Implementation of a quality care management system for patients with arthritis of the hip and knee

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.

What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting.

What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative.

What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.

Simulation and hardware implementation of new maximum power point tracking technique for partially shaded PV system using hybrid DEPSO method

In photovoltaic (PV) power generation, partial shading is an unavoidable complication that significantly reduces the efficiency of the overall system. Under this condition, the PV system produces a multiple-peak function in its output power characteristic. Thus, a reliable technique is required to track the global maximum power point (GMPP) within an appropriate time. This study aims to employ a hybrid evolutionary algorithm called the DEPSO technique, a combination of the differential evolutionary (DE) algorithm and particle swarm optimization (PSO), to detect the maximum power point under partial shading conditions. The paper starts with a brief description about the behavior of PV systems under partial shading conditions. Then, the DEPSO technique along with its implementation in maximum power point tracking (MPPT) is explained in detail. Finally, Simulation and experimental results are presented to verify the performance of the proposed technique under different partial shading conditions. Results prove the advantages of the proposed method, such as its reliability, system-independence, and accuracy in tracking the GMPP under partial shading conditions.

Implementation of fuzzy logic maximum power point tracking controller for photovoltaic system

In this study, simulation and hardware implementation of Fuzzy Logic (FL) Maximum Power Point Tracking (MPPT) used in photovoltaic system with a direct control method are presented. In this control system, no proportional or integral control loop exists and an adaptive FL controller generates the control signals. The designed and integrated system is a contribution of different aspects which includes simulation, design and programming and experimental setup. The resultant system is capable and satisfactory in terms of fastness and dynamic performance. The results also indicate that the control system works without steady-state error and has the ability of tracking MPPs rapid and accurate which is useful for the sudden changes in the atmospheric condition. MATLAB/Simulink software is utilized for simulation and also programming the TMS320F2812 Digital Signal Processor (DSP). The whole system designed and implemented to hardware was tested successfully on a laboratory PV array. The obtained experimental results show the functionality and feasibility of the proposed controller.

Identifying key success factors for the adoption and implementation of a chemotherapy ordering system: a case study from the Australian private healthcare sector

This paper is designed to systematically assess the benefits of a chemotherapy ordering system (COS) for the private healthcare sector in Australia. By taking a rational economic perspective and modeling the principle-agent relationships using an actor network framework, it is possible to evaluate various scenarios and thereby assess the benefits, barriers and facilitators, possible COS can have. In this study, four hypotheses are tested using a mixed methodology which will serve to facilitate the decision making processes regarding the choice and implementation of the appropriate COS for Epworth.

Organizational factors in the diffusion of an industry standard: implementing an online documentation system for Australian exporters

At present, governments in many countries are actively engaged in the development of electronic trading and certification standards to enable the smooth operation of export markets. Standards and their usability underpin confidence in the operations of markets and their effective functioning. In institutional markets, an important role for government agencies lies in developing the initial specifications for standards for interoperable systems. Once these specifications are accepted, governments can then facilitate the eventual diffusion of a standard to the B2B marketplace. Acceptance of an industry standard can determine demand, which defines the viability of that market. In this paper, we describe an initiative by a government agency, the Australian Quarantine and Inspection Service (AQIS), in developing EXDOC, a standard for export documentation and the role that AQIS played in its implementation and diffusion. Our case study illustrates a successfully facilitated B2G implementation. It demonstrates how a standard can be supported and promulgated for the effective functioning of markets in the transition from manual to online export documentation. Once the overarching specifications for related industries have been established and diffused by government, opportunities arise for private sector markets to develop across these industries. Government agencies can promote the effective operation of standards for electronic markets. The EXDOC implementation and its iterations provide an exemplar of active engagement in the development of electronic trading and certification standards for an institutional market. Its successful diffusion provides a model of the implementation process for other export sectors and agencies.

