The National Safety and Quality Health Service Standards requirements for orientation and induction within Australian healthcare: a review of the literature

Introduction: A workplace orientation program is a core requirement of the National Safety and Quality Health Service (NSQHS) Standards in Australia. This is particularly important within healthcare as patient safety and the patient experience are at risk if the healthcare workforce is not supported with an effective orientation and induction program. Aim: This study aimed to review the literature and map the requirements of the NSQHS Standards in relation to orientation and induction. Method: This study utilised online databases to search for literature pertaining to orientation and induction within healthcare. Inclusion criteria included relevance to research questions, and originating in a country with a comparative health system to Australia. Results: The search identified a total of 202 articles of potential relevance with 42 articles meeting the inclusion criteria. Articles were ranked according to hierarchy of evidence criteria for both qualitative and quantitative studies. The importance of using orientation to detail safety and quality roles, the organisations' risk management system, governance structure, operational processes and procedures was highlighted. Patient-centred care, antimicrobial stewardship, clinical handover and mechanisms for escalation of care and emergency assistance should also be covered within the orientation process. Conclusion: There is a dearth of studies in relation to orientation and induction in the healthcare literature. Orientation content is now clearly prescribed, what is lacking within healthcare is a standardised framework. Concept mapping, educational theory and adult learning methods have been shown to enhance workforce problem solving and engagement with orientation, however further research is needed to enhance practice

Modeling companion diagnostics in economic evaluations of targeted oncology therapies: systematic review and methodological checklist

The successful use of a targeted therapy is intrinsically linked to the ability of a companion diagnostic to correctly identify patients most likely to benefit from treatment. The aim of this study was to review the characteristics of companion diagnostics that are of importance for inclusion in an economic evaluation. Approaches for including these characteristics in model-based economic evaluations are compared with the intent to describe best practice methods. Five databases and government agency websites were searched to identify model-based economic evaluations comparing a companion diagnostic and subsequent treatment strategy to another alternative treatment strategy with model parameters for the sensitivity and specificity of the companion diagnostic (primary synthesis). Economic evaluations that limited model parameters for the companion diagnostic to only its cost were also identified (secondary synthesis). Quality was assessed using the Quality of Health Economic Studies instrument. 30 studies were included in the review (primary synthesis n = 12; secondary synthesis n = 18). Incremental cost-effectiveness ratios may be lower when the only parameter for the companion diagnostic included in a model is the cost of testing. Incorporating the test's accuracy in addition to its cost may be a more appropriate methodological approach. Altering the prevalence of the genetic biomarker, specific population tested, type of test, test accuracy and timing/sequence of multiple tests can all impact overall model results. The impact of altering a test's threshold for positivity is unknown as it was not addressed in any of the included studies. Additional quality criteria as outlined in our methodological checklist should be considered due to the shortcomings of standard quality assessment tools in differentiating studies that incorporate important test-related characteristics and those that do not. There is a need to refine methods for incorporating the characteristics of companion diagnostics into model-based economic evaluations to ensure consistent and transparent reimbursement decisions are made.

TESOL professional standards in the "Asian century": dilemmas facing Australian TESOL teacher education

Australian teacher education programmes that prepare teachers of English to speakers of other languages (TESOL) are confronting the nexus of two facets of globalization: transformations in the Asian region, captured in the notion of the "Asian century", and shifting conceptions of professionalism in TESOL in non-compulsory education. In booming Asian economies, English language learning is integral to the demand for high-quality education. This has produced increases in TESOL Teacher Education Programme (TTEP) enrolments of both domestic Australian students and international students from Asia. Growth in demand for TTEPs has necessitated that they cater to student diversity, and the intended contexts of practice. This demand has coincided with a concurrent movement towards professional standards for TESOL that, we argue, confronts complexities around quality, accountability, and professional identity and achieving conceptual and contextual coherence. Drawing on discourses of managerialism and performativity, this paper explores tensions between increased student demands for TTEPs, professional standards discourses which are part of the global policy discourses on teacher quality, and the achievement of programmatic conceptual and contextual coherence from the perspective of Australian TTEPs.

Using technology to improve peer review and collaborative conversations to benchmark academic standards

In 2010 the Australian government commissioned the Australian Learning and Teaching Council (ALTC) to undertake a national project to facilitate disciplinary development of threshold learning standards. The aim was to lay the foundation for all higher education providers to demonstrate to the new national higher education regulator, the Tertiary Education Quality and Standards Agency (TEQSA), that graduates achieved or exceeded minimum academic standards. Through a yearlong consultative process, representatives of employers, professional bodies, academics and students, developed learning standards applying to any Australian higher education provider. Willey and Gardner reported using a software tool, SPARKPLUS, in calibrating academic standards amongst teaching staff in large classes. In this paper, we investigate the effectiveness of this technology to promote calibrated understandings with the national accounting learning standards. We found that integrating the software with a purposely designed activity provided significant efficiencies in calibrating understandings about learning standards, developed expertise and a better understanding of what is required to meet these standards and how best to demonstrate them. The software and supporting calibration and assessment process can be adopted by other disciplines, including engineering, seeking to provide direct evidence about performance against learning standards. © 2012 IEEE.

