Patient safety ethics and human error management in ED contexts Part II : Accountability and the challenge to change

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end, patient safety has become the focus of a world-wide endeavour – endorsed by the World Health Organisation – to reduce the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments, of which the Emergency Department is a prime example. In Part I of this article series, an overview of the incidence and impact of preventable adverse events in Emergency Department contexts and the development of the global patient safety movement was presented. In this second article brief attention is given to examining some of the ethical tensions that have arisen in response to the patient safety movement and their possible implications for Emergency Department contexts and staff.

The emotional context of self-management in chronic illness: A qualitative study of the role of health professional support in the self-management of type 2 diabetes

Background: Support for patient self-management is an accepted role for health professionals. Little evidence exists on the appropriate basis for the role of health professionals in achieving optimum self-management outcomes. This study explores the perceptions of people with type 2 diabetes about their self-management strategies and how relationships with health professionals may support this.

Methods: Four focus groups were conducted with people with type 2 diabetes:  two with English speaking and one each with Turkish and Arabic-speaking. Transcripts from the groups were analysed drawing on grounded hermeneutics and interpretive description.

Results: We describe three conceptually linked categories of text from the focus groups based on emotional context of self management, dominant approaches to self management and support from health professionals for self management. All groups described important emotional contexts to living with and self-managing diabetes and these linked closely with how they approached their diabetes management and what they looked for from health professionals. Culture seemed an important influence in shaping these linkages.

Conclusion: Our findings suggest people construct their own individual self-management and self-care program, springing from an important emotional base. This is shaped in part by culture and in turn determines the aims each  person has in pursuing self-management strategies and the role they make available to health professionals to support them. While health professionals'  support for self-care strategies will be more congruent with patients' expectations if they explore each person's social, emotional and cultural circumstances, pursuit of improved health outcomes may involve a careful balance between supporting as well as helping shift the emotional constructs surrounding a patient life with diabetes.

Stimulating vertical integration in coastal management in a federated nation: The case of Australian coastal policy reform.

Four decades ago Australia was credited as being an early leader in  implementing integrated coastal management (ICM). Nevertheless, as a  federation of states and territories Australia has since struggled to fully  implement vertical integration of its coastal governance arrangements. In particular the federal government has historically possessed only a minor role in coastal management despite the recommendations of several major inquires suggesting that this role needed to be enhanced. This article examines a series of circumstances and events over the past two years in Australia that has created the opportunity for the federal government to adopt a more significant and prominent role in coastal management and hence to substantially complete the vertical integration of ICM in Australia. These stimuli for coastal policy reform could also play a role in enhancing ICM in other federated nations.

Performing arts management in a climate of adjustment : case studies from Vietnam and Australia

This paper presents a series of empirical case studies to discuss impacts of economic globalisation on the development of performing arts organisations in Vietnam (Hanoi Youth Theatre and Vietnam National Symphony Orchestra) and Australia (Melbourne Theatre Company and Sydney Symphony Orchestra), and focuses on how Vietnamese organisations have adapted to these changes. The paper also identifies cultural policy implications for the development of the sector; for arts management training in Vietnam so that the sector (and more importantly, the artists) may fully benefit from the open market context. The findings indicate that Vietnamese performing arts organisations have attempted to adapt to the new market context while struggling to balance artistic quality, freedom and financial viability in the new socialist regime. The Australian case studies offered a relevant management model to Vietnamese arts management practice and training.

Entrepreneurship : industry policy priorities and entrepreneurial education in Australia

Four fields of national policy - general economic policy, industry policy, education policy and specific research and development policy - are strongly interrelated. Unfortunately, in Australia, policy makers in the four fields have not recognized that the discipline of Entrepreneurship - with its emphasis on managing the innovation process - holds the key to effective co-ordination between the four vital policy areas. The paper argues that innovation strategy, not cost reduction or research expenditure, is the key to developing successful, export-oriented products and world competitiveness. Viable innovation strategy depends on the relationship between government, capital availability, development capital and industrial developers. In turn, this relationship requires a cadre of entrepreneurial business managers educated not in the 'traditional' MBA mainstream but in the discipline of Entrepreneurship, specifically focused on learning the practical skills involved in venture evaluation and management of the innovation process. The paper concludes by describing the philosophy and performance of Swinburne University of Technology's School of Innovation and Enterprise, a school at the forefront of entrepreneurial education in Australia and thus a school with important implications for the nation's industry policy priorities.

