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Rungan S, Liu HM, Smith-Merry J, Eastwood J. Kalgal Burnbona: An Integrated Model of Care Between the Health and Education Sector. Int J Integr Care 2024; 24:14. [PMID: 38706536 PMCID: PMC11067974 DOI: 10.5334/ijic.7745] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Kalgal Burnbona is a framework developed for applying school-based integrated care (SBIC) across Sydney Local Health District (SLHD). Description Kalgal Burnbona is an innovative and integrative framework developed to provide holistic, integrated, multidisciplinary child and family centred care to school-aged children from priority populations within SLHD, such as those belonging to the Aboriginal community. The expected outcomes include improved health, behavioural, education and social outcomes. This article contextualises the development of the Kalgal Burnbona framework from its beginnings as a pilot site called Ngaramadhi Space (NS) within the Healthy Homes and Neighbourhoods (HHAN) initiative, through to its evolution to an integrated partnership between the New South Wales (NSW) health and education sector. An example of how the framework can be implemented in other settings within SLHD is described. Discussion A tiered approach to integrated care across SLHD is postulated based on evidence from a mixed methods evaluation of NS and in line with the Rainbow Model of Integrated Care (RMIC). Kalgal Burnbona is an example of a community-driven response through collaborative partnerships to improve health, education and social outcomes. The framework described provides structure for multisector teams to work within, recognising that each community and school has its own history and needs. Conclusion The Kalgal Burnbona model can be scaled up to serve a wider network of students across SLHD. The initial successes of the model, which include improving access and engagement for children with unmet physical health, mental health and social needs while being accepted by communities provide evidence for policy changes and advocacy that centre on collaborative cross-sector partnerships.
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Affiliation(s)
- Santuri Rungan
- Croydon Health Centre, 24 Liverpool Road, Croydon, NSW, 2132, Australia
| | - Huei Ming Liu
- Menzies Centre for Health Policy, University of Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy (CDRP), Susan Wakil Health Building (D18), Camperdown Campus, The University of Sydney, NSW, 2006, Australia
| | - John Eastwood
- School of Population Health, University of New South Wales, Kensington, NSW, 2050, Australia
- Sydney Local Health District, Level 11, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia
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Rungan S, Smith-Merry J, Liu HM, Drinkwater A, Eastwood J. School-Based Integrated Care Within Sydney Local Health District: A Qualitative Study About Partnerships Between the Education and Health Sectors. Int J Integr Care 2024; 24:13. [PMID: 38706539 PMCID: PMC11067993 DOI: 10.5334/ijic.7743] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction The unmet physical and mental health needs of school-aged children (5-18 years) in New South Wales (NSW), stemming from poor access and engagement with healthcare, can be addressed by school-based integrated care (SBIC) models.This research aims to understand why and how partnerships between the health and education sector, in SBIC models, are important in providing care for children, and to identify the facilitating factors and barriers for implementation. Methods A qualitative study was conducted using semi-structured interviews and thematic analysis. The principles of the 'Integrated People-Centred Health Service (IPCHS)' framework and Looman et al's (2021) implementation strategies for integrated care were considered. Results Themes within IPCHS framework: Strategy 1: Engaging and empowering people and communities - community-driven models, improved access to healthcare, positive outcomes for children and families, 'connection', and service provision for marginalised populations; Strategy 2: Strengthening governance and accountability - system integration and developing evidence base; Strategy 3: Reorienting the model of care - shifting healthcare to schools reduces inequity and provides culturally safe practice; Strategy 4: Coordinating services within and across sectors - integrating care and stable workforce; Strategy 5: Creating an enabling environment: leadership, stakeholder commitment, and adequate resourcing. Discussion Potential strategies for implementing SBIC models across NSW include community consultation and co-design; building multidisciplinary teams with new competencies and roles e.g. linkers and coordinators; collaborative and shared leadership; and alignment of operational systems while maintaining a balance between structure and flexibility. Conclusion SBIC models require high-level collaboration across sectors and with communities to provide a shift towards child and family centred care that improves engagement, access and outcomes in health delivery.
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Affiliation(s)
- Santuri Rungan
- Croydon Health Centre, 24 Liverpool Road, Croydon, NSW, AU
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy (CDRP), Susan Wakil Health Building (D18), Camperdown Campus, The University of Sydney, NSW, 2006, AU
| | - Huei Ming Liu
- Menzies Centre for Health Policy, University of Sydney, AU
- The George Institute for Global Health, University of New South Wales, AU
| | - Alison Drinkwater
- Centre for Disability Research and Policy (CDRP), Susan Wakil Health Building (D18), Camperdown Campus, The University of Sydney, NSW, 2006, AU
| | - John Eastwood
- School of Population Health, University of New South Wales, Kensington, NSW 2050, AU
- Sydney Local Health District, Level 11, King George V Building, Missenden Road, Camperdown NSW 2050, AU
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Smith-Merry J. The NDIS at ten years: designing an equitable scheme for the next decade. Med J Aust 2024; 220:55. [PMID: 38009554 DOI: 10.5694/mja2.52174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023]
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Alkhaibari RA, Smith-Merry J, Forsyth R. "I am not just a place for implementation. I should be a partner": a qualitative study of patient-centered care from the perspective of diabetic patients in Saudi Arabia. BMC Health Serv Res 2023; 23:1412. [PMID: 38098092 PMCID: PMC10722796 DOI: 10.1186/s12913-023-10391-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Patient involvement in care is a major component of high quality of care and is becoming recognized worldwide with many beneficial for improving patient outcomes. However, a little is known about patient involvement in the Middle East region and Saudi Arabia in particular. OBJECTIVES To evaluate patients' perceptions of their involvement during their interactions with healthcare providers in Saudi Arabia. METHODS A qualitative exploratory study using semi structured interview was conducted from February 2022 to March 2022. Responses were transcribed and analyzed using a thematic analysis approach. RESULTS We conducted seven interviews with patients with diabetes ranging in age from 19 to 69 years old. We identified the following themes:1) patients' perceptions of their involvement in care, 2) barriers to patient involvement, 3) effective communication, 4) empathy, and 5) culture. We found that patients had minimal knowledge of patient involvement in care. CONCLUSION There is a clear need to improve education and awareness of patient involvement in Saudi Arabia. By educating patients about the possibilities of patient involvement and explaining their role it will make it easier for patients to understand appropriate levels of involvement. In addition, there is a need to understand the patient-centred care culture in Saudi Arabia through establishing frameworks with the focus on culture and patient-centred healthcare delivery.
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Affiliation(s)
- Reeham Ahmed Alkhaibari
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
- College of Nursing, Taif University, Taif, Saudi Arabia.
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rowena Forsyth
- Cyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Rungan S, Montgomery A, Smith-Merry J, Liu HM, Eastwood J. Retrospective audit of a school-based integrated health-care model in a specialised school for children with externalising behaviour. J Paediatr Child Health 2023; 59:1311-1318. [PMID: 37964701 DOI: 10.1111/jpc.16515] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/17/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
AIM Problematic externalising behaviours in adolescents are associated with high individual and societal burden. A school-based multidisciplinary health clinic, Ngaramadhi Space (NS), was developed at Yudi Gunyi School, a specialised behavioural school in Sydney, Australia, to improve access to holistic health-care and behavioural support. This evaluation aimed to describe the demographics, clinic attendance, health screening, recommendations made, and changes in Strengths and Difficulties Questionnaire (SDQ) scores of students attending the clinic. METHODS Retrospective evaluation of students including changes in SDQ scores using descriptive statistics (26 July 2016 to 14 May 2019; n = 79). RESULTS Prior to the assessment, few students engaged with a paediatrician or mental health professional (22.8%; 27.8%, respectively). Child protection services were involved with 76%. NS attendance was high (failure-to-attend = 7.6%; cancellations = 8.9%). New issues found at the assessment included: parental separation (31.6%); trauma history (27.8%); substance use (19%); emotional wellbeing concerns (16.5%), learning difficulties (12.7%), domestic violence (12.7%) and medical conditions (10.1%). SDQ teacher reports showed a significant decrease in total difficulties scores (M = 6.2, SD = 6.165, P < 0.05, eta squared = 1.013 (large effect)) and all subsets. No significant differences in parent and self-reported SDQ. CONCLUSIONS Students with problematic externalising behaviour have unmet health and social needs. The NS school-based integrated health-care model offers a novel, convenient and innovative way to engage these students. This approach has high initial attendance rates with teacher-reported SDQ results showing some behavioural improvement. Further qualitative studies are required.
