Task-relationship-self : a framework for understanding service encounter behaviors

Research conducted over past decades has investigated selected service encounter behaviors from either a customer or service provider perspective. However, a comprehensive, dual-perspective framework is lacking. Such a framework is needed to organize knowledge of these behaviors, and thereby provide structure, clarity, and parsimony to the field. This paper describes a three-tier framework of service encounter behavior that was developed by applying grounded theory principles to interviews with customers, service employees, and other stakeholders. These informants described many ways in which they behave when executing service exchanges, dealing with service difficulties, and managing themselves in the process. Using an iterative inductive approach, a conceptual framework was developed in which specific (Tier 1) behaviors were placed within broader (Tier 2) categories, and these lower classification levels were, in turn, interpreted within a conceptual space defined by the (Tier 3) dimensions of task, relationship, and self. This framework was then elaborated and refined by reference to the psychology and marketing literature, a set of 157 audio-recorded service interactions, and an expert panel study. The paper includes comparisons between the framework and those previously proposed, propositions regarding service encounter processes and outcomes, and implications for future research and practice.

Classifying natural aerial scenery for autonomous aircraft emergency landing

In this paper, we present an approach for image-based surface classification using multi-class Support Vector Machine (SVM). Classifying surfaces in aerial images is an important step towards an increased aircraft autonomy in emergency landing situations. We design a one-vs-all SVM classifier and conduct experiments on five data sets. Results demonstrate consistent overall performance figures over 88% and approximately 8% more accurate to those published on multi-class SVM on the KTH TIPS data set. We also show per-class performance values by using normalised confusion matrices. Our approach is designed to be executed online using a minimum set of feature attributes representing a feasible and ready-to-deploy system for onboard execution.

eHealth-as-a-Service (eHaaS) : towards universal stakeholder engagement

With the introduction of the Personally Controlled Health Record (PCEHR), the Australian public is being asked to accept greater responsibility for their healthcare by taking an active role in the management of personal health information. Although well designed, constructed and intentioned, policy and privacy concerns have resulted in an eHealth model that may impact future health sharing requirements. Hence, as a case study for a consumer eHealth initative in the Australian context, eHealth-as-a-Service (eHaaS) serves as a disruptive step in in the aggregation and transformation of health information for use as real-world knowledge. The strategic value of extending the community Health Record Bank (HRB) model lies in the ability to automatically draw on a multitude of relevant data repositories and sources to create a single source of the truth and to engage market forces to create financial sustainability. The opportunity to transform the beleaguered Australian PCEHR into a realisable and sustainable technology consumption model for patient safety is explored. Moreover, the current clerical focus of healthcare practitioners acting in the role of de facto record keepers is renegotiated to establish a shared knowledge creation landscape of action for safer patient interventions. To achieve this potential however requires a platform that will facilitate efficient and trusted unification of all health information available in real-time across the continuum of care. eHaaS provides a sustainable environment and encouragement to realise this potential.

Conceptual framework for understanding the demand for emergency health services

Background & Objectives Emergency health services (EHS) throughout the world are increasingly congested. As more people use EHS, factors such as population growth and aging cannot fully explain this increase. Also, focus on patients’ clinical characteristics ignores the role that attitudinal and perceptual factors and motivations play in directing their decisions and actions. The aim of this study is to review and synthesize an integrated conceptual framework for understanding social psychological factors underpinning demand for EHS. Methodology A comprehensive search and review of empirical and theoretical studies about the utilization of EHS was conducted using major medical, health, social and behavioral sciences databases. Results A small number of studies used a relevant conceptual framework (e.g. Health Services Utilization Model or Health Belief Model) or their components to analyze patients’ decision to use EHS. The studies evidenced that demand was affected by perceived severity of the condition; perceived costs and benefits (e.g. availability, accessibility and affordability of alternative services); experience, preference and knowledge; perceived and actual social support; and demographic characteristics (e.g. age, sex, socioeconomic status, ethnicity, marital and living circumstances, place of residence). Conclusions Conceptual models that are commonly used in areas like social and behavioral sciences have rarely been applied in the EHS utilization field. Understanding patients’ decision-making and associated factors will lay the groundwork for identification of the evidence to inform improved policy responses and the development of demand management strategies. An integrated conceptual framework will be introduced as part of this study.

Balancing organizational and professional commitments in professional service firms : the HR practices that matter

Due to their potential to positively influence sales quality and performance and reduce employee turnover in service organizations, HR practices targeting employee commitment have received considerable attention in the HRM literature in recent years. Parallel to this, there has been increasing focus on the nature of commitment, and in particular the existence of multiple commitment foci. In this paper, we examine how HR practices influence professionals' commitment to their organization, to their profession or to both organization and profession, in a qualitative study of three Danish financial investment firms. Our findings suggest that in professional service firms, HR practices encourage high levels of organizational commitment primarily and most often through their influence on professional commitment and that HR practices related to flexible work design are essential in creating balance between an employee's commitment to organization and commitment to their profession. Further, the findings suggest that these same HR practices may foster such high levels of professional commitment that labor turnover will increase when opportunities for pursuing professional goals afforded by work design are restricted.

