Managing Indian IT professionals for global competitiveness: the role of human resource practices in developing knowledge and learning capabilities for innovation

Little is known about how human resource practices contribute towards the competitiveness of people based-knowledge intensive organisations in developing countries. This paper examines the role of human resource practices in developing knowledge and learning capabilities for innovation in the Indian information technology services sector. The study draws from the experience of a sample of 11 of the largest information technology service providers (ITSPs) in India and is based on in-depth interviews. The main finding suggests that the talent management architecture of ITSPs that comprises human resource practices and the development of knowledge and learning capabilities is the main drivers of innovation. A conceptual framework showing the link between human resource practices, knowledge and learning capabilities and innovation of ITSPs is developed followed by the limitations of the study and avenues for future research.

Exploring in-hospital adverse drug events using ICD-10 codes

 Abstract
Objective Adverse drug events (ADEs) during hospital admissions are a widespread problem associated with adverse patient outcomes. The ‘external cause’ codes in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) provide opportunities for identifying the incidence of ADEs acquired during hospital stays that may assist in targeting interventions to decrease their occurrence. The aim of the present study was to use routine administrative data to identify ADEs acquired during hospital admissions in a suburban healthcare network in Melbourne, Australia.

Methods Thirty-nine secondary diagnosis fields of hospital discharge data for a 1-year period were reviewed for ‘diagnoses not present on admission’ and assigned to the Classification of Hospital Acquired Diagnoses (CHADx) subclasses. Discharges with one or more ADE subclass were extracted for retrospective analysis.

Results From 57 205 hospital discharges, 7891 discharges (13.8%) had at least one CHADx, and 402 discharges (0.7%) had an ADE recorded. The highest proportion of ADEs was due to administration of analgesics (27%) and systemic antibiotics (23%). Other major contributors were anticoagulation (13%), anaesthesia (9%) and medications with cardiovascular side-effects (9%).

Conclusion Hospital data coded in ICD-10 can be used to identify ADEs that occur during hospital stays and also clinical conditions, therapeutic drug classes and treating units where these occur. Using the CHADx algorithm on administrative datasets provides a consistent and economical method for such ADE monitoring.

What is known about the topic? Adverse drug events (ADEs) can result in several different physical consequences, ranging from allergic reactions to death, thereby posing a significant burden on patients and the health system. Numerous studies have compared manual, written incident reporting systems used by hospital staff with computerised automated systems to identify ADEs acquired during hospital admissions. Despite various approaches aimed at improving the detection of ADEs, they remain under-reported, as a result of which interventions to mitigate the effect of ADEs cannot be initiated effectively.

What does this paper add? This research article demonstrates major methodological advances over comparable published studies looking at the effectiveness of using routine administrative data to monitor rates of ADEs that occur during a hospital stay and reviews the type of ADEs and their frequency patterns during patient admission. It also provides an insight into the effect of ADEs that occur within different hospital treating units. The method implemented in this study is unique because it uses a grouping algorithm developed for the Australian Commission on Safety and Quality in Health Care (ACSQHC) to identify ADEs not present on admission from patient data coded in ICD-10. This algorithm links the coded external causes of ADEs with their consequences or manifestations. ADEs identified through the use of programmed code based on this algorithm have not been studied in the past and therefore this paper adds to previous knowledge in this subject area.

What are the implications for health professionals? Although not all ADEs can be prevented with current medical knowledge, this study can assist health professionals in targeting interventions that can efficiently reduce the rate of ADEs that occur during a hospital stay, and improve information available for future medication management decisions.

Preparing health professionals to work in diabetes education and care: a situation analysis

Worldwide, the increasing prevalence of chronic diseases places enormous expectations of and responsibility on health systems. Preparing the health workforce to adequately respond to these increasing demands is a challenge of critical importance. The aim of this study was to provide an overview of how health professionals (HPs) are prepared to work in diabetes care and education. A one shot cross-sectional study was undertaken to collect the data using self-completed anonymous on-line questionnaires. The invitation to complete the questionnaire was sent to more than 3745 HPs. One thousand one hundred and sixteen responses were collected, 68% were from highincome countries and 32% from middle- and low-income countries (LMIC). Most HPs developed their knowledge and skills through work experience and self-study: very few attended a formal education program as part of their training. Thirty-six percent of LMIC respondents did not have a credential/certification in diabetes and 72% reported their organizations support them to learn about diabetes education/care. Moreover, 80% referred to the International Diabetes Federation publications when making clinical decisions or planning diabetes care. Results provide insight into how HPs are educationally prepared to work in diabetes education and care and could serve as a foundation for future research. These findings emphasize the emerging necessity to develop certified/credentialing programs for HPs, especially in LMIC.

