Chronicling the patient journey: Co-creating value with digital health ecosystems

With the introduction of the PCEHR (Personally Controlled Electronic Health Record), the Australian public is being asked to accept greater responsibility for the management of their health information. However, the implementation of the PCEHR has occasioned poor adoption rates underscored by criticism from stakeholders with concerns about transparency, accountability, privacy, confidentiality, governance, and limited capabilities. This study adopts an ethnographic lens to observe how information is created and used during the patient journey and the social factors impacting on the adoption of the PCEHR at the micro-level in order to develop a conceptual model that will encourage the sharing of patient information within the cycle of care. Objective: This study aims to firstly, establish a basic understanding of healthcare professional attitudes toward a national platform for sharing patient summary information in the form of a PCEHR. Secondly, the studies aims to map the flow of patient related information as it traverses a patient’s personal cycle of care. Thus, an ethnographic approach was used to bring a “real world” lens to information flow in a series of case studies in the Australian healthcare system to discover themes and issues that are important from the patient’s perspective. Design: Qualitative study utilising ethnographic case studies. Setting: Case studies were conducted at primary and allied healthcare professionals located in Brisbane Queensland between October 2013 and July 2014. Results: In the first dimension, it was identified that healthcare professionals’ concerns about trust and medico-legal issues related to patient control and information quality, and the lack of clinical value available with the PCEHR emerged as significant barriers to use. The second dimension of the study which attempted to map patient information flow identified information quality issues, clinical workflow inefficiencies and interoperability misconceptions resulting in duplication of effort, unnecessary manual processes, data quality and integrity issues and an over reliance on the understanding and communication skills of the patient. Conclusion: Opportunities for process efficiencies, improved data quality and increased patient safety emerge with the adoption of an appropriate information sharing platform. More importantly, large scale eHealth initiatives must be aligned with the value proposition of individual stakeholders in order to achieve widespread adoption. Leveraging an Australian national eHealth infrastructure and the PCEHR we offer a practical example of a service driven digital ecosystem suitable for co-creating value in healthcare.

Telling tales and painting pictures: A narrative inquiry into the professional learning of Northern Territory primary teachers

This thesis narrates the professional learning experiences of seven Northern Territory teachers. It outlines the evolution from traditional professional development in schools to an active, responsive professional learning agenda. With increasing demands on teachers, standardisation and the quest for improved student outcomes, key themes in the re-storied narrative emerge about the definition and role of professional learning in complex conditions, effective teaching, quality programmes, and teacher agency. This thesis contributes to knowledge about the characteristics that teachers value in their professional learning experiences. An Ongoing Professional Enhancement Model (OPE) is proposed, highlighting directions in this field for key stakeholders.

Introduction: Japan’s gradual transformation in corporate governance

Japan has recovered from a ‘lost decade’ of economic stagnation over the 1990s. Anyway, it has been a ‘found decade’ for civil and criminal justice law reform, especially in corporate and securities law. Yet, have liberalisation and globalisation in those fields led to major changes in the ‘law in action’? Does this represent ‘Americanisation’ of Japan’s corporate governance system, focusing on shareholders rather than other key stakeholders such as ‘main banks’, core employees, and partners within diffuse corporate groups (keiretsu)? This version of our introductory chapter explains how our forthcoming book argues for a more complex ‘gradual transformation’. Such shifts are also found in many other post-industrial economies, but Japan appears to give greater emphasis given to certain modes of achieving change. The book brings together contributions from academics and practitioners from Japan, Australia, New Zealand, Canada and the United States. An early chapter introduces methodology for effective cross-country comparisons and for evaluating the burgeoning but divergent literature on Japanese corporate governance. The concluding chapter compares continuities and changes in Japan’s largest companies now and two decades ago. Other chapters cover ‘lifelong employment’, main banks, the untold story of closely-held companies, the limited uptake of the Committee-based governance form, and the procedural, substantive and FDI policy dimensions of takeovers law and practice.

