Evaluation of hospital preparedness for public health emergencies in Sichuan (China)

The aim of this research was to develop a set of reliable, valid preparedness metrics, built around a comprehensive framework for assessing hospital preparedness. This research used a combination of qualitative and quantitative methods which included interview and a Delphi study as well as a survey of hospitals in the Sichuan Province of China. The resultant framework is constructed around the stages of disaster management and includes nine key elements. Factor Analysis identified four contributing factors. The comparison of hospitals' preparedness using these four factors, revealed that tertiary-grade, teaching and general hospitals performed better than secondary-grade, non-teaching and non-general hospitals.

The impact of private and shared open space on liveability in subtropical apartment buildings

The study explores the relationship between open space design, factors impacting open space provision, and resident satisfaction with open space in multistorey apartment buildings in the context of the subtropical lifestyle and climate of Brisbane Australia. The purpose of the paper is to identify the specific physical and spatial design characteristics residents perceive to be important in open spaces associated with their private dwellings and with shared open spaces. Firsthand resident evaluations of everyday experiences of residing in inner urban high density environments are explored through a survey of 636 residents and interviews with 24 residents. Private balconies are highly valued, but residents’ satisfaction would be enhanced by spaciousness for diverse activities, privacy and climate responsive design. Communal spaces and facilities are used infrequently by many residents who prefer interactions with community outside of the building. This is related to preferences for a level of anonymity in a setting where privacy is difficult to achieve due to physical proximity of neighbours.

Private governance of public rights in Japan: Revisiting the Japanese governance debate

Dramatic growth in the Japanese economy in the postwar period – and its meltdown in the 1990s – has attracted sustained interest in the power dynamics underlying the management of Japan’s administrative state. For a long time, scholars and commentators have debated about who wields power in Japan. The question has been asked in different ways. In the 1970s and 1980s, the question was usually posed as: who orchestrated Japan’s economic miracle in the 1960s and 1970s? Today, the question is usually reframed to: who is accountable for the policy failures that plunged Japan into financial crisis and recession during the 1990s? Yet the core issue remains the same – who governs Japan? (Johnson 1995)...

Models for engaging public-private partnerships in civil infrastructure projects: A case of ‘having your cake and eating it too’?

Public-Private Partnerships (PPP) are established globally as an important mode of procurement and the features of PPP, not least of which the transfer of risk, appeal to governments and particularly in the current economic climate. There are many other advantages of PPP that are claimed as outweighing the costs of PPP and affording Value for Money (VfM) relative to traditionally financed projects or non-PPP. That said, it is the case that we lack comparative whole-life empirical studies of VfM in PPP and non-PPP. Whilst we await this kind of study, the pace and trajectory of PPP seem set to continue and so in the meantime, the virtues of seeking to improve PPP appear incontrovertible. The decision about which projects, or parts of projects, to offer to the market as a PPP and the decision concerning the allocation or sharing risks as part of engagement of the PPP consortium are among the most fundamental decisions that determine whether PPP deliver VfM. The focus in the paper is on latter decision concerning governments’ attitudes towards risk and more specifically, the effect of this decision on the nature of the emergent PPP consortium, or PPP model, including its economic behavior and outcomes. This paper presents an exploration into the extent to which the seemingly incompatible alternatives of risk allocation and risk sharing, represented by the orthodox/conventional PPP model and the heterodox/alliance PPP model respectively, can be reconciled along with suggestions for new research directions to inform this reconciliation. In so doing, an important step is taken towards charting a path by which governments can harness the relative strengths of both kinds of PPP model.

Public-private partnerships in information and communication technology for education

Public-private partnerships (PPPs) have generated a lot of interest from governments around the world for leveraging private sector involvement in developing and sustaining public infrastructure and services. Initially, PPPs were favoured by transport, energy, and other large infrastructure-intensive sectors. More recently, the concept has been expanded to include social sectors such as education.

Understanding the determinants of Australian hospital nurses' hand hygiene decisions following the implementation of a national hand hygiene initiative

Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The ‘5 critical moments’ of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this study was to understand the determinants of nurses’ hand hygiene decisions, using an extension of a common health decision-making model, the theory of planned behaviour (TPB), to inform future health education strategies to increase compliance. Nurses from 50 Australian hospitals (n = 2378) completed standard TPB measures (attitude, subjective norm, perceived behavioural control [PBC], intention) and the extended variables of group norm, risk perceptions (susceptibility, severity) and knowledge (subjective, objective) at Time 1, while a sub-sample (n = 797) reported their hand hygiene behaviour 2 weeks later. Regression analyses identified subjective norm, PBC, group norm, subjective knowledge and risk susceptibility as the significant predictors of nurses’ hand hygiene intentions, with intention and PBC predicting their compliance behaviour. Rather than targeting attitudes which are already very favourable among nurses, health education strategies should focus on normative influences and perceptions of control and risk in efforts to encourage hand hygiene adherence.

