What We Have Here is a Failure to Communicate! Improving Communication between Tertiary to Primary Care for Chronic Heart Failure Patients

Background:  The aims of this study were to determine the documentation of pharmacotherapy optimization goals in the discharge letters of patients with the principal diagnosis of chronic heart failure. Methods:  A retrospective practice audit of 212 patients discharged to the care of their local general practitioner from general medical units of a large tertiary hospital. Details of recommendations regarding ongoing pharmacological and non-pharmacological management were reviewed. The doses of medications on discharge were noted and whether they met current guidelines recommending titration of angiotensin-converting enzyme inhibitors and beta-blockers. Ongoing arrangements for specialist follow up were also reviewed. Results:  The mean age of patients whose letters were reviewed was 78.4 years (standard deviation ± 8.6); 50% were men. Patients had an overall median of six comorbidities and eight regular medications on discharge. Mean length of stay for each admission was 6 days. Discharge letters were posted a median of 4 days after discharge, with 25% not posted at 10 days. No discharge letter was sent in 9.4% (20) of the cases. Only six (2.8%) letters had any recommendations regarding future titration of angiotensin-converting enzyme inhibitors and 6.6% (14) for beta-blockers. Recommendations for future non-pharmacological management, for example, diuretic action plans, regular weight monitoring and exercise plans were not found in the letters in this audit. Conclusion:  Hospital discharge is an opportunity to communicate management plans for treatment optimization effectively, and while this opportunity is spurned, implementation gaps in the management of cardiac failure will probably remain.

Crisis communication under transformative change : the emergent context and roles of primary and secondary organisations

