Acceptability, impact and sustainability of the national pilot quality assurance system for self management programs

Chronic condition self-management education and training interventions such as the Stanford Self Management Programs (SMP) have the capacity to improve health and quality of life of people with chronic conditions whilst reducing the use of health services. This is in line with the outcomes from the recent Council of Australian Governments’ meeting where it was indicated that self-management will be a centrepiece in forthcoming chronic disease initiatives.
Aim: report on a large national pilot quality assurance program involving the implementation and of an evaluation and quality monitoring system for SMPs including the provision of structured feedback to courses course leaders and service providers. During 2005/06 the quality assurance program was implemented at 11 diverse organisations across Australia. The program involved assisting organisations apply the 42-item Health Education Impact Questionnaire (HEIQ), a chronic disease health education outcome measure, and then observe and evaluate the value and impact of the quality program. Interviews with course leaders (n=60) and course participants (n=35) have elicited views about course quality and feedback processes.
Results: The evaluation revealed enablers and barriers to effective implementation and sustainability. Important enablers were:
- Course Leaders and organisations valued an Australia-wide system that provided feedback on course
quality and the impact on participants.
- Course Leaders were strongly personally motivated to respond appropriately to HEI-Q course
report feedback.
- Completing the questionnaire provided participants with the opportunity to reflect on issues that
emerge in the course content and reflect on their progression at the end of the SSMP.
Sustainability issues included:
- Organisations and course leaders require support, training and flexibility on how to administer and
manage the use of the HEI-Q.
- Availability of administrative resources in organisations to support the quality assurance activities.
- The requirement that course leaders are trained in interpreting HEI-Q course report data.
A quality improvement framework was developed which identified the actions required of key stakeholders to
support effective implementation.
Discussion: With the increasing endorsement of SMP across sectors it is important that course quality is known, is acceptable, and is communicated to stakeholders to inform and engender confidence in the SSMP. To effectively implement and sustain a quality improvement program for SMP, the processes and tools for measuring outcomes need to be responsive, flexible and easily integrated into the organisation and delivery of programs.

Occupational health and safety management systems : system types and effectiveness

The aim of this thesis is to develop a framework to evaluate the relative performance of different types of health and safety management system. This objective is an analytical one, but it stems from a policy issue of public importance. Over the past decade Australia, like other countries, has seen the emergence and growth of interest in developing health and safety management systems. But are they all the same, and if not, do they differ in their effectiveness? The thesis does not seek to give a definitive answer to these questions. Given the novelty of the phenomenon and the lack of research on this subject, the research is exploratory. An hypothesis about the effectiveness of different health and safety management systems is developed rather than tested. The thesis proceeds by first defining health and safety management systems as a combination of the planning and review, the management arrangements, the consultative arrangements and the specific program elements that work together in an integrated way to improve health and safety performance. A research procedure is described involving twenty exploratory case studies. The thesis then - develops - from the literature and the case study research - an analytical framework to evaluate the performance of different health and safety management systems. That framework has two parts. First is a typology of health and safety management systems. This is constructed from two distinctions - between 'safe place' and 'safe person' approaches to health and safety; and between 'innovative' and traditional' management methods and structures. These distinctions yield four types of system. The typology was applied to the case studies which yielded a reasonable fit in most instances. The second part of the framework is a 'process evaluation' technique akin to Quality standards. Derived from the Victorian SafetyMAP audit criteria, the "e;process evaluation tool "e; is preferred to traditional outcome measures such as incident or claim rates. Using this measure, the twenty case study enterprises were classified as above average, average or below average in performance. These results correlated poorly with traditional incident trend and benchmark measures. The two elements of the framework are then combined to explore the relationship between the different types of system and their performance. Evidence from the twenty case studies showed a tendency for innovative/safe place firms to perform better than traditional/safe person firms. This finding can form the basis for a hypothesis that may be subject to statistical testing on a generalisable sample. In addition five 'best practice' cases were selected and subjected to a cross case analysis to search for common characteristics that might explain their performance. This analysis suggests the importance of a number of factors: senior managers who drive health and safety change and mobilise all possible resources in the pursuit of change; health and safety representatives who work with managers in a 'joint regulatory relationship' across system activities; the involvement of employees more generally, but not as a substitute for action by managers and health and safety representatives; a comprehensive approach to elimination of all hazards; and the introduction of innovative programs to continually improve systems and facilitate employee involvement in health and safety.

