Building Healthy Communities : GP Network, Medicare Local and Primary Health Care in the Wheatbelt Region of Western Australia

• Government reports consistently recognise the importance of Primary Health Care to an efficient health system. Barriers identified in Australia’s Primary Health Care include workforce pressures, increase rate of chronic disease, and equitable access to Primary Health Care services. • General Practitioners (GPs) are the key to the successful delivery of Primary Health Care especially in rural and remote regions such as the Wheatbelt region in Western Australia (WA). • The Wheatbelt region of WA is vast: some 72,500 residents spread across 150,000km2 in 43 Local Government Authorities catchments. Majority of the Wheatbelt residents live in small towns. There is a higher reported rates of chronic disease, more at risk of chronic diseases and less utilisation of Primary Health Care services in this region. • General practice patients in the Wheatbelt are among those most in need of Primary Health Care services. • Wheatbelt GP Network (the “Network”) was established in 1998. It is a key health service delivery stakeholder in the Wheatbelt. • The Network has responded to the health needs of the community by creating a mobile Allied Health Team that works closely with GPs and is adaptive to ensure priority needs are met. • The Medicare Local model introduced by the Australian Government in 2011 aimed to improve the delivery of Primary Health Care services by improved health planning and coordinating service delivery. • Little if any recognition has been given to the outstanding work that many Divisions of General Practice have done in improving the delivery of Primary Health Care services such as the Network. • The Network has continued to support GPs and general practices and created a complementary system that integrated general practice with the work of an Allied Health Team. Its program mix is extensive. • The Network has consistently delivered on-required contract outputs and has a fifteen (15) years history of operating successfully in a large geographical area comprising in the main smaller communities that cannot support the traditional health services model. • The complexity of supporting International Medical Graduates in the region requires special attention. • The introduction of the Medicare Local in the South West of WA and their intention to take over the delivery of health services, thus effectively shutting the Network will have catastrophic consequences and cannot be supported economically. • The Network proposes to create a new model, built on its past work that increases the delivery of Primary Health Care services through its current Allied Health Team. • The proposal uses the Wheatbelt GP Super Clinic currently under construction in Northam, part of the Network and funded by the Australian Government is a key to the proposed new model. • Wheatbelt GP Super Clinic is different from existing models of GP Super Clinics around Australia which focus predominately on co-location of services. Wheatbelt GP Super Clinic utilises a hub and spoke model of service outreach to small rural towns to ensure equitable Primary Health Care coverage and continuum of care in a financially responsible and viable manner. In particular, the Wheatbelt GP Super Clinic recognises the importance of Allied Health Professionals and will involve them in a collaborative model with rural general practice. • The proposed model advocated by the Network aims to substitute the South West WA Medicare Local direct service delivery proposed for the Wheatbelt. The Network’s proposed model is to expand on the current hub and spoke model of Primary Health Care delivery to otherwise small unviable Wheatbelt towns. A flexible and adaptive skill mix of Allied Health Professionals, Nurse Practitioners and GPs ensure equitable access to service. Expanded scope of practices are utilised to reduce duplication of service and concentration of services in major towns. This involves a partnership approach. • If the proposed model not funded, the Network and the Wheatbelt region will stand to lose 16 Allied Health Professionals and defeats the purpose of Australian Government current funding for the construction of the Wheatbelt GP Super Clinic. • The Network has considered how its model can best be funded. It proposes a re-allocation of funds made available to the South West WA Medicare Local. • This submission argues that the proposal for the South West WA Medicare Local to take over the service delivery of Primary Health Care services in the Wheatbelt makes no economic sense when an existing agency (the Network) has the infrastructure in place, is experienced in working in this geographical area that has special needs and is capable to expand its programs to meet demand.

