Skill shortages in health : innovative solutions using vocational education and training

Introduction: This article reports findings of a project funded by the Australian National Council for Vocational Education Research. The project explores solutions to current and projected skills shortages within the health and community services sector, from a vocational education and training perspective. Its purpose is to locate, analyse and disseminate information about innovative models of health training and service delivery that have been developed in response to skill shortages.

Methods: The article begins with a brief overview of Australian statistics and literature on the structure of the national health workforce and perceived skill shortages. The impact of location (state and rurality), demographics of the workforce, and other relevant factors, on health skill shortages is examined. Drawing on a synthesis of the Australian and international literature on innovative and effective models for addressing health skill shortages and nominations by key stakeholders within the health sector, over 70 models were identified. The models represent a mixture of innovative service delivery models and training solutions from Australia, as well as international examples that could be transposed to the Australian context. They include the skill ecosystem approach facilitated by the Australian National Training Authority Skill Ecosystem Project. Models were selected to represent diversity in terms of the nature of skill shortage addressed, barriers overcome in development of the model, healthcare specialisations, and different customer groups.

Results: Key barriers to the development of innovative solutions to skills shortages identified were: policy that is not sufficiently flexible to accommodate changing workplace needs; unwillingness to risk take in order to develop new models; delays in gaining endorsement/accreditation; current vocational education and training (VET) monitoring and reporting systems; issues related to working in partnership, including different cultures, ways of operating, priorities and timelines; workplace culture that is resistant to change; and organisational boundaries. For training-only models, additional barriers were: technology; low educational levels of trainees; lack of health professionals to provide training and/or supervision; and cost of training. Key enhancers for the development of models were identified as: commitment by all partners and co-location of partners; or effective communication channels. Key enhancers for model effectiveness were: first considering work tasks, competencies and job (re)design; high profile of the model within the community; community-based models; cultural fit; and evidence of direct link between skills development and employment, for example VET trained aged care workers upskilling for other health jobs. For training only models, additional enhancers were flexibility of partners in accommodating needs of trainees; low training costs; experienced clinical supervisors; and the provision of professional development to trainers.

Conclusions: There needs to be a balance between short-term solutions to current skill shortages (training only), and medium to longer term solutions (job redesign, holistic approaches) that also address projected skills shortages. Models that focus on addressing skills shortages in aged care can provide a broad pathway to careers in health. Characteristics of models likely to be effective in addressing skill shortages are: responsibility for addressing skills shortage is shared between the health sector, education and training organisations and government, with employers taking a proactive role; the training component is complemented by a focus on retention of workers; models are either targeted at existing employees or identify a target group(s) who may not otherwise have considered a career in health.

Corporate governance : some key challenges and opportunities for accounting researchers

The focus on corporate governance has grown exponentially over the last decade. As evidenced by the increasing number of codes of best practice developed by leading international bodies such as the OECD, the Commonwealth and CalPERS (refer Demirag et al. (2000) for a fuller list of publications), corporate governance reform has now become a key global issue. Not only do factors such as the increasing globalisation of financial markets, the growth in multinational corporations and regional economic developments motivate the need for good corporate governance, but the recent spate of large corporate collapses such as Enron and WorldCom in the United States and HIH Insurance in Australia clearly signal the urgency for significant improvements in corporate accountability and reporting.

A review of cashmere nutrition experiments with suggestions for improving their design and conduct