Survey of dental clinic patients: Smoking and preferences for cessation support

Background: Smoking cessation interventions delivered by dental practitioners can be as effective as those delivered by general medical practitioners. However, concern that addressing smoking may cause offence to their patients is a reason cited by dental practitioners for not regularly addressing patient smoking behaviours, despite believing they should play a role in smoking cessation. This study aimed to elicit the smoking behaviour and smoking cessation preferences of dental patients to determine if these concerns accurately reflect patient attitudes. Methods: We surveyed 726 adult dental patients attending the University of Queensland’s School of Dentistry Dental Clinics, Brisbane Dental Hospital, and four private dental practices in South East Queensland. Results: Most (80%) current daily smokers had tried to quit smoking. Smokers and non-smokers both agreed that dentists should screen for smoking behaviour and are qualified to offer smoking cessation advice (99% and 96% respectively). Almost all participants (96%) said they would be comfortable with their dentist asking about their smoking and that if their smoking was affecting their oral health their dentist should advise them to quit. Conclusions: Patients are receptive to dental practitioners inquiring about smoking behaviour and offering advice on quitting. Smoking patients showed considerable motivation and interest in quitting smoking, particularly in the context of health problems related to smoking being identified. These results should encourage dentists to raise the issue with their patients.

Accountable to everyone, or to no one? Perspectives on the accountability of Australian private ancillary funds

This thesis explores perspectives on the accountability of Private Ancillary Funds (PAFs), a type of Australian endowed philanthropic foundation. Privately established for a public benefit purpose, with limited formal accountability requirements, there are differing and sometimes conflicting perspectives on the nature and scope of PAF accountability. Through in-depth interviews with managers and trustees of 10 PAFs, forms and relationships of PAF accountability are uncovered. Findings reveal accountability for PAFs does not necessarily include public disclosure or transparency. However, engagement with accountability for a PAF results in greater impact and satisfaction for those involved.

Development and evaluation of training in culturally specific screening and brief intervention for hospital patients with alcohol-related injuries

Objective To evaluate health practitioners’ confidence and knowledge of alcohol screening, brief intervention and referral after training in a culturally adapted intervention on alcohol misuse and well-being issues for trauma patients. Design Mixed methods, involving semi-structured interviews at baseline and a post-workshop questionnaire. Setting: Targeted acute care within a remote area major tertiary referral hospital. Participants Ten key informants and 69 questionnaire respondents from relevant community services and hospital-based health care professionals. Intervention Screening and brief intervention training workshops and resources for 59 hospital staff. Main outcome measures Self-reported staff knowledge of alcohol screening, brief intervention and referral, and satisfaction with workshop content and format. Results After training, 44% of participants reported being motivated to implement alcohol screening and intervention. Satisfaction with training was high, and most participants reported that their knowledge of screening and brief intervention was improved. Conclusion Targeted educational interventions can improve the knowledge and confidence of inpatient staff who manage patients at high risk of alcohol use disorder. Further research is needed to determine the duration of the effect and influence on practice behaviour. Ongoing integrated training, linked with systemic support and established quality improvement processes, is required to facilitate sustained change and widespread dissemination.

Integrated lean six sigma approach for patient flow improvement in hospital emergency department

This research aims to develop an Integrated Lean Six Sigma approach to investigate and resolve the patient flow problems in hospital emergency departments. It was proposed that the voice of the customer and the voice of the process should be considered simultaneously to investigate the current process of patient flow. Statistical analysis, visual process mapping with A3 problem solving sheet, and cause and effect diagrams have been used to identify the major patient flow issues. This research found that engaged frontline workers, long-term leadership obligation, an understanding of patients' requirements and the implementation of a systematic integration of lean strategies could continuously improve patient flow, health care service and growth in the emergency departments.

‘I really needed help’: What mothers say about their post-birth care in Queensland, Australia

Background Australian mothers consistently rate postnatal care as the poorest aspect of their maternity care, and researchers and policymakers have widely acknowledged the need for improvement in how postnatal care is provided. Aim To identify and analyse mothers’ comments about postnatal care in their free text responses to an open ended question in the Having a Baby in Queensland Survey, 2010, and reflect on their implications for midwifery practice and maternity service policies. Methods The survey assessed mothers’ experiences of maternity care four months after birth. We analysed free-text data from an open-ended question inviting respondents to write ‘anything else you would like to tell us’. Of the final survey sample (N = 7193), 60% (N = 4310) provided comments, 26% (N = 1100) of which pertained to postnatal care. Analysis included the coding and enumeration of issues to identify the most common problems commented on by mothers. Comments were categorised according to whether they related to in-hospital or post-discharge care, and whether they were reported by women birthing in public or private birthing facilities. Results The analysis revealed important differences in maternal experiences according to birthing sector: mothers birthing in public facilities were more likely to raise concerns about the quality and/or duration of their in-hospital stay than those in private facilities. Conversely, mothers who gave birth in private facilities were more likely to raise concerns about inadequate post-discharge care. Regardless of birthing sector, however, a substantial proportion of all mothers spontaneously raised concerns about their experiences of inadequate and/or inconsistent breastfeeding support. Conclusion Women who birth in private facilities were more likely to spontaneously report concerns about their level of post-discharge care than women from public facilities in Queensland, and publically provided community based care is not sufficient to meet women's needs. Inadequate or inconsistent professional breastfeeding support remains a major issue for early parenting women regardless of birthing sector.

