Challenges in health services and health systems research

The relationship between emerging trends in healthcare systems and the consequent research priorities will be explored.

Governments and policy makers in developed countries are increasingly focused on the management of chronic disease, reflecting demographic changes and shifts in the burden of disease. Systems of quality improvement and reward are increasingly based on performance in chronic disease management. There is some evidence that countries with well-developed systems of primary care, such as Australia, achieve better health outcomes at less cost. In the past 15 years, almost all developed countries have undergone some type of health care reform. There has been a major focus on reducing costs; often involving shifting services from secondary to primary care. While there are few international comparisons, most suggest a complex relationship between the strength of primary care within the overall health services system and good performance, particularly with regard to lower costs of care and particularly relevant measures of health.

Aims for 21st century health systems
What, then, are the issues which are shaping contemporary general practice in developed countries? There are several imperatives: Safety, effectiveness, patient-centredness, timeliness, efficiency and equity. A study by the Nuffield Trust (Dargie, 1999) projected the shape of healthcare for the first fifteen years of this century. The study identified six issues that need to be addressed in the process of formulating health systems policies:

• Peoples’ expectations and financial sustainability
• Demography and ageing
• Information and knowledge management
• Scientific advance and new technology
• Workforce education and training
• Systems performance and quality (efficiency, effectiveness, economy
and equity)

Each of these six issues requires innovative thinking and priority setting on the part of the health sector, such as the delivery of health services in new and creative ways. Furthermore, there is a clear need for a finely tuned research, development and evaluation strategies to match these goals.

Towards solutions for a liveable future: progress, practice, performance, people: Proceedings of the 41st Annual Conference of the Architectural Science Association ANZAScA

There is hope! Since Al Gore disclosed the inconvenient truth, the climate has changed. The time of denial is over; the era of well-informed action and sound development is with us. Sustainability has now moved from the fringe, into the mainstream of politics, society, architecture and building practice. In this new context architectural science will contribute to two main tasks: prevent further damage to our environment, and respond to challenges invoked by climate change.
The built environment and human activity within it account for a large part of the problem. Architectural science and architectural practice are part of the solution. The ANZAScA 2007 conference focuses on the solutions architectural science has to offer toward a liveable future through the following generic themes:
progress – the evaluation and improvement of built facilities, new and existing, in terms of energy intensity, financial reward and environmental impact.
practice – the relationship between our cultural heritage, new facility design, retrofit design and its realisation
through construction.
performance – the connection between building operation targets, validation of performance, and user comfort and interaction in new and existing environments.
people – the effect of space on user behaviour, user responsibility and social wealth.
In response to this challenge, architectural science researchers including students, educators, and practitioners at ANZAScA 2007, present a broad range of research activity and concern within the built environment from global issues down to the specific actions of individuals.

A clarification of the ERI model : the importance of personality

The present study aimed to investigate the role of personality in the etfort-reward imbalance model along with the construct validity of overcommitment in relation to Type A behaviour. The study sample consisted of 898 operational law enforcement persolllel from a large Australian police service. Factor analysis revealed that the overcommitment construct was psychologically related to, but distinct from, the Type A dimensions achievement striving, impatience-irritability and hostility despite the hypothesised interrelatedness of the measures. Multiple regression analyses including tests for curvilinear effects revealed that the Type A dimensions made a significant improvement to the prediction of employee wellbeing and job satisfaction, The results of the study provide theoretical implications in terms of the augmentation of the effort-reward imbalance model.

Ethical, economic and efficient sector : is it a gamble? The case of New Zealand Health

The New Zealand public sector has gone through major reform as a result of fiscal deficit in 1984 (KettI, 1997; Schwartz, 1997), resulting in shift of emphasis from quality service provision to establishing financial supremacy (Kettl, 1997). This raises concern as to how public sector employees are attaining balance between their service objectives with financial ones and how is the ethics negotiated in this process. Following this concern, this paper focuses on determining the organisational variables consisting of organisational policies in the District Health Boards (DHBs) and hospitals of New Zealand on ethical behaviours of managers and the ethical climate of these departments. The aim of this study is to increase our understanding of the ethical climate of the public health. Our findings suggest that little emphasis has been provided to the aspect of ethics in New Zealand health sector. There is no reward for employees who exhibit exemplary ethical behaviour, no hot line to consult/report about ethics, any detailed guidelines and policies, and not enough ethics-related training provided to staff.