Preparing for the future: ageing and alternative and augmentative communication

Despite a large body of literature focusing on how the normal aging process affects quality of life, little is known about how aging influences the lives of those who use alternative and augmentative communication (AAC). This article explores issues relevant to aging and AAC, examining the responses of 78 augmented communicators aged 30 years and older who participated in a larger national survey of 270 adults with cerebral palsy. The survey sought information about health, modes of communication, and access to information. The results indicate that those involved in the AAC field must work with individuals who use augmentative communication to ensure that they maintain their health, well-being, and effective communication as they age.

Depression therapy: Future prospects.

Current biological approaches to the treatment of depression focus mainly on modification of monoaminergic neurotransmission. New agents targeting these neurotransmitters are under development. Many novel antidepressant targets are however under investigation. These include the neurokinins, glutamate, purinoceptors, opioids and trophic factors. While many of these potential targets are likely to fail clinical development, exciting novel therapeutic options are likely to emerge.

Self-reported access to and quality of healthcare for diabetes : Do the severely obese experience equal access?

Background: Given reported pejorative views that health professionals have about patients who are severely obese, we examined the self-reported views of the quality and availability of diabetes care from the perspective of adults with type 2 diabetes (T2DM), stratified by body mass index (BMI). Methods: 1795 respondents to the Diabetes MILES - Australia national survey had T2DM. Of these, 530 (30%) were severely obese (BMI ≥35 kg/m2) and these participants were matched with 530 controls (BMI <35 kg/m2). Data regarding participants' self-reported interactions with health practitioners and services were compared. Results: Over 70% of participants reported that their general practitioner was the professional they relied on most for diabetes care. There were no betweengroup differences in patient-reported availability of health services, quality of interaction with health practitioners, resources and support for selfmanagement, or access to almost all diabetes services. Discussion: Participants who were severely obese did not generally report greater difficulty in accessing diabetes care.

Views of women and health professionals on mHealth lifestyle interventions in pregnancy: a qualitative investigation

BACKGROUND: Evidence suggests that women are failing to meet guidelines for nutrition, physical activity, and weight gain during pregnancy. Interventions to promote a healthy lifestyle in pregnancy demonstrate mixed results and many are time and resource intensive. mHealth-delivered interventions offer an opportunity to provide trusted source information in a timely and cost-effective manner. Studies regarding women's and health professionals' views of mHealth in antenatal care are limited.

OBJECTIVE: This study aimed to explore women's and health professionals' views regarding mHealth information sources and interventions to assist women to eat well, be physically active, and gain healthy amounts of weight in pregnancy.

METHODS: A descriptive qualitative research approach employed focus groups and in-depth interviews with 15 pregnant or postpartum women and 12 in-depth interviews with health professionals including two from each category: obstetricians, general practitioners, midwives, dietitians, physiotherapists, and community pharmacists. All interviews were transcribed verbatim and thematically analyzed.

RESULTS: Women uniformly embraced the concept of mHealth information sources and interventions in antenatal care and saw them as central to information acquisition and ideally incorporated into future antenatal care processes. Health professionals exhibited varied views perceiving mHealth as an inevitable, often parallel, service rather than one integrated into the care model. Four key themes emerged: engagement, risk perception, responsibility, and functionality. Women saw their ability to access mHealth elements as a way to self-manage or control information acquisition that was unavailable in traditional care models and information sources. The emergence of technology was perceived by some health professionals to have shifted control of information from trusted sources, such as health professionals and health organizations, to nontrusted sources. Some health professionals were concerned about the medicolegal risks of mHealth (incorrect or harmful information and privacy concerns), while others acknowledged that mHealth was feasible if inherent risks were addressed. Across both groups, there was uncertainty as to who should be responsible for ensuring high-quality mHealth. The absence of a key pregnancy or women's advocacy group, lack of health funds for technologies, and the perceived inability of maternity hospitals to embrace technology were seen to be key barriers to provision. Women consistently identified the functionality of mHealth as adding value to antenatal care models. For some health professionals, lack of familiarity with and fear of mHealth limited their engagement with and comprehension of the capacity of new technologies to support antenatal care.

CONCLUSIONS: Women exhibited positive views regarding mHealth for the promotion of a healthy lifestyle in antenatal care. Conversely, health professionals expressed a much wider variation in attitudes and were more able to identify potential risks and barriers to development and implementation. This study contributes to the understanding of the opportunities and challenges in developing mHealth lifestyle interventions in antenatal care.

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.

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.

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.