Turning up the Heat on Admissions: A Study of the Impacts of Extreme Heat Events on Tasmanian Hospital Admissions 2003-2010

Introduction: Extreme heat events (both heat waves and extremely hot days) are increasing in frequency and duration globally and cause more deaths in Australia than any other extreme weather event. Numerous studies have demonstrated a link between extreme heat events and an increased risk of morbidity and death. In this study, the researchers sought to identify if extreme heat events in the Tasmanian population were associated with any changes in emergency department admissions to the Royal Hobart Hospital (RHH) for the period 2003-2010. Methods: Non-identifiable RHH emergency department data and climate data from the Australian Bureau of Meteorology were obtained for the period 2003-2010. Statistical analyses were conducted using the computer statistical computer software ‘R’ with a distributed lag non-linear model (DLNM) package used to fit a quassi-Poisson generalised linear regression model. Results: This study showed that RR of admission to RHH during 2003-2010 was significant over temperatures of 24 C with a lag effect lasting 12 days and main effect noted one day after the extreme heat event. Discussion: This study demonstrated that extreme heat events have a significant impact on public hospital admissions. Two limitations were identified: admissions data rather than presentations data were used and further analysis could be done to compare types of admissions and presentations between heat and non-heat events. Conclusion: With the impacts of climate change already being felt in Australia, public health organisations in Tasmania and the rest of Australia need to implement adaptation strategies to enhance resilience to protect the public from the adverse health effects of heat events and climate change.

Procurement-related critical factors for briefing in public-private partnership projects: Case of Hong Kong

Public private partnerships (PPP) are widely used for construction project procurement. However, the briefing stage of PPP projects has been largely overlooked, although it has a far-reaching influence throughout the project life cycle. In response, we rectify this by exploring the critical factors involved. A set of 15 procurement-related factors are first identified from the existing literature. Then the effects of four background variables on the factors are tested with Hong Kong government data by an exploratory factor analysis extracting four major dimensions. The relationships between these dimensions and background variables indicate the need to take the background variables into account when ranking the factors. The ranking of the factors is then obtained by considering their weighted importance. Finally, the final practical value of the results is discussed.

Public history, private memories: Historical imagination in the new Italian cinema 1988-1999

The concern with the following arguments started during a study of national and international cinemas, from the desire to account for a cinema that internationally was doing well, but was undervalued domestically. The aims were to account for the renewal of Italian filmmaking from 1988, the New Italian cinema, and understand the conditions behind this renewal. The thesis identifies in the historical theme and in the recurrence of features from Italian cinema history elements of coherence with previous cinema production. The first consideration that emerges is that a triangulation between a new generation of filmmakers, their audience and recent history shaped the recovery of Italian cinema from 1988. A second consideration is that no discussion of Italian cinema can be separated from a discussion of that which it represents: Italian society and politics. This representation has not only addressed questions of identity for a cohort of spectators, but on occasions has captured the attention of the international audience. Thus the thesis follows a methodologic approach that positions texts in relation to certain traditions in Italian filmmaking and to the context by taking into consideration also industrial factors and social and historical changes. By drawing upon a range of disciplines, from political history to socio-psychological studies, the thesis has focussed on representation of history and memory in two periods of Italian film history: the first and the last decade of twentieth century. The concern has been not so much to interpret the films, but to understand the processes that made the films and how spectarors have applied their knowledge structures to make meaning of the films. Thus the thesis abstains from ascribing implicit meanings to films, but acknowledges how films project cultural contingencies. This is beacause film is shaped by production conditions and cultural and historical circumstances that make the film intelligible. As Bordwell stated in Making Meaning, "One can do other things with films besides 'reading' them" (1989, p. xiii). Within this framework, the thesis proposes a project that understands history films with the norms that govern Italian filmic output, those norms that regulate conditions of production and consumption and the relation between films from various traditions.

Private mobile phones and public communication drums in rural Papua New Guinea

The voice of a traditional communication drum can be heard over great distances. Yet now in Papua New Guinea (PNG) it is hearing, by phone, the voice of a loved one who has moved far away from home for work, marriage or studies that brings the greatest delight. As recently as 2007, most areas of this Pacific island nation had no form of telephony available. Apart from radio, modern communication forms have been restricted predominantly to the urban areas where only a small percentage of the people reside. Landline telephones, television, Internet, facsimile machines and so on have never reached the majority of the inhabited areas...