The National Safety and Quality Health Service Standards requirements for orientation and induction within Australian healthcare: a review of the literature

Introduction: A workplace orientation program is a core requirement of the National Safety and Quality Health Service (NSQHS) Standards in Australia. This is particularly important within healthcare as patient safety and the patient experience are at risk if the healthcare workforce is not supported with an effective orientation and induction program. Aim: This study aimed to review the literature and map the requirements of the NSQHS Standards in relation to orientation and induction. Method: This study utilised online databases to search for literature pertaining to orientation and induction within healthcare. Inclusion criteria included relevance to research questions, and originating in a country with a comparative health system to Australia. Results: The search identified a total of 202 articles of potential relevance with 42 articles meeting the inclusion criteria. Articles were ranked according to hierarchy of evidence criteria for both qualitative and quantitative studies. The importance of using orientation to detail safety and quality roles, the organisations' risk management system, governance structure, operational processes and procedures was highlighted. Patient-centred care, antimicrobial stewardship, clinical handover and mechanisms for escalation of care and emergency assistance should also be covered within the orientation process. Conclusion: There is a dearth of studies in relation to orientation and induction in the healthcare literature. Orientation content is now clearly prescribed, what is lacking within healthcare is a standardised framework. Concept mapping, educational theory and adult learning methods have been shown to enhance workforce problem solving and engagement with orientation, however further research is needed to enhance practice

Interventions to improve cultural competency in healthcare: a systematic review of reviews

Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area.

A metasynthesis of patient-provider communication in hospital for patients with severe communication disabilities: informing new translational research

Poor patient-provider communication in hospital continues to be cited as a possible causal factor in preventable adverse events for patients with severe communication disabilities. Yet to date there are no reports of empirical interventions that investigate or demonstrate an improvement in communication in hospital for these patients. The aim of this review was to synthesize the findings of research into communication in hospital for people with severe communication disabilities arising from lifelong and acquired stable conditions including cerebral palsy, autism, intellectual disability, aphasia following stroke, but excluding progressive conditions and those solely related to sensory impairments of hearing or vision. Results revealed six core strategies suggested to improve communication in hospital: (a) develop services, systems, and policies that support improved communication, (b) devote enough time to communication, (c) ensure adequate access to communication tools (nurse call systems and communication aids), (d) access personally held written health information, (e) collaborate effectively with carers, spouses, and parents, and (f) increase the communicative competence of hospital staff. Currently there are no reports that trial or validate any of these strategies specifically in hospital settings. Observational and evaluative research is needed to investigate the ecological validity of strategies proposed to improve communication.

Medical tourism: A conceptual framework for an innovation in global healthcare provision

© 2015, IGI Global. The purpose of this chapter is to establish a conceptual model that can potentially fill research gaps in the literature about medical tourism as an innovative concept in global healthcare provision by developing emerging economies as they are providing low cost alternatives in medical treatment at internationally accredited medical facilities to treat patients from developed countries. Major databases such as Ebscohost and Emerald have been used to search relevant literature. The literature on medical tourism is reviewed so as to understand the key drivers of medical tourism as well as research gaps in the existing literature. Three major drivers of medical tourism have been identified, namely cost, waiting time, and perceived quality. Further empirical research is needed to test the conceptual model in order to better understand what drives a decision to engage in medical tourism. This chapter makes three major contributions; firstly, the identification of the medical tourism literature from the service marketing and management perspectives; secondly, to propose a conceptual model representing innovation in medical tourism for global healthcare by developing emerging economies; thirdly, the identification of research gaps in the medical tourism literature through which future research can further the knowledge of why people travel to developing countries for medical treatment.

Affective commitment and turnover intentions among healthcare professionals: the role of emotional exhaustion and disengagement

This paper utilises the conservation of resources theory to examine the mediating role played by disengagement in the relationships between emotional exhaustion, affective commitment and turnover intentions among healthcare professionals. Structural equation modelling was conducted on data obtained from 302 healthcare professionals in a major Australian cancer hospital. Our findings demonstrate that disengagement fully mediates the relationships between emotional exhaustion and both affective commitment and turnover intentions. Recommendations for future research are suggested and practical implications discussed. © 2013 Taylor & Francis.

Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study

OBJECTIVE: The objective of this study was to explore the decision-making processes and associated barriers and enablers that determine access and use of healthcare services in Arabic-speaking and English-speaking Caucasian patients with diabetes in Australia. STUDY SETTING AND DESIGN: Face-to-face semistructured individual interviews and group interviews were conducted at various healthcare settings-diabetes outpatient clinics in 2 tertiary referral hospitals, 6 primary care practices and 10 community centres in Melbourne, Australia. PARTICIPANTS: A total of 100 participants with type 2 diabetes mellitus were recruited into 2 groups: 60 Arabic-speaking and 40 English-speaking Caucasian. DATA COLLECTION: Interviews were audio-taped, translated into English when necessary, transcribed and coded thematically. Sociodemographic and clinical information was gathered using a self-completed questionnaire and medical records. PRINCIPAL FINDINGS: Only Arabic-speaking migrants intentionally delayed access to healthcare services when obvious signs of diabetes were experienced, missing opportunities to detect diabetes at an early stage. Four major barriers and enablers to healthcare access and use were identified: influence of significant other(s), unique sociocultural and religious beliefs, experiences with healthcare providers and lack of knowledge about healthcare services. Compared with Arabic-speaking migrants, English-speaking participants had no reluctance to access and use medical services when signs of ill-health appeared; their treatment-seeking behaviours were straightforward. CONCLUSIONS: Arabic-speaking migrants appear to intentionally delay access to medical services even when symptomatic. Four barriers to health services access have been identified. Tailored interventions must be developed for Arabic-speaking migrants to improve access to available health services, facilitate timely diagnosis of diabetes and ultimately to improve glycaemic control.

Professionalism in workplace learning: understanding interprofessional dilemmas through healthcare student narratives

Drawing on theory, research, and practice, the contributors to this interdisciplinary volume systematically analyze these ethical dilemmas and offer practical suggestions that are sure to interest students, academics, and professionals.

Hierarchical dirichlet process for tracking complex topical structure evolution and its application to autism research literature

In this paper we describe a novel framework for the discovery of the topical content of a data corpus, and the tracking of its complex structural changes across the temporal dimension. In contrast to previous work our model does not impose a prior on the rate at which documents are added to the corpus nor does it adopt the Markovian assumption which overly restricts the type of changes that the model can capture. Our key technical contribution is a framework based on (i) discretization of time into epochs, (ii) epoch-wise topic discovery using a hierarchical Dirichlet process-based model, and (iii) a temporal similarity graph which allows for the modelling of complex topic changes: emergence and disappearance, evolution, splitting and merging. The power of the proposed framework is demonstrated on the medical literature corpus concerned with the autism spectrum disorder (ASD) - an increasingly important research subject of significant social and healthcare importance. In addition to the collected ASD literature corpus which we made freely available, our contributions also include two free online tools we built as aids to ASD researchers. These can be used for semantically meaningful navigation and searching, as well as knowledge discovery from this large and rapidly growing corpus of literature.

The burden of neck pain: its meaning for persons with neck pain and healthcare providers, explored by concept mapping

PURPOSE: To empirically define the concept of burden of neck pain. The lack of a clear understanding of this construct from the perspective of persons with neck pain and care providers hampers adequate measurement of this burden. An additional aim was to compare the conceptual model obtained with the frequently used Neck Disability Index (NDI). METHODS: Concept mapping, combining qualitative (nominal group technique and group consensus) and quantitative research methods (cluster analysis and multidimensional scaling), was applied to groups of persons with neck pain (n = 3) and professionals treating persons with neck pain (n = 2). Group members generated statements, which were organized into concept maps. Group members achieved consensus about the number and description of domains and the researchers then generated an overall mind map covering the full breadth of the burden of neck pain. RESULTS: Concept mapping revealed 12 domains of burden of neck pain: impaired mobility neck, neck pain, fatigue/concentration, physical complaints, psychological aspects/consequences, activities of daily living, social participation, financial consequences, difficult to treat/difficult to diagnose, difference of opinion with care providers, incomprehension by social environment, and how person with neck pain deal with complaints. All ten items of the NDI could be linked to the mind map, but the NDI measures only part of the burden of neck pain. CONCLUSION: This study revealed the relevant domains for the burden of neck pain from the viewpoints of persons with neck pain and their care providers. These results can guide the identification of existing measurements instruments for each domain or the development of new ones to measure the burden of neck pain.

A classification of healthcare facilities: toward the development of energy performance benchmarks for day surgery centers in Australia

OBJECTIVE: In the literature, there is no consistent classification of healthcare facilities. In order to benchmark, assess, and compare the environmental performance of these buildings, it is important to clearly identify the typology within the scope of a particular research. This article identifies the different typologies within the healthcare sector, particularly in Australia, with the aim of the development of energy performance benchmarks for day surgery/procedure centers. BACKGROUND: Healthcare buildings encompass a wide range of facilities. They all share the same purpose of healing and offering a health service for patients. However, they vary significantly in terms of patient type and service provided. These buildings consume a considerable amount of energy, and as a result of the different designs and sizes, their pattern of energy consumption varies. METHODS: The research used a systematic review of the literature to determine how the term "healthcare facility" has been employed in different contexts. In order to better understand the differences in healthcare facilities, definitions and the origin of hospitals and healthcare facilities are introduced and a framework for the classification of healthcare facilities and hospitals is proposed. RESULTS: Healthcare facilities are classified into the following six categories: patient type, care provided, management and ownership, level of care, facility size, and location. Based on these classifications, a categorization for the studies of energy performance in healthcare is introduced. CONCLUSIONS: This study provides a basis for assessment and comparison for a particular healthcare building typology that will assist researchers working in the field of design and energy assessment of healthcare facilities.

