Ambulance use is associated with higher self-rated illness seriousness : user attitudes and perceptions

Objectives The objective was to study the role and effect of patients' perceptions on reasons for using ambulance services in Queensland, Australia. Methods A cross-sectional survey was conducted of patients (n = 911) presenting via ambulance or self-transport at eight public hospital emergency departments (EDs). The survey included perceived illness severity, attitudes toward ambulance, and reasons for using ambulance. A theoretical framework was developed to inform this study. Results Ambulance users had significantly higher self-rated perceived seriousness, urgency, and pain than self-transports. They were also more likely to agree that ambulance services are for everyone to use, regardless of the severity of their conditions. In compared to self-transports, likelihood of using an ambulance increased by 26% for every unit increase in perceived seriousness; and patients who had not used an ambulance in the 6 months prior to the survey were 66% less likely to arrive by ambulance. Patients who had presented via ambulance stated they considered the urgency (87%) or severity (84%) of their conditions as reasons for calling the ambulance. Other reasons included requiring special care (76%), getting higher priority at the ED (34%), not having a car (34%), and financial concerns (17%). Conclusions Understanding patients' perceptions is essential in explaining their actions and developing safe and effective health promotion programs. Individuals use ambulances for various reasons and justifications according to their beliefs, attitudes, and sociodemographic conditions. Policies to reduce and manage demand for such services need to address both general opinions and specific attitudes toward emergency health services to be effective.

(UN) Ethical practices and ethical dilemmas in universities : Academic leaders' perceptions

In this paper we report on the qualitative component of a study that explored middle level academic leaders’ experiences of (un)ethical practices and ethical dilemmas in their daily work. An electronic survey was distributed to academic leaders from universities across three Australian states. There are three major findings in this study. First, the messy context of universities is providing a fertile ground for ethical dilemmas to flourish. Second, the two main categories of unethical practices identified by participants were academic dishonesty and inappropriate behaviour towards staff and students. Third, the ethical dilemmas that emerged focused on the academic leaders’ strong sense of professional ethics that were in conflict with an ethic of care, supervisors’ directives, and the rules and policies of the organisation.

Employee perceptions regarding the effectiveness of occupational road safety initiatives

A range of risk management initiatives have been introduced in organisations in attempt to reduce occupational road incidents. However a discrepancy exists between the initiatives that are frequently implemented in organisations and the initiatives that have demonstrated scientific merit in improving occupational road safety. Given that employees’ beliefs may facilitate or act as a barrier to implementing initiatives, it is important to understand whether initiatives with scientific merit are perceived to be effective by employees. To explore employee perceptions pertaining to occupational road safety initiatives, a questionnaire was administered to 679 employees sourced from four Australian organisations. Participants ranged in age from 18 years to 65 years (M = 42, SD = 11). Participants rated 35 initiatives based on how effective they thought they would be in improving road safety in their organisation. The initiatives perceived by employees to be most effective in managing occupational road risks comprised: making vehicle safety features standard e.g. passenger airbags; practical driver skills training; and investigation of serious vehicle incidents. The initiatives perceived to be least effective in managing occupational road risks comprised: signing a promise card commitment to drive safely; advertising the organisation’s phone number on vehicles for complaints and compliments; and consideration of driving competency in staff selection process. Employee perceptions were analysed at a factor level and at an initiative level. The mean scores for the three extracted factors revealed that employees believed occupational road risks could best be managed by the employer implementing engineering and human resource methods to enhance road safety. Initiatives relating to employer management of identified risk factors were perceived to be more effective than feedback or motivational methods that required employees to accept responsibility for their driving safety. Practitioners can use the findings from this study to make informed decisions about how they select, manage and market occupational safety initiatives.