Comparing the strength of auditing and reporting standards and investigating their predictors in Europe and Asia

The World Economic Forum conducted an opinion survey to determine the strength of auditing and reporting standards (SARS) in 133 countries. It then assigned a score for SARS to each country as one of its global competitive indices. This is a unique dataset on SARS at country level. Using this dataset, this paper compares SARS scores for 72 countries (41 European and 31 Asian). A multi-phase regression analysis is employed to empirically investigate the predictors of SARS using five sub-models. Findings from the study support existing theory and add new findings to the auditing and reporting literature at a regional level. It suggests that there are nine predictors of SARS which are similar for both Europe and Asia but with different magnitude. In Asia the efficiency of the legal framework and the size of the foreign export market are also significant predictors of SARS compared to Europe.

Managing dynamic public sector networks : effectiveness, performance, and a methodological framework in the field of national security

Networks are increasing in number and in importance across the security field as a means of providing inter-agency coordination. Based on a large qualitative study of networks in the field of national security in Australia, this article aims to advance our knowledge of the internal properties of public sector networks in the field of national security and the conditions shaping their performance. It puts forward a multi-level theoretical framework involving five interdependent levels of analysis—structural, cultural, policy, technological, and relational—which aims to account for the internal properties of networks and examines each of these levels in relation to public sector networks in the field of national security. Using detailed interviews with senior members of security, law enforcement, and intelligence agencies, the article aims to highlight the potential lessons this framework has for strategically organizing and managing dynamic networks within and beyond the field of national security.

A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital

OBJECTIVES: Report the use of an objective tool, UK Gold Standards Framework (GSF) criteria, to describe the prevalence, recognition and outcomes of patients with palliative care needs in an Australian acute health setting. The rationale for this is to enable hospital doctors to identify patients who should have a patient-centred discussion about goals of care in hospital.

DESIGN: Prospective, observational, cohort study.

PARTICIPANTS: Adult in-patients during two separate 24 h periods.

MAIN OUTCOME MEASURES: Prevalence of in-patients with GSF criteria, documentation of treatment limitations, hospital and 1 year survival, admission and discharge destination and multivariate regression analysis of factors associated with the presence of hospital treatment limitations and 1 year survival.

RESULTS: Of 626 in-patients reviewed, 171 (27.3%) had at least one GSF criterion, with documentation of a treatment limitation discussion in 60 (30.5%) of those patients who had GSF criteria. Hospital mortality was 9.9%, 1 year mortality 50.3% and 3-year mortality 70.2% in patients with GSF criteria. One-year mortality was highest in patients with GSF cancer (73%), renal failure (67%) and heart failure (60%) criteria. Multivariate analysis revealed age, hospital length of stay and presence of the GSF chronic obstructive pulmonary disease criteria were independently associated with the likelihood of an in-hospital treatment limitation. Non-survivors at 3 years were more likely to have a GSF cancer (25% vs 6%, p=0.004), neurological (10% vs 3%, p=0.04), or frailty (45% vs 3%, p=0.04) criteria. After multivariate logistic regression GSF cancer criteria, renal failure criteria and the presence of two or more GSF clinical criteria were independently associated with increased risk of death at 3 years. Patients returning home to live reduced from 69% (preadmission) to 27% after discharge.

CONCLUSIONS: The use of an objective clinical tool identifies a high prevalence of patients with palliative care needs in the acute tertiary Australian hospital setting, with a high 1 year mortality and poor return to independence in this population. The low rate of documentation of discussions about treatment limitations in this population suggests palliative care needs are not recognised and discussed in the majority of patients.

TRIAL REGISTRATION NUMBER: 11/121.

The Maltreatment-Offending Association: a systematic review of the methodological features of prospective and longitudinal studies

Although the association between childhood maltreatment and the subsequent development of offending behavior is well documented, the association does not necessarily reflect a causal relationship. This paper provides a systematic review of prospective and longitudinal studies using official records of maltreatment to gain insights into the extent to which methodological variations are likely to influence the conclusions drawn about the likely relationship between maltreatment and offending. Sixty-two original studies met the inclusion criteria. These studies were assessed according to a set of seven methodological criteria: (1) inclusion of comparison groups, (2) the use of statistical controls, (3) valid outcome measures, (4) operationalization of maltreatment, (5) proper temporal order of associations, (6) data relating to unsubstantiated maltreatment, and (7) consideration of mediating and moderating factors. The strength of evidence in support of the maltreatment-offending association was influenced by a number of methodological factors. Despite the increasing sophistication of studies, there is a need to be mindful of how these factors are taken into account in future research in order to gain a deeper understanding of the adverse consequences of maltreatment and how this might influence outcomes and inform interventions.