Introduction

The production of knowledge has become central to economic life. Competitiveness in the 21st century market place is now characterized by the ability to translate scientific and technological knowledge into innovation. But does this render cultural and social knowledge unimportant? This unique book advocates a broader epistemological base for the term ‘knowledge’ and develops policy implications from this perspective. By examining long-term challenges, the volume argues that fresh policy thinking is needed not only in the obviously knowledge-intensive portfolios but across all areas of knowledge production and questions how the different dynamics of the knowledge era affect defence, employment, environment, indigenous and international relations, multiculturalism and urban policy.

Realistic yet humanitarian? The comprehensive plan of action and refugee policy in Southeast Asia

The 1989 Comprehensive Plan of Action (CPA) has recently been described as a successful example of how to manage large protracted refugee flows. However, this article revisits the circumstances surrounding the CPA used to resolve the prolonged Indo-Chinese refugee crisis to highlight that part of its development was linked to the fact that Southeast Asian states refused to engage with proposed solutions, which did not include repatriation for the majority of the Indo-Chinese asylum seekers who were deemed to be ‘non-genuine’1 ( UNGA, 1989a) refugees. This resulted in the CPA often forcibly repatriating ‘non-genuine’ refugees, particularly near the end of its program. This article reviews the CPA in order to assess whether its practices and results should be repeated.

Open Access and Public Sector Information : Policy Developments in Australia and Key Jurisdictions

This book chapter considers recent developments in Australia and key jurisdictions both in relation to the formation of a national information strategy and the management of legal rights in public sector information.

Mobility and safety are conflicting goals for transport policy makers when making decisions about graduated driver licensing

Policy decisions are frequently influenced by more than research results alone. This review examines one road safety countermeasure, graduated driver licensing, in three jurisdictions and identifies how the conflict between mobility and safety goals can influence policy decisions relating to this countermeasure. Evaluations from around the world of graduated driver licensing have demonstrated clear reductions in crashes for young drivers. However, the introduction of this countermeasure may be affected, both positively and negatively, by the conflict some policy makers experience between ensuring individuals remain both mobile and safe as drivers. This review highlights how this conflict in policy decision making can serve to either facilitate or hinder the introduction of graduated driver licensing systems. However, policy makers whose focus on mobility is too strong when compared with safety may be mistaken, with evidence suggesting that after a graduated driver licensing system is introduced young drivers adapt their behaviour to the new system and remain mobile. As a result, policy makers should consciously acknowledge the conflict between mobility and safety and consider an appropriate balance in order to introduce these systems. Improvements to the licensing system can then be made in an incremental manner as the balance between these two priorities change. Policy makers can achieve an appropriate balance by using empirical evidence as a basis for their decisions.

Setting hospital infection control policy : a decision-making framework incorporating health economics and healthcare epidemiology

