The "free-factor" impact on value in health services

Purpose - This paper seeks to understand the impact of financial cost on customer value in health prevention services by comparing free government services with private fee-charging providers. This is important as there is a common belief that a free health service is of lower quality and thus lower value than a paid service. However there is no evidence to verify this notion. Design / Methodology / Approach - A large-scale online survey was administered nationwide to Australian women. The respondents were asked about the functional and emotional value derived from their service experiences. Findings - Structural equation modelling (SEM) revealed non significant relationships between fee/free services and functional and emotional value (FV/EV). The non-significant relationship with FV is contrary to the theory of price quality relationship in services. This could be attributed to consumer perceptions that the technical quality of health professionals is comparable across free and paid services. The non-significant relationship with EV could be explained by the indicators used to reflect EV. These indicators were reflective of breast screening behaviour, not breast screening services. Subsequently, it may be posited that the act of having a breast screen is sufficient for consumers to derive emotional value, regardless of the financial cost. Originality / Value - This research fills an important gap in the literature by investigating the impact of financial cost on a service that consumers use proactively(prevention), rather than reactively (treatment). Insights are provided into the impact of cost on customer value in preventive health services, which are valuable to social marketing academics, health practitioners, and governments

Interactive product browsing and configuration using remote augmented reality sales services

Real-time remote sales assistance is an underdeveloped component of online sales services. Solutions involving web page text chat, telephony and video support prove problematic when seeking to remotely guide customers in their sales processes, especially with configurations of physically complex artefacts. Recently, there has been great interest in the application of virtual worlds and augmented reality to create synthetic environments for remote sales of physical artefacts. However, there is a lack of analysis and development of appropriate software services to support these processes. We extend our previous work with the detailed design of configuration context services to support the management of an interactive sales session using augmented reality. We detail the context and configuration services required, presenting a novel data service streaming configuration information to the vendor for business analytics. We expect that a fully implemented configuration management service, based on our design, will improve the remote sales experience for both customers and vendors alike via analysis of the streamed information.

Perceptions of clinical safety climate of the multicultural nursing workforce in Saudi Arabia : a cross-sectional survey

Purpose The purpose of this study is to explore the safety climate perceptions of the multicultural nursing workforce, and to investigate the influence of diversity of the multicultural nursing workforce on clinical safety in a large tertiary hospital in Saudi Arabia. Background Working in a multicultural environment is challenging. Each culture has its own unique characteristics and dimensions that shape the language, lifestyle, beliefs, values, customs, traditions, and patterns of behaviour, which expatriate nurses must come to terms with. However, cultural diversity in the health care environment can potentially affect the quality of care and patient safety. Method A mixed-method case study (survey, interview and document analysis) was employed. A primary study phase entailed the administration of the Safety Climate Survey (SCS). A population sampling strategy was used and 319 nurses participated, yielding a 76.8% response rate. Descriptive and inferential statistics (Kruskal–Wallis test) were used to analyse survey data. Results The data revealed the nurses’ perceptions of the clinical safety climate in this multicultural environment was unsafe, with a mean score of 3.9 out of 5. No significant difference was found between the age groups, years of nursing experience and their perceptions of the safety climate in this context. A significant difference was observed between the national background categories of nurses and perceptions of safety climate. Conclusion Cultural diversity within the nursing workforce could have a significant influence on perceptions of clinical safety. These findings have the potential to inform policy and practice related to cultural diversity in Saudi Arabia.