Ten basic factors to identify suitable subcontractors for construction projects

With unpredictable workloads and a need for a multitude of specialized skills, many main contractors rely heavily on subcontracting to reduce their risks (Bresnen et al., 1985; Beardsworth et al., 1988). This is especially the case In Hong Kong, where the average direct labour content accounts for only around 1% of the total contract sum (Lai, 1987). Extensive usage of subcontracting is also reported in many other countries, including the UK (Gray and Flanagan, 1989) and Japan (Bennett et al., 1987). In addition, and depending upon the scale and complexity of works, it is not uncommon for subcontractors to further sublet their works to lower tier(s) subcontractors. Richter and Mitchell (1982) argued that main contractors can obtain a higher profit margin by reducing their performance costs by subcontracting work to those who have the necessary resources to perform the work more efficiently and economically. Subcontracting is also used strategically to allow firms to employ a minimum work force under fluctuating demand (Usdiken and Sözen, 1985). Through subcontracting, the risks of main contractors are also reduced, as errors in estimating or additional costs caused by delays or extra labour requirements can be absorbed by the subcontractors involved (Woon and Ofori, 2000). Despite these benefits, the quality of work can suffer when incapable or inexperienced subcontractors are employed. Additional problems also exist in the form of bid shopping, unclear accountability, and high fragmentation (Palaneeswaran et al., 2002). A recent CIB TG 23 International Conference, October 2003, Hong Kong report produced by the Hong Kong Construction Industry Review Committee (CIRC) points to development of a framework to help distinguish between capable and incapable subcontractors (Tang, 2001). This paper describes research aims at identifying and prioritising criteria for use in such a framework.

A process-oriented approach to supporting Off-site Manufacture in construction projects

It is well-known that the use of off-site manufacture (OSM) techniques can assist in timely completion of a construction project though the utilisation of such techniques may have other disadvantages. Currently, OSM uptake within the Australian construction industry is limited. To successfully incorporate OSM practices within a construction project, it is crucial to understand the impact of OSM adoption on the processes used during a construction project. This paper presents how a systematic process-oriented approach may be able to support OSM utilisation within a construction project. Process modelling, analysis and automation techniques which are well-known within the Business Process Management (BPM) discipline have been applied to develop a collection of construction process models that represent the end-to-end generic construction value chain. The construction value chain enables researchers to identify key activities, resources, data, and stakeholders involved in construction processes in each defined construction phase. The collection of construction process models is then used as a basis for identification of potential OSM intervention points in collaboration with domain experts from the Australian construction industry. This ensures that the resulting changes reflect the needs of various stakeholders within the construction industry and have relevance in practice. Based on the input from the domain experts, these process models are further refined and operational requirements are taken into account to develop a prototype process automation (workflow) system that can support and coordinate OSM-related process activities. The resulting workflow system also has the potential to integrate with other IT solutions used within the construction industry (e.g., BIM, Acconex). As such, the paper illustrates the role that process-oriented thinking can play in assisting OSM adoption within the industry.

The impact of organizational boundaries on (re)building capabilities

The literature concerning firm boundaries has focussed extensively on the rationale for different boundary choices and the economic efficiencies that such choices can make. There is also an acknowledged position that a firm’s boundary choices may impact the ability of a firm to maintain and even build new capabilities, though such choices may not be optimal from an economic efficiency perspective. It is in this context that we seek to investigate how firms make this potential trade-off in respect of their boundary choices and how these choices are implemented across a wide range of activities. Using qualitative data from three public sector construction oriented organizations, we observe that neither pure make nor buy decisions assisted significantly in capability building. Dual modes – where firms make and buy the same product or service simultaneously – provided firms with some opportunities to manage this paradox, but the most successful decisions seemed to occur in respect of using intermediate governance modes such as alliances. We also observed that the boundary choice was just one dimension of the capability building process and firms pursuing the same boundary choice decisions often had quite divergent outcomes on the basis of their boundary management and the ability of knowledge to move across firm boundaries.