Improve construction knowledge management system by using the soft system methodology

The construction industry has a poor record in the management of its knowledge and results into huge wastage of resources and detrimental effect to quality. Research has shown that data and information management system plus knowledge management are a critical part of today's project management practice for construction projects. Few people will deny that 'quality information' and 'useful knowledge' are extremely important to any decision-making. However, the current processes of handling information and knowledge in the construction industry and increasingly costly. One of the major reasons is the nature of this industry is not conducive to good knowledge management and the traditional data/information systems used in the industry has long been critisized. It is very common that information is often duplicated, inconsistent and not current. In turn, making knowledge becomes difficult to manage properly. Project managers have in the past found it very difficult to source and analyse data in order to make sound decisions. This paper is part of a doctoral research project which summarizes three exploratory surveys; namely ERP system, Partnering strategy and Leadership impact of a knowledge management system in a construction company. Those findings are described by using the Soft Systems Methodology (SSM) which later becomes the basis for actions research. SSM is useful to reveal complexities of the knowledge management situations that occur in construction industry. The first stage was to conduct interviews of the different practices in knowledge and reporting process. Then, the SSM rich picture was developed to present the problematic areas including difficulties in inputting data to enable the knowledge platform in place. The research then develops root definition and CATWOE, and a conceptual model was formed. Interviewees were conducted with structured questions to identify prioritized actions and activities that can be undertaken to improve and manage the knowledge platform.

Occupational safety and health management systems in Australia: barriers to success

The growing popularity of occupational safety and health management systems in Australia has stimulated critical debate about their effectiveness. This paper asks whether the performance of such systems lives up to expectations. Making use of a research review and an extensive interviewing programme, the paper draws several conclusions. First, it observes that the definitional requirements for an occupational safety and health management system have been watered down, making it more likely that organisations can claim to have a system, but less likely that it will be effective. Second, a review of empirical research reinforces the view that systems can improve health and safety outcomes, but only if they meet strict conditions concerning senior management commitment, effective workforce involvement and programme integration. Third, several barriers to successful implementation are identified, including the failure to meet essential success factors, the inappropriate application of audit tools to ensure compliance, and their problematic application in certain sectors such as small business, contractors, and the part-time and temporary workforce. The paper concludes that occupational safety and health management systems can live up to their promise, but often fail to do so because of inadequate implementation or application in hostile environments.

Implementation of a quality care management system for patients with arthritis of the hip and knee

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.

What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting.

What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative.

What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.

An investigation of scale economies and quality issues in the teaching and management of large subjects

Many in the tertiary education system have had concerns with the issues surrounding the teaching of large classes, including teaching quality and whether there are effective learning outcomes for students. An issue closely related to quality is the cost of providing an efficacious education system. It is a common perception that large classes are economical to run and small subjects are not. As with any complex issue there are several perspectives that could be utilised, the needs of the institution, the teaching staff, the community or the students, and whether or not these needs are being met.

This study aims to assess whether universities are meeting the needs of students in large marketing classes. For this purpose the study investigates the application of selfdetermination theory and psychological needs satisfaction. The basic needs scale, comprising of three constructs; Control, Competence and Caring was adapted and used to evaluate students' perception of an introductory marketing subject.

The study used a multi-method approach consisting of a literature review, a qualitative phase involving in-depth interviews and focus groups. A survey of 366 students who had undertaken an introductory level marketing subject in a large class format was also conducted. The results show that the psychological needs satisfaction of many students are not being fully realised. It was also found that marketing degree students enjoyed the challenges and were more stimulated by the subject (than students in other degree streams). The higher achieving students enjoyed the challenge of the subject more than the lower achieving students. The implications of these findings and suggestions for
further investigation are discussed.

Environmental management system and electronic communication : Is it the need of the hour?

Implementation and certification of Environmental Management Systems (EMS) is a reality for many businesses. Communication with an organisation’s stakeholders is a required element of any EMS. In the last five years companies have steadily moved towards integrating their different management systems, such as quality, environmental, and occupational health and safety, in an attempt to reduce their costs and increase efficiency. Legislation requires extensive reporting in each of these areas, so compliance is another important driver. During this period, communication by digital technology, or electronic communication, has gained prominence and acceptance amongst all groups of people including businesses primarily as a means to disseminate crucial EMS information to geographically diverse employees in a cost effective and instantaneous manner. Some perspectives have emerged to suggest that change processes in organisations may be hindered or helped in various ways through the application of digital technology in EMS. There are, however, gaps in the literature that document the impact and effectiveness of electronic communication amongst EMS stakeholders. In this paper we will discuss employees as one of the major stakeholders and whether the move to electronic communication has been assisting or hindering transformations in awareness and understanding of issues amongst employees. We highlight opportunities and challenges presented by an increased use of electronic communication in light of the environmental and climate change debates, which underpin EMS.