Faster, richer, better: rapid appraisal techniques for the study of IS implementation in virtual communities

A major issue in Information Systems (IS) research is how to combine relevance and rigor (Benbasat and Zmud, 1999) and reduce the widening gap between research results and adoption (Dunn, 1994). Qualitative researchers make use of interpretivist methods to add richness and depth to their understanding of user problems. Interpretivist methods applied to IS implementations can thus result in research which communicates those findings more effectively. However standard interpretivist data-collection and analysis methods can be time-consuming and expensive. Findings based on these methods may be irrelevant to practitioners by the time they reach publication stage. A potential solution to this problem lies in Rapid Appraisal or RA, a qualitative appraisal methodology derived from rural development-related research. It offers IS researchers an additional technique for learning and acquiring relevant information in a limited period of time that  supplements current data collection and analysis techniques. RA adds value to the traditional approach for studying diffusion of innovation, supporting and extending the IS researcher’s qualitative ‘tool-kit’. In this paper we review an electronic gateway designed to facilitate the diffusion of an Australian government to business [G2B] export documentation system, EXDOC, which was first implemented with meat producers. RA techniques were used to collect and analyse data regarding the implementation of the first regional Electronic Trade Facilitation Center [ETFC] successfully established for Australian exporters in the horticulture sector. The findings from the original EXDOC implementation in the meat sector were confirmed and extended through this study. These include the importance of developing a governance structure that ensures all community members share the benefits of an implementation and the fact that virtual trading communities are attractive to users only if they add value to their business and extend standard ways of operating. Interactive interviews, part of the RA approach; also enabled us to expand our understanding of the way in which procedures developed in the course of implementing an electronic market represent value-adding opportunities for virtual trading communities. The paper has special relevance for researchers investigating adoption and diffusion issues experienced by small-scale producers with low exposure to technology in remote and rural settings.

Environmental management system adoption by Australasian organisations: part 1: reasons, benefits and impediments

The decision to adopt environmental management system (EMS) and to develop effective implementation strategies has engrossed managers at all levels and in all types of organisations in recent years. Some organisations have claimed that environmental issues have been determining their  bottom-line and business performance in the market place. This paper is first part in the series focussing on the reasons for EMS implementation and the benefits and impediments associated with the process. Measures  commonly practised by organisations to overcome/address the  impediments are also presented in this paper. The findings of this paper are based on a questionnaire survey mailed to Australasian organisations on their experiences with ISO 14001 implementation and certification.

A study of the environmental management system (EMS) adoption process within Australasian organisations-2. Role of stakeholders

The importance of an Environmental Management System (EMS) for organisations is becoming widely known across all industrial sectors. EMS has brought both challenges and benefits for the organisations and these many-a-times are determined by the role played by the organisational stakeholders. Stakeholder is a broad term and can encompass a number of individual(s) or group(s) directly or indirectly impacted by organisational activities. This paper, second part in the series, focuses on the role of the stakeholders, primarily employees and suppliers during the EMS planning and implementation stages. It is based on the findings of the quantitative part of a large research project exploring the role of employees and suppliers, as organisational stakeholders, during the EMS adoption stages. A response rate of almost 50% was achieved from a questionnaire survey of ISO 14001 certified organisations in Australia and New Zealand. The key relationships existing between the organisations and stakeholder involvement and the benefits and impediments associated with the process have also been presented.

A framework for environmental management system adoption and maintenance : an Australian perspective

Purpose – The purpose of this paper is to present a framework for environmental management system (EMS) adoption which can be used by managers to enable them to achieve a faster, smoother, effective and sustainable EMS implementation. This is termed by the authors as “successful” EMS implementation.
Design/methodology/approach – The framework presented is based on an extensive field study conducted in Australia that included a questionnaire survey and in-depth interviews conducted with practitioners, the results of which have been reported in this and other journals.
Findings – The framework presented covers three distinct phases, namely development, certification and maintenance and continuous improvement. Preliminary assessment of this framework by a group of Australian experts that included four senior managers, one academic and one consultant suggests that this framework is a useful tool for implementing an effective EMS.
Practical implications – Each of the three phases of the framework provides a step-by-step approach and a sequential map towards a successful EMS implementation.
Originality/value – The framework has been developed from extensive fieldwork and has been validated by a group of “experts” which comprised of four industry practitioners, one management academic, and one EMS consultant. The framework provides a detailed understanding of the steps involved in the implementation, certification, and maintenance of EMS.

Integrated management system:the experiences of three Australian organisations

Purpose – Management systems and standards have become a key part of the organisation's lifeline and a prerequisite for survival in the twenty-first century. Systems for quality environmental and occupational health and safety (OHS) now form the three main pillars of the organisation, the fourth one being financial accounting. In light of the increasing pressure and demands from different stakeholders, it is becoming necessary for organisations to adopt the different systems/standards. However, to achieve the benefits from the implementation and subsequently maintenance of these systems it is only a practical and logical step that the existing management systems/standards be integrated into a single system.

