Case study 1: Nursing informatics and eHealth in Australia

There are currently many changes happening in nursing and healthcare in Australia. Healthcare reform has been high on the national government agenda and has created many changes in healthcare including eHealth. Healthcare information technologies and informatics are providing many challenges and excitement for the future of healthcare in Australia. The challenge for professional nursing organisations and nursing leaders of Australia is to be proactive in developments and initiatives for nursing to remain visible and viable in health care systems to safeguard the profession for the future as health care reform is implemented.

Traps for the unwary : reform stories of private sector managers entering public service

The purpose of this research is to capture and interpret the stories of “outsider” managers who make the transition to the public sector. These experiences are considered in the context of efforts to shift public management culture in a direction consistent with meeting contemporary demands placed on public sector organisations. It is often noted that an important strategy for changing culture is the infusion of outsiders. Outsiders are thought to bring new perspectives that, through a dialectical process (Van de Ven 1995), create the potential for change. While there have been cross-sector comparisons (Broussine 1990; Silfvast 1994; Redman 1997), little attention has been given to the experience of those who make the transition in the context of efforts to reform public sector management culture. Not only is the infusion of private sector managers into the public sector a potential culture change strategy, it is also a personal experience for those who make the transition. Boundary crossing is typically an anxiety provoking experience (Van Maanen & Schein 1979) and the quality of this experience influences decisions to commit, engage, disengage or exit. The quality of the experience is likely to be affected by how the public organisation responds to people making this transition, that is, their investment in people processing (Saks 2007). The cost of recruitment and selection processes at middle and senior management levels warrants a greater research focus on this transition. In this paper we argue that the experiences of those who make the transition from private to public sectors has much to tell us about the traps that transition managers experience in making this change, the implications for injecting outsider managers as a strategy for achieving public management culture change, and how reform-oriented public organisations can manage the transitions of outsider managers into the public sector in order that best value might be achieved for both the individual and organisational change goals.

Commercialisation of regenerative human tissue : Regulation and reform in Australia and England, Wales and Northern Ireland

The commercialisation of therapeutic products containing regenerative human tissue is regulated by the common law, statute and ethical guidelines in Australia and England, Wales and Northern Ireland. This article examines the regulatory regimes in these jurisdictions and considers whether reform is required to both support scientific research and ensure conformity with modern social views on medical research and the use of human tissue. The authors consider the crucial role of informed consent in striking the balance between the interests of researchers and the interests of the public.

Stability of the learning and development survey : findings for mature aged local government and private healthcare organisations.

This article investigates work related learning and development amongst mature aged workers from a lifespan developmental psychology perspective. The current study follows on from research regarding the construction and revision of the Learning and Development Survey (LDS; Tones & Pillay, 2008). Designed to measure adaptive development for work related learning, the revised LDS (R-LDS) encompasses goal selection, engagement and disengagement from individual and organisational perspectives. Previous survey findings from a mixed age sample of local government workers suggest that mature aged workers aged over 45 years are less likely to report engagement in learning and development goals than younger workers, which is partly due to insufficient opportunities at work. In the current paper, exploratory factor analysis was used to investigate responses to the R-LDS amongst two groups of mature aged workers from a local government (LG) and private healthcare (PH) organisation to determine the stability of the R-LDS. Organisational constraints to development accounted for almost a quarter of the variance in R-LDS scores for both samples, while remaining factors emerged in different orders for each data set. Organisational opportunities for development explained about 17% of the variance in R-LDS scores in the LG sample, while the individual goal disengagement factor contributed a comparable proportion of variance to R-LDS scores for the PH sample. Findings from the current study indicate that opportunities for learning and development at work may be age structured and biased towards younger workers. Implications for professional practice are discussed and focus on improving the engagement of mature aged workers.

Assessment and curriculum reform in China : the college English test and tertiary English as a foreign language education.