Information support for health management in regional Sri Lanka : health managers’ perspectives

Good management, supported by accurate, timely and reliable health information, is vital for increasing the effectiveness of Health Information Systems (HIS). When it comes to managing the under resourced health systems of developing countries, information-based decision making is particularly important. This paper reports findings of a self-report survey that investigated perceptions of local health managers (HMs) of their own regional HIS in Sri Lanka. Data were collected through a validated, pre-tested postal questionnaire, and distributed among a selected group of HMs to elicit their perceptions of the current HIS in relation to information generation, acquisition and use, required reforms to the information system and application of information and communication technology (ICT). Results based on descriptive statistics indicated that the regional HIS was poorly organised and in need of reform; that management support for the system was unsatisfactory in terms of relevance, accuracy, timeliness and accessibility; that political pressure and community and donor requests took precedence over vital health information when management decisions were made; and use of ICT was unsatisfactory. HIS strengths included user-friendly paper formats, a centralised planning system and an efficient disease notification system; weaknesses were lack of comprehensiveness, inaccuracy, and lack of a feedback system. Responses of participants indicated that HIS would be improved by adopting an internationally accepted framework and introducing ICT applications. Perceived barriers to such improvements were high initial cost of educating staff to improve computer literacy, introduction of ICTs, and HIS restructure. We concluded that the regional HIS of Central Province, Sri Lanka had failed to provide much needed information support to HMs. These findings are consistent with similar research in other developing countries and reinforce the need for further research to verify causes of poor performance and to design strategic reforms to improve HIS in regional Sri Lanka.

Paramedics' perceptions of their role in palliative care : analysis of focus group transcripts

Paramedics play an important role in out-of-hospital health care. They provide unscheduled care, assisting both patients with minor injuries and those experiencing life-threatening emergencies. Increasingly, paramedics are called on to manage chronic and complex health needs, including symptom relief for patients at the end of life. However, paramedics may not be well prepared to offer palliative care, as practice guidelines and education tend to focus on the management of acute medical emergencies and major trauma. Emergency medical services that employ paramedics rarely have practice guidelines or protocols that deal specifically with palliative care.

Perceptions of visitor relationship marketing opportunities by destination marketers : an importance-performance analysis

Customer relationship marketing (CRM) initiatives are increasingly being adopted by businesses in the attempt to enhance brand loyalty and stimulate repeat purchases. The purpose of this study was to examine the extent to which destination marketing organisations (DMOs) around the world have developed a visitor relationship marketing (VRM) orientation. The proposition underpinning the study is that maintaining meaningful dialogue with previous visitors in some markets would represent a more efficient use of resources than above the line advertising to attract new visitors. Importance-performance analysis was utilised to measure destination marketers’ perceptions of the efficacy of CRM initiatives, and then rate their own organisation’s performance across the same range of initiatives. A key finding was that mean importance was higher than perceived performance for every item. While the small sample limits generalisability, in general there are appears to be a lack of strategic intent by DMOs to invest in VRM.

‘Hot chicks’, ‘better parties’ or academic stuff : perceptions of a regional university campus using Repertory Grid Analysis and Importance-performance Analysis

In the increasingly competitive Australian tertiary education market, a consumer orientation is essential. This is particularly so for small regional campuses competing with larger universities in the state capitals. Campus management need to carefully monitor both the perceptions of prospective students within the catchment area, and the (dis)satisfaction levels of current students. This study reports the results of an exploratory investigation into the perceptions held of a regional campus, using two techniques that have arguably been underutilised in the education marketing literature. Repertory Grid Analysis, a technique developed almost fifty years ago, was used to identify attributes deemed salient to year 12 high school students at the time they were applying for university places. Importance-performance analysis (IPA), developed three decades ago, was then used to identify attributes that were determinant for a new cohort of first year undergraduate students. The paper concludes that group applications of Repertory Grid offer education market researchers a useful means for identifying attributes used by high school students to differentiate universities, and that IPA is a useful technique for guiding promotional decision making. In this case, the two techniques provided a quick, economical and effective snapshot of market perceptions, which can be used as a foundation for the development of an ongoing market research programme.