Encouraging, assisting and time to EAT : improved nutritional intake for older medical patients receiving Protected Mealtimes and/or additional nursing feeding assistance

Background & Aims: Inadequate feeding assistance and mealtime interruptions during hospitalisation may contribute to malnutrition and poor nutritional intake in older people. This study aimed to implement and compare three interventions designed to specifically address mealtime barriers and improve energy intakes of medical inpatients aged ≥65 years. Methods: Pre-post study compared three mealtime assistance interventions: PM: Protected Mealtimes with multidisciplinary education; AIN: additional assistant-in-nursing (AIN) with dedicated meal role; PM+AIN: combined intervention. Dietary intake of 254 patients (pre: n=115, post: n=141; mean age 80±8) was visually estimated on a single day in the first week of hospitalisation and compared with estimated energy requirements. Assistance activities were observed and recorded. Results: Mealtime assistance levels significantly increased in all interventions (p<0.01). Post-intervention participants were more likely to achieve adequate energy intake (OR=3.4, p=0.01), with no difference noted between interventions (p=0.29). Patients with cognitive impairment or feeding dependency appeared to gain substantial benefit from mealtime assistance interventions. Conclusions: Protected Mealtimes and additional AIN assistance (implemented alone or in combination) may produce modest improvements in nutritional intake. Targeted feeding assistance for certain patient groups holds promise; however, alternative strategies are required to address the complex problem of malnutrition in this population.

The relationship between quality of work life and turnover intention of primary health care nurses in Saudi Arabia

Background Quality of work life (QWL) has been found to influence the commitment of health professionals including nurses. However, reliable information on the QWL and turnover intention of primary health care (PHC) nurses is limited. The aim of this study was to examine the relationship between QWL and turnover intention of PHC nurses in Saudi Arabia. Methods A cross-sectional survey was used in this study. Data were collected using Brooks’ survey of Quality of Nursing Work life (QNWL), the Anticipated Turnover Scale and demographic data questions. A total of 508 PHC nurses in the Jazan region, Saudi Arabia completed the questionnaire (RR = 87%). Descriptive statistics, t-test, ANOVA, General Linear Model (GLM) univariate analysis, standard multiple regression (SMR), and hierarchical multiple regression (HMR) were applied for analysis using SPSS v17 for Windows. Results Findings suggested that the respondents were dissatisfied with their work life, with almost 40% indicating a turnover intention from their current PHC centres. Turnover intention was significantly related to QWL. Using SMR, 26% of the variance in turnover intention was explained by the QWL, p < 0.001, with R² = .263. Further analysis using HMR found that the total variance explained by the model as a whole (demographics and QWL) was 32.1%, p < 0.001. QWL explained an additional 19% of the variance in turnover intention, after controlling for demographic variables. Conclusions Creating and maintaining a healthy work life for PHC nurses is very important to improve their work satisfaction, reduce turnover, enhance productivity and improve nursing care outcomes.

Community-based asylum seekers’ use of primary health care services in Melbourne

Objective: To investigate primary health care service utilisation and health presentations among asylum seekers living in Melbourne. Design and setting: Retrospective audit of files of people who attended three Melbourne asylum-seeker health clinics between 1 July 2005 and 30 June 2006. Main outcome measures: Rates of reasons for the encounter, diagnostic tests or investigations required, treatments prescribed and referrals. Results: Data were collected from 998 consultations corresponding to 341 people. Eighty-eight per cent of visits involved people with no Medicare access, owing to their visa status. The most common reasons for the encounter were general and unspecified symptoms or problems (rate, 59.9 per 100 encounters; 95% CI, 55–65), followed by musculoskeletal conditions (27.1; 95% CI, 24–30), and psychological problems (26.5; 95% CI, 23–30). The rate of referrals was 18.3 per 100 encounters (95% CI, 16–21). Conclusions: The three clinics providing services to asylum seekers in Melbourne are delivering care to a considerable number of people with complex health needs. A substantial number of asylum seekers present to clinics with psychological and social problems. Most cannot access government-subsidised health care. This must be addressed urgently by policy change at the federal and state and territory levels.

Using staffing ratios for workforce planning : evidence on nine allied health professions - a narrative review

Background: Modern healthcare managers are faced with pressure to deliver effective, efficient services within the context of fixed budget constraints. This requires decisions regarding the skill mix of the workforce particularly when staffing new services. One measure used to identify numbers and mix of staff in healthcare settings is workforce ratio. The aim of this study was to identify workforce ratios in nine allied health professions and to identify whether these measures are useful for planning allied health workforce requirements. Method: A systematic literature search using relevant MeSH headings of business, medical and allied health databases and relevant grey literature for the period 2000-2008 was undertaken. Results: Twelve articles were identified which described the use of workforce ratios in allied health services. Only one of these was a staffing ratio linked to clinical outcomes. The most comprehensive measures were identified in rehabilitation medicine. Conclusions: The evidence for use of staffing ratios for allied health practitioners is scarce and lags behind the fields of nursing and medicine.