Strategic facilities management system in relation with building performance; the significance and relationship

Healthcare design frequently involves complex concepts that are difficult to measure and evaluate because the building require a modern, quality, functional and therapeutic environment. For this specific reason, facilities management has become a very important support system to ensure smoothness in healthcare business. Facilities management in healthcare building is a complicated system involving multiple layers of administrative division and sub-divisions. Building performance such as building impact, function and quality prove to have significant impact on strategic facilities management. This paper will do an extensive review of strategic healthcare business management as a holistic approach and examine how facilities management can effectively manage their division with consideration and understanding of building performance. The correlation between strategic facilities management and building performance will be identified and a framework for strategic FM system with regards to building performance will be developed.

Environmental management system adoption by Australasian organisations: part 1: reasons, benefits and impediments

The decision to adopt environmental management system (EMS) and to develop effective implementation strategies has engrossed managers at all levels and in all types of organisations in recent years. Some organisations have claimed that environmental issues have been determining their  bottom-line and business performance in the market place. This paper is first part in the series focussing on the reasons for EMS implementation and the benefits and impediments associated with the process. Measures  commonly practised by organisations to overcome/address the  impediments are also presented in this paper. The findings of this paper are based on a questionnaire survey mailed to Australasian organisations on their experiences with ISO 14001 implementation and certification.

A framework for environmental management system adoption and maintenance : an Australian perspective

Purpose – The purpose of this paper is to present a framework for environmental management system (EMS) adoption which can be used by managers to enable them to achieve a faster, smoother, effective and sustainable EMS implementation. This is termed by the authors as “successful” EMS implementation.
Design/methodology/approach – The framework presented is based on an extensive field study conducted in Australia that included a questionnaire survey and in-depth interviews conducted with practitioners, the results of which have been reported in this and other journals.
Findings – The framework presented covers three distinct phases, namely development, certification and maintenance and continuous improvement. Preliminary assessment of this framework by a group of Australian experts that included four senior managers, one academic and one consultant suggests that this framework is a useful tool for implementing an effective EMS.
Practical implications – Each of the three phases of the framework provides a step-by-step approach and a sequential map towards a successful EMS implementation.
Originality/value – The framework has been developed from extensive fieldwork and has been validated by a group of “experts” which comprised of four industry practitioners, one management academic, and one EMS consultant. The framework provides a detailed understanding of the steps involved in the implementation, certification, and maintenance of EMS.

Integrated management system:the experiences of three Australian organisations

Purpose – Management systems and standards have become a key part of the organisation's lifeline and a prerequisite for survival in the twenty-first century. Systems for quality environmental and occupational health and safety (OHS) now form the three main pillars of the organisation, the fourth one being financial accounting. In light of the increasing pressure and demands from different stakeholders, it is becoming necessary for organisations to adopt the different systems/standards. However, to achieve the benefits from the implementation and subsequently maintenance of these systems it is only a practical and logical step that the existing management systems/standards be integrated into a single system.

Design/methodology/approach – This paper presents the experiences of three Australian-based organisations that have successfully undertaken the integration of their management systems/standards. Data for this paper were collected through in-depth interviews conducted with the managers responsible for quality, environment and OHS systems.

Findings – The interviews revealed a number of quantifiable and unquantifiable benefits experienced by the companies from operating one integrated system, such as saving of dollars, better utilisation of resources and improved communication across the organisation, to name a few. However, for the benefits to be realized it is essential that organisations are aware of the challenges and obstacles accompanying integration of systems/standards. If these challenges are not addressed early in the process they can delay the completion of the integration process.

Originality/value – Recommendations for other organisations contemplating integrating their management system include: obtaining commitment from the top management; having adequate resources to integrate the systems; having communication and training across the organisation in aspects of integration; and, last but not the least, having integrated audits. Implementation of these recommendations may vary from one organisation to another; however, it would result in lesser resistance for the organisations following them.

Analysis of stamping production data with view towards quality management

A quality analysis trial was undertaken at Ford Geelong Stamping Plant on a press line that was fitted with standard press sensors to measure press and binder force over the stamping cycle for each panel. The quality of randomly sampled panels was measured by obtaining the panel thicknesses at five points, for 135 panels in total. These points were chosen such that they exhibited different forming modes. This paper analyses the input force data and the output quality data from the trial to determine any potential relationships. The analysis of the production data was performed using statistical correlation techniques to determine initial potential relationships between input and output variables. An Active Shape Model was used to extract features when identifying the major sources of variation within the input data. However, the initial analysis of the data elicited no direct relationship between the input variables measured and the panel thicknesses. This result is significant as the data collected is from a standard sensor configuration found in many press lines through-out the world. The reason for the lack of a direct relationship is believed to come from the lack of sensitivity in the force measurements which are not able to identify small changes in the process, whereas gross geometric variations have in previous studies shown an obvious relationship with changes in the force press profile. This means that existing force sensors require augmentation by additional sensors if a detailed automatic quality control system for the press lines based on input sensors alone.