Implementing best practice principles in the delivery of a Learner Driver Mentor Program in rural Queensland: A case study report

Learner Driver Mentor Programs (LDMPs) assist disadvantaged learner drivers to gain supervised on-road driving experience by providing access to vehicles and volunteer mentors. In the absence of existing research investigating the implementation of Best Practice principles in LDMPs, this case study examines successful program operation in the context of a rural town setting. The study is based on an existing Best Practice model for LDMPs, and triangulation of data from a mentor focus group (n = 7), interviews with program stakeholders (n = 9), and an in-depth interview with the site-based program development officer. The data presented is based upon selected findings of the broader evaluation study. Preliminary findings regarding driving session management, support of mentors and mentees, and building and maintaining relationships with program stakeholders, are discussed. Key findings relate to the importance of relationships in engagement with the program and collaborating across sectors to achieve a range of positive outcomes for learners. The findings highlight the need for the program to be relevant and responsive to the requirements of the population and the context in which it is operating.

Hashtag as hybrid forum: The case of #agchatoz

This chapter imports Michel Callon’s model of the ‘hybrid forum’ (Callon et al, 2009, p. 18) into social media research, arguing that certain kinds of hashtag publics can be mapped onto this model. It explores this idea of the hashtag as hybrid forum through the worked example of #agchatoz—a hashtag used as both ‘meetup’ organizer for Australian farmers and other stakeholders in Australian agriculture, and as a topic marker for general discussion of related issues. Applying the principles and techniques of digital methods (Rogers, 2013), we employ a standard suite of analytics to a longitudinal dataset of #agchatoz tweets. The results are used not only to describe various elements and dynamics of this hashtag, but also to experiment with the articulation of such approaches with the theoretical model of the hybrid forum, as well as exploring the ways that controversies animate and transform such forums as part of the emergence and cross-pollination of issue publics.

Infant product-related injuries: comparing specialised injury surveillance and routine emergency department data

- Objective To explore the potential for using a basic text search of routine emergency department data to identify product-related injury in infants and to compare the patterns from routine ED data and specialised injury surveillance data. - Methods Data was sourced from the Emergency Department Information System (EDIS) and the Queensland Injury Surveillance Unit (QISU) for all injured infants between 2009 and 2011. A basic text search was developed to identify the top five infant products in QISU. Sensitivity, specificity, and positive predictive value were calculated and a refined search was used with EDIS. Results were manually reviewed to assess validity. Descriptive analysis was conducted to examine patterns between datasets. - Results The basic text search for all products showed high sensitivity and specificity, and most searches showed high positive predictive value. EDIS patterns were similar to QISU patterns with strikingly similar month-of-age injury peaks, admission proportions and types of injuries. - Conclusions This study demonstrated a capacity to identify a sample of valid cases of product-related injuries for specified products using simple text searching of routine ED data. - Implications As the capacity for large datasets grows and the capability to reliably mine text improves, opportunities for expanded sources of injury surveillance data increase. This will ultimately assist stakeholders such as consumer product safety regulators and child safety advocates to appropriately target prevention initiatives.

#auspol: The hashtag as community, event, and material object for engaging with Australian politics

Critical, loud, highly discursive and polarised; the #auspol hashtag represents a space, an event and a network for politically involved individuals to engage in and with Australian politics and speak to, at and about a variety of involved stakeholders. Contributors declare, debate and often berate each other’s opinions about current Australian politics. The hashtag itself is an important material object and engagement event involved within this performance of political participation. As a long-standing institution in the Twittersphere, and one studied by the authors and their colleagues since its early beginnings (Bruns and Burgess, 2011; Bruns and Stieglitz, 2012; 2013), the #auspol hashtag provides a potent case study through which to explore the discursive and affective dimensions of a hashtag public. This chapter that engages both empirically and theoretically with the use of this particular hashtag on Twitter to provide a qualitatively illustrated case in point for thinking about the long-term use of political hashtags as engagement events.