Building distributed leadership for effective supervision of creative practice higher research degrees : final report 2014

Building distributed leadership for effective supervision of creative practice higher research degrees is an Office for Learning and Teaching (OLT) funded project, conducted in partnership between Queensland University of Technology, The University of Melbourne, Auckland University of Technology, University of New South Wales and University of Western Sydney. The project was initiated to develop a cooperative approach to establishing an understanding of the contextual frameworks of the emergent field of creative practice higher degrees by research (HDRs); capturing early insights of administrators and supervisors; gathering exemplars of good practices; and establishing an in-common understanding of effective approaches to supervision. To this end, the project has produced: • A literature review, to provide a research foundation for creative practice higher research degree supervision (Chapter 3). • A contextual review of disciplinary frameworks for HDR programs, produced through surveys of postgraduate research administrators (Section 4.1), and an analysis of institutional materials and academic development programs for supervisors (Section 4.2). • A National Symposium, Effective Supervision of Creative Arts Research Degrees (ESCARD), at QUT in Brisbane in February 2013, with 62 delegates from 20 Australasian Universities, at which project findings were disseminated, and delegates presented case studies and position papers, and participated in discussions on key issues for supervisors (Appendix 1). • Resources, including a booklet for supervisors: 12 Principles for the Effective Supervision of Creative Practice Higher Research Degrees, which encapsulates attitudes, insights and good practices of experienced and new supervisors. It was produced through a content analysis of interviews with twenty-five supervisors in creative disciplines (visual and performing arts, music, new media, creative writing and design) (Printed booklet, PDF, Appendix 3). • A project website to disseminate project outcomes , which holds project findings, relevant references, and a repository of case studies and position papers by supervisors and program administrators. • A call for papers for a special issue ‘Supervising Practice: Perspectives on the Supervision of Creative Practice Research Higher Degrees’ of ACCESS Journal: Critical Perspectives on Communication, Cultural & Policy Studies (ERA ranked A quality) in 2014 (Appendix 2). • A community of supervisory practice initiated through project partnerships, a national symposium where supervisors from across Australasia met in dialogue for the first time, resource sharing, and joint publishing opportunities. • A set of recommendations for supervision capacity building and academic development, produced through the triangulation of literature and contextual reviews, analysis of institutional frameworks, interviews with supervisors and national dialogues. It is anticipated that the project’s outcomes will support experienced and new supervisors in this emergent field, and so benefit HDR students, and will enable creative disciplines to build supervision capacity, and so to accommodate growth in postgraduate enrolments. Funded as a pilot project, the project set out to establish a robust research base to provide a foundation for future work involving sharing good practices, resource building, and designing effective approaches to academic development for supervisors. Recommendations that were produced out of this project include the need to extend beyond generic, formal training for supervisors to academic development that harnesses and extends distributed leadership; focuses on local, disciplinary contexts; has a strong emphasis on case studies; provides diverse resources; and facilitates dialogue between supervisors. Recommendations also include developing frameworks for mentoring new supervisors and building a national network to facilitate cross-institutional discourse, disseminate good practices, and share insights into the management of risk factors, ethical issues, and preparing candidates for examination. As a pilot investigation, the outcomes of this project lay the ground for this future work.

Validation of an instrument to measure governance and performance on collaborative infrastructure projects

Collaborative infrastructure projects use hybrid formal and informal governance structures to manage transactions. Based on previous desk-top research, the authors identified the key mechanisms underlying project governance, and posited the performance implications of the governance (Chen et al. 2012). The current paper extends that qualitative research by testing the veracity of those findings using data from 320 Australian construction organisations. The results provide, for the first time, reliable and valid scales to measure governance and performance of collaborative projects, and the relationship between them. The results confirm seven of seven hypothesised governance mechanisms; 30 of 43 hypothesised underlying actions; eight of eight hypothesised key performance indicators; and the dual importance of formal and informal governance. A startling finding of the study was that the implementation intensity of informal mechanisms (non-contractual conditions) is a greater predictor of project performance variance than that of formal mechanisms (contractual conditions). Further, contractual conditions do not directly impact project performance; instead their impact is mediated by the non-contractual features of a project. Obligations established under the contract are not sufficient to optimise project performance.