Dimensions of short break destination attractiveness : a comparison of cognitive, affective and conative perceptions

Although there has been exponential growth in the number of studies of destination image appearing in the tourism literature, few have addressed the role of affective perceptions. This paper analyses the market positions held by a competitive set of destinations, through a comparison of cognitive, affective and conative perceptions. Cognitive perceptions were measured by trialling a factor analytic adaptation of importance-performance analysis. Affective perceptions were measured using an affective response grid. The alignment of the results from these techniques identified leadership positions held by two quite different destinations on two quite different dimensions of short break destination attractiveness.

Perceptions of corporate social and environmental accounting and reporting practices from accountants in Bangladesh

Purpose – The aim of this study is to elicit accountants’ perceptions regarding corporate social and environmental accounting and reporting practices in a developing country such as Bangladesh. Design/methodology/approach – Members of the Institute of Chartered Accountants of Bangladesh (ICAB) were surveyed to determine their perceptions on issues pertaining to social and environmental accounting and reporting practices in Bangladesh. Findings – Whilst the findings show that accountants have positive attitudes toward corporate social and environmental accounting, progress is limited, with the absence of ICAB in making any noticeable effort to develop such practices. Research implications – Unlike prior studies, the implications of this study suggest that without international influence, it is less likely that institutional forces in Bangladesh (ICAB and the government) would be effective in dealing with social and environmental accounting and reporting issues. Originality/value – While prior studies advocate proactive roles of the accounting profession, this study argues that proactive roles are less likely to prevail in the context of Bangladesh without direct intervention from institutional and regulatory authorities in the international arena.

Chinese teaching English as a foreign language (TEFL) academics' perceptions about research in a transitional culture

Research capacity building has become a prominent theme in higher education institutions in China and across the world. However, Chinese Teaching English as a Foreign Language academics' research output has been quite limited. In order to build their research capacity, it is necessary to understand their perceptions about research. This case study presents the perceptions about research of six Chinese Teaching English as a Foreign Language academics in a context of growing institutional demands for research. One-on-one interviews of 35-60 minutes' duration were conducted with these academics from an institution in north China. Thematic analysis of the transcribed interviews indicated that the Chinese Teaching English as a Foreign Language academics held positive perceptions about the teaching-research nexus. However, the value of research to them seemed to be limited to teaching and career advancement. They also expressed varied concerns about the institutional research requirements. The findings suggested several implications for the institution's administrators to further enhance academics' research capacity building.

Brownfield re-development : Perceptions and risk mitigation strategies

Scarcity of large parcels of land in well-serviced areas has motivated people to re-develop brownfield land. Most of brownfield land has high risk of contamination from wide range of industrial activities such as gas works, factories, railway land and waste tips. In addition, people who live in brownfield re-development areas may be exposed to health hazards. This paper discusses public perceptions on the brownfield sites and also the risk and mitigation strategy to promote brownfield re-development. Data is gathered from face to face survey of fifty respondents who work in Brisbane Central Business District (CBD) and interview with an expert on remediation of contaminated land. From this preliminary study, it is found that majority of the population are not aware of any brownfield sites near their residence and those who are aware showed very little concern on their proximity to the site. Further discussion on the paper based on a simple cross tabulation analysis. The main risk mitigation strategy of re-development of brownfield site is by updating the registration through Environmental Management Register (EMR) and Contaminated Land Register (CLR). In addition, insurance may offer to cover cost overruns on remediation cost.

Perceptions and expectations for learning and development for older workers within Queensland local government councils : a case study