In an era of complex challenges that draw sustained media attention and entangle multiple organisational actors, this thesis addresses the gap between current trends in society and business, and existing scholarship in public relations and crisis communication. By responding to calls from crisis communication researchers to develop theory (Coombs, 2006a), to examine the interdependencies of crises (Seeger, Sellnow, & Ulmer, 1998), and to consider variation in crisis response (Seeger, 2002), this thesis contributes to theory development in crisis communication and public relations. Through transformative change, this thesis extends existing scholarship built on a preservation or conservation logic where public relations is used to maintain stability by incrementally responding to changes in an organisation‘s environment (Cutlip, Center, & Broom, 2006; Everett, 2001; Grunig, 2000; Spicer, 1997). Based on the opportunity to contribute to ongoing theoretical development in the literature, the overall research problem guiding this thesis asks: How does transformative change during crisis influence corporate actors’ communication? This thesis adopts punctuated equilibrium theory, which describes change as alternating between long periods of stability and short periods of revolutionary or transformative change (Gersick, 1991; Romanelli & Tushman, 1994; Siggelkow, 2002; Tushman, Newman, & Romanelli, 1986; Tushman & Romanelli, 1985). As a theory for change, punctuated equilibrium provides an opportunity to examine public relations and transformative change, building on scholarship that is based primarily on incremental change. Further, existing scholarship in public relations and crisis communication focuses on the actions of single organisations in situational or short-term crisis events. Punctuated equilibrium theory enables the study of multiple crises and multiple organisational responses during transformative change. In doing so, punctuated equilibrium theory provides a framework to explain both the context for transformative change and actions or strategies enacted by organisations during transformative change (Tushman, Newman, & Romanelli, 1986; Tushman & Romanelli, 1985; Tushman, Virany, & Romanelli, 1986). The connections between context and action inform the research questions that guide this thesis: RQ1: What symbolic and substantive strategies persist and change as crises develop from situational events to transformative and multiple linked events? RQ2: What features of the crisis context influence changes in symbolic and substantive strategies? To shed light on these research questions, the thesis adopts a qualitative approach guided by process theory and methods to explicate the events, sequences and activities that were essential to change (Pettigrew, 1992; Van de Ven, 1992). Specifically, the thesis draws on an alternative template strategy (Langley, 1999) that provides several alternative interpretations of the same events (Allison, 1971; Allison & Zelikow, 1999). Following Allison (1971) and Allison and Zelikow (1999), this thesis uses three alternative templates of crisis or strategic response typologies to construct three narratives using media articles and organisational documents. The narratives are compared to identify and draw out different patterns of crisis communication strategies that operate within different crisis contexts. The thesis is based on the crisis events that affected three organisations within the pharmaceutical industry for four years. The primary organisation is Merck, as its product recall crisis triggered transformative change affecting, in different ways, the secondary organisations of Pfizer and Novartis. Three narratives are presented based on the crisis or strategic response typologies of Coombs (2006b), Allen and Caillouet (1994), and Oliver (1991). The findings of this thesis reveal different stories about crisis communication under transformative change. By zooming in to a micro perspective (Nicolini, 2009) to focus on the crisis communication and actions of a single organisation and zooming out to a macro perspective (Nicolini, 2009) to consider multiple organisations, new insights about crisis communication, change and the relationships among multiple organisations are revealed at context and action levels. At the context level, each subsequent narrative demonstrates greater connections among multiple corporate actors. By zooming out from Coombs‘ (2006b) focus on single organisations to consider Allen and Caillouet‘s (1994) integration of the web of corporate actors, the thesis demonstrates how corporate actors add accountability pressures to the primary organisation. Next, by zooming further out to the macro perspective by considering Oliver‘s (1991) strategic responses to institutional processes, the thesis reveals a greater range of corporate actors that are caught up in the process of transformative change and accounts for their varying levels of agency over their environment. By zooming in to a micro perspective and out to a macro perspective (Nicolini, 2009) across alternative templates, the thesis sheds light on sequences, events, and actions of primary and secondary organisations. Although the primary organisation remains the focus of sustained media attention across the four-year time frame, the secondary organisations, even when one faced a similar starting situation to the primary organisation, were buffered by the process of transformative change. This understanding of crisis contexts in transforming environments builds on existing knowledge in crisis communication. At the action level, the thesis also reveals different interpretations from each alternative template. Coombs‘ (2006b) narrative shows persistence in the primary organisation‘s crisis or strategic responses over the four-year time frame of the thesis. That is, the primary organisation consistently applies a diminish crisis response. At times, the primary organisation drew on denial responses when corporate actors questioned its legitimacy or actions. To close the crisis, the primary organisation uses a rebuild crisis posture (Coombs, 2006). These finding are replicated in Allen and Caillouet‘s (1994) narrative, noting this template‘s limitation to communication messages only. Oliver‘s (1991) narrative is consistent with Coombs‘ (2006b) but also demonstrated a shift from a strategic response that signals conformity to the environment to one that signals more active resistance to the environment over time. Specifically, the primary organisation‘s initial response demonstrates conformity but these same messages were used some three years later to set new expectations in the environment in order to shape criteria and build acceptance for future organisational decisions. In summary, the findings demonstrate the power of crisis or strategic responses when considered over time and in the context of transformative change. The conclusions of this research contribute to scholarship in the public relations and management literatures. Based on the significance of organisational theory, the primary contribution of the theory relates to the role of interorganisational linkages or legitimacy buffers that form during the punctuation of equilibrium. The network of linkages among the corporate actors are significant also to the crisis communication literature as they form part of the process model of crisis communication under punctuated equilibrium. This model extends existing research that focuses on crisis communication of single organisations to consider the emergent context that incorporates secondary organisations as well as the localised contests of legitimacy and buffers from regulatory authorities. The thesis also provides an empirical base for punctuated equilibrium in public relations and crisis communication, extending Murphy‘s (2000) introduction of the theory to the public relations literature. In doing this, punctuated equilibrium theory reinvigorates theoretical development in crisis communication by extending existing scholarship around incrementalist approaches and demonstrating how public relations works in the context of transformative change. Further research in this area could consider using alternative templates to study transformative change caused by a range of crisis types from natural disasters to product tampering, and to add further insight into the dynamics between primary and secondary organisations. This thesis contributes to practice by providing guidelines for crisis response strategy selection and indicators related to the emergent context for crises under transformative change that will help primary and secondary organisations‘ responses to crises.

Managerial cognition and reputation : does communication about firms’ intangibles affect performance?

Corporate reputation is viewed as fundamental to firm performance, growth and survival and the maintenance and enhancement of that reputation is a key responsibility of senior executives. However, relatively little is known about the main dimensions of corporate reputation and the amount of attention given to them by senior executives. Based on the corporate reputation and intangible resources literatures, thirteen reputational elements were identified and the amount of attention given to those elements in a large, longitudinal sample of annual reports from Australian firms was measured using computer aided text analysis. This identified five, main reputational dimensions that were both stable over time and related to firms’ future financial performance.