Learning routines used by firms during construction of infrastructure projects using the alliance procurement method

Collaborative contracting has emerged over the past 15 years as an innovative project delivery framework that is particularly suited to infrastructure projects. Australia leads the world in the development of project and program alliance approaches to collaborative delivery. These approaches are considered to promise superior project results. However, very little is known about the learning routines that are most widely used in support of collaborative projects in general and alliance projects in particular. The literature on absorptive capacity and dynamic capabilities indicates that such learning enhances project performance. The learning routines employed at corporate level during the operation of collaborative infrastructure projects in Australia were examined through a large survey conducted in 2013. This paper presents a descriptive summary of the preliminary findings. The survey captured the experiences of 320 practitioners of collaborative construction projects, including public and private sector clients, contractors, consultants and suppliers (three per cent of projects were located in New Zealand, but for brevity’s sake the sample is referred to as Australian). The majority of projects identified used alliances (78.6%); whilst 9% used Early Contractor Involvement (ECI) contracts and 2.7% used Early Tender Involvement contracts, which are ‘slimmer’ types of collaborative contract. The remaining 9.7% of respondents used traditional contracts that employed some collaborative elements. The majority of projects were delivered for public sector clients (86.3%), and/or clients experienced with asset procurement (89.6%). All of the projects delivered infrastructure assets; one third in the road sector, one third in the water sector, one fifth in the rail sector, and the rest spread across energy, building and mining. Learning routines were explored within three interconnected phases: knowledge exploration, transformation and exploitation. The results show that explorative and exploitative learning routines were applied to a similar extent. Transformative routines were applied to a relatively low extent. It was also found that the most highly applied routine is ‘regularly applying new knowledge to collaborative projects’; and the least popular routine was ‘staff incentives to encourage information sharing about collaborative projects’. Future research planned by the authors will examine the impact of these routines on project performance.

Student focus and prioritization of design parameters in first-year engineering design projects

BACKGROUND Research on engineering design is a core area of concern within engineering education and a fundamental understanding of how engineering students approach and undertake design is necessary in order to develop effective design models and pedagogies. Understanding the factors related to design experiences in education and how they affect student practice can help educators as well as designers to leverage these factors as part of the design process. PURPOSE This study investigated the design practices of first-year engineering students’ and their experiences with a first-year engineering course design project. The research questions that guided the investigation were: 1. From a student perspective, what design parameters or criteria are most important? 2. How does this perspective impact subsequent student design practice throughout the design process? DESIGN/METHOD The authors employed qualitative multi-case study methods (Miles & Huberman, 1994) in order to the answer the research questions. Participant teams were observed and video recorded during team design meetings in which they researched the background for the design problem, brainstormed and sketched possible solutions, as well as built prototypes and final models of their design solutions as part of a course design project. Analysis focused on explanation building (Yin, 2009) and utilized within-case and cross-case analysis (Miles & Huberman, 1994). RESULTS We found that students focused disproportionally on the functional parameter, i.e. the physical implementation of their solution, and the possible/applicable parameter, i.e. a possible and applicable solution that benefited the user, in comparison to other given parameters such as safety and innovativeness. In addition, we found that individual teams focused on the functional and possible/ applicable parameters in early design phases such as brainstorming/ ideation and sketching. When prompted to discuss these non-salient parameters (from the student perspective) in the final design report, student design teams often used a post-hoc justification to support how the final designs fit the parameters that they did not initially consider. CONCLUSIONS This study suggests is that student design teams become fixated on (and consequently prioritize) certain parameters they interpret as important because they feel these parameters were described more explicitly in terms how they were met and assessed. Students fail to consider other parameters, perceived to be less directly assessable, unless prompted to do so. Failure to consider other parameters in the early design phases subsequently affects their approach in design phases as well. Case studies examining students’ study strategies within three Australian Universities illustrate similarities with some student approaches to design.