Future predictions of body mass index and overweight prevalence in Australia, 2005-2025

To predict current and future body mass index (BMI) and prevalence of overweight and obesity in Australian children and adults based on sex, age and year of birth (cohort). These predictions are needed for population health planning and evaluation. Data were drawn from 11 cross-sectional national or state population surveys conducted in Australia between 1969 and 2004. These included representative population samples of children (n= 27,635) and adults (n= 43,447) aged 5 years or older with measured height and weight data. Multiple linear regression analyses of measured log-transformed BMI data were conducted to determine the independent effects of age and year of birth (cohort) on ln(BMI) for males and females, respectively. Regression coefficients for cohort obtained from these analyses were applied to the National Nutrition Survey 1995 data set to predict mean BMI and prevalence of overweight (BMI 25-29.99 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)) in 2005, 2015 and 2025. Based on past trends, BMI is predicted to continue to increase for both males and females and across the age span. This would result in increases in the prevalence of overweight and obesity of between 0.4 and 0.8% per year, such that by 2025 around one-third of 5-19 year olds will be overweight or obese as will 83% of males and 75% of females aged 20 years and over. The increases in prevalence and mean BMI predicted in this study will have significant impacts on disease burden, healthcare costs and need for prevention and treatment programmes.

End of life care - the importance of advance care planning

Background: Communication about end of life care may involve difficult conversations for patients, family members and health professionals. However, a lack of understanding of a person's wishes about their future care may result in a loss of dignity for the person, and additional distress for their family members and health professionals and burden to the healthcare system. Objective: This article discusses the barriers to advance care planning and provides some guidance for the general practitioner in undertaking advance care planning with patients and their families. Tips for initiating end of life discussions with patients and families utilising the 'PREPARED' acronym, and ensuring appropriate care delivery are included. Discussion: Involving patients and their family members in advance care planning may be challenging and time consuming for GPs. However, there are a number of resources to support this activity in relation to training, communication support and Medicare item funding.

Building allied health workforce capacity: a strategic approach to workforce innovation

Objective The aim of the present study was to identify areas where allied health assistants (AHAs) are not working to their full scope of practice in order to improve the effectiveness of the allied health workforce.

Methods Qualitative data collected via focus groups identified suitable AHA tasks and a quantitative survey with allied health professionals (AHPs) measured the magnitude of work the current AHP workforce spends undertaking these tasks.

Results Quantification survey results indicate that Victoria’s AHP workforce spends up to 17% of time undertaking tasks that could be delegated to an AHA who has relevant training and adequate supervision. Over half this time is spent on clinical tasks.

Conclusions The skills of AHAs are not being optimally utilised. Significant opportunity exists to reform the current allied health workforce. Such reform should result in increased capacity of the workforce to meet future demands.

What is known about the topic? Increasing skill shortages across Australia’s health workforce necessitates that the capabilities of all healthcare team members should be used optimally. AHA roles are an important and growing response to current health workforce needs. Increasing workforce capacity will ensure the right health workers are matched to the right task by skill, experience and expertise.

What does this paper add? This paper presents a model that assists services to identify tasks suitable for delegation to an AHA by an AHP. The model is unique because it describes a process that quantifies the need for AHAs and it has been successfully implemented in rural, regional and metropolitan health services in Victoria.

What are the implications for practitioners? Working collaboratively, with executive support, will lead to a sustainable and integrated approach to support workforce capacity building. Altering the skill mix of healthcare teams through increasing the role of AHAs has benefits for AHPs, patients and the healthcare system.

A framework for mixed-type multi-outcome prediction with applications in healthcare

Health analysis often involves prediction of multiple outcomes of mixed-type. Existing work is restrictive to either a limited number or specific outcome types. We propose a framework for mixed-type multi-outcome prediction. Our proposed framework proposes a cumulative loss function composed of a specific loss function for each outcome type - as an example, least square (continuous outcome), hinge (binary outcome), poisson (count outcome) and exponential (non-negative outcome). Tomodel these outcomes jointly, we impose a commonality across the prediction parameters through a common matrix-Normal prior. The framework is formulated as iterative optimization problems and solved using an efficient Block coordinate descent method (BCD). We empirically demonstrate both scalability and convergence. We apply the proposed model to a synthetic dataset and then on two real-world cohorts: a Cancer cohort and an Acute Myocardial Infarction cohort collected over a two year period. We predict multiple emergency related outcomes - as example, future emergency presentations (binary), emergency admissions (count), emergency length-of-stay-days (non-negative) and emergency time-to-next-admission-day (non-negative). Weshow that the predictive performance of the proposed model is better than several state-of-the-art baselines.