The influence of cultural selection on strategic communication

Strategic communication is held to be a key process by which organisations respond to environmental uncertainty. In the received view articulated in the literatures of organisational communication and public relations, strategic communication results from collaborative efforts by organisational members to create shared understanding about environmental uncertainty and, as a result of this collective understanding, formulate appropriate communication responses. In this study, I explore how such collaborative efforts towards the development of strategic communication are derived from, and bounded by, culturally shared values and assumptions. Study of the influences of an organisation‟s culture on the formulation of strategic communication is a fundamental conceptual challenge for public relations and, to date, a largely unaddressed area of research. This thesis responds to this challenge by describing a key property of organisational culture – the action of cultural selection (Durham, 1992). I integrate this property of cultural selection to extend and refine the descriptive range of Weick‟s (1969, 1979) classic sociocultural model of organizing. From this integration I propose a new model, the Cultural Selection of Strategic Communication (CSSC). Underpinning the CSSC model is the central proposition that because of the action of cultural selection during organizing processes, the inherently conservative properties of an organisation‟s culture constrain development of effective strategic communication in ways that may be unrelated to the outcomes of “environmental scanning” and other monitoring functions heralded by the public relations literature as central to organisational adaptation. Thus, by examining the development of strategic communication, I describe a central conservative influence on the social ecology of organisations. This research also responds to Butschi and Steyn‟s (2006) call for the development of theory focusing on strategic communication as well as Grunig (2006) and Sriramesh‟s (2007) call for research to further understand the role of culture in public relations practice. In keeping with the explorative and descriptive goals of this study, I employ organisational ethnography to examine the influence of cultural selection on the development of strategic communication. In this methodological approach, I use the technique of progressive contextualisation to compare data from two related but distinct cultural settings. This approach provides a range of descriptive opportunities to permit a deeper understanding of the work of cultural selection. Findings of this study propose that culture, operating as a system of shared and socially transmitted social knowledge, acts through the property of cultural selection to influence decision making, and decrease conceptual variation within a group. The findings support the view that strategic communication, as a cultural product derived from the influence of cultural selection, is an essential feature to understand the social ecology of an organisation.

The development of a program to assist international nursing students to be prepared for clinical practice in the Australian health care context

Health education in Western Countries has grown considerably in the last decade and this has occurred for a number of reasons. Specifically Universities actively recruit International students as the health workforce becomes global; also it is much easier for students to move and study globally. Internationally there is a health workforce shortage and if students gain a degree in a reputable university their ability to work globally is improved significantly. However, when studying to practice in the health care field the student must undertake clinical practice in an acute or aged care setting. This can be a significant problem for students who are culturally and linguistically diverse in an English speaking country such as Australia. The issues that can arise stem from the language differences where communication, interpretation understanding and reading the cultural norms of the health care setting are major challenges for International students. To assist international students to be successful in their clinical education, an extra curriculum workshop program was developed to provide additional support. The program which runs twice each year includes on-campus interactive workshops that are complemented by targeted support provided for students and clinical staff who are supervising students’ practice experience in the workplace. As this is an English speaking country the workshop is based on practicing reading, writing, listening and speaking, as well as exploring basic health care concepts and cultural differences. This enables students to gain knowledge of and practice interpretation of cultural norms and expectations in a safe environment. This innovative series of interactive workshops in a highly student-centred learning environment combine education with role play and discussion with peers who are supported by culturally aware and competent Educators. Over the years it has been running, the program has been undertaken by an increasing number of students. In 2011, more than 100 students are expected to participate. Student evaluation of the program has confirmed that it has assisted the majority of them to be successful in their clinical studies. Effectiveness of the project is measured throughout the program and in follow up sessions. This ongoing information allows for continuous development of the program that serves to meet individual needs of the International student, the University and Service providers such as the hospitals. This feedback from students regarding their increased comprehension of the Australian colloquial Language, healthcare terminology, critical thinking and clinical skill development and a cultural awareness also enables them to maintain their feelings of self confidence and self esteem.

Enhancing workplace learning through collaborative HRD

Human resource development (HRD) has evolved a great deal over the past 20 years. Indeed, developments in HRD theory, research and practice have helped transform HRD from a reactive function focusing on administrative and bureaucratic issues to a proactive function focusing on creating learning and development opportunities for employees that not only allow them to achieve their potential but also make a substantial contribution to the longterm survival and sustainability of the organisation. HRD is now seen as an investment in the future of an organisation. This investment perspective is based on the recognition that HRD is linked to business strategy and the achievement of competitive advantage (Caravan et al. 2002). One reason for the shift in emphasis is that many of the traditional sources of competitive advantage (technology, economies of scale) have diminished in value. Nowadays it is the workforce that has come to be seen as an important source of competitive advantage for the organisation. However, not too long ago employees were viewed by management as a disposable resource rather than an asset to an organisation.