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Affiliation(s)
- Santuri Rungan
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - Alicia Montgomery
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, New South Wales, Australia
| | - Huei Ming Liu
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - John Eastwood
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
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Rungan S, Gardner S, Liu HM, Woolfenden S, Smith-Merry J, Eastwood J. Ngaramadhi Space: An Integrated, Multisector Model of Care for Students Experiencing Problematic Externalising Behaviour. Int J Integr Care 2023; 23:19. [PMID: 38107833 PMCID: PMC10723013 DOI: 10.5334/ijic.7612] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Behavioural and emotional disorders are a significant cause of morbidity for young people aged 10-19 years. School-based health care (SBHC) provides an innovative approach to addressing these issues within Australia. Description We describe an innovative and integrative SBHC model called Ngaramadhi Space (NS) based at a specialised behavioural school called Yudi Gunyi school (YGS) in metropolitan Sydney, Australia. NS was developed in partnership with the Aboriginal community to provide holistic, integrated, multidisciplinary child and family centred care to students experiencing problematic externalising behaviour. We contextualise the historical factors leading to the development of NS, highlighting the importance of effective partnerships between sectors, and providing the theoretical framework and key components underpinning the model of care. Discussion In Australia, schools are an under-utilised resource for the delivery of health and support alongside education. Collaboration between sectors can be challenging but allows a more coordinated approach to the management of complex social and health issues. By forming effective partnerships with schools and communities, the health sector has an opportunity to improve access to health and social care in a culturally safe and acceptable way. This is in line with national and international frameworks for improving health service delivery and addressing inequity. Conclusion The health sector can play a pivotal role in improving the wellbeing of children by forming effective partnerships with schools and communities. The NS model is a practice-based example of this.
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Affiliation(s)
- Santuri Rungan
- Sydney Local Health District, University of Sydney, Sydney Institute for Women, Children & their Families, AU
| | | | - Huei-Ming Liu
- The George Institute for Global Health, University of New South Wales, AU
| | - Susan Woolfenden
- Sydney Local Health District, University of Sydney, AU
- Sydney Institute Women, Children and their Families, University of New South Wales, AU
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, The University of Sydney, AU
| | - John Eastwood
- University of New South Wales, Sydney, AU
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- University of Sydney, Sydney Institute for Women, Children and their Families and Sydney Local Health District, AU
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Alkhaibari RA, Smith-Merry J, Forsyth R, Raymundo GM. Patient-centered care in the Middle East and North African region: a systematic literature review. BMC Health Serv Res 2023; 23:135. [PMID: 36759898 PMCID: PMC9909864 DOI: 10.1186/s12913-023-09132-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The need for patient centered care (PCC) and its subsequent implementation has gained policy maker attention worldwide. Despite the evidence showing the benefits and the challenges associated with practicing PCC in western countries there has been no comprehensive review of the literature on PCC practice in the Middle East and North African (MENA) region, yet there is good reason to think that the practices of PCC in these regions would be different. OBJECTIVES This paper summarizes the existing research on the practice of PCC in the MENA region and uses this analysis to consider the key elements of a PCC definition based on MENA cultural contexts. METHODS Five electronic databases were searched (EMBASE, Cochrane, Medline, CINAHL and Scopus) using the search terms: patient OR person OR client OR consumer AND centered OR centred AND care. The MENA countries included were Bahrain, Iran, Iraq, Jordan, Kuwait, Lebanon, Oman, Palestine, Israel, Qatar, Saudi Arabia, Syria, United Arab Emirates, Yemen, Algeria, Egypt, Libya, Morocco, Tunisia, Djibouti, Pakistan, Sudan, and Turkey. Identified papers were imported to Covidence where they were independently reviewed against the inclusion criteria by two authors. The following data were extracted for each paper: author, year, location (i.e., country), objectives, methodology, study population, and results as they related to patient centred care. RESULT The electronic search identified 3582 potentially relevant studies. Fifty articles met the inclusion criteria. Across all papers five themes were identified: 1) patient centered care principles; 2) patient and physician perceptions of PCC; 3) facilitators of PCC; 4) implementation and impact of PCC; and 5) barriers to PCC. CONCLUSION The preliminary findings suggest that the concept of PCC is practiced and supported to a limited extent in the MENA region, and that the implementation of PCC might be impacted by the cultural contexts of the region. Our review therefore highlights the importance of establishing patient-centered care definitions that clearly incorporate cultural practices in the MENA region. The elements and impact of culture in the MENA region should be investigated in future research.
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Affiliation(s)
- Reeham Ahmed Alkhaibari
- grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.412895.30000 0004 0419 5255Nursing Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
| | - Rowena Forsyth
- grid.1013.30000 0004 1936 834XCyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - Gianina Marie Raymundo
- grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
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Boisvert I, Dunn AG, Lundmark E, Smith-Merry J, Lipworth W, Willink A, Hughes SE, Nealon M, Calvert M. Disruptions to the hearing health sector. Nat Med 2023; 29:19-21. [PMID: 36604541 DOI: 10.1038/s41591-022-02086-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Isabelle Boisvert
- Communication Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia. .,Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erik Lundmark
- Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Wendy Lipworth
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
| | - Amber Willink
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah E Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) West Midlands, Birmingham, UK.,UK SPINE, University of Birmingham, Birmingham, UK
| | - Michele Nealon
- Collaborator with lived experience of hearing loss. Disability Leadership Institute, Sydney, New South Wales, Australia
| | - Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) West Midlands, Birmingham, UK.,UK SPINE, University of Birmingham, Birmingham, UK.,DEMAND Hub, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
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Smith-Merry J, Fujita K, Chen T, Baillie A. Unintentional drug-related deaths in people with mental illness in NSW Australia, 2012-2016: a retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:239-248. [PMID: 35501478 PMCID: PMC9922235 DOI: 10.1007/s00127-022-02280-4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE People with mental illness are a vulnerable and stigmatised group with poor health outcomes including greater premature mortality. This study aimed to investigate trends and rates of change in unintentional drug-related deaths for people with mental illness, describe types of medicines involved, and identify populations at risk in a cohort from New South Wales, Australia. METHODS Features of unintentional drug-related deaths for people with mental illness between 2012 and 2016 were identified in a retrospective review of data from the National Coronial Information System. RESULTS A total of 495 unintentional drug-related deaths were identified (1.6 deaths/100,000 population), showing an upward trend (p < 0.01). The most common substance involved was diazepam in both genders (males 135/319, 42%, female 76/176, 43%) and more than one contributory drug was included in 80% of cases. Between 2012 and 2016, amphetamine-related deaths showed the highest increase (3.2-fold), followed by codeine (2.5-fold) and quetiapine (2.5-fold). Males (RR 1.8, 95% CI 1.5-2.2) and people aged 35-44 (RR 1.7, CI 1.3-2.2) were more likely to die from unintentional drug-related deaths compared with the reference (females and people aged 25-34). CONCLUSION This study found that the drugs commonly involved in deaths are also the drugs commonly used by and prescribed to people with mental illness. There were also significant differences between gender, age group, and marital status in the trend and rate of unintentional drug-related deaths for people with mental illness. A multifaceted approach encompassing both pharmaceutical prescribing and targeted public health messaging is required to inform intervention and prevention strategies.
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Affiliation(s)
- Jennifer Smith-Merry
- Centre for Disability Research and Policy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Kenji Fujita
- grid.1013.30000 0004 1936 834XSchool of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006 Australia
| | - Tim Chen
- grid.1013.30000 0004 1936 834XSchool of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006 Australia
| | - Andrew Baillie
- grid.1013.30000 0004 1936 834XSchool of Health Sciences and Matilda Centre for Research in Mental Health and Substance Abuse, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006 Australia
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Fortune N, Curryer B, Badland H, Smith-Merry J, Devine A, Stancliffe RJ, Emerson E, Llewellyn G. Do Area-Level Environmental Factors Influence Employment for People with Disability? A Scoping Review. Int J Environ Res Public Health 2022; 19:ijerph19159082. [PMID: 35897452 PMCID: PMC9330484 DOI: 10.3390/ijerph19159082] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022]
Abstract
Employment is an important social determinant of health and wellbeing. People with disability experience labour market disadvantage and have low labour force participation rates, high unemployment rates, and poor work conditions. Environmental factors are crucial as facilitators of or barriers to participation for people with disability. Understanding how the physical, social, and economic characteristics of local areas influence employment for people with disability can potentially inform interventions to reduce employment inequalities. We conducted a scoping review of research investigating associations between area-level environmental factors and employment for people with disability. Eighteen articles published between 2000 and 2020 met the inclusion criteria, and data were extracted to map the current evidence. Area-level factors were categorised into six domains relating to different aspects of environmental context: socioeconomic environment, services, physical environment, social environment, governance, and urbanicity. The urbanicity and socioeconomic environment domains were the most frequently represented (15 and 8 studies, respectively). The studies were heterogeneous in terms of methods and data sources, scale and type of geographic units used for analysis, disability study population, and examined employment outcomes. We conclude that the current evidence base is insufficient to inform the design of interventions. Priorities for future research are identified, which include further theorising the mechanisms by which area-level factors may influence employment outcomes, quantifying the contribution of specific factors, and interrogating specific factors underlying the association between urbanicity and employment outcomes for people with disability.