Using an ‘interpretative model’ for contextual design of heritage landscape databases: The case of St Helena Island National Park in Queensland, Australia

Due to the increasing speed of landscape changes and the massive development of computer technologies, the methods of representing heritage landscapes using digital tools have become a worldwide concern in conservation research. The aim of this paper is to demonstrate how an ‘interpretative model’ can be used for contextual design of heritage landscape information systems. This approach is explored through building a geographic information system database for St Helena Island national park in Moreton Bay, South East Queensland, Australia. Stakeholders' interpretations of this landscape were collected through interviews, and then used as a framework for designing the database. The designed database is a digital inventory providing contextual descriptions of the historic infrastructure remnants on St Helena Island. It also reveals the priorities of different sites in terms of historic research, landscape restoration, and tourism development. Additionally, this database produces thematic maps of the intangible heritage values, which could be used for landscape interpretation. This approach is different from the existing methods because building a heritage information system is deemed as an interpretative activity, rather than a value-free replication of the physical environment. This approach also shows how a cultural landscape methodology can be used to create a flexible information system for heritage conservation. The conclusion is that an ‘interpretative model’ of database design facilitates a more explicit focus on information support, and is a potentially effective approach to user-centred design of geographic information systems.

The role of engagement on stakeholder's satisfaction with the destination marketing organisation's performance

In the tourism literature there has been a lack of research related to stakeholders' satisfaction with destination marketing organisations (DMO). This study addresses this research gap, in the context of the national tourism office of Oman, by investigating the relationship between stakeholder's perceptions of DMO performance and their overall satisfaction with the DMO. Conceptually the study found DMO engagement with stakeholders to partially mediate satisfaction, a finding of relevance to destination marketers in other parts of the world. From a practical perspective the research was supported by the Oman national tourism office, which has only been in operation for 10 years.

Strengthening local road safety capacity in Cambodia

Road crashes and injuries have become a growing issue worldwide. In 2011, more than 75,000 people died in road crashes in the ten member countries of the Association of South East Asian Nations (ASEAN) and many times this number sustained long term injuries. In 2014, the Asian Development Bank (ADB), funded by the Japan Fund for Poverty Reduction, commenced a package of actions to improve road safety in ASEAN. In 2015, as part of the technical assistance for this project, a Road Safety Advisor was appointed for Cambodia for four months. The assignment produced several primary outputs, which included the organization of national training on traffic law enforcement and road safety management, the conduct of a training needs survey and cost analysis study, and the development of a proposal for strengthening speed management. It is important to note that unlike other ADB technical assistance projects, this assignment adopted a capacity building approach, which promoted and encouraged the local road safety team in the government to step up and take action. The research capacity building approach adopted in this project highlighted the feasibility of increasing participation from existing stakeholders, especially the government in identifying existing human resources, building the capacity of relevant government officials and supporting them to take the ownership of the project. It is hoped that similar outcomes will occur in the other ASEAN countries.