Funding emergency care : Australian style

The ongoing challenge for ED leaders is to remain abreast of system-wide changes that impact on the day-to-day management of their departments. Changes to the funding model creates another layer of complexity and this introductory paper serves as the beginning of a discussion about the way in which EDs are funded and how this can and will impact on business decisions, models of care and resource allocation within Australian EDs. Furthermore it is evident that any funding model today will mature and change with time, and moves are afoot to refine and contextualise ED funding over the medium term. This perspective seeks to provide a basis of understanding for our current and future funding arrangements in Australian EDs.

How should future building structure and emergency response cope with bushfire attack?

Bushfires are regular occurrences in the Australian landscape which can, under adverse weather conditions, give rise to losses of life, property, infrastructure, environmental and cultural values. Where property loss is involved, historical surveys of house losses have focussed on ember, radiant heat and flame contact as key bushfire attack mechanisms. Although often noted, little work has been done to quantify the impact of fire generated or fire enhanced wind and pyro-convective events on house loss and to improve construction practice within Australia. It is well known that strong winds are always associated with bushfire events. It is less well known, although increasingly shown through anecdotal evidence, that bushfires are not a passive companion of wind, but indeed they interact with winds and can together cause significant damages to exposed buildings and ecological structures. Previous studies have revealed the effects of wind, fire and structure interactions with the result of increased pressure coefficient distributions on the windward side of a building downstream of a fire front. This paper presents a further analysis of the result in relations to the relevant standards and fire weather conditions. A review of wind code and bushfire code was conducted. Based on the result of the current study, the authors believe it is necessary to consider wind as an attack mechanism in bushfire events. The results of the study will also have implications on bushfire emergency management, design of emergency shelters, perception of danger, emergency evacuation and on risk assessment.

Specialist versus generic models of psychiatry training and service provision for people with intellectual disabilities

Background  Models of service provision and professional training differ between countries. This study aims to investigate a specialist intellectual disabilities model and a generic mental health model, specifically comparing psychiatrists’ knowledge and competencies, and service quality and accessibility in meeting the mental health needs of people with intellectual disabilities. Method  Data were collected from consultant and trainee psychiatrists within a specialist intellectual disabilities model (UK) and a generic mental health model (Australia). Results  The sample sizes were 294 (UK) and 205 (Australia). Statistically significant differences were found, with UK participants having positive views about the specialist intellectual disabilities service model they worked within, demonstrating flexible and accessible working practices and service provision, responsive to the range of mental health needs of the population with intellectual disabilities, and providing a wide range of treatments and supports. The UK participants were knowledgeable, well trained and confident in their work. They wanted to work with people with intellectual disabilities. In all of these areas, the converse was found from the Australian generic mental health service model. Conclusions  The specialist intellectual disabilities model of service provision and training has advantages over the generic mental health model.

Life story work and social work practice : a case study with ex-prisoners labelled as having an intellectual disability

In common with other professions social workers have the power to articulate certain ‘‘truths’’ about the people who use their services (Hare Mustin, 1994). These knowledge statements about people, often situated in case files may become the only background information of the lived experience for people with disability (Gillman, Swain, & Heyman, 1997). Social workers need to develop interviewing, assessment and recording practices that give precedent to the worldview of service users, if they are to truly understand and respond effectively to people's lives (Bigby, 2007). One such way of doing this is by adopting a life story approach to working with vulnerable people, which can provide a holistic stance to a person's social reality (Ortiz, 1985). This article outlines the use of this approach in research with Queensland ex-prisoners who were labelled as having an intellectual disability. By explaining the process used by the first author (hereafter known as the researcher), the methodological findings of this study illustrate how life story work can contribute to social work practice.

Social work with marginalised people who have a mild or borderline intellectual disability : practicing gentleness and encouraging hope

People with mild or borderline intellectual disabilities are a group of people who usually do not meet the eligibility criteria for specialist disability services, yet are high users of many generalist services, such as mental health, child protection, and criminal justice systems. They may traverse many services, often entering, exiting, and returning to the same service providers with few positive results. This article explores the practice approach of the Meryton Association, a medium-sized nongovernment agency located in Brisbane, Australia. The Meryton Association provides social work support to people with mild to borderline intellectual disabilities, actively assisting this group to build relationships, resources, knowledge, and autonomy in their everyday lives. Using qualitative in-depth interviews with Meryton Association staff and secondary analysis of Meryton Association policy and practice documents, the challenges and opportunities of using this practice approach have been documented. The article proposes that specialist services are needed that use a developmental approach, stress the importance of relationship, and the need to practice gentleness and hope in social worker-client interaction.