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Affiliation(s)
- Nicola Fortune
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Correspondence:
| | - Bernadette Curryer
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
| | - Hannah Badland
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Centre for Urban Research, RMIT University, Melbourne, VIC 3000, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
| | - Alexandra Devine
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Roger J. Stancliffe
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
| | - Eric Emerson
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Centre for Disability Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
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Case J, Walton M, Harrison R, Manias E, Iedema R, Smith-Merry J. What Drives Patients' Complaints About Adverse Events in Their Hospital Care? A Data Linkage Study of Australian Adults 45 Years and Older. J Patient Saf 2021; 17:e1622-e1632. [PMID: 33512865 DOI: 10.1097/pts.0000000000000813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to determine from patient-reported data the relationships between patients' experiences of adverse events (AEs), the disclosure of the events, and patients propensity for complaints or legal action. METHODS A cross-sectional survey was administered to 20,000 participants randomly chosen from the 45 and Up Study. The surveyed participants were older than 45 years and hospitalized in New South Wales, Australia, between January and June 2014. They were identified using data linkage to capture experiences of AEs. RESULTS Of the 7661 respondents, 474 participants (7%) reported experiencing an AE. Those who did not receive an apology or expression of regret in the incident disclosure process were significantly more likely to make a complaint (P < 0.05). Those who found out about the event from hospital staff but did not receive a formal open disclosure process were found to be significantly more likely to seek legal advice (P < 0.05). Patients who made a complaint generally perceived that they experienced more problems in their hospital care, with significant differences identified between those who did and did not make a complaint on 13 of the 15-item Picker Patient Experience Questionnaire. CONCLUSIONS Although incident disclosure was not associated with whether a complaint was made or legal action pursued, significant associations between key aspects of the disclosure process and these outcomes were noted. Significant differences between those who did and did not make a complaint were noted in relation to the timing and apology components of open disclosure. The critical role of overall patient experience in the context of optimal AE management was evident from these data.
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Affiliation(s)
| | | | | | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Rick Iedema
- Centre for Team-based Practice & Learning in Health Care, King's College London, London, United Kingdom
| | - Jennifer Smith-Merry
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales
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Smith-Merry J, O'Donovan MA, Dew A, Hemsley B, Imms C, Carey G, Darcy S, Ellem K, Gallego G, Gilroy J, Guastella A, Marella M, McVilly K, Plumb J. The future of disability research in Australia: protocol for a multi-phase research agenda-setting exercise. JMIR Res Protoc 2021; 11:e31126. [PMID: 34706859 PMCID: PMC8764607 DOI: 10.2196/31126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/24/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background For people with disabilities to live a good life, it is essential that funded research in health and social care addresses their interests, meets their needs, and fills gaps in our understanding of the impact that services, systems, and policies may have on them. Decisions about research funding should be based on an understanding of the research priorities of people with disabilities, their supporters and allies, disability researchers, service providers, and policy makers working in the field. Objective The aim of this protocol is to describe the research design and methods of a large-scale, disability research agenda–setting exercise conducted in 2021 in Australia. Methods The research agenda–setting exercise involves 3 integrated phases of work. In the first phase, a previous audit of disability research in Australia is updated to understand previous research and continuing gaps in the research. Building on this, the second phase involves consultation with stakeholders—people with disabilities and their supporters and family members, the disability workforce, and people working within services and connected sectors (eg, aging, employment, education, and housing), academia, and public policy. Data for the second phase will be gathered as follows: a national web-based survey; a consultation process undertaken through the government and nongovernment sector; and targeted consultation with Aboriginal and Torres Strait Islander people, children with disabilities and their families, people with cognitive disability, and people with complex communication needs. The third phase involves a web-based survey to develop a research agenda based on the outcomes of all phases. Results We have started working on 2 parts of the research prioritization exercise. Through the research-mapping exercise we identified 1241 journal articles and book chapters (referred to as research papers) and 225 publicly available reports (referred to as research reports) produced over the 2018-2020 period. Data collection for the national survey has also been completed. We received 973 fully completed responses to the survey. Analysis of these data is currently underway. Conclusions This multi-method research agenda–setting study will be the first to provide an indication of the areas of health and social research that people across the Australian disability community consider should be prioritized in disability research funding decisions. Project results from all phases will be made publicly available through reports, open-access journal publications, and Easy Read documents. International Registered Report Identifier (IRRID) DERR1-10.2196/31126
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Affiliation(s)
- Jennifer Smith-Merry
- Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, School of Health SciencesSusan Wakil Health Building, The University of Sydney, Camperdown, AU
| | - Mary-Ann O'Donovan
- Centre for Disability Studies, Faculty of Medicine and Health, The University of Sydney, Camperdown, AU
| | - Angela Dew
- Disability and Inclusion, School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, AU
| | - Bronwyn Hemsley
- Disability Research Network, University of Technology Sydney, Sydney, AU.,Faculty of Education and Arts, The University of Newcastle, Newcastle, AU
| | - Christine Imms
- Murdoch Children's Research Institute, The University of Melbourne, Melbourne, AU
| | - Gemma Carey
- Centre for Social Innovation, University of New South Wales, Sydney, AU
| | - Simon Darcy
- Disability Research Network, University of Technology Sydney, Sydney, AU
| | - Kathy Ellem
- School of Nursing, midwifery and Social Work, The University of Queensland, Brisbane, AU
| | - Gisselle Gallego
- Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, School of Health SciencesSusan Wakil Health Building, The University of Sydney, Camperdown, AU
| | - John Gilroy
- Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, School of Health SciencesSusan Wakil Health Building, The University of Sydney, Camperdown, AU
| | - Adam Guastella
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, AU
| | - Manjula Marella
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, AU
| | - Keith McVilly
- School of Social and Political Sciences, The University of Melbourne, Melbourne, AU
| | - Jenny Plumb
- Disability and Inclusion, School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, AU
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Honey A, Waks S, Hines M, Glover H, Hancock N, Hamilton D, Smith-Merry J. COVID-19 and Psychosocial Support Services: Experiences of People Living with Enduring Mental Health Conditions. Community Ment Health J 2021; 57:1255-1266. [PMID: 34235615 PMCID: PMC8262584 DOI: 10.1007/s10597-021-00871-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022]
Abstract
This paper uses secondary analysis to understand how COVID-19 shaped people's experiences with psychosocial support services in Australia. Data are drawn from questionnaires (n = 66) and semi-structured interviews (n = 62), conducted for a national service evaluation, with 121 people living with enduring mental health conditions and using psychosocial support services. Data relating to COVID-19 were inductively coded and analysed using constant comparative analysis. Most people's experiences included tele-support. While some people described minimal disruption to their support, many reported reduced engagement. People's wellbeing and engagement were influenced by: their location, living situation and pre-COVID lifestyles; physical health conditions; access to, comfort with, and support worker facilitation of technology; pre-COVID relationships with support workers; and communication from the organisation. The findings can help services prepare for future pandemics, adjust their services for a 'COVID-normal' world, and consider how learnings from COVID-19 could be incorporated into a flexible suite of service delivery options.
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Affiliation(s)
- Anne Honey
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Shifra Waks
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Monique Hines
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Helen Glover
- Enlightened Consultants, Brisbane, QLD, Australia
| | - Nicola Hancock
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Debra Hamilton
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Walton M, Harrison R, Smith-Merry J, Kelly P, Manias E, Jorm C, Iedema R. Disclosure of adverse events: a data linkage study reporting patient experiences among Australian adults aged ≥45 years. AUST HEALTH REV 2020; 43:268-275. [PMID: 29695314 DOI: 10.1071/ah17179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/23/2017] [Indexed: 11/23/2022]
Abstract
Objective Since Australia initiated national open disclosure standards in 2002, open disclosure policies have been adopted in all Australian states and territories. Yet, research evidence regarding their adoption is limited. The aim of the present study was to determine the frequency with which patients who report an adverse event had information disclosed to them about the incident, including whether they participated in a formal open disclosure process, their experiences of the process and the extent to which these align with the current New South Wales (NSW) policy. Methods A cross-sectional survey about patient experiences of disclosure associated with an adverse event was administered to a random sample of 20000 participants in the 45 and Up Study who were hospitalised in NSW, Australia, between January and June 2014. Results Of the 18993 eligible potential participants, completed surveys were obtained from 7661 (40% response rate), with 474 (7%) patients reporting an adverse event. Of those who reported an adverse event, a significant majority reported an informal or bedside disclosure (91%; 430/474). Only 79 patients (17%) participated in a formal open disclosure meeting. Most informal disclosures were provided by nurses, with only 25% provided by medical practitioners. Conclusions Experiences of open disclosure may be enhanced by informing patients of their right to full disclosure in advance of or upon admission to hospital, and recognition of and support for informal or bedside disclosure for appropriate types of incidents. A review of the open disclosure guidelines in relation to the types of adverse events that require formal open disclosure and those more suitable to informal bedside disclosure is indicated. Guidelines for bedside disclosure should be drafted to assist medical practitioners and other health professionals facilitate and improve their communications about adverse events. Alignment of formal disclosure with policy requirements may also be enhanced by training multidisciplinary teams in the process. What is known about the topic? While open disclosure is required in all cases of serious adverse events, patients' experiences are variable, and lack of, or poor quality disclosures are all too common. What does this paper add? This paper presents experiences reported by patients across New South Wales in a large cross-sectional survey. Unlike previous studies of open disclosure, recently hospitalised patients were identified and invited using data linkage with medical records. Findings suggest that most patients receive informal disclosures rather than a process that aligns with the current policy guidance. What are the implications for practitioners? Experiences of open disclosure may be enhanced by informing patients of their right to full disclosure in advance of or upon admission to hospital, and recognition of and support for informal or bedside disclosure for appropriate types of incidents.
