Moving beyond resistance to restraint minimization : a case study of change management in aged care

Aim: This case study describes a quality initiative to minimize restraint in an Australian residential aged care facility.

Approach: The process of improving practice is examined with reference to the literature on implementation of research into practice and change management. The differences between planned and emergent approaches to change management are discussed. The concepts of resistance and attractors are explored in relation to our experiences of managing the change process in this initiative. The importance of the interpersonal interactions that were involved in facilitating the change process is highlighted.

Implications: Recommendations are offered for dealing with change management processes in clinical environments, particularly the need to move beyond an individual mind-set to a systems-based approach for quality initiatives in residential aged care.

Integration and coordination of care

The health care systems in Australia are under pressure from workforce shortages, increasing costs and an ageing population with a high prevalence of chronic disease. There is a well-established description of inequity in health outcomes among rural and remote populations. Most of the inequity appears to be due to poorer access to services than higher levels of health risk factors, such as cholesterol, blood pressure or obesity. Over the last 15 years, the science of improvement has led to quality improvement techniques, such as collaboratives, managed clinical networks and collaborative care, all of which have been tried successfully in Australia. Each of these offers ways to reduce the inequity in health outcomes attributed to rurality or remoteness.

Investigation of overweight and obesity management in a rural primary health care setting

Background : The rural region of interest has one main central medical clinic and several smaller outlying clinics. The services available for weight management include dietetic services, community-based groups and bariatric surgery. At present, no formal area specific referral pathway exists for the treatment of overweight and obesity.
Aims & rationale/Objectives : To investigate general practitioners':
- assessment practices and experiences with overweight and obese clients
- experience of different treatment options for overweight and obesity
- perceived barriers to overweight and obesity management.
Methods : A self-administered survey will be sent to general practitioners within the region of interest. The survey was designed to investigate current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management. Participants will also be offered a brief interview to discuss the following topics; Usefulness of NHMRC's Overweight and Obesity Guidelines; barriers and frustrations of weight management, GP's and dietitian's roles in overweight and obesity treatment.
Principal findings : It is expected the principal findings will include details about methods used to determine overweight and obesity; factors considered when selecting patients for treatment; favoured treatment options of GPs; perceived barriers and frustrations of managing overweight and obese patients.
Discussion : Overweight and obesity are significant health issues in Australia, with recent data indicating more than 60% of Australian adults are affected (NHMRC, 2003). Studies have also suggested that the prevalence of overweight and obesity is higher in rural populations (Coulson, 2005). GPs have been recognised as an important contributor in the treatment of overweight and obesity (Campbell, 2000). There have been guidelines produced to assist GPs, however the extent to which guidelines are utilised or their perceived effectiveness have not yet been investigated.
Implications : It is thought that an investigation into current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management will provide valuable information to inform primary health care service provision and future quality improvement directions.
Presentation type : Poster
Session theme : Primary health care delivery

Rapeseed (canola) oil and other monounsaturated fatty acid-rich vegetable oils

Rapeseed (canola) and other monounsaturated fatty acid (MUFA)-rich oils are viewed as good candidates to replace, at least partially, the fish oil normally included in aquaculture feeds (aquafeeds). In fact, their utilization as a dietary lipid source for aquatic animals has some advantages over other readily available terrestrial alternative oils and fats; however, this is not without difficulties. MUFA are, indeed, easily digestible and a good source of available energy, and their deposition into fish flesh is considered to be less detrimental than other fatty acid classes, from a human nutritional viewpoint. This chapter attempts to review the principal information available regarding the utilization of MUFA-rich vegetable oil (VO) in aquaculture feed. Initially the chapter focuses on the rapeseed oil eRa) industry, agronomy, quality improvement, processing, and uses, and the main chemical and physical characteristics of rapeseed oil and other MUFA-rich va such as olive oil, peanut oil, and rice bran oil, amongst others. Following this, the potential advantages and challenges of using these alternative oils in the aquaculture feed industry are presented and discussed.

Addressing the basics : academics' views of the purpose of higher education

A number of changes have occurred in the higher education sector under the auspices of quality and quality improvement. Much of this change has resulted in a compliance-driven environment (more measures, more meetings, more form-filling and less time for the core activities of teaching and research). It is an environment that seeks to assure all and sundry of the quality of academic programs. Anecdotally, many academics are not convinced that the current systems do, indeed, assure quality. The reasons for this may be many and varied. One suggestion is that differences in perceptions about the purpose of higher education inevitably lead to differences in the definition of quality itself and consequently, differences in systems designed to assure that quality. Understanding what academics think about the purpose of higher education may provide some clues about how they consider quality should be defined.

In this research, the focus is on the views of academic accountants in Australia, defined as: academics whose main discipline area is accounting and who are involved in accounting education at an Australian university. The findings of this research show that the respondent group do, in fact, view the purpose of higher education currently promoted in their schools/departments differently from the purpose that they consider ought to be promoted. Such fundamental differences have the potential to influence the motivation and effectiveness of staff undertaking core activities in Australian universities. In addition, articulating the views of this important stakeholder group also has the potential to ensure that their views are considered in the discussions around purpose, quality and performance measures in higher education – all of which impact on the working lives of academic accountants in Australian universities.