Educational assessment was a worldwide commonplace practice in the last century. With the theoretical underpinnings of education shifting from behaviourism and social efficiency to constructivism and cognitive theories in the past two decades, the assessment theories and practices show a widespread changing movement. The emergent assessment paradigm, with a futurist perspective, indicates a deviation away from the prevailing large scale high-stakes standardised testing and an inclination towards classroom-based formative assessment. Innovations and reforms initiated in attempts to achieve better education outcomes for a sustainable future via more developed learning and assessment theories have included the 2007 College English Reform Program (CERP) in Chinese higher education context. This paper focuses on the College English Test (CET) - the national English as a Foreign Language (EFL) testing system for non-English majors at tertiary level in China. It seeks to explore the roles that the CET played in the past two College English curriculum reforms, and the new role that testing and assessment assumed in the newly launched reform. The paper holds that the CET was operationalised to uplift the standards. However, the extended use of this standardised testing system brings constraints as well as negative washback effects on the tertiary EFL education. Therefore in the newly launched reform -CERP, a new assessment model which combines summative and formative assessment approaches is proposed. The testing and assessment, assumed a new role - to engender desirable education outcomes. The question asked is: will the mixed approach to formative and summative assessment provide the intended cure to the agony that tertiary EFL education in China has long been suffering - spending much time, yet achieving little effects? The paper reports the progresses and challenges as informed by the available research literature, yet asserts a lot needs to be explored on the potential of the assessment mix in this examination tradition deep-rooted and examination-obsessed society.

Aligning school reform and teacher education reform in the middle years : an Australian case study

This paper discusses the development of a new Bachelor of Education (Middle Years of Schooling) at The University of Queensland, Australia. The middle years of schooling have increasingly been the focus of education reform initiatives in Australia, but this has not been accompanied by significant increases in the number of teacher education institutions offering specialised middle schooling-level teacher preparation programmes. Considering the rapidly changing social and economic context and the emergent state of middle schooling in Australia, the programme represented a conceptual and practical opportunity and challenge for The University of Queensland team. Working collaboratively, the team sought to design a teacher education preservice programme that was both responsive and generative: that is, responsive to local school contexts and to current education research and reform at national and international levels; and generative of cutting-edge theories and practices associated with middle schooling, teachers' work, and teacher education. This paper focuses on one component of the Middle Years of Schooling Teacher Education programme at The University of Queensland; namely, the practicum. We first present the underlying principles of the practicum programme and then examine "dilemmas" that emerged early in the practicum. These issues and tensions were associated with the ideals of "middle years" philosophy and the pragmatics of school reform associated with that approach. Within this context, we explore what it means to be both responsive and generative, and describe how we as teacher educators negotiated the extremes these terms implied.

High quality/high equity systems of education: Curriculum, teachers and reform in the search for equitable outcomes for all students

The issue of what an effective high quality / high equity education system might look like remains contested. Indeed there is more educational commentary on those systems that do not achieve this goal (see for example Luke & Woods, 2009 for a detailed review of the No Child Left Behind policy initiatives put forward in the United States under the Bush Administration) than there is detailed consideration of what such a system might enact and represent. A long held critique of socio cultural and critical perspectives in education has been their focus on deconstruction to the supposed detriment of reconstructive work. This critique is less warranted in recent times based on work in the field, especially the plethora of qualitative research focusing on case studies of ‘best practice’. However it certainly remains the case that there is more work to be done in investigating the characteristics of a socially just system. This issue of Point and Counterpoint aims to progress such a discussion. Several of the authors call for a reconfiguration of the use of large scale comparative assessment measures and all suggest new ways of thinking about quality and equity for school systems. Each of the papers tackles different aspects of the problematic of how to achieve high equity without compromising quality within a large education system. They each take a reconstructive focus, highlighting ways forward for education systems in Australia and beyond. While each paper investigates different aspects of the issue, the clearly stated objective of seeking to delineate and articulate characteristics of socially just education is consistent throughout the issue.

An evaluation framework for educational reform projects for teacher quality improvements in developing countries : a case study of Egyptian education reform

The role of the evaluation for Official Development Assistance (ODA) enterprises including educational development has become critical after increasing “aid fatigue” experienced by the international community in the 1990s. To date, however, monitoring and evaluating outcomes of the projects has been limited to the project life. Consequently these have been mainly through the international aid agencies. Furthermore, the monitoring and evaluation led by international aid agencies have paid little attention to aspects of the sustainability of technical cooperation in educational development. To sustain the impact of technical cooperation, the reinforcement of evaluation has drawn increasing attention in light of the emerging modalities in international development. Therefore this research was inspired to investigate alternative evaluation frameworks for an educational reform project for teacher quality improvement that may increase possibilities for long term sustainability. Importantly, the new modalities in international development and educational issues provide new options. In addition, the research reviewed theoretical and practical issues surrounding evaluation in general, and highlighted the evaluation of education reform projects. The research reported explored via case studies, the evaluation processes employed by the Egyptian education reform projects implemented by the Japan International Cooperation Agency (JICA) and the United Nations Children’s Fund (UNICEF). The case studies used three data sources (archival and relevant documents, a survey questionnaire and interviews) to illuminate the contextually-embedded evaluation processes. The research found that process evaluation is a potential alternative method since it is likely to be locally institutionalised, which may yield long-term sustainability of the projects.