Current literature warns organisations about a global ageing phenomenon. Workplace ageing is causing a diminishing work pool which has consequences for a sustainable workforce in the future. This phenomenon continues to impact on local government councils in Australia. Australia has one of the world’s most rapidly ageing populations, and there is evidence that Australian local government councils are already resulting in an unsustainable workforce. Consequently, this research program investigated the role of older workers in the Queensland local government workplace in enabling them to extend their working lives towards transitional employment and a sustainable workforce in the future. Transitional Employment is intended as a strategy for enabling individuals to have greater control over their employment options and their employability during the period leading to their final exit from the workforce. There was no evidence of corporate support for older workers in Queensland local government councils other than tokenistic government campaigns encouraging organisations to "better value their older workers". (Queensland Government, 2007d, p.6). TE is investigated as a possible intervention for older workers in the future. The international and national literature review reflected a range of matters impacting on current older workers in the workforce and barriers preventing them from accessing services towards extending their employment beyond the traditional retirement age (60 years) as defined by the Australian Government; an age when individuals can access their superannuation. Learning and development services were identified as one of those barriers. There was little evidence of investment in or consistent approaches to supporting older workers by organisations. Learning and development services appeared at best to be ad hoc, reactive to corporate productivity and outputs with little recognition of the ageing phenomenon (OECD, 2006, p.23) and looming skills and labour shortages (ALGA, 2006, p. 19). Themes from the literature review led to the establishment of three key research questions: 1. What are the current local government workforce issues impacting on skills and labour retention? 2. What are perceptions about the current workplace environment? And, 3. What are the expectations about learning and development towards extending employability of older workers within the local government sector? The research questions were explored by utilising three qualitative empirical studies, using some numerical data for reporting and comparative analysis. Empirical Study One investigated common themes for accessing transitional employment and comprised two phases. A literature review and Study One data analysis enabled the construction of an initial Transitional Employment Model which includes most frequent themes. Empirical Study Two comprised focus groups to further consider those themes. This led to identification of issues impacting the most on access to learning and development by older workers and towards a revised TEM. Findings presented majority support for transitional employment as a strategy for supporting older workers to work beyond their traditional retirement age. Those findings are presented as significant issues impacting on access to transitional employment within the final 3-dimensionsal TEM. The model is intended as a guide for responding to an ageing workforce by local government councils in the future. This study argued for increased and improved corporate support, particularly for learning and development services for older workers. Such support will enable older workers to maintain their employability and extend their working lives; a sustainable workforce in the future.

Inadequate management of medicines by the older-aged living in a retirement village

BACKGROUND: A comparison of the management of medicines by the older-aged living in freehold (fully owned) and rental homes in retirement villages has suggested that the older-aged living in rental, but not freehold, retirement villages may require help to manage their medicines. OBJECTIVE: The objective of this study was to investigate the management of medicines by the older-aged living independently in a leasehold (partly owned) home in retirement village to determine whether they also need help in managing their medicines. METHOD: Semi-structured interviews were conducted with 22 older-aged residents living in a leasehold retirement village. MAIN OUTCOME MEASURE: The main outcome measure was the perception of present and ongoing adherence. RESULTS: Amongst participants in the leasehold retirement village, with an average age of 82.9 years, the perceptions of present and ongoing adherence indicated that only 55 % of older-aged participants were adherent at the time of the study, and not likely to have problems with adherence within the next 6-12 months. Participants from the leasehold retirement village had a good understanding of 58 % of their illnesses. A mean of 9.8 medicines per person were prescribed. Cardiovascular medicines were the most commonly prescribed at 86 %. CONCLUSION: The older-aged living in leasehold retirement villages may require extra assistance/resources to manage their medicines.

Patients perceptions of emergency department services : better specialised staff, convenient and available services

Many factors are identified as contributing to the high demand for emergency department (ED) care. Similarly, there have been many initiatives taken to minimise the impact that is placed on EDs. Many of these, however, do not consider the patient's opinions and motivations. The aim of this cross-sectional study was to understand patients’ perspectives and reasons behind their decision to present to EDs. 911 surveys were collected from patients presenting to eight QLD EDs in 2011. Based on the Principal Component Analysis technique, a six-item scale entitled "Best services at emergency departments" was extracted (α = 0.729) measuring patients' opinions and perspectives. Further, the independent t-tests were conducted between various groups of ED users. The results suggest that multiple users more likely viewed EDs as the best place for their conditions than the first-time users (Median 10.73 v 11.56, p<0.001). Moreover, patients who made the decision to present by themselves had a more favourable perception of the ED services than those for whom the decision was made or others were involved (Median 11.38 v 10.80, p=0.003). Method of arrival did not affect the respondents’ perception of ED (11.13 v 11.00, p=0.65). The results of this research indicate that patients’ perception of ED as the best and most appropriate place for attention to their medical conditions plays an important role in their decision to present and keep returning to ED. Understanding patients’ reasons and decisions enhances the success of planning and implementing alternative services to manage the demand for ED services.