Living the good life : how content providers can better conceptualize the content requirements of the ubiquitous technology user

Content provision via ubiquitous technology platforms such as smart mobile phones and personal digital assistants raises interesting practical and research challenges. Many current theoretical frameworks and models are based on assumptions which may not necessarily be valid in the case of ubiquitous technologies, which users employ in a variety of contexts and for different reasons. In this research-in-progress paper we explore how content providers can better conceptualize the content requirements of ubiquitous technology users. We introduce the principle of Continuous Quality of Life Optimization as a theoretical concept to understand the content requirements of these users. We put forth a number of propositions to guide further research and provide details about our own research approach, in which we are exploring ubiquitous content provision from the perspective of content providers.

Student evaluation of teaching : keeping in touch with reality

Student evaluation of teaching is commonplace in many universities and may be the predominant input into the performance evaluation of staff and organisational units. This article used publicly available student evaluation of teaching data to present examples of where institutional responses to evaluation processes appeared to be educationally ineffective and where the pursuit of the ‘right’ student evaluation results appears to have been mistakenly equated with the aim of improved teaching and learning. If the vast resources devoted to student evaluation of teaching are to be effective, then the data produced by student evaluation systems must lead to real and sustainable improvements in teaching quality and student learning, rather than becoming an end in itself.

The performance of a student evaluation of teaching system

Student evaluation of teaching (SET) is now commonplace in many universities internationally. While much effort has been devoted to examining the statistical validity of SET instruments, there has been limited examination of the methodological and consequential validity (together referred to as ‘utility’) of the ways in which SET data are used. This paper examines the SET system at Deakin University from the perspective of utility. It draws on publicly available SET results for an entire annual cycle of unit offerings. Consideration is given to the representativeness of the data produced, and to the utility of the data reported, by the system. While this investigation focuses on the SET system currently employed at Deakin University, it offers both an analysis methodology and conclusions that can be applied more generally.

Clinical sensemaking: a systematic approach to reduce the impact of normalised deviance in the medical profession

organisational culture, quality assurance, health care, state medicine, Great Britain, Health care reform, quality improvement

Elements underpinning successful implementation of a national best-practice child investigative interviewing framework

The complexity and effort required to achieve the widespread implementation of best-practice child interview guidelines justifies the establishment of structures to enhance cross-jurisdictional sharing of expertise, resources and training delivery support. Australia has made great strides toward such a system via work currently being undertaken by police jurisdictions to facilitate greater consistency in education and training for practitioners in the area of investigative interviewing, strengthening collaboration between police and tertiary education institutions, and growing commitment to evidence-based policy and practice among police executives. To maximise progress, however, organisations need to consider the development of a coordinated continual quality improvement approach. This will be impeded by three structural elements: access to field interviews for practitioner feedback and organisational evaluation, interviewer tenure and case tracking. This article discusses each element, their roles within a national best-practice interview framework, and attempts by some jurisdictions to address them. It also provides recommendations to guide further reform.

Creating spaces in intensive care for safe communication : a video-reflexive ethnographic study

The built environment in acute care settings is a new focus in patient safety research, with few studies focusing primarily on the design of ward environments and the location and choice of material objects such as light fittings and hand-washing basins.

Convergence and divergence dynamics in British and French business schools: how will the pressure for accreditation influence these dynamics?

This paper focuses on convergence and divergence dynamics among leading British and French business schools and explores how the pressure for accreditation influences these dynamics. We illustrate that despite historical differences in approaches to management education in Britain and France, these approaches have converged partly based on the influence of the American model of management education but more recently through the pursuit of accreditation, in particular from the Association to Advance Collegiate Schools of Business and the European Quality Improvement Standard. We explore these dynamics through the application of the resource-based view of the firm and institutional theory and suggest that, whilst achieving accreditation is a necessary precursor for international competition, it is no longer a form of competitive advantage. The pursuit of accreditation has fostered a form of competitive mimicry reducing national distinctiveness. The resource-based view of the firm suggests that the top schools need a more heterogeneous approach that is not easily replicable if they are to outperform the competitors. Consequently, the convergence of management education in Britain and France will become a new impetus for divergence. We assert that future growth and competitive advantage might be better achieved through the reassertion of national, regional and local cultural characteristics. © 2013 British Academy of Management.

Understanding context in knowledge translation: a concept analysis study protocol.

AIM: To conduct a concept analysis of clinical practice contexts (work environments) that facilitate or militate against the uptake of research evidence by healthcare professionals in clinical practice. This will involve developing a clear definition of context by describing its features, domains and defining characteristics. BACKGROUND: The context where clinical care is delivered influences that care. While research shows that context is important to knowledge translation (implementation), we lack conceptual clarity on what is context, which contextual factors probably modify the effect of knowledge translation interventions (and hence should be considered when designing interventions) and which contextual factors themselves could be targeted as part of a knowledge translation intervention (context modification). DESIGN: Concept analysis. METHODS: The Walker and Avant concept analysis method, comprised of eight systematic steps, will be used: (1) concept selection; (2) determination of aims; (3) identification of uses of context; (4) determination of defining attributes of context; (5) identification/construction of a model case of context; (6) identification/construction of additional cases of context; (7) identification/construction of antecedents and consequences of context; and (8) definition of empirical referents of context. This study is funded by the Canadian Institutes of Health Research (January 2014). DISCUSSION: This study will result in a much needed framework of context for knowledge translation, which identifies specific elements that, if assessed and used to tailor knowledge translation activities, will result in increased research use by nurses and other healthcare professionals in clinical practice, ultimately leading to better patient care.