Estimating expected excess returns using historical and option-implied volatility

We test the relation between expected and realized excess returns for the S&P 500 index from January 1994 through December 2003 using the proportional reward-to-risk measure to estimate expected returns. When risk is measured by historical volatility, we find no relation between expected and realized excess returns. In contrast, when risk is measured by option-implied volatility, we find a positive and significant relation between expected and realized excess returns in the 1994–1998 subperiod. In the 1999–2003 subperiod, the option-implied volatility risk measure yields a positive, but statistically insignificant, risk-return relation. We attribute this performance difference to the fact that, in the 1994–1998 subperiod, return volatility was lower and the average return was much higher than in the 1999–2003 subperiod, thereby increasing the signal-to-noise ratio in the latter subperiod.

Conceptualising a voluntary certification system for highly accomplished teachers

In this paper I argue that a voluntary certification system for highly accomplished teachers must be part of a coherent system of professional accountability which is developed, implemented and managed by the profession. This would be a system that engages professional judgement of evidence provided by teachers in relation to their professional knowledge and practice, and professional standards for teaching would provide the organising framework for that judgment. It would be a system incorporating and aligning all forms of professional licensure, including entry into the profession and subsequent professional milestones. It would be a system that all partners in the profession across Australia—employers, professional associations, and registration authorities—endorse, participate in and align with.

The profession can take the lead in developing and implementing such a coherent and coordinated national approach by carefully developing a system to recognise and reward highly accomplished teaching. Such a system should aim to recognise and build teacher quality by defining what it is highly accomplished teachers know and are able to do. Moreover, such a system must fi nd ways of making teaching public and acknowledging teaching as intellectual work which involves professional judgment that draws on a recognised professional knowledge base and contextualised knowledge about students and their learning.

The paper is presented in two main sections. First, a proposed conceptual framework for the professional recognition and certification of highly accomplished teachers is outlined. Then, the argument for this proposed conceptual framework is presented drawing on learnings from relevant research and professional activity in both Australia and the USA.

Evaluation of Australian undergraduate engineering management education for flexible delivery

This thesis examines issues in Australian undergraduate engineering management studies in the context of flexible learning delivery. It is proposed that, within an Australian context: a) the management skills and competencies required by graduate engineers can be determined and classified on a rational basis, permitting an educational focus on those elements most appropriate for graduates; and b) on-line and other computer-based technologies are a practical and effective method for the support of undergraduate engineering management studies. The doctoral project incorporates: • an examination of the nature of engineering management; • a review of the relevant literature establishing the importance of management studies in undergraduate engineering courses; • a review of historical and recent developments in Australian undergraduate engineering management studies; • an investigation of the management skills and competencies required by graduate engineers - based on original research; • an examination of flexible delivery of engineering education - based on professional practice experience; and • an evaluation of case studies of flexible delivery of engineering management education - based on original research and professional practice experience. A framework of ranked classified management skills is developed. Broadly, the ranking framework is generic professional skills, followed by general management skills and technical discipline specific management skills, followed by other professional discipline skills and theoretical skills. This framework provides a rational basis for design of undergraduate engineering management studies. This is supplemented by consideration of the management skills required for the future of engineering practice. It is concluded that undergraduate engineering management education is well suited to delivery and support by on-line and computer-based technology. Recent developments in improved access to the Internet, software systems for on-line collaboration and changes in copyright legislation to create a broad-based right to communication via on-line media have contributed to the facilitation of on-line delivery of teaching and learning. It is noted that though many on-line infrastructure issues have been satisfactorily resolved, higher level issues will emerge as being crucial, including the academic staff development and reward for operating in an online teaching environment and the financial sustainability of on-line development and delivery of courses.