Theories of the policy process in health promotion research: a review

The Ottawa Charter laid the ground work for a new research and practice agenda by urging health promoters to advocate for healthy public policies. After more than 20 years, it is now time to reflect on the state of policy research in health promotion and to examine how rigorously theories are applied. The review of the literature was
conducted on 11 peer-reviewed journals. The journals were selected for their solid track record in publishing health promotion articles and by using a set of predefined
inclusion and exclusion criteria. The articles, published between January 1986 and June 2006, were searched using Medline and CINAHL databases. The selected papers feature search terms related to ‘politics’, ‘policy’, ‘advocacy’ and ‘coalition’. We examined the theoretical grounding of each paper and whether it focuses on policy content (e.g. nature, impact, evolution of the policy), policy processes (e.g. advocacy capacity building and strategies) or theoretical/methodological issues in policy analysis. This review demonstrates that policy research in health promotion is still largely an a theoretical enterprise. Out of the 119 articles that were found eligible, 39 did apply to some degree a theoretical framework, of which 21 referred to a theoretical framework from political science. We conclude that the field has yet to acknowledge critical concepts that would help to shed light on the policy process, and that validated rigorous theoretical frameworks to inform research and practice are hardly applied. Recommendations are formulated to improve policy research in health promotion.

The equipping inclusion studies : assistive technology use and outcomes in Victoria ; key findings and policy implications, study 1 - the equipment study, study 2 - the economic study

Approximately one in five of the Australian population lives with disability (AIHW 2006a; ABS 2003). Of these, almost 1.9 million rely on assistive technologies to live independently (Hobbs, Close, Downing, Reynolds & Walker 2009).

Assistive Technology (AT) is defined as,

‘any device, system or design, whether acquired commercially or off the shelf, modified or customised, that allows an individual to perform a task that they would otherwise be unable to do, or increase the ease and safety with which a task can be performed’ (Independent Living Centres Australia n.d).

‘Assistive Technology solutions’ have been defined as entailing a combination of devices (aids and equipment), environmental modifications (both in the home and outside of it), and personal care (paid and unpaid) (Assistive Technology Collaboration n.d).

Despite a large number of Australians relying on AT, there is little data available about life for these Australians, the extent of AT use, or unmet need for AT. Existing research in Australia suggests that aids and equipment provision in Australia is ‘fragmented’ across a plethora of government and non government programs (AIHW 2006a:35). In Victoria, one of the prime sources of government funding for AT is the Victorian Aids and Equipment Program (VAEP) which is a subsidy program for the purchase of aids and equipment, home and vehicle modifications for people with permanent or long term disability. Recent research suggests that waiting times for accessing equipment through the VAEP are high, as is the cost burden to applicants (Wilson, Wong & Goodridge 2006). In addition, there appears to be a substantial level of unmet need (KPMG 2007).

Additionally, there is a paucity of literature around the economic evaluation of AT interventions and solution packages, resulting in little evidence of their cost-effectiveness credentials.

‘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.

Retribution, deterrence and reform : the dilemmas of plagiarism management in universities

Universities face constant scrutiny about their plagiarism management strategies, policies and procedures. A resounding theme, usually media inspired, is that plagiarism is rife, unstoppable and university processes are ineffectual in its wake. This has been referred to as a 'moral panic' approach (Carroll & Sutherland-Smith, forthcoming; Clegg, 2007) and suggests plagiarism will thwart all efforts to reclaim academic integrity in higher education. However, revisiting the origins of plagiarism and exploring its legal evolution reveals that legal discourse is the foundation for many plagiarism management policies and processes around the world. Interestingly, criminal justice aims are also reflected in university plagiarism management strategies. Although universities strive for deterrence of plagiarism in a variety of ways, the media most often calls for retribution through increasingly tougher penalties. However, a primary aim of the justice system, sustainable reform, is not often reported in the media or visible in university policies or processes. Using critical discourse analysis, this paper examines the disjunction between media calls for increased retribution in the wake of moral panic and institutional responses to plagiarism. I argue that many universities have not yet moved to sustainable reform in plagiarism management.