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Affiliation(s)
- Merrilyn Walton
- School of Public Health, University of Sydney, NSW 2006, Australia.
| | - Reema Harrison
- School of Public Health and Community Medicine, UNSW Sydney, NSW 2052, Australia
| | | | - Patrick Kelly
- School of Public Health, University of Sydney, NSW 2006, Australia.
| | - Elizabeth Manias
- The University of Melbourne, Parkville, Vic. 3052, Australia. Email
| | - Christine Jorm
- School of Public Health, University of Sydney, NSW 2006, Australia.
| | - Rick Iedema
- School of Health Sciences, Monash University, Vic. 3800, Australia. Email
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Raymundo G, Smith-Merry J, McNab J. Experiences of health service literacy and access amongst Australian young adults from migrant backgrounds. Health Promot J Austr 2020; 32 Suppl 1:69-79. [PMID: 32808333 DOI: 10.1002/hpja.408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/24/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/09/2022] Open
Abstract
ISSUE ADDRESSED We currently know very little about the attitudes of young adult Australians from migrant backgrounds towards health service utilisation. This qualitative study aimed to explore their experiences of accessing health services and identify barriers and facilitators to health service utilisation. METHODS Semi-structured interviews were conducted with young people aged between 18-24 and living in Greater Western Sydney. Interview questions focused on facilitators and barriers to health service access. NVivo 11 was used to facilitate thematic analysis of the interviews. RESULTS Twenty-five young adults between 18-24 years from migrant backgrounds participated. Twenty semi-structured individual interviews and one group interview with five participants were conducted. Analysis identified themes relating to health literacy, cultural factors and quality of care and showed the importance of families, the education system and service outreach in facilitating access. CONCLUSIONS Findings indicate that more effective delivery of health services information in education, positive engagement between service-providers and service-users, and age-appropriate, culturally considerate health promotion strategies are needed to overcome barriers to health services accessibility. SO WHAT?: The results show the importance of families and communities, the education system and health service outreach in facilitating health service access for young people from migrant backgrounds. The paper highlights the need for more effective health promotion strategies targeting this group, their families and communities. To increase access, health promotion practitioners need to actively reach out to families and young people from migrant backgrounds through education and community-relevant forums.
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Affiliation(s)
- Gianina Raymundo
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, NSW, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy and Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, NSW, Australia
| | - Justin McNab
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, NSW, Australia
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Smith-Merry J, Goggin G, Campbell A, McKenzie K, Ridout B, Baylosis C. Social Connection and Online Engagement: Insights From Interviews With Users of a Mental Health Online Forum. JMIR Ment Health 2019; 6:e11084. [PMID: 30912760 PMCID: PMC6454344 DOI: 10.2196/11084] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/23/2018] [Accepted: 01/09/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Over the past 2 decades, online forums for mental health support have emerged as an important tool for improving mental health and well-being. There has been important research that analyzes the content of forum posts, studies on how and why individuals engage with forums, and how extensively forums are used. However, we still lack insights into key questions on how they are experienced from the perspective of their users, especially those in rural and remote settings. OBJECTIVE The aim of our study was to investigate the dynamics, benefits, and challenges of a generalized peer-to-peer mental health online forum from a user perspective; in particular, to better explore and understand user perspectives on connection, engagement, and support offered in such forums; information and advice they gained; and what issues they encountered. We studied experiences of the forums from the perspective of both people with lived experience of mental illness and people who care for people with mental illness. METHODS To understand the experience of forum users, we devised a qualitative study utilizing semistructured interviews with 17 participants (12 women and 5 men). Data were transcribed, and a thematic analysis was undertaken. RESULTS The study identified 3 key themes: participants experienced considerable social and geographical isolation, which the forums helped to address; participants sought out the forums to find a social connection that was lacking in their everyday lives; and participants used the forums to both find and provide information and practical advice. CONCLUSIONS The study suggests that online peer support provides a critical, ongoing role in providing social connection for people with a lived experience of mental ill-health and their carers, especially for those living in rural and remote areas. Forums may offer a way for individuals to develop their own understanding of recovery through reflecting on the recovery experiences and peer support shown by others and individuals enacting peer support themselves. Key to the success of this online forum was the availability of appropriate moderation, professional support, and advice.
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Affiliation(s)
- Jennifer Smith-Merry
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Gerard Goggin
- Department of Media and Communications, Faculty of Arts and Social Science, The University of Sydney, Sydney, Australia
| | - Andrew Campbell
- Cyberpsychology Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Kirsty McKenzie
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Brad Ridout
- Cyberpsychology Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Cherry Baylosis
- Department of Media and Communications, Faculty of Arts and Social Science, The University of Sydney, Sydney, Australia
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Harrison R, Walton M, Smith-Merry J, Manias E, Iedema R. Open disclosure of adverse events: exploring the implications of service and policy structures on practice. Risk Manag Healthc Policy 2019; 12:5-12. [PMID: 30774487 PMCID: PMC6350650 DOI: 10.2147/rmhp.s180359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 12/01/2022] Open
Abstract
Purpose The aim of this study was to explore the service and policy structures that impact open disclosure (OD) practices in New South Wales (NSW), Australia. Participants and methods An explorative study using semi-structured interviews was undertaken with 12 individuals closely involved in the implementation of OD in hospitals at policy or practice levels within the state of NSW, Australia. Interviews explored the service and policy structures surrounding OD and the perceived impact of these on the implementation of the OD policy. These data were thematically analyzed to understand the factors facilitating and creating barriers to openness after adverse events. Results The data identified three key areas in which greater alignment between OD policy and the wider service and policy structures may enhance the implementation of OD practice: 1) alignment between OD and root cause analysis processes, 2) holistic training that links to other relevant processes such as communicating bad news, risk management, and professional regulation and insurance, and 3) policy clarification regarding the disclosure of incidents that result in no or low-level harm. Conclusion Evidence from this study indicates that formal OD processes are not routinely applied after adverse events in NSW, despite clear guidelines for OD. The reasons for this are unclear as the service-level and policy-level phenomena that support or hinder OD are understudied. This knowledge is critical to addressing the policy-practice gap. Our paper provides insights regarding the influence of current service-level and policy-level phenomena on the delivery of OD and how policy clarification may contribute to addressing some of the challenges for implementing OD policy. The principles of virtue ethics – specifically, openness and the involvement of service users – may contribute to progressing in this area.
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Affiliation(s)
- Reema Harrison
- Faculty of Medicine, School of Public Health and Community Medicine, UNSW, Sydney, NSW, Australia,
| | - Merrilyn Walton
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Faculty of Health, Centre for Quality and Patient Safety Research, Deakin University, Sydney, NSW, Australia.,Department of Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rick Iedema
- Centre for Team-Based Practice and Learning in Health Care, King's College London, London, UK
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Harrison R, Walton M, Kelly P, Manias E, Jorm C, Smith-Merry J, Iedema R, Luxford K, Dyda A. Hospitalization from the patient perspective: a data linkage study of adults in Australia. Int J Qual Health Care 2018; 30:358-365. [PMID: 29506029 DOI: 10.1093/intqhc/mzy024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 02/01/2018] [Indexed: 12/18/2022] Open
Abstract
Objective Evidence of the patient experience of hospitalization is an essential component of health policy and service improvement but studies often lack a representative population sample or do not examine the influence of patient and hospital characteristics on experiences. We address these gaps by investigating the experiences of a large cohort of recently hospitalized patients aged 45 years and over in New South Wales (NSW), Australia who were identified using data linkage. Design Cross-sectional survey. Setting Hospitals in NSW, Australia. Participants The Picker Patient Experience Survey (PPE-15) was administered to a random sample of 20 000 patients hospitalized between January and June 2014. Main outcome measure Multivariable negative binomial regression was used to investigate factors associated with a higher PPE-15 score. Results There was a 40% response rate (7661 completed surveys received). Respondents often reported a positive experience of being treated with dignity and respect, yet almost 40% wanted to be more involved in decisions about their care. Some respondents identified other problematic aspects of care such as receiving conflicting information from different care providers (18%) and feeling that doctors spoke in front of them as if they were not there (14%). Having an unplanned admission or having an adverse event were both very strongly associated with a poorer patient experience (P < 0.001). No other factors were found to be associated. Conclusions Patient involvement in decision-making about care was highlighted as an important area for improvement. Further work is needed to address the challenges experienced by patients, carers and health professionals in achieving a genuine partnership model.