Success factors for ICT shared services in the higher education sector

Shared services is a prominent organizational arrangement for organizations, in particular for support functions. The success (or failure) of shared services is a critical concern as the move to shared services can entail large scale investment and involve fundamental organizational change. The Higher Education (HE) sector is particularly well poised to benefit from shared services as there is a need to improve organizational performance and strong potential from sharing. Through a multiple case study of shared services experiences in HE, this study identifies ten important antecedents of shared services success: (1) Understanding of shared services; (2) Organizational environment; (3) Top management support; (4) IT environment; (5) Governance; (6) Process centric view; (7) Implementation strategy; (8) Project management; (9) Change management; and (10) Communication. The study then develops a preliminary model of shared services success that addresses the interdependencies between the success factors. As the first empirical success model for shared services, it provides valuable guidance to practice and future research.

GLBTI police liaison services : a critical analysis of existing literature

GLBTI (gay, lesbian, bisexual, transgender, intersex) police liaison programs have been an important part of policing these communities for a number of decades now. In fact, this model appears to dominate approaches as the preferred way to manage relationships between GLBTI communities and police. Interestingly, while this model dominates, research on the effectiveness of this model, and the services that align with it, is limited. To date, only few studies have asked critical questions about the effectiveness of GLBTI police liaison services. For instance, we know that over 70% of GLBTI communities are aware of police liaison services, but only 4% of those victimised access them (Berman & Robinson, 2010). This paper critically examines existing literature about GLBTI police liaison services to demonstrate key themes and omissions. It argues that police liaison services as a preferred model has been taken for granted as the correct way of engaging with GLBTI communities in ways that may exclude other forms of engagement, and suggests that further research into these liaison programs is necessary if the relationships between GLBTI communities and the police are to be strengthened.

Ageing out of place: health and well-being needs and access to home and aged care services for recently arrived older refugees in Melbourne, Australia

Recently arrived older refugees in resettlement countries are a particularly vulnerable population who face many risks to their health and well-being, and many challenges in accessing services.This paper reports on a project undertaken in Victoria,Australia to explore the needs of older people from 14 recently arrived refugee communities, and the barriers to their receiving health and aged care. Findings from consultations with community workers and service providers highlight the key issues of isolation, family conflict and mental illness affecting older refugees, and point to ways in which policy-makers and service providers can better respond to these small but deserving communities.

Problem-based learning : does accounting education need it?

Problem-based learning (PBL) has been used successfully in disciplines such as medicine, nursing, law and engineering. However a review of the literature shows that there has been little use of this approach to learning in accounting. This paper extends the research in accounting education by reporting the findings of a case study of the development and implementation of PBL at the Queensland University of Technology (QUT) in a new Accountancy Capstone unit that began in 2006. The fundamentals of the PBL approach were adhered to. However, one of the essential elements of the approach adopted was to highlight the importance of questioning as a means of gathering the necessary information upon which decisions are made. This approach can be contrasted with the typical ‘give all the facts’ case studies that are commonly used. Another feature was that students worked together in the same group for an entire semester (similar to how teams in the workplace operate) so there was an intended focus on teamwork in solving unstructured, real-world accounting problems presented to students. Based on quantitative and qualitative data collected from student questionnaires over seven semesters, it was found that students perceived PBL to be effective, especially in terms of developing the skills of questioning, teamwork, and problem solving. The effectiveness of questioning is very important as this is a skill that is rarely the focus of development in accounting education. The successful implementation of PBL in accounting through ‘learning by doing’ could be the catalyst for change to bring about better learning outcomes for accounting graduates.