Towards more integrated natural resource management in Victoria : possible elements of an integrated state-wide policy framework

There is a growing recognition of the complexity of environmental issues and acceptance of the value of more integrated approaches to address them. Evidence of progress with the development of more integrated approaches is however less clear cut. Within this context, this paper explores how a more integrated approach 10 natural resource management at a state government level could be progressed. Using recent experience in Victoria as a focus, this paper provides an overview of environment and natural resources issues confronting the State. highlights why integration is an important element of any response. and outlines the current policy and organisational context. Possible elements of a state-wide policy framework for more integrated natural resource management across a state government organisation are also outlined and discussed.

Tax planning, avoidance and evasion in Australia 1970-2010 : the regulatory responses and taxpayer compliance

This article examines tax avoidance strategies used by Australian taxpayers over the last four decades and analyses the regulatory responses by the government, noting a move away from the ‘command-and-control’ approach of the 1980s towards one of ‘responsive regulation’ and ‘meta risk management’. It is argued that despite inherent complexity issues, this regulatory approach has nevertheless contributed to the fostering of trust and a perception of fairness in the Australian tax system.

An empirical study of BI-based corporate performance management in North America and East Asia

Managing corporate performance is an important yet challenging process. Recently, many enterprises have adopted business intelligence (BI) tools to facilitate more effective corporate performance management. Based on a survey with 290 organizations across North America and East Asia, this paper presents empirical evidence on the key benefits of and barriers to BI-based corporate performance management (CPM). The study reveals that the implementation of BI-based CPM faces multi-dimensional challenges. Organizations in East Asia perceived higher CPM benefits as well as higher CPM barriers than their counterparts in North America. Cultural, economic and environmental differences between the two regions explain these issues. The research findings offer important insights for multinational organizations that are planning or are in the process of implementing or reviewing their BI-based CPM, as well as for consulting companies that are assisting with CPM implementation in different countries.

CSR and water management in the sport sector : a research agenda

Water management and the sport industry’s responsibilities surrounding it have not yet received any attention in the sport management scholarly literature. This research aims to address this oversight by identifying the key issues of corporate social responsibility inherent in water management in the sport sector and suggesting a research agenda. This research paper will present a model of water use in sport in the Australian context, and suggest research methods to further develop an understanding of sustainable water management policy, governance, and stakeholder management in the sport industry.

Multi-owner low-cost housing management in Malaysia : effects of owner-occupant characteristics and occupancy rates

Purpose – Homeownership is considered both economically and socially beneficial for homeowners. However, in the collective living arrangement, reaching a consensus with regard to the residential environment is difficult. The purpose of this paper is to identify factors that can reduce the conflict among the stakeholders in multi-owner low-cost housing in Malaysia.
Design/methodology/approach – This study tested three hypotheses examining whether the demographic and socio-economic characteristics of owner-occupants and occupancy rates affect owner-occupants' satisfaction with stakeholders' relationships. Data were collected through questionnaires from owner-occupants of multi-owner low-cost settlements in Selangor state. Data on housing characteristics were collected from chairpersons of the respective owners' organisations. The data were treated as parametric, and analysis of variance was conducted.
Findings – Four factors – number of children in the family, duration of residency, participation in social activities and participation in meetings – were found to affect owners-occupants' satisfaction with the stakeholders' relationships. The significant effect of occupancy rates was also indicated.
Practical implications – The Management Corporations (MCs) should encourage social relationships among residents. To avoid conflict, the costs and benefits of participation must be balanced. Policy makers should take two key aspects seriously: owner-managed strategy practices by the MCs and high rates of tenant-residents. A mechanism should be identified for assisting the MCs in housing management and for protecting the benefits of homeownership for owner-occupants.
Originality/value – Past studies on low-income household settlements examined public housing or low-income homeowners of single detached dwellings. This study adds to the existing body of knowledge by examining low-income homeowners in multi-owner low-cost settlements.