Reinforcement sensitivity theory : a paradigm for understanding the motivational processes underlying alcohol use

Provides an examination of the processes which motivate individuals to drink alcohol. It was found that heavier drinkers are highly sensitive to reward yet more likely to experience negative affect, both generally, and in response to alcohol-related cues. Based on these findings a model focusing on the links between personality, mood and craving for alcohol was developed.

Sensitivity to motivational cues in attention-deficit / hyperactivity disorder

This thesis examined a prediction of Reinforcement Sensitivity Theory regarding the association between personality traits and motivated behaviour and, whether reward-and-punishment sensitivity is associated with Attention-deficit / Hyperactivity disorder (ADHD). Results supported the predicted association between personality and motivated behaviour, but not the predicted association between reward-and-punishment sensitivity and ADHD.

PROJAM : the management of complex projects and programs

Challenges the existing normal science in project management with its limitations of high certainty in scope definition and develops a contingency based model for project / program management (PROJAM). The PROJAM concept is theoretically supported through the identification of eight inter related aspects - uncertainty, maturity, stakeholders, pareto, reward, transparency, partnering, and program management. The ideas presented represent a radical change to the eisting project management body of knowledge and expand the scope of project management to deal with complex projects / programs including organisational change, core function outsourcing (asset management) and IT hardware and software outsourcing.

Teaching music in New South Wales primary schools : 1920-1956

This thesis concerns the place of music in New South Wales schools from 1920 to 1956. The initial chapters explore issues related to the investigation and the methodology that has guided the research. To provide a foundation for the thesis as a whole, the investigation’s British antecedents are considered and the relevant literature is reviewed. Six broad themes are used as the organisational framework for this thesis: the major events that shaped schooling, the syllabus and recommended music resources, the rationales for the inclusion of music in schools, the place of school music broadcasts, music teaching practice in schools, and the provision of teacher training. Each theme forms the basis of one chapter, with the exception of one extensive theme which is discussed in two adjoining chapters.

This investigation concluded that from 1920 to 1956, the Department of Education’s fundamental aim for schooling was to develop the state’s children into good citizens. Music was valued for its ability to contribute to this aim.

During this period, the Department engaged in a policy of music transmissionism. Specifically, the Department sought to transmit the music values, knowledge and skills that it held in high regard to teachers who in turn were expected to transmit them to their students. The dominant culture and values that were transmitted were those of Britain and the British Empire—that is, music was used to transmit Britishness to children.

The investigation also concluded that during this period there was an expansion of music curriculum and pedagogy in New South Wales. However, in a oneway traffic of ideas between Britain and Australia, it was British music education practices that continued to influence the methods used in New South Wales schools.

In addition, this investigation concluded that there were past periods when New South Wales schools were very musical places—specifically, at the turn of the twentieth century, during the Second World War and during the immediate post-war years. The successes achieved in music during these times required the interplay of six factors: a Department of Education that valued music for the contribution it made to the development of children as good citizens; a Department of Education that provided strong leadership for music by employing a conscientious, inspirational music educator or educators whose sole responsibility was to champion and supervise music across the state; a Departmental expectation that music would be taught by generalist teachers who themselves had developed music expertise during their pre-service preparation or through professional development opportunities offered to them; the existence of a reward system to encourage teachers to increase their music discipline knowledge and skills; a music syllabus that was developmental and hence built on prior music knowledge and skills; and teachers who were able to deliver quality music programs to their students because they themselves were one element in a cycle of respect for music.