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Affiliation(s)
- Reema Harrison
- School of Public Health and Community Medicine, University of New South Wales, Australia
| | - Merrilyn Walton
- School of Public Health, University of Sydney, New South Wales, Australia
| | - Patrick Kelly
- School of Public Health, University of Sydney, New South Wales, Australia
| | - Elizabeth Manias
- Faculty of Health (Deakin), School of Nursing and Midwifery (Melbourne), University of Melbourne & Deakin University, Victoria, Australia
| | - Christine Jorm
- School of Public Health, University of Sydney, New South Wales, Australia
| | - Jennifer Smith-Merry
- Centre for Team-Based Practice & Learning in Health Care, School of Health Sciences, University of Sydney, New South Wales, Australia
| | - Rick Iedema
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Karen Luxford
- Royal Australasian College of Dental Surgeon, Level 13/37 York St, Sydney NSW, Australia
| | - Amalie Dyda
- Department of Health Systems and Populations/Australian Institute of Health Innovation, Macquarie University, Sydney NSW, Australia
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Gestos M, Smith-Merry J, Campbell A. Representation of Women in Video Games: A Systematic Review of Literature in Consideration of Adult Female Wellbeing. Cyberpsychol Behav Soc Netw 2018; 21:535-541. [PMID: 30132695 DOI: 10.1089/cyber.2017.0376] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aims to provide a comprehensive systematic review of the literature relating to the representation of women within video games in consideration of adult female wellbeing. The research question of the study assessed whether the representation of women in video games leads to female self-objectification and negative body image in adult women. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review method was used; comprising a thorough keyword database search, followed by literature screening and data extraction. Adult women were the focus of the study, with video games as the study exposure. Only 2 of the 22 studies directly assessed female wellbeing in relation to video game play. Results showed that women do report self-objectification and low levels of self-efficacy, as a result of exposure to objectified female content within video games, compared with participants exposed to nonobjectified content. Male and female belief in real-life female competence was jeopardized after exposure to objectified content of women within video games. Results demonstrated that female characters within video games are unevenly represented compared with male characters, with female characters mostly shown as subordinate to the male hero of the game, objectified, and hypersexualized with disproportionate body parts. The review also uncovered the propensity for men exposed to objectified and sexualized female characters within video games to hold sexist attitudes toward women in a real-life setting, and being more lenient to accept cultural rape myths.
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Affiliation(s)
- Meghan Gestos
- Faculty of Health Sciences, The University of Sydney , Camperdown, Australia
| | | | - Andrew Campbell
- Faculty of Health Sciences, The University of Sydney , Camperdown, Australia
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20
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Hancock N, Smith-Merry J, Mckenzie K. Facilitating people living with severe and persistent mental illness to transition from prison to community: a qualitative exploration of staff experiences. Int J Ment Health Syst 2018; 12:45. [PMID: 30116292 PMCID: PMC6085690 DOI: 10.1186/s13033-018-0225-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 08/04/2018] [Indexed: 11/25/2022] Open
Abstract
Background Transition from prison to community is a challenging time for all people who have been incarcerated. It is particularly challenging for those also living with serious and persistent mental illness. This study explored staff experiences and perspectives of what helped and hindered them in their work to support that transition. Methods Semi-structured interviews were conducted with 12 mental health staff working across three service sectors directly engaged in the process of supporting people with mental illness transitioning from prison to community; the forensic mental health provider Justice Health, Community Mental Health and a non-government delivered community-based service called Partners in Recovery. Data were analysed using constant comparative analysis. Results Five main themes were identified through the analysis. All five themes were key practices that, when occurring, supported staff to work in a way that they felt would maximise positive outcomes for people transitioning from prison to community. These included: housing secured before release; clearly defined and effective communication pathways; shared understanding of systems and roles; in-reach and continuity of contact, and consumers’ pre-release preparation and knowledge. All staff participants described barriers to good transition to community outcomes when some or all of these practices could not, or did not, occur. Conclusions Staff experiences highlight the complexity but importance of getting multi-sectorial partnerships and practices right for good prison to community transitions for people living with serious and persistent mental illness. Currently fragmented and disparate systems and practices need to align and clear expectations and understandings need to be shared across the whole. These changes, along with prioritised housing are likely to lead to better long-term outcomes for people.
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Affiliation(s)
- Nicola Hancock
- 1Faculty of Health Sciences, University of Sydney, J Block, Cumberland Campus C43J, PO Box 170, Lidcombe, NSW 1825 Australia
| | - Jennifer Smith-Merry
- 1Faculty of Health Sciences, University of Sydney, J Block, Cumberland Campus C43J, PO Box 170, Lidcombe, NSW 1825 Australia.,2Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Kirsty Mckenzie
- 1Faculty of Health Sciences, University of Sydney, J Block, Cumberland Campus C43J, PO Box 170, Lidcombe, NSW 1825 Australia
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Kelly K, Cumming S, Kenny B, Smith-Merry J, Bogaardt H. Getting comfortable with "comfort feeding": An exploration of legal and ethical aspects of the Australian speech-language pathologist's role in palliative dysphagia care. Int J Speech Lang Pathol 2018; 20:371-379. [PMID: 29591838 DOI: 10.1080/17549507.2018.1448895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 07/08/2017] [Revised: 01/31/2018] [Accepted: 03/01/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE With an ageing population, speech-language pathologists (SLPs) can expect to encounter legal and ethical challenges associated with palliative and end-of-life care more frequently. An awareness of the medico-legal and ethical framework for palliative dysphagia management will better equip SLPs to work effectively in this area. METHOD This narrative review examines a range of legislation, legal, ethical and SLP literature that is currently available to orient SLPs to legal and ethical palliative dysphagia management in the Australian context. RESULT Relevant legal and ethical considerations in palliative and end-of-life care are described. CONCLUSION SLPs have a role in palliative dysphagia management, however, this can involve unique legal and ethical challenges. The legal position on provision and cessation of nutrition and hydration differs between Australian States and Territories. Decisions by the courts have established a body of relevant case law. This article introduces SLPs to some of the important considerations for legal and ethical palliative care, but is not intended to be directive. SLPs are encouraged to explore their local options for ethical and medico-legal guidance. It is hoped that increasing SLPs awareness of many of the concepts discussed in this article enhances the provision of high-quality patient-centred care.
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Affiliation(s)
- Katherine Kelly
- a Speech Pathology Department, Camden and Campbelltown Hospitals, South Western Sydney Local Health District , Sydney , Australia and
- b Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney , Lidcombe , Australia
| | - Steven Cumming
- b Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney , Lidcombe , Australia
| | - Belinda Kenny
- b Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney , Lidcombe , Australia
| | - Jennifer Smith-Merry
- b Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney , Lidcombe , Australia
| | - Hans Bogaardt
- b Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney , Lidcombe , Australia
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Hancock N, Smith-Merry J, Jessup G, Wayland S, Kokany A. Understanding the ups and downs of living well: the voices of people experiencing early mental health recovery. BMC Psychiatry 2018; 18:121. [PMID: 29728097 PMCID: PMC5935906 DOI: 10.1186/s12888-018-1703-1] [Citation(s) in RCA: 13] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/23/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study was to better understand early-stage mental health recovery experiences of people living with severe and persistent mental illness and complex needs. METHODS Semi-structured, in-depth interviews were conducted with 13 people engaged in an Australian program specifically designed for people facing complex barriers to their recovery. Interview data were analysed thematically using constant comparative methods. RESULTS Participants described engaging with seven interconnecting aspects of early recovery: (1) engaging with the challenge of recovery; (2) struggling for a secure and stable footing; (3) grieving for what was and what could have been; (4) seeking and finding hope; (5) navigating complex relationships; (6) connecting with formal and informal support, and finally, (7) juggling a complexity of health issues. CONCLUSIONS This study illuminated the complexity of earlier-stage recovery which was characterised both by challenging personal circumstances and a hope for the future. It illustrated that even at an early point in their recovery journey, and amidst these challenging circumstances, people still actively engage with support, draw on inner strengths, source resources and find accomplishments. Stability and security was foundational to the ability of participants to draw on their own strengths and move forward. Stability came when material needs, including housing, were addressed, and an individual was able to connect with a supportive network of workers, carers, friends and family.
