marketing. Human resource and marketing management appear to represent the biggest challenges. CONCLUSIONS Periodontists running practices would prefer more information, development, and support in dealing with IT, finance, marketing, and people management. The empirical evidence reported here suggests that although tailored educational programs on key management issues at both undergraduate and postgraduate levels have become ubiquitous, nevertheless some respondents seek further training opportunities. Evidence-based practice management information will be invaluable to the clinician considering strategic and marketing planning, and also for those responsible for the design and conduct of predoctoral and postdoctoral programs.
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Affiliation(s)
- H M Wong
- Mount Elizabeth Medical Center, Singapore.
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Abstract
Jeffrey Braithwaite is Senior Lecturer and Director, Graduate Management Programs and Don Hindle isVisiting Professor in the Faculty of Medicine, University of New South Wales.
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Affiliation(s)
- J Braithwaite
- Graduate Management Programs, Faculty of Medicine, University of New South Wales
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Abstract
Addresses the issue of empowerment and its possible role in promoting the effectiveness of health services. Empowerment represents the ability of people within organisations to use their own initiative to further organisational interests. However, despite its apparent simplicity, the concept turns out to be quite complex and to have unanticipated implications. We explore some of these implications in health service organisations, and their consequences for health policy. Our conclusion is that many health policies may well act to degrade the empowerment of health service workers, and hence the performance of health service organisations.
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Affiliation(s)
- P Lloyd
- School of Public Health, Charles Sturt University, Bathurst, New South Wales, Australia
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Braithwaite J. Victor Bonney Society, Spring Weekend Meeting, Down Hall Country House Hotel, Hertfordshire, 21-22 May 1999. J OBSTET GYNAECOL 2000; 20:445-447. [DOI: 10.1080/01443610050112327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Braithwaite J. Complex systems and the nature of professionalism. AUST HEALTH REV 1999; 21:11-4. [PMID: 10537549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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