The scientific literature contains divergent views about the effects of nutrition on cashmere. The consequences of ignoring nutrition will be an increase in the number of goats suffering lower production, increased welfare risks and premature mortality. This review evaluated published reports to identify current knowledge and best practice in regard to the design and management of cashmere nutrition experiments. The ability of experiments to distinguish between treatments was evaluated based on their statistical evidence. Many experiments had serious deficiencies in their design, conduct and reporting. Six of 16 papers did not provide statistical information that would enable a reader to verify differences between treatments. For most experiments to detect nutrition affects at P < 0.05, they required a difference between treatments of 0.2–0.8 μm in cashmere mean fibre diameter and 15–42 g in clean cashmere production. Government Research Institutes research was characterised by more experienced authors conducting longer (P < 0.05) and larger (P < 0.05) experiments than those conducted by Universities. Much of the “debate” regarding the affects of nutrition on cashmere production arises from the misinterpretation of both experiments that did not detect statistically significant effects and of experiments that did detect statistically significant effects. Based on a comparison between experiments reporting responses to nutrition with those reporting no response, 13 design and management features were identified that are related to the ability of experiments to detect significant treatment affects. Methods must be adopted to reduce the variance in cashmere production within treatments, by using sufficient animals per treatment, and having replication to provide sufficient degrees of freedom to reduce error terms in analysis. The power of experimental designs should be evaluated before experiments commence. Cashmere production records from a previous full production year could be used as co-variants during statistical analyses but this requires that potential experimental goats are managed in one flock, without variations resulting from different grazing, reproduction or other management for a year prior to an experiment. It is preferable to use more productive and older goats, and goats that are used to handling, and to the conditions and feed to be used. Allocation of animals to treatments must take into account live weight. Nutrition treatments need to be sufficiently different to produce different growth curves. An appropriate control is needed such as live weight maintenance. Evidence of both nutrition intake and growth curves must be published with cashmere production data so the claims made can be verified by the actual responses. As cashmere production is an order of magnitude less than fibre production of Merino sheep or Angora goats and is more difficult to measure, the requirements for measurement, sampling and testing cashmere fleeces are summarised. The use of mid side cashmere patches to determine cashmere growth and quality is seriously biased and must be avoided, preferably by shearing goats prior to and at the end of experiments. In order to obtain higher fleece growth responses and improve the ability of experiments to detect treatment effects it is preferable to start cashmere growth experiments by midsummer and conduct experiments for at least 4 months. These requirements make it difficult for many university students to plan, undertake and complete long-term cashmere nutrition experiments without considerable management support. It is not possible for experiments to disprove the Null hypothesis regarding the effects of nutrition on cashmere production as they can only report a failure to detect treatment effects. Researchers and journals need to be more rigorous in providing statistical information including: degrees of freedom for error terms, treatment variances, standard error of differences or similar to enable readers to compare treatment effects. Publications that do not provide sufficient statistical information should be disregarded from future discussions. Claims that an experiment shows no responses to nutrition should be subject to rigorous examination using the issues identified in this review.

Enhancing the dietary management of general practice patients through collaborative care: perspectives of general practitioners and dietitians

Aim:  To describe how general practitioners and dietitians view their role in the dietary management of cardiac patients and to provide insights on how to facilitate collaborative care.
Methods:  Two studies were conducted in Victoria (Australia) 2005–2006. Study One: semi-structured interviews with general practitioners. Study Two: cross-sectional quantitative surveys of general practitioners and dietitians. Study One: texts were analysed using the grounded theory approach. Study Two: frequency analysis was conducted and chi-squared test for independence was used to explore the impact of age, sex and consultation time on the role and reporting scales.
Results:  Study One: Themes arising from the interviews with 30 general practitioners showed their involvement in dietary management fell into three broad roles: ‘Influencing’, ‘Coordinator’ of referrals and dietary ‘Educator’. They described dietetic education as a process that included dietary assessment, education, application of behavioural change techniques and reporting back to general practitioners. Study Two: Respondents were 248 general practitioners (30% response) and 180 dietitians (60% response). General practitioners' counselling consisted mostly of advocating for dietary change, coordinating dietetic referrals and reinforcing dietitians' recommendations. General practitioners considered dietary education as the role of dietitians. Dietitians reported a much broader role in the management of patients with some overlap with general practitioners' roles.
Conclusions:   The findings indicate the need: (i) for more structured reporting to ensure general practitioners receive appropriate information to enable them to reinforce dietetic counselling and recommendations; and (ii) to streamline the communication process in order to expedite dietitians' reports to general practitioners.

Combining the forces of science and conservation to turn around the fortunes of shorebirds

At the start of the 21st century the majority of migratory wader (shorebird) populations are faced with serious threats. This commonly results from the continuous destruction of wetlands, their key habitat. Healthy wetlands are highly biodiverse and extremely vulnerable, and as functioning ecosystems particularly important for us humans for a sustained livelihood (artisanal fisheries, small-scale farming) and our well-being (effective water filtering and cleaning systems). In many parts of the world, wetlands have been seen as wastelands, or even as a source of threat (malaria). Many freshwater wetlands have been drained for agricultural use and mudflats have been reclaimed for settlement and urbanization. Wetlands are continuously squeezed by economic development and increasingly used for recreational activities, and their resources are, in general, notoriously overexploited.