New Generation Rollingstock Depot: Case Study Report

This report summarises the findings of a case study on Queensland’s New Generation Rollingstock (NGR) Project carried out as part of SBEnrc Project 2.34 Driving Whole-of-life Efficiencies through BIM and Procurement. This case study is one of three exemplar projects studied in order to leverage academic research in defining indicators for measuring tangible and intangible benefits of Building Information Modelling (BIM) across a project’s life-cycle in infrastructure and buildings. The NGR is an AUD 4.4 billion project carried out under an Availability Payment Public-Private Partnership (PPP) between the Queensland Government and the Bomabardier-led QTECTIC consortium comprising Bombardier Transportation, John Laing, ITOCHU Corporation and Aberdeen Infrastructure Investments. BIM has been deployed on the project from conceptual stages to drive both design and the currently ongoing construction at the Wulkuraka Project Site. This case study sourced information from a series of semi-structured interviews covering a cross-section of key stakeholders on the project. The present research identified 25 benefits gained from implementing BIM processes and tools. Some of the most prominent benefits were those leading to improved outcomes and higher customer satisfaction such as improved communications, data and information management, and coordination. There were also a number of expected benefits for future phases such as: • Improved decision making through the use of BIM for managing assets • Improved models through BIM maturity • Better utilisation of BIM for procurement on similar future projects • New capacity to specify the content of BIM models within contracts There were also three benefits that were expected to have been achieved but were not realised on the NGR project. These were higher construction information quality levels, better alignment in design teams as well as project teams, and capability improvements in measuring the impact of BIM on construction safety. This report includes individual profiles describing each benefit as well as the tools and processes that enabled them. Four key BIM metrics were found to be currently in use and six more were identified as potential metrics for the future. This case study also provides insights into challenges associated with implementing BIM on a project of the size and complexity of the NGR. Procurement aspects and lessons learned for managers are also highlighted, including a list of recommendations for developing a framework to assess the benefits of BIM across the project life-cycle.

The role of comfort in child restraint use practices

Suboptimal restraint use, particularly the incorrect use of restraints, is a significant and widespread problem among child vehicle occupants, and increases the risk of injury. Previous research has identified comfort as a potential factor influencing suboptimal restraint use. Both the real comfort experienced by the child and the parent’s perception of the child’s comfort are reported to influence the optimal use of restraints. Problems with real comfort may lead the child to misuse the restraint in their attempt to achieve better comfort whilst parent-perceived discomfort has been reported as a driver for premature graduation and inappropriate restraint choice. However, this work has largely been qualitative. There has been no research that objectively studies either the association between real and parent-perceived comfort, or any association between comfort and suboptimal restraint use. One barrier to such studies is the absence of validated tools for quantifying real comfort in children. We aimed to develop methods to examine both real and parent-perceived comfort and examine their effects on suboptimal restraint use. We conducted online parent surveys (n=470) to explore what drives parental perceptions of their child’s comfort in restraint systems (study 1) and used data from field observation studies (n=497) to examine parent-perceived comfort and its relationship with observed restraint use (study 2). We developed methods to measure comfort in children in a laboratory setting (n=14) using video analysis to estimate a Discomfort Avoidance Behaviour (DAB) score, pressure mapping and adapted survey tools to differentiate between comfortable and induced discomfort conditions (study 3). The DAB rate was then used to compare an integrated booster with an add-on booster (study 4) Preliminary analysis of our recent online survey of Australian parents (study 1) indicates that 23% of parents report comfort as a consideration when making a decision to change restraints. Logistic regression modelling of data collected during the field observation study (study 2) revealed that parent-perceived discomfort was not significantly associated with premature graduation. Contrary to expectation, children of parents who reported that their child was comfortable were almost twice as likely to have been incorrectly restrained (p<0.01, 95% CI 1.24 - 2.77).In the laboratory study (study 3) we found our adapted survey tools did not provide a reliable measurement of real comfort among children. However our DAB score was able to differentiate between comfortable and induced discomfort conditions and correlated well with pressure mapping. Preliminary results from the laboratory comparison study (study 4) indicate a positive correlation between DAB rate and use errors. In experiments conducted to date, we have seen a significantly higher DAB rate in the integrated booster compared to the add-on booster (p < 0.01). However, this needs to be confirmed in a naturalistic setting and in further experiments that take length of time under observation into account. Our results suggest that while some parents report concern about their child’s comfort, parent-reported comfort levels were not associated with restraint choice. If comfort is important for optimal restraint use, it is likely to be the real comfort of the child rather than that reported by the parent. The method we have developed for studying real comfort can be used in naturalistic studies involving child occupants to further understand this relationship. This work will be of interest to vehicle and child restraint manufacturers interested in improving restraint design for young occupants as well as researchers and other stakeholders interested in reducing the incidence of restraint misuse among children.