Forming a joint venture project team for multi-discipline engineering services in Australia

Joint venture design teams are formed to combine resources and expertise in order to secure multi-discipline engineering design services on major projects. Bringing together resources from two ordinarily competing companies to form one joint team is however challenging as each parent company brings to the project its own organisational culture, processes and team attitudes. This study examined the factors that impact on forming a successful joint venture project team. Three critical areas were identified from an extensive literature review; Joint Venture Arrangements, Parent Companies and Forming the Team; and a survey was conducted with professionals who have worked in joint venture project teams in the Australian building industry in order to identify factors that affected successful joint venture team formation, and the common lessons learnt. This study reinforced the importance of three key criteria - trust, commitment and compatibility - for partner alignment. The results also identified four key lessons learnt which included; selecting the right resources, enabling a collaborative working environment by way of project office, implementing an independent Joint Venture Manager, and allocating work which is best for project with fees reflecting risk where risk is disproportionate.

Tools for successful NRM in the Lake Eyre Basin : achieving effective engagement

This chapter was developed as part of the ‘People, communities and economies of the Lake Eyre Basin’ project. It has been written for communities, government agencies and interface organisations involved in natural resource management (NRM) in the Lake Eyre Basin (LEB). Its purpose is to identify the key factors for successful community engagement processes relevant to the LEB and present tools and principles for successful engagement processes. The term ‘interface organisation’ is used here to refer to the diverse range of local and regional organisations (such as Catchment Committees or NRM Regional Bodies) that serve as linkages, or translators, between local communities and broader Australian and State Governments. The importance of fostering and harnessing effective processes of community engagement has been identified as crucial to building a prosperous future for rural and remote regions in Australia. The chapter presents an overview of the literature on successful community engagement processes for NRM, as well as an overview of the current NRM arrangements in the LEB. The main part of the chapter presents findings of the series of interviews conducted with the government liaison officers representing both state and federal organisations who are responsible for coordinating and facilitating regional NRM in the LEB, and with the members of communities of the LEB.

Public sector project delay : the Malaysian perspective and the way forward

Construction delay has been a protracted problem for the Malaysian construction industry. Recent report showed that 80% of public sector projects are behind schedule. This underachieving time performance has led to many problems including public complaints, loss of reputation and revenue for the government and a slump in the industry’s GDP contribution. Research in the area of project delay has mushroomed worldwide with attempts to place mitigation plans, but delay remains a global phenomenon. There is now an urgent need for revolutionizing construction practices and past research, backed up with few successful cases suggests that Supply Chain Management (SCM) could prove beneficial to reduce or eliminate delays in construction. SCM which originated from the automotive manufacturing industry promotes a more collaborative approach to construction management and has recently gained attention of the construction industry. However every country, including Malaysia, would certainly have disparities of their own compared to others being it from the cultural point of view, nature of problems, locality or improvements needed. Therefore, this paper will present part of a Ph.D. research which aims at illustrating the Malaysian construction industry experts’ perception of the Malaysian public sector project delay, provide insight into these dilemmas, highlights the problems with current practices, its effects and the improvements needed. Subsequently, this paper would propose ratification to the problems using SCM. A semi-structured interview has been conducted to practitioners with at least 20 years’ experience in the industry. The findings showed that Malaysia may be unique compared to other countries and that by considering a number of additional factors, SCM could prove beneficial to increase efficiency of the Malaysian public sector projects.

