Benchmarking clinical indicators of quality for Australian residential aged care facilities

To undertake exploratory benchmarking of a set of clinical indicators of quality care in residential care in Australia, data were collected from 107 residents within four medium-sized facilities (40–80 beds) in Brisbane, Australia. The proportion of residents in each sample facility with a particular clinical problem was compared with US Minimum Data Set quality indicator thresholds. Results demonstrated variability within and between clinical indicators, suggesting breadth of assessment using various clinical indicators of quality is an important factor when monitoring quality of care. More comprehensive and objective measures of quality of care would be of great assistance in determining and monitoring the effectiveness of residential aged care provision in Australia, particularly as demands for accountability by consumers and their families increase. What is known about the topic? The key to quality improvement is effective quality assessment, and one means of evaluating quality of care is through clinical outcomes. The Minimum Data Set quality indicators have been credited with improving quality in United States nursing homes. What does this paper add? The Clinical Care Indicators Tool was used to collect data on clinical outcomes, enabling comparison of data from a small Australian sample with American quality benchmarks to illustrate the utility of providing guidelines for interpretation. What are the implications for practitioners? Collecting and comparing clinical outcome data would enable practitioners to better understand the quality of care being provided and whether practices required review. The Clinical Care Indicator Tool could provide a comprehensive and systematic means of doing this, thus filling a gap in quality monitoring within Australian residential aged care.

The relationship between strategic positioning and perceived value of social networking sites

The use of social networking sites (SNS) by online citizens to share photos, update friends, play games and to connect with the world has exploded, with SNS and blogs now eclipsing email traffic (eMarketer 2009). Just one popular application on one SNS, (Farmville on Facebook) acquired more than 63 million users since its launch in June 2009 (Marketing 2009. The major global social networks are Facebook, Twitter, YouTube and MySpace, with Facebook claiming that it passed 350 million users in November (Marketing 2009). As usage increases and competition intensifies, the major sites must strategically position themselves to develop a competitive advantage in order to maintain or grow their share of the pie. So how do the major SNS position their brands, and do users perceive significant differences among the big players? This presentation answers these questions by reporting the results of an empirical study of SNS usage by Australian adults. Like other brands, aligning brand positioning strategies with user knowledge and perceptions of SNS is an important ingredient to achieving success (Keller 1993). Furthermore we compare the types of value for three different SNS to identify the relationships between the value derived by users and the stated positioning of the site.

Clinical indicators of quality for Australian residential aged care facilities : establishing reliability, validity, and quality thresholds

Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.

Multiculturalism, education for sustainable development (ESD) and the shifting discursive landscape of social inclusion

Australia has a long and sometimes turbulent relationship with the migrant Other. This paper examines a component of this relationship via the window of contemporary multicultural policy. The paper begins with an analysis of the political and social conditions that enabled a national and bipartisan policy of multiculturalism to emerge as formalised federal policy during the late 1960s and early 1970s. The paper re-problematises the influences that helped shape Australia's articulation of race and ethnicity and argues that multiculturalism, within a post-September 11 environment, can no longer be framed solely within its traditional framework of social justice. The paper positions education for sustainable development (ESD) as an emerging discursive field that provides educators with an alternative road map for critiquing Australia's fluid relationship with the migrant Other. By linking the tenets of multiculturalism with ESD, this paper suggests pre-service teacher educators are presented with a productive, and at the same time politically palatable, means for regaining pedagogical traction for a semi-dormant agenda of social inclusion.

The geometric modelling of social frames and contexts

How do humans respond to their social context? This question is becoming increasingly urgent in a society where democracy requires that the citizens of a country help to decide upon its policy directions, and yet those citizens frequently have very little knowledge of the complex issues that these policies seek to address. Frequently, we find that humans make their decisions more with reference to their social setting, than to the arguments of scientists, academics, and policy makers. It is broadly anticipated that the agent based modelling (ABM) of human behaviour will make it possible to treat such social effects, but we take the position here that a more sophisticated treatment of context will be required in many such models. While notions such as historical context (where the past history of an agent might affect its later actions) and situational context (where the agent will choose a different action in a different situation) abound in ABM scenarios, we will discuss a case of a potentially changing context, where social effects can have a strong influence upon the perceptions of a group of subjects. In particular, we shall discuss a recently reported case where a biased worm in an election debate led to significant distortions in the reports given by participants as to who won the debate (Davis et al 2011). Thus, participants in a different social context drew different conclusions about the perceived winner of the same debate, with associated significant differences among the two groups as to who they would vote for in the coming election. We extend this example to the problem of modelling the likely electoral responses of agents in the context of the climate change debate, and discuss the notion of interference between related questions that might be asked of an agent in a social simulation that was intended to simulate their likely responses. A modelling technology which could account for such strong social contextual effects would benefit regulatory bodies which need to navigate between multiple interests and concerns, and we shall present one viable avenue for constructing such a technology. A geometric approach will be presented, where the internal state of an agent is represented in a vector space, and their social context is naturally modelled as a set of basis states that are chosen with reference to the problem space.

