Health systems and social transition in Asia

 This study examines the intersection of political and health policy history in selected countries of the Asian region including Cambodia, Myanmar and North Korea. The main finding is that political and social history sets the parameters for health policy making. The thesis then considers the implications this main finding has for the approach to health policy making in the region.

Improving access for community health and sub-acute outpatient services: protocol for a stepped wedge cluster randomised controlled trial

BACKGROUND: Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional "waitlist and triage" model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care. This trial aims to test whether the model is cost effective in reducing waiting time across multiple services, and to measure the impact on service provision, health-related quality of life and patient satisfaction.

METHODS/DESIGN: A stepped wedge cluster randomised controlled trial has been designed to evaluate the impact of the STAT model in 8 community health and outpatient services. The primary outcome will be waiting time from referral to first appointment. Secondary outcomes will be nature and quantity of service received (collected from all patients attending the service during the study period and health-related quality of life (AQOL-8D), patient satisfaction, health care utilisation and cost data (collected from a subgroup of patients at initial assessment and after 12 weeks). Data will be analysed with a multiple multi-level random-effects regression model that allows for cluster effects. An economic evaluation will be undertaken alongside the clinical trial.

DISCUSSION: This paper outlines the study protocol for a fully powered prospective stepped wedge cluster randomised controlled trial (SWCRCT) to establish whether the STAT model of access and triage can reduce waiting times applied across multiple settings, without increasing health service costs or adversely impacting on other aspects of patient care. If successful, it will provide evidence for the effectiveness of a practical model of access that can substantially reduce waiting time for outpatient and community services with subsequent benefits for both efficiency of health systems and patient care.

Issues in developing e-health systems: an Australian case study

Over the last few years, perceptions of the importance of eHealth have increased rapidly, together with the use of IS&T in the delivery of health and social services. Although “e” approaches to health and social services have much potential, they are not panaceas, and the use of new technologies in improving the efficiency and effectiveness of such systems cannot be considered in isolation from their wider context. eHealth systems remain complex socio-organisational systems and, as we will argue and illustrate through this case study, require that a balanced approach to feasibility and desirability analysis be taken.

The case study in this paper describes a feasibility study into the potential effectiveness of a smartdevice-based electronic data collection and payment system which was proposed for the provision of disability services. A key finding of the study was that the most significant impediment to such a system was the highly diffused, fragmented, interlocking organisational structure of the social service administration itself. Rather than raise issues specific to the implementation or diffusion of new technologies in designing e-health services, it raised issues associated with decision making and control in such an environment, and with the design of the underlying organisational system: for service provision, the level of detail required in the service data, and the locus of decision-making power among the stakeholders.

In our account we illustrate the existence of multiple, incommensurate but valid perceptions of the human service provision problem, and discuss the implications for developers or managers of information systems in the arena of e-health or governance. We examine this environment from sociological and information systems perspectives, and confirm the usefulness of socio-organisational approaches in understanding such contexts.

The Resilient Families program: promoting health and wellbeing in adolescents and their parents during the transition to secondary school.

Resilient Families is a school-based prevention program designed to help students and parents develop knowledge, skills and support networks to promote health and wellbeing during the early years of secondary school. the program is designed to build within-family connectedness (parent--adolescent communication, conflict resolution) as well as improve social support between different families, and between families and schools. It is expected to promote social, emotional and academic competence and to prevent health and social problems in youth.

Building brand identity : Does it pay? An investigation into cultural and recreational services

This conceptual paper aims to contribute to current services branding literature by conceptualising the relationship between brand identity and critical antecedents and empirically verifying whether the creation of a strong brand identity results in the ultimate pay off in terms of improved organisational performance. A conceptual model is developed in the context of the cultural and recreational services sector and central constructs and subsequent propositions are discussed.

Living high but healthy : high-rise housing, nature, health and wellbeing

This exploratory mixed method study investigated the factors, including access to nature (i.e. parks and gardens), impacting on inner city high-rise residents' health and wellbeing. Analysis of the integrated findings revealed that a range of factors (including accessibility, choice and control and tenure) impact on residents' health and wellbeing.

Human rights and rehabilitation outcomes

Purpose. The aim of this article is to introduce rehabilitation professionals to the rapidly growing literature on human rights particularly as it relates to health and rehabilitation. The article aims to stimulate further discussion and debate concerning the place of human rights in rehabilitation practice.

Method. Some important milestones in the recent history of the human rights movement are briefly outlined, and some important terms in the rights literature are explained. The Ward and Birgden model of the structure of human rights is then described as an example of a rights perspective that might have particular relevance for health and social services and rehabilitation.

Results. A rehabilitation case study is presented as an example of how the Ward and Birgden model could have practical relevance when deciding on the most important outcomes for an individual in rehabilitation.

Conclusion. Human rights are playing an increasing role in the struggle to improve health and healthcare globally. They also have important implications for rehabilitation practitioners and researchers and should form the core of any ethical framework for rehabilitation. It might even be argued that rights and dignity are themselves valued outcomes for rehabilitation.

Use of the program explication method to explore the benefits of a service for homeless and marginalized young people

Maintaining the alignment between the dynamic development of health and social services and the rapidly advancing scientific evaluation literature is a central challenge facing service administrators. We describe “program explication,” a consulting method designed to assist services to identify and review implicit program logic assumptions against the evaluation literature. Program explication initially facilitates agency staff to identify and document service components and activities considered critical for improving client outcomes. Program assumptions regarding the relationship between service activities and client outcomes are then examined against available scientific evidence. We demonstrate the application of this method using an example of its use in reviewing a service for homeless young people operating in Melbourne, Australia, known as the Young People's Health Service (YPHS). The YPHS involved 21 activities organized within 4 components. The intended benefits of each of the activities were coherently articulated and logically consistent. Our literature search revealed moderate to strong evidence for around 1 quarter of the activities. The program explication method proved feasible for describing and appraising the YPHS service assumptions, thereby enhancing service evaluability.