Sui Generis protection for plant varieties and traditional knowledge in biodiversity and agriculture : the international framework and national approaches in the Philippines and India

The so-called ‘biotechnology clause’ of Article 27.3(b) of the WTO-TRIPS Agreement requires from member states protection for plant varieties either via the patent system or via an ‘effective sui generis system’ or by a combination of the two. Many developing countries prefer forms of sui generis protection, which allow them to include exceptions and protection measures for traditional agricultural practices and the traditional knowledge of farmers and local communities. However, ‘traditional knowledge’ remains a vaguely defined term. Its extension to biodiversity has brought a diffusion of the previously clearer link between protected subject matter, intellectual property and potential beneficiaries. The Philippine legislation attempts a ‘bottom-up’ approach focusing on the holistic perceptions of indigenous communities, whereas national economic interests thus far receive priority in India’s more centralist approach. Administrative decentralisation, recognition of customary rights, disclosure requirements, registers of landraces and geographical indications are discussed as additional measures, but their implementation is equally challenging. The article concludes that many of the concepts remain contested and that governments have to balance the new commercial incentives with the biodiversity considerations that led to their introduction, so that the system can be made sufficiently attractive for both knowledge holders and potential users of the knowledge.

Quantifying the potential impacts of increasing agricultural fragmentation on land value

Societal expectations from rural lands have traditionally focused on the production of food and fibre. Yet the perception of rural areas is changing and they are now seen in many instances to be capable of delivering multiple functions or non‐commodity outputs including land conservation and the preservation of biodiversity, contributing to the sustainable management of renewable natural resources and enhancing the socio‐economic viability of many areas . The overall multi‐functionality is constrained or favoured by biophysical and socio‐economic drivers. As these types of drivers vary spatially and temporally, so does the functionality of the landscape and heterogeneous patterns emerge. Associated with multiple functions at a single location are a variety of pressures which can manifest themselves as conflict between interacting land uses. One such conflict in rural zones is that between agricultural use and residential use. Warrnambool City Council (WCC) is a Local Government Area (LGA) in southwest Victoria where the debate surrounding the best use of rural land is currently being debated. In a region where agriculture has historically been the mainstay of the economy there is some resistance to unplanned conversion to residential use. Despite concerns and much strategy being discussed it appears an investigation quantifying the impacts of these conversions is yet to be done. This paper addresses the issue of the allocation of land by using GIS mapping to incorporate economic, social and environmental attributes, and applying a theoretical economic framework for the optimal allocation of land to the comprehensive data set. Marginal values of land for competing purposes are estimated and discussed. The method is relevant for other regions where the rural/residential interface and associated planning decisions are highly topical.

Closed vs open corporate social networking communities : a case study of the Victoria Police and Dairy Australia.

The availability of affordable, user-friendly audio-visual equipment, software and the Internet, allows anyone to become a content creator or media outlet. This exploratory case study examines the adoption of social networking by Victoria Police and Diary Australia, a non-media and non-profit organization respectively, in corporate communication, public infmmation and community relations. The paper initiates discussions on the implications for traditional media and audiences of this phenomenon. It content analyzed the two websites during a two-week period and conducted interviews with their moderators about the sites' content, functions and efficacy. The purpose, role and community acceptance of these sites are examined, along with organizational motivations for establishing these channels to reach audiences, bypassing traditional media's gatekeeping function. It highlights how these organizations may set both media and public agendas when traditional media use this web content in their news gathering and reporting, similar to using press releases in the past.

The traditional decision-making process of Berkaul in Tanjung Emas, West Sumatra : its nature and significance

Berkaul is a traditional practice associated with the rice cultivation cycle in West Sumatra, Indonesia, intended to seek consensus within the local community about agricultural practices and management of water for irrigation. Berkaul is deeply rooted in the adat and worldview of the region but is much less commonly practiced today than in the past and has disappeared in many parts of the region. This article describes the process of berkaul in Tanjung Emas, West Sumatra, places it within the context of Minangkabau adat and tradition, and considers its value in fostering participation, empowerment, and social inclusion in the context of rural development.

Shared care for chronic eye diseases : perspectives of ophthalmologists, optometrists and patients

Objective: To report the perspectives of optometrists, ophthalmologists and patients on a model of shared care for patients with chronic eye diseases.

Design, setting and participants: Qualitative study of a model of shared care between optometrists and ophthalmologists for patients with stable age-related macular degeneration, diabetic retinopathy and glaucoma, trialled by the Royal Victorian Eye and Ear Hospital in Melbourne during 2007–2009. Semi-structured interviews were conducted with optometrists, ophthalmologists and patients at completion of the project to obtain their perspectives on this model.

Results: Seventeen optometrists submitted expressions of interest to participate, and 12 completed web-based training modules and clinical observerships and adhered to specified examination and reporting protocols. All five participating ophthalmologists and 11 of the optometrists were interviewed. Ninety-eight patients participated and 37 were interviewed. Optometrists not only met ophthalmologists’ expectations but exceeded them, appropriately detecting and referring patients with additional, previously undetected conditions. Patients reported savings in travel time and were satisfied with the quality of care they received. Optometrists, ophthalmologists and patients indicated a general acceptance of shared care arrangements, although there were some issues relating to interprofessional trust.