Assimilating healthcare information systems in a Malaysian hospital

The importance of information systems/information technology (IS/IT) to healthcare organisations is being recognised today as paramount and critical in order to realise superior healthcare delivery. Successful assimilation of IS/IT, which is the central focus of this study, then becomes a key consideration in ensuring that IS/IT is appropriately and systematically deployed into a healthcare organisation. The key findings from this research indicate that there are people, process, technology and environment elements that should be considered as facilitators to the healthcare information systems (HIS) assimilation process, as well as barriers that the healthcare organisation should overcome throughout the entire assimilation process or at specific stages. This research, therefore, is not only topical but especially beneficial to management and administrators in the web of healthcare players as they grapple with trying to successfully assimilate HIS into their respective organisations. © 2014 by the Association for Information Systems.

Factors influencing compliance to universal precautions in healthcare workers: a systematic literature review

Background: Occupational exposure to blood borne viruses involving hollow bore needles is one of the most commonly reported adverse events affecting staff in the National Health Service in the UK. Universal Precautions Guidelines were originally developed in 1987 in order to minimise the risk of contact with body fluid. Universal precautions not only protect staff against blood borne pathogens but are also considered as an efficient mean to reduce the spread of pathogens from patients to patients via healthcare workers.Aim of the study: The aim of this study was to identify and evaluate the objective evidence on factors influencing healthcare workers compliance to universal precautions through a systematic literature review.Methodology: This systematic review was conducted in 2009 and studies were retrieved through electronic databases, manual journal searches and communications with experts in the field. Studies of cross sectional survey design and observational design were included in the review as they constituted the most commonly used research design evaluating compliance to universal precautions.A quality checklist was developed based on existing assessment criteria.Findings: Studies conducted to ascertain compliance to universal precautions are plentiful but remain of low quality. Sixty studies were retrieved and evaluated for potential inclusion in this study. Four studies met the inclusion criteria. Three were of cross-sectional survey design and one of direct observational design.Conclusions: Uptake of universal precautions remains low despite known benefits. Lack of time, resources and lack of knowledge have been shown as being factors negatively influencing healthcare workers compliance with universal precautions.This paper also highlights the issues surrounding the inclusion of low grade evidence in systematic literature reviews and the implications of reviews including low grade evidence on practice.Type of article: Research paperKeywords: systematic review, universal precautions, standard precautions, compliance, healthcare worker.

Harnessing the potential of community-based participatory research approaches in bipolar disorder

BACKGROUND: Despite the rapid growth in the sophistication of research on bipolar disorder (BD), the field faces challenges in improving quality of life (QoL) and symptom outcomes, adapting treatments for marginalized communities, and disseminating research insights into real-world practice. Community-based participatory research (CBPR)-research that is conducted as a partnership between researchers and community members-has helped address similar gaps in other health conditions. This paper aims to improve awareness of the potential benefits of CBPR in BD research. METHODS: This paper is a product of the International Society for Bipolar Disorders (ISBD) Taskforce on Community Engagement which includes academic researchers, healthcare providers, people with lived experience of BD, and stakeholders from BD community agencies. Illustrative examples of CBPR in action are provided from two established centres that specialize in community engagement in BD research: the Collaborative RESearch Team to study psychosocial issues in BD (CREST.BD) in Canada, and the Spectrum Centre for Mental Health Research in the United Kingdom. RESULTS AND DISCUSSION: We describe the philosophy of CBPR and then introduce four core research areas the BD community has prioritized for research: new treatment approaches, more comprehensive outcome assessments, tackling stigma, and enhanced understanding of positive outcomes. We then describe ways in which CBPR is ideal for advancing each of these research areas and provide specific examples of ways that CBPR has already been successfully applied in these areas. We end by noting potential challenges and mitigation strategies in the application of CBPR in BD research. CONCLUSIONS: We believe that CBPR approaches have significant potential value for the BD research community. The observations and concerns of people with BD, their family members, and supports clearly represent a rich source of information. CBPR approaches provide a collaborative, equitable, empowering orientation to research that builds on the diversity of strengths amongst community stakeholders. Despite the potential merits of this approach, CBPR is as yet not widely used in the BD research field, representing a missed opportunity.

An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study

Background

Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed.

Methods

The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data.

Results

The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices.

Conclusion

The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.