The politics of public sector change: trends in health and education sector change in South Australia

BACKGROUND: As the changes underpinning the Coordinated Care Trials in South Australia have become more apparent, similarities have emerged between the rationalisation of public schooling in the mid 1980s and the transformation of public health in the 1990s.

OBJECTIVE: This article aims to discuss the evolution of health services in South Australia and help us answer the question of how best to manage our public and private health infrastructure in a changing economic and social context.

DISCUSSION: Both strategies in education and health share common elements of cost cutting, attempts at improving efficiencies, a flirting with the private sector and the attendant risk of reduced quality of services to the public. This situation in both sectors is indicative of a shift in public policy and a growth in the belief that private management of public sector infrastructure can help resolve the funding crises around our education and health systems.

Promoting social support and social networks among Irish pensioners in South London, UK

This paper explores the activities of an Irish-led voluntary sector project that sought to minimise social isolation and build social networks among Irish elderly people living in a socio-economically deprived borough in South London, UK. The study from which this paper is drawn aimed to explore the nature and extent of unmet mental health needs among Irish pensioners. Using a naturalistic and exploratory design, data were collected through 19 semi-structured interviews, observation of project activities and analysis of members' case files. The paper presents findings in relation to the significant themes that emerged from the data analysis, which used a grounded theory approach. It discusses the social support systems within the project and examines the ways in which they maintained the mental wellbeing of the projects' members and interconnected with other areas of the project's activities. The study's findings demonstrated that the project provided space for social interaction among otherwise isolated Irish pensioners, many of whom experienced multiple morbidity. The project worked successfully to overcome the sense of stigma that prevented many of its members accessing statutory services; it also identified needs among carers. There was an Irish cultural ambience at the project centre, which generated a sense of belonging among members, and assisted in the development of social networks. The project initiated other forms of social support through the use of volunteers and developed befriending and telephone support services. The project developed partnership working with other agencies, particularly community mental health services, in order to provide support to elderly people who might otherwise have been institutionalised. The project engaged with the cultural norms of this marginalised white minority ethnic community to promote both social interaction and social networks. It offered a model of good practice for agencies working with isolated elderly members of minority ethnic communities.

Health system reform and social capital

Jim Hyde suggests that the research on building the capacity of communities and the accumulation of social capital shows that how we organize our health systems - in both micro and macro contexts - is important. He argues that collaboration, flexibility and community participation must become central in health structures.

School health policies and practices in Victoria- a comparison involving socio-economic status

Issue addressed: Health programs have been part of the responsibility of Victorian school education for 90 years. Yet rarely have there been studies to identify what is happening in school health promotion, or what the differences between schools might be, particularly in relation to the socioeconomic status of the school community and whether the school is in a metropolitan or regional area. Methods: In 1997 all Victorian schools (primary and secondary) in the State, Catholic and Independent systems were sent questionnaires in order to promote broader awareness about health promotion, and to identify what health programs, policies and activities the schools believed existed within their school community. A response rate of 43% was achieved, and results were collated under the six domains of the Health Promoting School model as outlined by the Western Pacific Regional Office of the World Health Organisation. Data analysed in this paper compared highest versus lowest quartiles for socioeconomic status (SES), and schools in metropolitan Melbourne versus regional areas. Results: Most differences between schools based on socioeconomic status occurred in secondary schools and were related mainly to environmental policies and practices, use of back packs, the presence of safety policies, involvement of parents in school activities and the provision of services for mental and social health needs. All differences were in favour of the highest SES quartile schools. Environmental policies and procedures, and school-based health and welfare services were present more often in metropolitan schools than in regional and rural schools. Conclusion: Although there were notable differences between schools, the audit results pointed to more similarities than differences between schools in the highest and lowest SES quartiles for health-related policies and practices; there were even fewer differences between metropolitan and non-metropolitan schools. So what: Regardless of the actual advantages and disadvantages schools experience with respect to location or socioeconomic status, it is important to understand that school staff perceive that they can and do have reasonably comprehensive health policies, procedures and practices to address health issues. Nevertheless, clear differences between schools did emerge in certain health areas and findings will assist policy making and the allocation of limited resources.

Governance, social responsibility and the banking sector

Banks in both the developed and undeveloped world remain at the core of financial systems and have the unique ability to write cheques against themselves. In light of the essential culture of credit at the heart of banking operations then the structures of corporate governance should especially reflect the supervision and management of risks and credit. This means that committee and management structures as well as staffing commitments revolve around credit and other risks.

Outdoor education and bush adventure therapy: A social-ecological approach to health and wellbeing.

Together, outdoor education and bush adventure therapy can be seen to constitute a population-wide health intervention strategy. Whether in educational or therapeutic settings, the intentional use of contact with nature, small groups, and adventure provides a unique approach in the promotion of health and wellbeing for the general population, and for individuals with identified health vulnerabilities. This paper explicitly emphasises human and social health, however, an integral assumption is that a healthy and sustainable environment is dependent on healthy human relationships with nature. We invite outdoor educators and bush adventure therapy practitioners to examine the proposition that healthy interactions with nature can create a unique stream of socio-ecological interventions. A spectrum of outdoor adventure programs is provided, allowing outdoor educators and bush adventure therapy practitioners to locate their work according to program context and aims, and participant aims and needs.