Conclusions: Shared care between local optometrists and hospital-based ophthalmologists can help to reduce patient waiting time for review and offers an opportunity for these two groups of eye care professionals to collaborate in providing localised care for the benefit of patients. However, trust and relationship building need to be further developed.

Does agricultural food provide a good alternative to a natural diet for body store deposition in geese?

Over the past decades most goose populations have become increasingly dependent on agricultural crops during wintering and migration periods. The suitability of agricultural crops to support all nutritional requirements of migratory geese for the deposition of body stores has been questioned; feeding on agricultural crops may yield higher rates of fat deposition at the cost of reduced protein accretion due to an unbalanced diet. We compared amino-acid composition of forage, and investigated food-habitat use and dynamics and composition of body stores deposited by barnacle geese feeding on agricultural pasture and in natural salt marsh during spring migratory preparation. Overall content and composition of amino acids was similar among forage from both habitats and appeared equally suitable for protein accretion. There was no relationship between body composition of geese and their preferred food habitat. Fat and wet protein contributed with 67% and 33%, respectively, to body stores gained at a rate of 11 g/d throughout the one-month study period. We found no evidence of impaired protein accretion in geese using agricultural grassland compared to natural salt marsh. Our study supports the hypothesis that the expansion of feeding habitat by including agricultural grassland has played an important role in the recent growth of the East Atlantic flyway population of barnacle geese and other herbivorous waterbirds. Feeding refuges of improved grassland provide geese with an adequate diet for the deposition of body stores crucial for spring migration and subsequent reproduction, thereby alleviating the conflict with agriculture.

The theoretical underpinnings of rural injury and its impact on prevention programs

Many observations support the concept of an entity that could be described as ‘rural injury,’ yet the nature and limits of this concept are little explored. We demonstrate the complexity through descriptions along a single dimension: place.

Rural injury may be considered as consisting of both ‘Rural specific injury’ (Farm/agricultural, Forestry and Mining related injuries and Injuries in state/national parks) and also rural instances of ‘Injury which is not location specific’. Examples of the latter category include water related (especially boating & fishing), other industrial, Road Trauma, Sporting and Domestic injuries.

Assessing data quality issues in the Emergency Department through data and process mapping

Data and information quality is a well-established research topic and gradually appears on the decision-makers' top concern lists. Many studies have been conducted on how to investigate the generic data/information quality issues and factors by providing a high-level abstract framework or model. Based on these previous studies, this study tries to discuss the actual data quality issues with the operation-level and middle-level managers emerged during the emergency department data collection and reporting processes. By conduct data quality issues and business processes mapping, possible data quality issues are summarised under the well-known TOP model and the recommendations of data quality improvement are suggested.)

Australia, Papua New Guinea, and a communal blindness in our history education

The teaching of history to Australians has been under the spotlight in recent years as experts, commentators, and politicians vie for command of the uses to be made of the past. This was very evident in the — one hopes — now concluded ‘history wars’ of the last decade or so. But the old warriors are oiling their rusty swords in preparation for what may be yet another battle, perhaps one that will be particularly bloody in this election year. The field for this battle will be broadly centred on the new national history curriculum, being developed by the Australian Curriculum, Assessment, and Reporting Agency (ACARA).

An investigation into the drivers of Australian REIT merger and acquisition announcements

Purpose – The purpose of this paper is to use Australian Real Estate Investment Trust (A-REIT) data to empirically examine potential influencing factors on A-REITs becoming a bidder or a target in the mergers and acquisitions (M&A) area.

Design/methodology/approach – This study uses logistic regression analysis to investigate the odds of publically traded A-REITs being either a bidder or a target as a function of a number of financial and corporate governance variables.

Findings – Prior research in the US REIT M&A area has shown that target size is inversely related to takeover likelihood; in contrast, the authors’ Australian results show that size has a positive impact. Prior research on share price and asset performance has shown that underperformance increases the odds of an entity becoming a target, but this paper’s results further support these findings and provide confirmation of the inefficient management hypothesis. For acquirers it was found that leverage, cash balances, management structure, the level of shares held by related parties and the global financial crisis have an important impact on bidder likelihood.

Practical implications – Given that the literature suggests that investors can earn significant positive abnormal returns by owning targets, but incur significant abnormal losses by owning bidders, at announcement, this study will be useful to fund managers and other investors in A-REITs by investigating the characteristics of those firms that become targets and bidders.

Originality/value – This paper adds to the recent US REIT M&A literature by examining the second biggest REIT market in the world and reporting a number of factors that might influence A-REITs to become targets or bidders.