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Affiliation(s)
| | | | - Glenda Jessup
- 0000 0004 1936 834Xgrid.1013.3The University of Sydney, Sydney, Australia
| | - Sarah Wayland
- 0000 0004 1936 7611grid.117476.2University of Technology, Sydney, Sydney, Australia
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Smith-Merry J, Mellifont D, McKenzie K, Clenaghan P. A narrative review of mental health support for people during transition from incarceration to community: the grass can be greener on the other side of the fence. J Ment Health 2018; 28:189-197. [DOI: 10.1080/09638237.2018.1466029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jennifer Smith-Merry
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia,
- Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia, and
| | - Damian Mellifont
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia,
| | - Kirsty McKenzie
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia,
| | - Paul Clenaghan
- Community Mental Health Services, Sydney Local Health District, Sydney, Australia
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Fernandez A, Gillespie JA, Smith-Merry J, Feng X, Astell-Burt T, Maas C, Salvador-Carulla L. Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations. AUST HEALTH REV 2018; 41:38-44. [PMID: 27007640 DOI: 10.1071/ah15154] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/01/2016] [Indexed: 11/23/2022]
Abstract
Objective Australian mental health care remains hospital centric and fragmented; it is riddled with gaps and does little to promote recovery. Reform must be built on better knowledge of the shape of existing services. Mental health atlases are an essential part of this knowledge base, enabling comparison with other regions and jurisdictions, but must be based on a rigorous classification of services. The main aim of this study is to create an integrated mental health atlas of the Western Sydney LHD in order to help decision makers to better plan informed by local evidence. Methods The standard classification system, namely the Description and Evaluation of Services and Directories in Europe for Long-term Care model, was used to describe and classify adult mental health services in the Western Sydney Local Health District (LHD). This information provided the foundation for accessibility maps and the analysis of the provision of care for people with a lived experience of mental illness in Western Sydney LHD. All this data was used to create the Integrated Mental Health Atlas of Western Sydney LHD. Results The atlas identified four major gaps in mental health care in Western Sydney LHD: (1) a lack of acute and sub-acute community residential care; (2) an absence of services providing acute day care and non-acute day care; (3) low availability of specific employment services for people with a lived experience of mental ill-health; and (4) a lack of comprehensive data on the availability of supported housing. Conclusions The integrated mental health atlas of the Western Sydney LHD provides a tool for evidence-informed planning and critical analysis of the pattern of adult mental health care. What is known about the topic? Several reports have highlighted that the Australian mental health system is hospital based and fragmented. However, this knowledge has had little effect on actually changing the system. What does this paper add? This paper provides a critical analysis of the pattern of adult mental health care provided within the boundaries of the Western Sydney LHD using a standard, internationally validated tool to describe and classify the services. This provides a good picture of the availability of adult mental health care at the local level that was hitherto lacking. What are the implications for practitioners? The data presented herein provide a better understanding of the context in which mental health practitioners work. Managers and planners of services providing care for people with a lived experience of mental illness can use the information herein for better planning informed by local evidence.
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Affiliation(s)
- Ana Fernandez
- The Mental Health Policy Unit, Brain and Mind Centre, The University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - James A Gillespie
- Menzies Centre for Health Policy and Sydney School of Public Health, The University of Sydney, City Road, Edward Ford Building A27, NSW 2006, Australia. Email
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia.
| | - Xiaoqi Feng
- Menzies Centre for Health Policy and Sydney School of Public Health, The University of Sydney, City Road, Edward Ford Building A27, NSW 2006, Australia. Email
| | - Thomas Astell-Burt
- School of Health and Society, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - Cailin Maas
- The Mental Health Policy Unit, Brain and Mind Centre, The University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Luis Salvador-Carulla
- The Mental Health Policy Unit, Brain and Mind Centre, The University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia
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Hancock N, Scanlan JN, Gillespie JA, Smith-Merry J, Yen I. Partners in Recovery program evaluation: changes in unmet needs and recovery. AUST HEALTH REV 2017; 42:445-452. [PMID: 28693718 DOI: 10.1071/ah17004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/26/2017] [Indexed: 11/23/2022]
Abstract
Objective Partners in Recovery (PIR) is an Australian government initiative designed to provide support and service linkage for individuals with complex needs living with severe and persistent mental illness. The aim of the present study was to examine whether consumers engaged in PIR programs in two large regions of Sydney experienced: (1) a reduction in unmet needs (either via self- or staff report); and (2) progress in their self-reported mental health recovery. Methods Unmet needs were measured using the Camberwell Assessment of Need Short Appraisal Scale and recovery was measured using the Recovery Assessment Scale - Domains and Stages. For individuals with initial and follow-up data, paired t-tests were used to examine change over time. Results At follow-up, individuals reported an average of two to three fewer unmet needs, and recovery scores increased by approximately 5% across each domain and the total score. At follow-up, the most common unmet needs were in the areas of 'company' and 'daytime activities'. Conclusions The results of the present study suggest that PIR services in these two geographical regions have achieved positive results. Individuals with severe and persistent mental illness engaged with PIR appear to have reduced their unmet needs and enhanced their mental health recovery. What is known about the topic? PIR services were established to support individuals with severe and persistent mental illness by creating service linkages to address unmet needs in order to facilitate recovery. Services were delivered through the new role of 'support facilitator'. What does this paper add? By examining routinely collected outcome measures, this paper shows the success of the PIR program. Individuals engaged with PIR reported fewer unmet needs and enhanced recovery over the time they were involved with the program. However, they still faced serious challenges in building successful social interactions, such as developing friendships, and participating in meaningful activities. What are the implications for practitioners? The support facilitator role developed as part of PIR appears to be a useful method of supporting individuals to reduce unmet needs and enhance recovery. However, further work is required to address the challenges associated with overcoming social isolation and participation in meaningful activities.
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Affiliation(s)
- Nicola Hancock
- The University of Sydney, Faculty of Health Sciences, PO Box 170, Lidcombe, NSW 1825, Australia.
| | - Justin Newton Scanlan
- The University of Sydney, Faculty of Health Sciences, PO Box 170, Lidcombe, NSW 1825, Australia.
| | - James A Gillespie
- The University of Sydney, Menzies Centre for Health Policy, University of Sydney, NSW 2006, Australia. Email
| | - Jennifer Smith-Merry
- The University of Sydney, Faculty of Health Sciences, PO Box 170, Lidcombe, NSW 1825, Australia.
| | - Ivy Yen
- The University of Sydney, Menzies Centre for Health Policy, University of Sydney, NSW 2006, Australia. Email
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Walton MM, Harrison R, Kelly P, Smith-Merry J, Manias E, Jorm C, Iedema R. Patients' reports of adverse events: a data linkage study of Australian adults aged 45 years and over. BMJ Qual Saf 2017; 26:743-750. [DOI: 10.1136/bmjqs-2016-006339] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/13/2017] [Accepted: 03/10/2017] [Indexed: 11/04/2022]
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Abstract
Purpose
In 2010, Australia introduced the National Registration and Accreditation Scheme for the health professions (the Australian scheme) creating a legislative framework for a national system of health workforce regulation, delivering a model of collective (and multi-level) government involvement in regulatory activities. The purpose of this paper is to examine how its governance arrangement compares to different national systems and other health regulatory bodies in Australia.
Design/methodology/approach
This qualitative case study is informed by documentary analysis in conjunction with policy mapping. This is part of a larger project investigating the policy pathway which led to establishment of the Scheme. The authors compare the Scheme with other Australian health standard setting and regulatory bodies.
Findings
The Australian scheme’s governance model supported existing constitutional arrangements, and enabled local variations. This facilitated the enduring interest of ministers (and governments) on matters of health workforce and articulated the activities of the new regulatory player. It maintains involvement of the six states and two territories, with the Commonwealth Government, and profession-specific boards and accreditation agencies. This resulted in a unique governance framework delivering a new model of collective ministerial responsibility. The governance design is complex, but forges a new way to embed existing constitutional arrangements within a tripartite arrangement that also delivers National Boards specific to individual health professions and an organisation to administer regulatory activities.
Originality/value
This study demonstrates that effective design of governance arrangements for regulatory bodies needs to address regulatory tasks to be undertaken as well as the existing roles, and ongoing interests of governments in participating in those regulatory activities. It highlights that a unique arrangement, while appearing problematic in theory may in practice deliver intended regulatory outcomes.
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Hancock N, Smith-Merry J, Gillespie JA, Yen I. Is the Partners in Recovery program connecting with the intended population of people living with severe and persistent mental illness? What are their prioritised needs? AUST HEALTH REV 2017; 41:566-572. [DOI: 10.1071/ah15248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/28/2016] [Indexed: 11/23/2022]
Abstract
Objective
The Partners in Recovery (PIR) program is an Australian government initiative designed to make the mental health and social care sectors work in more coordinated ways to meet the needs of those with severe and complex mental illness. Herein we reflect on demographic data collected during evaluation of PIR implementation in two Western Sydney sites. The aims of the present study were to: (1) explore whether two Sydney-based PIR programs had recruited their intended population, namely people living with severe and persistent mental illness; and (2) learn more about this relatively unknown population and their self-identified need priorities.