Working in partnership to develop engineering capability in energy efficiency

Energy efficiency is a complex topic to integrate into higher education curricula, with limited success internationally or in Australia. This paper discusses one of the successful initiatives within the Energy Efficiency Training Program, which was jointly managed and implemented by the New South Wales Office of Environment and Heritage and Department of Education and Communities. The state government initiative aimed to increase the knowledge and skills of the New South Wales workforce, help business to identify and implement energy efficiency projects, and provide professional development for the training providers. Key sectors targeted included property, construction, manufacturing and services. The Program was externally evaluated over the three years 2011 to 2013 and a range of insights were gained through these facilitated reflective opportunities, confirming and building upon literature on the topic to date. This paper presents lessons learned from the engineering part of the program (‘the project’), spanning government agencies, academic institutions, and academia. The paper begins with a contextual summary, followed by a synthesis of key learnings and implications for future training initiatives. It is intended that sharing these lessons will contribute to literature in the field, and assist other organisations in Australia and overseas planning similar initiatives.

RMAA safety performance : how does it compare with Greenfield projects?

Gross value of cons truction work in the repair , maintenance, minor alte ration and addition (RMAA) sector in Hong Kong has expanded dramatically by 58% from 1998 to 2007, accounting for over 53% of the whole construction market in 2007. Unfortunately, the portion of industrial accidents arising from this sector also increased substantially during the same period. It is important to improve the safety performance of the RMAA sector. This paper has set out the objectives to examine safety statistics of RMAA works; to compare them with those of green field projects; and more importantly, to highlight potential hurdles en countered in the process of comparison and finally to provide effective recommendations for overcoming these impediments. To strive for continuous safety improvement of RMAA works, comparable safety statistics should be compiled for this sector.

Navigating the social dimension of sustainability decision making of mega-projects

Until recently, sustainable development was perceived as essentially an environmental issue, relating to the integration of environmental concerns into economic decision-making. As a result, environmental considerations have been the primary focus of sustainability decision making during the economic development process for major projects, and the assessment and preservation of social and cultural systems has been arguably too limited. The practice of social impact and sustainability assessment is an established and accepted part of project planning, however, these practices are not aimed at delivering sustainability outcomes for social systems, rather they are designed to minimise ‘unsustainability’ and contribute to project approval. Currently, there exists no widely recognised standard approach for assessing social sustainability and accounting for positive externalities of existing social systems in project decision making. As a result, very different approaches are applied around the world, and even by the same organisations from one project to another. This situation is an impediment not only to generating a shared understanding of the social implications as related to major projects, but more importantly, to identifying common approaches to help improve social sustainability outcomes of proposed activities. This paper discusses the social dimension of sustainability decision making of mega-projects, and argues that to improve accountability and transparency of project outcomes it is important to understand the characteristics that make some communities more vulnerable than others to mega-project development. This paper highlights issues with current operational level approaches to social sustainability assessment at the project level, and asserts that the starting point for project planning and sustainability decision making of mega-projects needs to include the preservation, maintenance, and enhancement of existing social and cultural systems. It draws attention to the need for a scoping mechanism to systematically assess community vulnerability (or sensitivity) to major infrastructure development during the feasibility and planning stages of a project.

How public owners communicate the sustainability requirements of green design-build projects

The design-build (DB) system is regarded as an effective means of delivering sustainable buildings. Specifying clear sustainability requirements to potential contractors is of great importance to project success. This research investigates the current state-of-the-practice for the definition of sustainability requirements within the public sectors of the U.S. construction market using a robust content analysis of 49 DB requests for proposals (RFPs). The results reveal that owners predominantly communicate their desired level of sustainability through the LEED certification system. The sustainability requirement has become an important dimension for the best-value evaluation of DB contractors with specific importance weightings of up to 25%. Additionally, owners of larger projects and who provide less design information in their RFPs generally allocate significantly higher importance weightings to sustainability requirements. The primary knowledge contribution of this study to the construction industry is the reveal of current trend in DB procurement for green projects. The findings also provide owners, architects, engineers, and constructors with an effective means of communicating sustainability objectives in solicitation documents.