Background: Reducing rates of healthcare acquired infection has been identified by the Australian Commission on Safety and Quality in Health Care as a national priority. One of the goals is the prevention of central venous catheter-related bloodstream infection (CR-BSI). At least 3,500 cases of CR-BSI occur annually in Australian hospitals, resulting in unnecessary deaths and costs to the healthcare system between $25.7 and $95.3 million. Two approaches to preventing these infections have been proposed: use of antimicrobial catheters (A-CVCs); or a catheter care and management ‘bundle’. Given finite healthcare budgets, decisions about the optimal infection control policy require consideration of the effectiveness and value for money of each approach. Objectives: The aim of this research is to use a rational economic framework to inform efficient infection control policy relating to the prevention of CR-BSI in the intensive care unit. It addresses three questions relating to decision-making in this area: 1. Is additional investment in activities aimed at preventing CR-BSI an efficient use of healthcare resources? 2. What is the optimal infection control strategy from amongst the two major approaches that have been proposed to prevent CR-BSI? 3. What uncertainty is there in this decision and can a research agenda to improve decision-making in this area be identified? Methods: A decision analytic model-based economic evaluation was undertaken to identify an efficient approach to preventing CR-BSI in Queensland Health intensive care units. A Markov model was developed in conjunction with a panel of clinical experts which described the epidemiology and prognosis of CR-BSI. The model was parameterised using data systematically identified from the published literature and extracted from routine databases. The quality of data used in the model and its validity to clinical experts and sensitivity to modelling assumptions was assessed. Two separate economic evaluations were conducted. The first evaluation compared all commercially available A-CVCs alongside uncoated catheters to identify which was cost-effective for routine use. The uncertainty in this decision was estimated along with the value of collecting further information to inform the decision. The second evaluation compared the use of A-CVCs to a catheter care bundle. We were unable to estimate the cost of the bundle because it is unclear what the full resource requirements are for its implementation, and what the value of these would be in an Australian context. As such we undertook a threshold analysis to identify the cost and effectiveness thresholds at which a hypothetical bundle would dominate the use of A-CVCs under various clinical scenarios. Results: In the first evaluation of A-CVCs, the findings from the baseline analysis, in which uncertainty is not considered, show that the use of any of the four A-CVCs will result in health gains accompanied by cost-savings. The MR catheters dominate the baseline analysis generating 1.64 QALYs and cost-savings of $130,289 per 1.000 catheters. With uncertainty, and based on current information, the MR catheters remain the optimal decision and return the highest average net monetary benefits ($948 per catheter) relative to all other catheter types. This conclusion was robust to all scenarios tested, however, the probability of error in this conclusion is high, 62% in the baseline scenario. Using a value of $40,000 per QALY, the expected value of perfect information associated with this decision is $7.3 million. An analysis of the expected value of perfect information for individual parameters suggests that it may be worthwhile for future research to focus on providing better estimates of the mortality attributable to CR-BSI and the effectiveness of both SPC and CH/SSD (int/ext) catheters. In the second evaluation of the catheter care bundle relative to A-CVCs, the results which do not consider uncertainty indicate that a bundle must achieve a relative risk of CR-BSI of at least 0.45 to be cost-effective relative to MR catheters. If the bundle can reduce rates of infection from 2.5% to effectively zero, it is cost-effective relative to MR catheters if national implementation costs are less than $2.6 million ($56,610 per ICU). If the bundle can achieve a relative risk of 0.34 (comparable to that reported in the literature) it is cost-effective, relative to MR catheters, if costs over an 18 month period are below $613,795 nationally ($13,343 per ICU). Once uncertainty in the decision is considered, the cost threshold for the bundle increases to $2.2 million. Therefore, if each of the 46 Level III ICUs could implement an 18 month catheter care bundle for less than $47,826 each, this approach would be cost effective relative to A-CVCs. However, the uncertainty is substantial and the probability of error in concluding that the bundle is the cost-effective approach at a cost of $2.2 million is 89%. Conclusions: This work highlights that infection control to prevent CR-BSI is an efficient use of healthcare resources in the Australian context. If there is no further investment in infection control, an opportunity cost is incurred, which is the potential for a more efficient healthcare system. Minocycline/rifampicin catheters are the optimal choice of antimicrobial catheter for routine use in Australian Level III ICUs, however, if a catheter care bundle implemented in Australia was as effective as those used in the large studies in the United States it would be preferred over the catheters if it was able to be implemented for less than $47,826 per Level III ICU. Uncertainty is very high in this decision and arises from multiple sources. There are likely greater costs to this uncertainty for A-CVCs, which may carry hidden costs, than there are for a catheter care bundle, which is more likely to provide indirect benefits to clinical practice and patient safety. Research into the mortality attributable to CR-BSI, the effectiveness of SPC and CH/SSD (int/ext) catheters and the cost and effectiveness of a catheter care bundle in Australia should be prioritised to reduce uncertainty in this decision. This thesis provides the economic evidence to inform one area of infection control, but there are many other infection control decisions for which information about the cost-effectiveness of competing interventions does not exist. This work highlights some of the challenges and benefits to generating and using economic evidence for infection control decision-making and provides support for commissioning more research into the cost-effectiveness of infection control.

Determination of optimal preventive maintenance strategy for serial production lines

A Split System Approach (SSA) based methodology is presented to assist in making optimal Preventive Maintenance decisions for serial production lines. The methodology treats a production line as a complex series system with multiple PM actions over multiple intervals. Both risk related cost and maintenance related cost are factored into the methodology as either deterministic or random variables. This SSA based methodology enables Asset Management (AM) decisions to be optimized considering a variety of factors including failure probability, failure cost, maintenance cost, PM performance, and the type of PM strategy. The application of this new methodology and an evaluation of the effects of these factors on PM decisions are demonstrated using an example. The results of this work show that the performance of a PM strategy can be measured by its Total Expected Cost Index (TECI). The optimal PM interval is dependent on TECI, PM performance and types of PM strategies. These factors are interrelated. Generally it was found that a trade-off between reliability and the number of PM actions needs to be made so that one can minimize Total Expected Cost (TEC) for asset maintenance.

Innovation

Innovation can be defined broadly to include the development and uptake of new technology, the introduction of new products, the utilisation of new market opportunities and the implementation of new business processes including new forms of work organisation or management structures and approaches. Innovation, or the commercial application of new knowledge, is of increasing importance to economic competitiveness given the growth in production and trade in high technology industries and knowledge intensive service sectors such as business services (Edquist, Hommen and McKelvey 2001). An important field of innovation in modern economies is associated with the rapid development and application of information and communications technologies (ICTs). ICTs constitute an increasing share of value added, growth and employment and also impact on employment and productivity in other industry sectors. The structural transformation of modern economies associated with ICTs has led to an increase in the importance of information and knowledge resources (rather than physical capital) as inputs or factors of production. Technology and product innovations are often given central attention in innovation research, however, organisational and managerial changes have been recognised as critical. Over the last two decades, understandings of the nature and process of innovation have advanced significantly. In the 1950s and 1960s, there was a view that innovation resulted from basic research, or in essence that scientific research acted as a 'push' for innovation. As such there was a great deal of emphasis on formal research and development, undertaken either by governments or research and development units within business organisations. Radical innovations involving new products and new technological trajectories were thought to derive from basic research (Freeman 1995).

Traceability : retracing law and public policy on measurement standards

This presentation outlines key aspects of public policy in broad terms insofar as they relate to establishment, implementation and compliance with legal measurement standards. It refers in particular to traceability of a legal measurement unit from its source in a single international standard as a compliance issue. It comments on accreditation of legal measurement and liability concerned with errors in measurement.