Design/methodology/approach – This paper presents the experiences of three Australian-based organisations that have successfully undertaken the integration of their management systems/standards. Data for this paper were collected through in-depth interviews conducted with the managers responsible for quality, environment and OHS systems.

Findings – The interviews revealed a number of quantifiable and unquantifiable benefits experienced by the companies from operating one integrated system, such as saving of dollars, better utilisation of resources and improved communication across the organisation, to name a few. However, for the benefits to be realized it is essential that organisations are aware of the challenges and obstacles accompanying integration of systems/standards. If these challenges are not addressed early in the process they can delay the completion of the integration process.

Originality/value – Recommendations for other organisations contemplating integrating their management system include: obtaining commitment from the top management; having adequate resources to integrate the systems; having communication and training across the organisation in aspects of integration; and, last but not the least, having integrated audits. Implementation of these recommendations may vary from one organisation to another; however, it would result in lesser resistance for the organisations following them.

Evalutaion of the implementation of the folate-neural tube defect health claim and its impact on the availability of folate-fortified food in Australia

Objective: To evaluate the implementation of the folate-neural tube defect (NTD) health claim and its impact on the availability of folate-fortifed food in Australia.

Methods: During late 2005, a survey was conducted in 16 supermarkets across all Australian capital cities to identify the use of the folate-NTD health claim on the labels of the 128 food products listed in food standard 1.1A.2: 'Transitional standard - Health claims' and the number of products fortifed with folic acid.

Results: Seventy-nine per cent of existing listed food products were found and two of these were implementing the folate-NTD health claim. Forty-four per cent of these listed products, previously fortifed with folic acid, were no longer fortifed. One hundred and seventeen generally available food products were fortifed with folic acid, predominantly breakfast cereals (73%). Twenty-seven per cent of these folate-fortifed products were listed in the transitional standard.

Conclusions: The health claim was not used widely to inform women of child-bearing age of the importance of periconceptional folate intake. The increased availability of folate-fortifed products generally has occurred independently of the health claim. Defciencies in the verifcation system of the tested regulatory framework are identifed. The voluntary regulatory provisions for both folate fortifcation and the use of the health claim diminished the States' infuence over their implementation of public health tools.

Evaluating health promotion in schools: a case study of design, implementation and results from the Hong Kong Healthy Schools Award Scheme

Health promoting schools (HPS) and Healthy Schools Award Schemes from a number of countries have demonstrated positive changes in children’s health behaviours and the culture and organisation of the school. The Hong Kong Healthy Schools Award Scheme (HKHSA) aims to promote staff development, parental education, involvement of the whole school community, and linkage with different stakeholders to improve the health and well-being of the pupils, parents and staff, and the broader community, supported by a system to monitor the achievement. This concept is very much in line with the research literature on school effectiveness and improvement. The indicators examined to evaluate the success of the HKHSA reflect outcomes related to both health and education and are not limited to changes in population health status. The early results demonstrated significant improvements in various aspects of student health and also improvement in school culture and organisation. The evaluation framework described in this paper and data collected to assess how schools perform in the HKHSA scheme, provides insight into how HPSs could lead to better outcomes for both education and health.

An agent-based hybrid intelligent system for foreign exchange trading

The foreign exchange (FX) market has many features including (1) Each trader’s payoff depends not only on his own behavior, but also on other traders’ decisions; (2) The number of traders is too large to make them all know the other dealers’ methods of decision making; and (3) The FX market has many levels. The FX market is complex because of these features. A diversity of techniques are required to deal with such complex problems. That is hybrid solutions are crucial for the FX market. On the other hand, research into the FX market has revealed that it demonstrates some characteristics of multi-agent systems such as autonomy, interaction, and emergence. To this end, an agent-based hybrid intelligent system was developed for FX trading, which is based on our proposed agent-based hybrid framework. This paper is to discuss the analysis, design, and implementation such a system. Some experimental results and comparisons with related works are also provided. The interest of this paper does not reside in improving the predictive capabilities of different FX models, but rather in how to integrate different models into one system under the unifying agent framework. The success of this system indicates that agent perspectives are very appropriate to model complex problems such as the FX trading.