Methods
Routinely collected initial client assessment data were analysed descriptively.
Results
The data suggest that the two programs are engaging the intended population. The highest unmet needs identified included psychological distress, lack of daytime activities and company, poor physical health and inadequate accommodation. Some groups remain hard to connect, including people from Aboriginal and other culturally diverse communities.
Conclusions
The data confirm that the PIR program, at least in the two regions evaluated, is mostly reaching its intended audience. Some data were being collected inconsistently, limiting the usefulness of the data and the ability to build on PIR findings to develop ongoing support for this population.
What is known about the topic?
PIR is a unique national program funded to engage with and address the needs of Australians living with severe and persistent mental illness by facilitating service access.
What does this paper add?
This paper reports on recruitment of people living with severe and persistent mental illness, their need priorities and data collection. These are three central elements to successful roll-out of the much anticipated mental health component of the National Disability Insurance Scheme, as well as ongoing PIR operation.
What are the implications for practitioners?
Active recruitment, exploration of self-reported need priorities and routine outcome measurement are essential yet challenging work practices when working with people living with severe and persistent mental illness.
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Mellifont D, Smith-Merry J, Scanlan JN. Disabling accommodation barriers: A study exploring how to better accommodate government employees with anxiety disorders. Work 2016; 55:549-564. [PMID: 27792025 DOI: 10.3233/wor-162423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Accommodating mental health in the workplace is challenging. Despite policy efforts to encourage the availability of mental health accommodations in the workplace, employees experiencing mental illness are missing out on accommodations that they need. OBJECTIVE To inform vocational rehabilitation professionals and managers in the public service of best practice accommodations for government employees with anxiety disorders. METHODS Thematic analysis was applied to data collected from the online Accommodating Government Employees with Anxiety Disorders Survey undertaken by 71 Australian public service employees diagnosed with at least one anxiety disorder. RESULTS Our research results include theme and sub-theme representations of accommodations received, accommodations reported as missing, accommodations that study participants felt they couldn't request, along with rejected accommodations. CONCLUSION From the study participants' accounts, three key findings supporting desirable vocational outcomes become apparent. First, that the availability of 'standard' flexible work arrangements, along with personalised accommodations, can assist persons with anxiety disorders (where needed) to reach and retain government positions. Second, the chief barriers reported to making accommodation requests revolve around fears of being stigmatised and penalised. Finally, there is a need for managerial decision-makers to remain open-minded, particularly when assessing requests for accommodations that may break from government norms.
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Smith-Merry J, Walton M, Healy J, Hobbs C. Responses by hospital complaints managers to recommendations for systemic reforms by health complaints commissions. AUST HEALTH REV 2016; 41:527-532. [PMID: 27764646 DOI: 10.1071/ah16138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/30/2016] [Indexed: 11/23/2022]
Abstract
Objective This paper explores how hospital complaints managers react to recommendations for systemic quality reforms by health complaints commissions in response to complaints by patients in Queensland and New South Wales. Methods Semi-structured qualitative interviews were conducted with complaints managers in 17 hospitals. Interview transcripts were then thematically analysed and data on responses to health complaint commissions was organised in relation to Valerie Braithwaite's typology of motivational postures. Results Respondents supported involvement by an independent authority where patients had serious complaints about the services they received in hospital, but wanted more negotiation with commissions on service improvement recommendations. Conclusions Hospital complaints managers mostly responded as virtuous or rational actors to the symbolic power of complaints commissions. This may be context dependent because Australian health commissions operate within a pro-reform context as a result of recent publicity around health system failures. What is known about the topic? Little is known about regulatory relationships between complaints commissions and hospitals. There has been no Australian research considering how complaints managers respond to commission recommendations for quality improvements and reforms to hospital services. What does the paper add? The paper uses a novel theoretical framework based on regulatory theory to understand and describe the reactions of complaints managers to commission recommendations. What are the implications for practitioners? Commissions should seek commentary from complaints managers through open dialogue before making final recommendations. This will ease the progress of reforms and make recommendations more acceptable and 'genuine' in the specific context of the hospital.
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Affiliation(s)
- Jennifer Smith-Merry
- Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia
| | - Merrilyn Walton
- School of Public Health, Sydney Medical School, University of Sydney, Edward Ford Building, NSW 2006, Australia.
| | - Judith Healy
- School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, ACT 0200, Australia. Email
| | - Coletta Hobbs
- School of Public Health, Sydney Medical School, University of Sydney, Edward Ford Building, NSW 2006, Australia.
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Mellifont D, Smith-Merry J, Scanlan JN. Pitching a Yerkes–Dodson curve ball?: A study exploring enhanced workplace performance for individuals with anxiety disorders. Journal of Workplace Behavioral Health 2016. [DOI: 10.1080/15555240.2015.1119654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Harrison R, Walton M, Healy J, Smith-Merry J, Hobbs C. Patient complaints about hospital services: applying a complaint taxonomy to analyse and respond to complaints. Int J Qual Health Care 2016; 28:240-5. [PMID: 26826722 DOI: 10.1093/intqhc/mzw003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore the applicability of a patient complaint taxonomy to data on serious complaint cases. DESIGN Qualitative descriptive study. SETTING Complaints made to the New South Wales (NSW) Health Care Complaints Commission, Australia between 2005 and 2010. PARTICIPANTS All 138 cases of serious complaints by patients about public hospitals and other health facilities investigated in the 5-year period. MAIN OUTCOME MEASURE A thematic analysis of the complaints was conducted to identify particular complaint issues and the Reader et al. (Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf 2014;23:678-89.) patient complaint taxonomy was then used to classify these issues into categories and sub-categories. RESULTS The 138 investigated cases revealed 223 complaint issues. Complaint issues were distributed into the three domains of the patient complaint taxonomy: clinical, management and relationships. Complaint issue most commonly related to delayed diagnosis, misdiagnosis, medication errors, inadequate examinations, inadequate/nil treatment and quality of care including nursing care. CONCLUSIONS The types of complaints from patients about their healthcare investigated by the NSW Commission were similar to those received by other patient complaint entities in Australia and worldwide. The application of a standard taxonomy to large numbers of complaints cases from different sources would enable the creation of aggregated data. Such data would have better statistical capacity to identify common safety and quality healthcare problems and so point to important areas for improvement. Some conceptual challenges in devising and using a taxonomy must be addressed, such as inherent problems in ensuring coding consistency, and giving greater weight to patient concerns about their treatment.
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Affiliation(s)
- Reema Harrison
- School of Public Health, University of Sydney, Edward Ford Building, Sydney, NSW 2006, Australia
| | - Merrilyn Walton
- School of Public Health, University of Sydney, Edward Ford Building, Sydney, NSW 2006, Australia
| | - Judith Healy
- Research School of Pacific and Asian Studies, Australian National University, Canberra, Australian Capital Territory 0200, Australia
| | - Jennifer Smith-Merry
- Faculty of Health Sciences, University of Sydney, Edward Ford Building, Sydney, NSW 2006, Australia
| | - Coletta Hobbs
- School of Public Health, University of Sydney, Edward Ford Building, Sydney, NSW 2006, Australia
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Harrison R, Walton M, Manias E, Smith-Merry J, Kelly P, Iedema R, Robinson L. The missing evidence: a systematic review of patients' experiences of adverse events in health care. Int J Qual Health Care 2015; 27:424-42. [PMID: 26424702 DOI: 10.1093/intqhc/mzv075] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Preventable patient harm due to adverse events (AEs) is a significant health problem today facing contemporary health care. Knowledge of patients' experiences of AEs is critical to improving health care safety and quality. A systematic review of studies of patients' experiences of AEs was conducted to report their experiences, knowledge gaps and any challenges encountered when capturing patient experience data. DATA SOURCES Key words, synonyms and subject headings were used to search eight electronic databases from January 2000 to February 2015, in addition to hand-searching of reference lists and relevant journals. STUDY SELECTION Titles and abstracts of publications were screened by two reviewers and checked by a third. Full-text articles were screened against the eligibility criteria. DATA EXTRACTION Data on design, methods and key findings were extracted and collated. RESULTS Thirty-three publications demonstrated patients identifying a range of problems in their care; most commonly identified were medication errors, communication and coordination of care problems. Patients' income, education, health burden and marital status influence likelihood of reporting. Patients report distress after an AE, often exacerbated by receiving inadequate information about the cause. Investigating patients' experiences is hampered by the lack of large representative patient samples, data over sufficient time periods and varying definitions of an AE. CONCLUSION Despite the emergence of policy initiatives to enhance patient engagement, few studies report patients' experiences of AEs. This information must be routinely captured and utilized to develop effective, patient-centred and system-wide policies to minimize and manage AEs.