The mobile phone : the new communication drum of Papua New Guinea

This thesis examines the role of mobile telephony in rural communities in Papua New Guinea (PNG). It is a threshold study which reports on research conducted in the earliest stages of mobile phone adoption in these areas. It explores the ways in which this new technology changes people’s lives, social structures and relationships. The research focuses on non-urban communities, which previously had little or no access to modern communication technologies, but which are in some cases still using traditional forms of communication such as drums. It has found that the introduction of mobile telecommunications has generally been viewed positively, although several negative concerns have been strongly felt. Specific benefits related to enhanced communication with relatives and friends living away from home villages, and use of the technology in time-critical emergencies or crises. Difficulties have arisen with respect to the cost of owning and operating a handset, as well as financial and logistical challenges when recharging handset batteries, particularly in areas with no mains electricity supply. Perceived damaging effects of mobile phone access related to sex, crime and pornography. The changes taking place are described through a social lens, by foregrounding the perceptions of villagers. The perspectives of key informants, such as telecommunication company managers, are also discussed. Employing the technique of triangulation (using different methods and sources) has helped to validate the findings of the research project. The sources constantly overlap and agree on the main themes, such as those outlined above. PNG is a developing country which performs poorly on a wide range of development indicators. A large majority of the people live outside of the major towns and cities. It is therefore worthwhile investigating the introduction of mobile phone technology in rural areas. These areas often have poor access to services, including transport, health, education and banking. Until 2007, communities in such regions fell outside of mobile phone coverage areas. In the case of all ten villages discussed in this thesis, there has never been any landline telephone infrastructure available. Therefore, this research on mobile phones is in effect documenting the first ever access to any kind of phone in these communities. This research makes a unique contribution to knowledge about the role of communication in PNG, and has implications for policy, practice and theory. In the policy arena, the thesis aids understanding of the impact which communication sector competition and regulation can have on rural and relatively isolated communities. There are three practical problems which have emerged from the research: cost, battery recharging difficulties and breakage are all major obstacles to uptake and use of mobile telephony in rural communities. Efforts to reduce usage costs, enable easier recharging, and design more robust handsets would allow for increased utilisation of mobile phones for a range of purposes. With respect to the realm of theory, this research sits amongst the most recent scholarship in the mobile phone field, located within the broader communication theory area. It recommends cautionary reading of any literature which suggests that mobile phones will reduce poverty and increase incomes in poor, rural communities in developing countries. Nonetheless, the present research adds weight to mobile phone studies which suggest that the primary advantages of mobile phones in such settings are for the satisfactions of communication of itself, and for social interaction among loved ones.

Employee perceived workplace stress : examining core self-evaluations, political skill, coping strategies and support

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Laying the Groundwork for the Successful Deployment of Communication Interception Technology (CIT) in Modern Policing

With the growth and development of communication technology there is an increasing need for the use of interception technologies in modern policing. Law enforcement agencies are faced with increasingly sophisticated and complex criminal networks that utilise modern communication technology as a basis for their criminal success. In particular, transnational organised crime (TOC) is a diverse and complicated arena, costing global society in excess of $3 trillion annually, a figure that continues to grow (Borger, 2007) as crime groups take advantage of disappearing borders and greater profit markets. However, whilst communication can be a critical success factor for criminal enterprise it is also a key vulnerability. It is this vulnerability that the use of CIT, such as phone taps or email interception, can exploit. As such, law enforcement agencies now need a method and framework that allows them to utilise CIT to combat these crimes efficiently and successfully. This paper provides a review of current literature with the specific purpose of considering the effectiveness of CIT in the fight against TOC and the groundwork that must be laid in order for it to be fully exploited. In doing so, it fills an important gap in current research, focusing on the practical implementation of CIT as opposed to the traditional area of privacy concerns that arise with intrusive methods of investigation. The findings support the notion that CIT is an essential intelligence gathering tool that has a strong place within the modern policing arena. It identifies that the most effective use of CIT is grounded within a proactive, intelligence‐led framework and concludes that in order for this to happen Australian authorities and law enforcement agencies must re‐evaluate and address the current legislative and operational constraints placed on the use of CIT and the culture that surrounds intelligence in policing.

Naming and claiming workplace sexual harassment in Australia

The persistence of sexual harassment in the workplace and the fact such behaviour remains significantly unreported suggest that legal definitions of sexual harassment may not be well understood. In this paper we explore the naming and claiming of sexual harassment in Australian workplaces, drawing on a unique dataset from a national sexual harassment prevalence survey. We compare a group of individuals who stated they had been sexually harassed according to a legal definition with a group who denied having experienced sexual harassment according to this definition but who went on to report sexually harassing behaviours. The study offers important insights into how workplace sexual harassment comes to be defined and understood in the Australian community, as well as some possible explanations for persistently low rates of formal complaints.