Economics and preventing healthcare acquired infection

The evolution of organisms that cause healthcare acquired infections (HAI) puts extra stress on hospitals already struggling with rising costs and demands for greater productivity and cost containment. Infection control can save scarce resources, lives, and possibly a facility’s reputation, but statistics and epidemiology are not always sufficient to make the case for the added expense. Economics and Preventing Healthcare Acquired Infection presents a rigorous analytic framework for dealing with this increasingly serious problem. ----- Engagingly written for the economics non-specialist, and brimming with tables, charts, and case examples, the book lays out the concepts of economic analysis in clear, real-world terms so that infection control professionals or infection preventionists will gain competence in developing analyses of their own, and be confident in the arguments they present to decision-makers. The authors: ----- Ground the reader in the basic principles and language of economics. ----- Explain the role of health economists in general and in terms of infection prevention and control. ----- Introduce the concept of economic appraisal, showing how to frame the problem, evaluate and use data, and account for uncertainty. ----- Review methods of estimating and interpreting the costs and health benefits of HAI control programs and prevention methods. ----- Walk the reader through a published economic appraisal of an infection reduction program. ----- Identify current and emerging applications of economics in infection control. ---- Economics and Preventing Healthcare Acquired Infection is a unique resource for practitioners and researchers in infection prevention, control and healthcare economics. It offers valuable alternate perspective for professionals in health services research, healthcare epidemiology, healthcare management, and hospital administration. ----- Written for: Professionals and researchers in infection control, health services research, hospital epidemiology, healthcare economics, healthcare management, hospital administration; Association of Professionals in Infection Control (APIC), Society for Healthcare Epidemiologists of America (SHEA)

Patterns of reporting to child protection services in Canada by healthcare and nonhealthcare professionals

Background: All Canadian jurisdictions require certain professionals to report suspected or observed child maltreatment. This study examined the types of maltreatment, level of harm and child functioning issues, controlling for family socioeconomic status, age and gender of the child reported by healthcare and non-healthcare professionals. Methods: We conducted chi-square analyses and logistic regression on a national child welfare sample from the 2003 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003) and compared the differences in professional reporting with its previous cycle (CIS-1998) using Bonferroni-corrected confidence intervals. Results: Our analysis of CIS-2003 data revealed that the majority of substantiated child maltreatment is reported to service agencies by non-healthcare professionals (57%), followed by non-professionals (33%) and healthcare professionals (10%). The number of professional reports increased 2.5 times between CIS-1998 and CIS-2003, while non-professionals’ increased 1.7 times. Of the total investigations, professional reports represented 59% in CIS-1998 and 67% in CIS-2003 (p<0.001). Compared to non-healthcare professionals, healthcare professionals more often reported younger children, children who experienced neglect and emotional maltreatment and those assessed as suffering harm and child functioning issues, but less often exposure to domestic violence. Conclusion: The results indicate that healthcare professionals played an important role in identifying children in need of protection considering harm and other child functioning issues. The authors discuss the reasons why underreporting is likely to remain an issue.

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.

Practising inspired leadership : the use of applied theatre 'prophetical' in the Executive Leadership Development Program for Queensland Health

The Executive Leadership Development Program embarked upon by Queensland Health as a part of the major reform program is discussed. The second stage of the program has begun and the main aim is to ensure leadership development across the organization.

Utmost good faith in insurance : reform overdue?

Considerable attention has been devoted to the duty or doctrine of utmost good faith in the academic literature and in the courts. This attention ranges from an analysis of the precise legal basis for the duty through a consideration of the continuing nature of that duty in the post-contract environment.It is quite clear that all contracts of insurance are subject to this duty of utmost good faith. What is less clear and certain are the incidents attendant upon such a duty and the scope of the obligations that such a duty imposes. This article examines the relative positions that have been reached in England and Australia and concludes with some recommendations for legislative reform to this area of the law.

`Getting the city right' : the city as crucible for social reform

The connection between social reform and urban management is evident throughout the history of the city. This article maps out how ideas about social reform and social housing were established historically, during the development of the nineteenth century city. The second part examines contemporary shifts in thinking about homelessness through a case study of two Brisbane City Council initiatives in Brisbane: The Homeless Shelter Trial and Footprints along Kurilpa.