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Affiliation(s)
- Reema Harrison
- School of Public Health, Sydney Medical School, University of Sydney, Rm 314 Edward Ford Building (A27), Sydney, NSW 2006, Australia
| | - Merrilyn Walton
- School of Public Health, Sydney Medical School, University of Sydney, Rm 314 Edward Ford Building (A27), Sydney, NSW 2006, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3125, Australia Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC 3125, Australia
| | - Jennifer Smith-Merry
- Faculty of Health Sciences, University of Sydney, Cumberland Campus, Sydney, NSW, Australia
| | - Patrick Kelly
- School of Public Health, Sydney Medical School, University of Sydney, Rm 314 Edward Ford Building (A27), Sydney, NSW 2006, Australia
| | - Rick Iedema
- Health Sciences, University of Tasmania and Agency for Clinical Innovation, PO Box 699, Chatswood, NSW 2057, Australia
| | - Lauren Robinson
- Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
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Smith-Merry J, Gillespie J, Hancock N, Yen I. Doing mental health care integration: a qualitative study of a new work role. Int J Ment Health Syst 2015; 9:32. [PMID: 26300963 PMCID: PMC4546146 DOI: 10.1186/s13033-015-0025-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health care in Australia is fragmented and inaccessible for people experiencing severe and complex mental ill-health. Partners in Recovery is a Federal Government funded scheme that was designed to improve coordination of care and needs for this group. Support Facilitators are the core service delivery component of this scheme and have been employed to work with clients to coordinate their care needs and, through doing so, bring the system closer together. OBJECTIVE To understand how Partners in Recovery Support Facilitators establish themselves as a new role in the mental health system, their experiences of the role, the challenges that they face and what has enabled their work. METHODS In-depth qualitative interviews were carried out with 15 Support Facilitators and team leaders working in Partners in Recovery in two regions in Western Sydney (representing approximately 35 % of those working in these roles in the regions). Analysis of the interview data focused on the work that the Support Facilitators do, how they conceptualise their role and enablers and barriers to their work. RESULTS The support facilitator role is dominated by efforts to seek out, establish and maintain connections of use in addressing their clients' needs. In doing this Support Facilitators use existing interagency forums and develop their own ad hoc groupings through which they can share knowledge and help each other. Support Facilitators also use these groups to educate the sector about Partners in Recovery, its utility and their own role. The diversity of support facilitator backgrounds are seen as both and asset and a barrier and they describe a process of striving to establish an internally collective identity as well as external role clarity and acceptance. At this early stage of PIR establishment, poor communication was identified as the key barrier to Support Facilitators' work. CONCLUSIONS We find that the Support Facilitators are building the role from within and using trial and error to develop their practice in coordination. We argue that a strong organisational hierarchy is necessary for support facilitation to be effective and to allow the role to develop effectively. We find that their progress is limited by overall program instability caused by changing government policy priorities.
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Affiliation(s)
- Jennifer Smith-Merry
- Faculty of Health Sciences and Menzies Centre for Health Policy, University of Sydney, PO Box 170, Lidcombe, NSW 1825 Australia
| | - Jim Gillespie
- School of Public Health and Menzies Centre for Health Policy, Edward Ford Building A27, The University of Sydney, Sydney, NSW 2006 Australia
| | - Nicola Hancock
- Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825 Australia
| | - Ivy Yen
- Faculty of Health Sciences and Menzies Centre for Health Policy, University of Sydney, PO Box 170, Lidcombe, NSW 1825 Australia
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Walton M, Smith-Merry J, Harrison R, Manias E, Iedema R, Kelly P. Using patients' experiences of adverse events to improve health service delivery and practice: protocol of a data linkage study of Australian adults age 45 and above. BMJ Open 2014; 4:e006599. [PMID: 25311039 PMCID: PMC4194751 DOI: 10.1136/bmjopen-2014-006599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/24/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Evidence of patients' experiences is fundamental to creating effective health policy and service responses, yet is missing from our knowledge of adverse events. This protocol describes explorative research redressing this significant deficit; investigating the experiences of a large cohort of recently hospitalised patients aged 45 years and above in hospitals in New South Wales (NSW), Australia. METHODS AND ANALYSIS The 45 and Up Study is a cohort of 265,000 adults aged 45 years and above in NSW. Patients who were hospitalised between 1 January and 30 June 2014 will be identified from this cohort using data linkage and a random sample of 20,000 invited to participate. A cross-sectional survey (including qualitative and quantitative components) will capture patients' experiences in hospital and specifically of adverse events. Approximately 25% of respondents are likely to report experiencing an adverse event. Quantitative components will capture the nature and type of events as well as common features of patients' experiences. Qualitative data provide contextual knowledge of their condition and care and the impact of the event on individuals. Respondents who do not report an adverse event will report their experience in hospital and be the control group. Statistical and thematic analysis will be used to present a patient perspective of their experiences in hospital; the characteristics of patients experiencing an adverse event; experiences of information sharing after an event (open disclosure) and the other avenues of redress pursued. Interviews with key policymakers and a document analysis will be used to create a map of the current practice. ETHICS AND DISSEMINATION Dissemination via a one-day workshop, peer-reviewed publications and conference presentations will enable effective clinical responses and service provision and policy responses to adverse events to be developed.
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Affiliation(s)
- Merrilyn Walton
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | | | - Reema Harrison
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Manias
- Department of Medicine & School of Health Sciences, University of Melbourne & School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Rick Iedema
- Agency for Clinical Innovation and University of Tasmania, Sydney, Australia
| | - Patrick Kelly
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Smith-Merry J, Caple A. Safety, risk and mental health: decision-making processes prescribed by Australian mental health legislation. J Law Med 2014; 21:661-681. [PMID: 24804534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Adverse events in mental health care occur frequently and cause significant distress for those who experience them, derailing treatment and sometimes leading to death. These events are clustered around particular aspects of care and treatment and are therefore avoidable if practices in these areas are strengthened. The research reported in this article takes as its starting point coronial recommendations made in relation to mental health. We report on those points and processes in treatment and discharge where coronial recommendations are most frequently made. We then examine the legislative requirements around these points and processes in three Australian States. We find that the key areas that need to be strengthened to avoid adverse events are assessment processes, communication and information transfer, documentation, planning and training. We make recommendations for improvements in these key areas.
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Smith-Merry J, Freeman R, Sturdy S. Implementing recovery: an analysis of the key technologies in Scotland. Int J Ment Health Syst 2011; 5:11. [PMID: 21569633 PMCID: PMC3121682 DOI: 10.1186/1752-4458-5-11] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 05/15/2011] [Indexed: 11/21/2022] Open
Abstract
Background Over the past ten years the promotion of recovery has become a stated aim of mental health policies within a number of English speaking countries, including Scotland. Implementation of a recovery approach involves a significant reorientation of mental health services and practices, which often poses significant challenges for reformers. This article examines how four key technologies of recovery have assisted in the move towards the creation of a recovery-oriented mental health system in Scotland. Methods Drawing on documentary analysis and a series of interviews we examine the construction and implementation of four key recovery 'technologies' as they have been put to use in Scotland: recovery narratives, the Scottish Recovery Indicator (SRI), Wellness Recovery Action Planning (WRAP) and peer support. Results Our findings illuminate how each of these technologies works to instantiate, exemplify and disseminate a 'recovery orientation' at different sites within the mental health system in order to bring about a 'recovery oriented' mental health system. They also enable us to identify some of the factors that facilitate or hinder the effectiveness of those technologies in bringing about a change in how mental health services are delivered in Scotland. These finding provide a basis for some general reflections on the utility of 'recovery technologies' to implement a shift towards recovery in mental health services in Scotland and elsewhere. Conclusions Our analysis of this process within the Scottish context will be valuable for policy makers and service coordinators wishing to implement recovery values within their own national mental health systems.
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Affiliation(s)
- Jennifer Smith-Merry
- School of Social and Political Science, University of Edinburgh, School of Public Health, University of Sydney.
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Smith-Merry J, Gillespie J, Leeder SR. A pathway to a stronger research culture in health policy. Aust New Zealand Health Policy 2007; 4:19. [PMID: 17927814 PMCID: PMC2104534 DOI: 10.1186/1743-8462-4-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 10/10/2007] [Indexed: 12/02/2022]
Abstract
BACKGROUND There are currently limited pathways into a career in health policy research in Australia, due in part to a serious absence of health policy research capability in Australian universities. DISCUSSION We define what we consider health policy research and education should comprise. We then examine what is currently on offer and propose ways to strengthen health policy research in Australia. SUMMARY This paper, which is part analysis and part commentary, is offered to provoke wider debate about how health policy research can be nurtured in Australia.
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Affiliation(s)
- Jennifer Smith-Merry
- School of Social and Political Studies, The University of Edinburgh, Edinburgh, UK
- Australian Health Policy Institute, The University of Sydney, Sydney, Australia
| | - James Gillespie
- Menzies Centre for Health Policy; School of Public Health, The University of Sydney, Sydney, Australia
| | - Stephen R Leeder
- Menzies Centre for Health Policy; Australian Health Policy Institute, The University of Sydney, Sydney, Australia
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