Anchoring and exposing in the third place : regular identification at the boundaries of social realms

Harry’s is my favourite bar in my neighbourhood. It is a small wine bar, owned by three men in their late thirties and targeted at people like them; my gentrifying inner city neighbourhood’s 20 to 40 something urban middle class. Harry’s has seats along the bar, booths inside, and a courtyard out the back. The seating arrangements mean that larger groups tend to gather outside, groups of two to four spread around the location, and people by themselves, or in groups of two, tend to sit at the bar. I usually sit at the bar....

The analysis of social capital in online social communities

Social networks have proven to be an attractive avenue of investigation for researchers since humans are social creatures. Numerous literature have explored the term “social networks” from different perspectives and in diverse research fields. With the popularity of the Internet, social networking has taken on a new dimension. Online social communities therefore have become an emerging social avenue for people to communicate in today’s information age. People use online social communities to share their interests, maintain friendships, and extend their so-called circle of “friends”. Likewise, social capital, also known as human capital, is an important theory in sociology. Researchers usually utilise social capital theory when they investigate the topic relating to social networks. However, there is little literature that can provide an explicit and strong assertion in that research area due to the complexity of social capital. This thesis therefore focuses on the issue related to providing a better understanding about the relationship between social capital and online social communities. To enhance the value within the scope of this analysis, an online survey was conducted to examine the effects of the dimensions of social capital: relational capital, structural capital, and cognitive capital, determining the intensity of using online social communities. The data were derived from a total of 350 self-selected respondents completing an online survey during the research period. The main results indicate that social capital exists in online social communities under normal circumstances. Finally, this thesis also presents three contributions for both theory and practice in Chapter 5. The main results contribute to the understanding of connectivity in the interrelationships between individual social capital exchange within online social networks. Secondly, social trust was found to have a weak effect in influencing the intensity of individuals using online social communities. Third, the perpetual role of information sharing has an indirect influence on individual users participating in online social communities. This study also benefits online marketing consultants as marketers can not only gain consumer information easier from online social communities but also this understanding assists in designing effective communication within online social communities. The cross-sectional study, the reliability of Internet survey data, and sampling issues are the major three limitations in this research. The thesis provides a new research model and recommends that the mediating effects, privacy paradox, and social trust on online social communities should be further explored in future research.

The moral economy of social media

In this chapter we take a high-level view of social media, focusing not on specific applications, domains, websites, or technologies, but instead our interest is in the forms of engagement that social media engender. This is not to suggest that all social media are the same, or even that everyone’s experience with any particular medium or technology is the same. However, we argue common issues arise that characterize social media in a broad sense, and provide a different analytic perspective than we would gain from looking at particular systems or applications. We do not take the perspective that social life merely happens “within” such systems, nor that social life “shapes” such systems, but rather these systems provide a site for the production of social and cultural reality – that media are always already social and the engagement with, in, and through media of all sorts is a thoroughly social phenomenon. Accordingly, in this chapter, we examine two phenomena concurrently: social life seen through the lens of social media, and social media seen through the lens of social life. In particular, we want to understand the ways that a set of broad phenomena concerning forms of participation in social life is articulated in the domain of social media. As a conceptual entry-point, we use the notion of the “moral economy” as a means to open up the domain of inquiry. We first discuss the notion of the “moral economy” as it has been used by a number of social theorists, and then identify a particular set of conceptual concerns that we suggest link it to the phenomena of social networking in general. We then discuss a series of examples drawn from a range of studies to elaborate and ground this conceptual framework in empirical data. This leads us to a broader consideration of audiences and publics in social media that, we suggest, holds important lessons for how we treat social media analytically.

Towards an understanding of teacher judgement in the context of social moderation

Social moderation involves teachers gathering together to discuss their judgements of the quality of student work and to reach agreement regarding the standard awarded. This qualitative study conducted over a three-year period investigated the social practice of moderation and the influence on teachers’ judgements of students work. An initial survey of teachers’ understandings of moderation and standards, pre-interviews of teachers who participated in the moderation meetings, observations of these meetings with a particular focus on one teacher (focus teachers) comprised the data collection methods. Data analysis involved organising, matching, coding, identifying patterns and themes using a constant comparative method. Socio-cultural theories of learning and assessment underpinned the approach to data analysis and proved helpful in explaining the diverse influences on teachers’ judgements beyond the task criteria, and the progressive development of shared understandings through engaging in professional discussions of students’ work. The study revealed that the process is not clear and linear and is influenced by factors such as the representation of the standards and the knowledge base of the teachers.

The Use of Social Technology to Support Organisational Knowledge

In the current economy, knowledge has been recognized to be a valuable organisational asset, a crucial factor that aids organisations to succeed in highly competitive environments. Many organisations have begun projects and special initiatives aimed at fostering better knowledge sharing amongst their employees. Not surprisingly, information technology (IT) has been a central element of many of these projects and initiatives, as the potential of emerging information technologies such as Web 2.0 for enabling the process of managing organisational knowledge is recognised. This technology could be used as a collaborative system for knowledge management (KM) within enterprises. Enterprise 2.0 is the application of Web 2.0 in an organisational context. Enterprise 2.0 technologies are web-based social software that facilitate collaboration, communication and information flow in a bidirectional manner: an essential aspect of organisational knowledge management. This chapter explains how Enterprise 2.0 technologies (Web 2.0 technologies within organisations) can support knowledge management. The chapter also explores how such technologies support the codifying (technology-centred) and social network (people-centred) approaches of KM, towards bridging the current gap between these two approaches.