Emergency Health Services (EHS) : demand and service delivery models. monograph 3 : patients’ reasons and perceptions

Executive Summary Emergency health is a critical component of Australia’s health system and emergency departments (EDs) are increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the perspectives of users of both ambulance services and EDs. The research reported here aimed to identify the perspectives of users of emergency health services, both ambulance services and public hospital Emergency Departments and to identify the factors that they took into consideration when exercising their choice of location for acute health care. A cross-sectional survey design was used involving a survey of patients or their carers presenting to the EDs of a stratified sample of eight hospitals. A specific purpose questionnaire was developed based on a novel theoretical model which had been derived from analysis of the literature (Monograph 1). Two survey versions were developed: one for adult patients (self-complete); and one for children (to be completed by parents/guardians). The questionnaires measured perceptions of social support, health status, illness severity, self-efficacy; beliefs and attitudes towards ED and ambulance services; reasons for using these services, and actions taken prior to the service request. The survey was conducted at a stratified sample of eight hospitals representing major cities (four), inner regional (two) and outer regional and remote (two). Due to practical limitations, data were collected for ambulance and ED users within hospital EDs, while patients were waiting for or under treatment. A sample size quota was determined for each ED based on their 2009/10 presentation volumes. The data collection was conducted by four members of the research team and a group of eight interviewers between March and May 2011 (corresponding to autumn season). Of the total of 1608 patients in all eight emergency departments the interviewers were able to approach 1361 (85%) patients and seek their consent to participate in the study. In total, 911 valid surveys were available for analysis (response rate= 67%). These studies demonstrate that patients elected to attend hospital EDs in a considered fashion after weighing up alternatives and there is no evidence of deliberate or ill-informed misuse. • Patients attending ED have high levels of social support and self-efficacy that speak to the considered and purposeful nature of the exercise of choice. • About one third of patients have new conditions while two thirds have chronic illnesses • More than half the attendees (53.1%) had consulted a healthcare professional prior to making the decision. • The decision to seek urgent care at an ED was mostly constructed around the patient’s perception of the urgency and severity of their illness, reinforced by a strong perception that the hospital ED was the correct location for them (better specialised staff, better care for my condition, other options not as suitable). • 33% of the respondent held private hospital insurance but nevertheless attended a public hospital ED. Similarly patients exercised considered and rational judgements in their choice to seek help from the ambulance service. • The decision to call for ambulance assistance was based on a strong perception about the severity of the illness (too severe to use other means of transport) and that other options were not considered appropriate. • The decision also appeared influenced by a perception that the ambulance provided appropriate access to the ED which was considered most appropriate for their particular condition (too severe to go elsewhere, all facilities in one spot, better specialised and better care). • In 43.8% of cases a health care professional advised use of the ambulance. • Only a small number of people perceived that ambulance should be freely available regardless of severity or appropriateness. These findings confirm a growing understanding that the choice of professional emergency health care services is not made lightly but rather made by reasonable people exercising a judgement which is influenced by public awareness of the risks of acute health and which is most often informed by health professionals. It is also made on the basis of a rational weighing up of alternatives and a deliberate and considered choice to seek assistance from a service which the patient perceived was most appropriate to their needs at that time. These findings add weight to dispensing with public perceptions that ED and ambulance congestion is a result of inappropriate choice by patients. The challenge for health services is to better understand the patient’s needs and to design and validate services that meet those needs. The failure of our health system to do so should not be grounds for blaming the patient, claiming inappropriate patient choices.