Australian teaching and learning centres through the eyes of their directors : characteristics, capacities and constraints

This paper is based on research to identify common factors that contribute to the effective strategic leadership of teaching and learning centres. The second of three phases of data collection involved a survey of Directors of Australian teaching and learning centres. The data collected were quantitatively analysed using a range of descriptive, parametric and non-parametric techniques. Based on a response rate of 81.6 percent, we present a contemporary, comprehensive and representative quantitative snapshot of Australian teaching and learning centres, as seen through the eyes of their Directors. The time since last restructure, incumbency of the current Director and total Directorship experience of the current Centre Director all have mean values of ‘sometime in the previous one to three years’. Most Centres would consider their work in the areas of ‘recognition and reward’ and ‘professional development of staff’ as high impact functions, and they would be pleased with their efforts in the former area, and wish to perform better on the latter. The principal constraint identified by Centres was ‘lack of staff time’, both in the Faculties and in the Centre, to engage in teaching and learning improvement activities. Overall, Centres feel well included in relevant university committees and other activities.

CAS : student engagement requires unambiguous advantages

Encouraging students to develop effective use of Computer Algebra Systems (CAS) is not trivial. This paper reports on a group of undergraduate students who, despite carefully planned lectures and CAS availability for all learning and assessment tasks, failed to capitalize on its affordances. If students are to work within the technical constraints, and develop effective use of CAS, teachers need to provide assistance with technical difficulties, actively demonstrate CAS' value and unambiguously reward its strategic use in assessment.

Alcohol expectancies and drinking refusal self-efficacy mediate the association of impulsivity with alcohol misuse

Background: Recent work suggests that 2 biologically based traits convey risk for alcohol misuse: reward sensitivity ⁄ drive and (rash) impulsiveness. However, the cognitive mechanisms through which these traits convey risk are unclear. This study tested a model predicting that the risk conveyed by reward sensitivity is mediated by a learning bias for the reinforcing outcomes of alcohol consumption (i.e., positive alcohol expectancy). The model also proposed that the risk conveyed by rash impulsiveness (RI) is mediated by drinkers’ perceived ability to resist alcohol (i.e., drinking refusal self-efficacy).
Methods: Study 1 tested the model in a sample of young adults (n = 342). Study 2 tested the model in a sample of treatment-seeking substance abusers (n = 121). All participants completed a battery of personality, cognitive, and alcohol use questionnaires and models were tested using structural equation modeling.
Results: In both studies, the hypothesized model was found to provide a good fit to the data, and a better fit than alternative models. In both young adults and treatment-seeking individuals, positive alcohol expectancy fully mediated the association between reward sensitivity and hazardous alcohol use. For treatment seekers, drinking refusal self-efficacy fully mediated the association between RI and hazardous drinking. However, there was partial mediation in the young adult sample. Furthermore, neither trait was directly associated with the other cognitive mediator.
Conclusions: The hypothesized model was confirmed on a large sample of young adults and replicated on a sample of treatment-seeking substance abusers. Taken together, these findings shed further light on the mechanisms through which an impulsive temperament may convey risk for alcohol misuse.

‘Inspired and assisted’, or ‘berated and destroyed’? Research leadership, management and performativity in troubled times

Research leadership in Australian universities takes place against a backdrop of policy reforms concerned with measurement and comparison of institutional research performance. In particular, the Excellence in Research in Australian initiative undertaken by the Australian Research Council sets out to evaluate research quality in Australian universities, using a combination of expert review process, and assessment of performance against ‘quality indicators’. Benchmarking exercises of this sort continue to shape institutional policy and practice, with inevitable effects on the ways in which research leadership, mentoring and practice are played out within university faculties and departments. In an exploratory study that interviewed 32 Australian academics in universities in four Australian states, we asked participants, occupying formal or informal research leadership roles, to comment on their perceptions of research leadership as envisioned and enacted in their particular workplaces. We found a pervasive concern amongst participants that coalesced around binaries characterized in metaphoric terms of ‘carrots and whips’. Research leadership was seen by many as managerial in nature, and as such, largely tethered to instrumentalist notions of productivity and performativity, while research cultures were seen as languishing under the demoralizing weight of reward and punishment systems. Here, we consider what is at stake for the future of the academic workforce under such conditions, arguing that new models of visionary research leadership are urgently needed in the ‘troubled times’ of techno-bureaucratic university reforms.