New forms of organising : changing structures, processes and boundaries in a public sector institution

Globalisation, deregulation, privatisation, and advances in communications technologies have intensified competition and impacted on the structures, processes and boundaries that define organisations. Increased competition at both the local and global level calls for increased responsiveness and flexibility, and continuous improvement and innovation. As organisations endeavour to become more attentive and responsive to environmental trends, and customer needs and expectations, they are experimenting with different forms of organising. This has included flattening structures, devolving decision-making responsibility and encouraging greater collaboration and knowledge transfer across functional areas.

The William Angliss Institute of TAFE operates in the post-secondary sector which has experienced significant changes over the past decade as a result of: wide-ranging public sector reforms imposed by successive governments; budgetary cutbacks; accountability and performance improvement pressures; increased national and international competition, industrial relations changes and more demanding, sophisticated customers. This paper draws on the INNFORM Study's three organisational design dimensions of structure, process, and boundaries to examine the nature and degree of change that has taken place at the Institute. Case study findings indicate that while William Angliss has implemetted changes across the three design dimensions, the depth and breadth of these vary and this has impacted on overall performance outcomes. Its experience suggests that even when an organisation adopts a systemic approach and implements changes simultaneously across structure, process and boundaries, optimal performance benefits will not accrue unless these elemental changes are mutually reinforcing and complementary. It also suggests that improvement to processes, particularly communications and human resources practices must be an overarching consideration, as complementary change across all three design dimensions depends ultimately on the contribution and commitment organisational members are prepared to make.

A gaze through the lens of decision theory toward knowledge translation science

Research findings become evidence when an individual decides that the information is relevant and useful to a particular circumstance. Prior to that point, they are unrelated facts. For research translation to occur, research evidence needs filtering, interpretation, and application by individuals to the specific situation. For this reason, decision science is complementary to knowledge translation science. Both aim to support the individual in deciding the most appropriate action in a dynamic environment where there are masses of uncensored and nonprioritized information readily available. Decision science employs research theories to study the cognitive processes underpinning the filtering and integration of current scientific information into changing contexts. Two meta-theories, coherence and correspondence theories, have been used to provide alternative views and prompt significant debate to advance the science. The aim of this article is to stimulate debate about the relationship between decision theory and knowledge translation. Discussed is the critical role of cognition in clinical decision making, with a focus on knowledge translation. A critical commentary of the knowledge utilization modeling papers is presented from a decision science perspective. The article concludes with a discussion on the implications for knowledge translation when viewed through the lens of decision science.

Preparing Australia's future lawyers: an exposition of changing values over time in the context of teaching about ethical dilemmas

This study investigated what values may be influential to decision making in relation to ethical behaviour for early career lawyers. It adopted a longitudinal approach to investigate how values develop or degrade over time as final year law students move into their first two years of employment or further study. To this end, the study investigated the role that tertiary education and employers fulfill in building and perpetuating ‘appropriate’ professional values? Results demonstrate that, in general, ethical behaviour was not uniformly reinforced over time in the workplace. The undertaking of pro bono work stands out here. Results suggested that certain behaviour relevant values may develop or degrade over the early years of the Australian lawyer's career. The implications of results are discussed in the contexts of ethics education in a tertiary context and the continuing education and regulation of the legal profession.

Decision-making models used by `graduate nurses` managing patients` medications

Background. Nurses in a graduate programme in Australia are those who are in the first year of clinical practice following completion of a 3-year undergraduate nursing degree. When working in an acute care setting, they need to make complex and ever-changing decisions about patients' medications in a clinical environment affected by multifaceted, contextual issues. It is important that comprehensive information about graduate nurses' decision-making processes and the contextual influences affecting these processes are obtained in order to prepare them to meet patients' needs.
Aim. The purpose of this paper is to report a study that sought to answer the following questions: What are the barriers that impede graduate nurses' clinical judgement in their medication management activities? How do contextual issues impact on graduate nurses' medication management activities? The decision-making models considered were: hypothetico-deductive reasoning, pattern recognition and intuition.
Methods. Twelve graduate nurses who were involved in direct patient care in medical and surgical wards of a metropolitan teaching hospital located in Melbourne, Australia participated in the study. Participant observations were conducted with the graduate nurses during a 2-hour period during the times when medications were being administered to patients. Graduate nurses were also interviewed to elicit further information about how they made decisions about patients' medications.
Results. The most common model used was hypothetico-deductive reasoning, followed by pattern recognition and then intuition. The study showed that graduate nurses had a good understanding of how physical assessment affected whether medications should be administered or not. When negotiating treatment options, graduate nurses readily consulted with more experienced nursing colleagues and doctors.
Study limitations. It is possible that graduate nurses demonstrated a raised awareness of managing patients' medications as a consequence of being observed.
Conclusions. The complexity of the clinical practice setting means that graduate nurses need to adapt rapidly to make sound and appropriate decisions about patient care.