Maintaining the ethic of service [Editorial]

This issue of Precedent is concerned with professional legal ethics. ln my view, professional ethics are rules about how you do your job, based on moral principles. By virtue of the nature of the work they do, the reputation of the institution through which they are admitted to practice (the court), and the consequences that can flow if they act inappropriately or incompetently, lawyers are under constant scrutiny in all aspects of their lives. Errors, omissions or misdeeds in both their professional and their personal lives have the potential to damage them, their clients, the profession itself and the court. We ought never to take for granted the trust the public places in us to preserve the integrity of the legal system itself, especially in times when that system may be under threat, either from without or from within.

Integrated chronic disease management in primary-secondary care : a systematic literature review of the evidence

Introduction: Diabetes has traditionally been managed as a single chronic disease state, but it exists with co-morbidities such as depression and metabolic syndrome. Treatment is multifaceted, requiring both primary and secondary care, however, the delivery of diabetes care is often fragmented. Integrated chronic disease management is a growing model of interest, and is underpinned by the chronic care model (CCM), devised as a guide for primary care management of patients with chronic conditions. The model identifies six key elements for effective care, and has shown promise in improving the management of diabetes. Aim: To find empirical evidence of integrated care interventions targeted at co-morbidities including diabetes, across primary/secondary care. Method: A systematic review of peer reviewed literature from PubMed, CINAHL, Embase, Cochrane Library and Joanna Briggs was performed. Studies were reviewed according to inclusion criteria- studies published in English, between 2004-2014, empirical studies, studies with evidence of primary/secondary implementation, and those dealing with chronic co-morbid disease states. Results: 51 studies met the inclusion criteria. Included studies were mostly from the US (38), with five from Australia, UK (2), Canada (2), Netherlands (1), Norway (1), Ireland (1), and one multi-country study. It was found that all interventions adopted at least one (average 3-4) of the chronic care model, with the majority implementing delivery system redesign activities within the primary care practice/s. We found evidence of interventions which significantly reduced emergency department and hospital admissions, improved processes of care, patient health outcomes such as HbA1c, improved patient satisfaction, and reduced costs. Conclusion/Implications for practice: Diabetes exists as a co-morbid disease, requiring both primary and secondary care. We found that integrated care interventions adopting elements of the chronic care model positively impacted on patient outcomes, service utilisation, as well as costs. This review has highlighted that it may not be necessary to adopt all CCM elements to improve clinical outcomes, patient satisfaction and costs.

Public sector change, person-organization fit, and work attitudes : a mediation model

Organizational change is a typical phenomenon within public sector agencies in OECD countries. An increasing number of studies in the literature examine the implementation of change and its resulting impact on the work attitudes of public sector employees; however, little is known about the extent to which change management processes impact on employees’ work attitudes. This study aims to address this issue by developing a path model underpinned by change management and public service motivation literature. The path model was tested on a sample of 308 managerial and non-managerial public sector employees from the U.S. The results provide further empirical evidence on the types of change initiatives on nursing work and change management processes being implemented. Public sector agencies in the sample implemented a variety of change initiatives such as downsizing, delayering and empowerment. Employees reported two change management processes: the provision of change-related information and participation in change decision making. While the results indicate that change produces change-induced stressors, change information tends to reduce stressors and, subsequently, role stress. The results also indicate that change management processes are associated with higher levels of public service motivation, which is in turn connected to higher levels of person–organization fit. Person–organization fit was found to partially mediate the relationship between public service motivation and job satisfaction in the context of change.

Progress and challenges of disaster health management in China : a scoping review

Background Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

Facilitators of expanded and extended scope of paramedic practice - what makes them work?

Introduction Better integration of health services and redefinition of health workforce roles through expanding and extending traditional scope of clinical practice have been explored nationally and internationally. This paper aims to extend our earlier work by examining models of expanded and extended scope of paramedic practice for attributes which facilitate such a practice. Methods An exploratory multi-case study analysis of Australia, New Zealand, Canada and the United Kingdom expanded and extended paramedic practices were analysed. Results Successful models of advanced practice harness the capacity and personality of the paramedic practitioner, and are supported by enabling infrastructures, specifically: professional development/ education; clinical guideline and policy (boundary); access to physical infrastructure and clinical support from senior medical practitioners; and, ability to directly refer to other health services (service integration). The scope of advanced practice is however influenced by individual employers’ capacity, perceived needs and preference/ prioritises. The potential for advanced paramedic practice is equally applicable to urban as well as rural Australia. The Council of Ambulance Authorities’ Professional Competency Standard provides the form and functions for building on advanced paramedic practice. Recognition of such advanced paramedic practice provides a structure for professional growth, process for career progression and will support workforce retention. Conclusion The achievement of advanced knowledge and skills has positioned the paramedic profession to be recognized as a valuable clinician. The Council of Ambulance Authorities’ Professional Competency Standards provides the form and function for supporting advanced paramedic practice.