Building information modelling project decision support framework

Building Information Modelling (BIM) is an information technology [IT] enabled approach to managing design data in the AEC/FM (Architecture, Engineering and Construction/ Facilities Management) industry. BIM enables improved interdisciplinary collaboration across distributed teams, intelligent documentation and information retrieval, greater consistency in building data, better conflict detection and enhanced facilities management. Despite the apparent benefits the adoption of BIM in practice has been slow. Workshops with industry focus groups were conducted to identify the industry needs, concerns and expectations from participants who had implemented BIM or were BIM “ready”. Factors inhibiting BIM adoption include lack of training, low business incentives, perception of lack of rewards, technological concerns, industry fragmentation related to uneven ICT adoption practices, contractual matters and resistance to changing current work practice. Successful BIM usage depends on collective adoption of BIM across the different disciplines and support by the client. The relationship of current work practices to future BIM scenarios was identified as an important strategy as the participants believed that BIM cannot be efficiently used with traditional practices and methods. The key to successful implementation is to explore the extent to which current work practices must change. Currently there is a perception that all work practices and processes must adopt and change for effective usage of BIM. It is acknowledged that new roles and responsibilities are emerging and that different parties will lead BIM on different projects. A contingency based approach to the problem of implementation was taken which relies upon integration of BIM project champion, procurement strategy, team capability analysis, commercial software availability/applicability and phase decision making and event analysis. Organizations need to understand: (a) their own work processes and requirements; (b) the range of BIM applications available in the market and their capabilities (c) the potential benefits of different BIM applications and their roles in different phases of the project lifecycle, and (d) collective supply chain adoption capabilities. A framework is proposed to support organizations selection of BIM usage strategies that meet their project requirements. Case studies are being conducted to develop the framework. The results of the preliminary design management case study is presented for contractor led BIM specific to the design and construct procurement strategy.

The complexity of social practice : understanding inertia and change in maternity care organizations

Beyond the limited efficiency and economy goals of neoliberal health policy lies the promise of genuine health services reform. In maternity care in particular, recent policy developments have sought to make the management of birth more ‘women-centred and family-friendly’. Interprofessional collaboration and greater consumer participation in policy and decision-making are key means to achieve this goal, but changing the entrenched system of medicalised birth remains difficult. Recent social contestation of maternity care has destabilised but not eradicated pervasive medical hegemony. Further reform requires analysis both of institutionalised patterns of power, and attention to the fluidity and situated knowledge shaping organisational and professional practices. Accordingly, this paper outlines a framework with which to explore the multi-layered social processes involved in implementing organisational and cultural change in maternity care. Analysis of social interventions in health systems, we suggest, can be advanced by drawing on strands from critical organization studies, complexity and critical discourse theories and social practice approaches.

Lawyers and ethics in practice : the impact of clinical and ethics curricula on lawyers’ ethical decision-making

The authors have conducted a longitudinal study exploring the relationships between values and ethical behaviour for early-career legal practitioners. The study comprised a representative Australian cohort of final-year law students and tracked them through their first two years of employment or further study. It examined changes to ethical decision-making by presenting participants with hypothetical scenarios that provided ethical dilemmas. A questionnaire utilising hypothetical situations was presented in 11 scenarios. This chapter examines responses to the scenarios across the three years of the study, particularly exploring changes over time. Of particular interest were the effects of gender and prior ethics education on changing responses. Findings suggested significant differences between males and females in their ethical responses. They also suggested that involvement in clinical practice, in particular during the law degree, may have a positive impact on future willingness to assist access to justice (insofar as such lawyers were more inclined to participate in later pro bono activity).

Medical error and decision making : learning from the past and present in intensive care

Background : Human error occurs in every occupation. Medical errors may result in a near miss or an actual injury to a patient that has nothing to do with the underlying medical condition. Intensive care has one of the highest incidences of medical error and patient injury in any specialty medical area; thought to be related to the rapidly changing patient status and complex diagnoses and treatments.

Purpose : The aims of this paper are to: (1) outline the definition, classifications and aetiology of medical error; (2) summarise key findings from the literature with a specific focus on errors arising from intensive care areas; and (3) conclude with an outline of approaches for analysing clinical information to determine adverse events and inform practice change in intensive care.

Data source : Database searches of articles and textbooks using keywords: medical error, patient safety, decision making and intensive care. Sociology and psychology literature cited therein.

Findings : Critically ill patients require numerous medications, multiple infusions and procedures. Although medical errors are often detected by clinicians at the bedside, organisational processes and systems may contribute to the problem. A systems approach is thought to provide greater insight into the contributory factors and potential solutions to avoid preventable adverse events.

Conclusion : It is recommended that a variety of clinical information and research techniques are used as a priority to prevent hospital acquired injuries and address patient safety concerns in intensive care.

Changing perspectives : teaching and learning centres’ strategic contributions to academic development in Australian higher education

This article reports on a study of Australian teaching and learning centres to identify factors that contribute to their effective strategic leadership. These centres remain in a state of flux, with seemingly endless reconfiguration. The drivers for such change appear to lie in decision makers’ search for their centres to add more strategic value to organisational teaching, learning and the student experience. Through a synthesis of findings based on interviews, a survey of directors of centres and focus groups, the article identifies paradigmatic shifts in the ways centres see themselves, relate to their organisations and respond to external environmental forces. From an understanding of paradigm shifts, strategic contributions to academic development in the sector are framed organisationally through key points of leverage. Points of leverage are manageable actions that can be taken to maximise overall institutional impact and effectiveness.

Changing teaching practice using a school improvement cycle

This paper discusses the actions, strategies and responses of teachers during their involvement with a short cycle school improvement model in four schools. The school improvement cycles are designed to build the leadership of principals to support teachers at an individual level through a web of decision making and practices. In these cycles, teachers are both more supported and more accountable for implementing changed classroom practices in order to bring about improved student outcomes. T he school improvement model follows a pattern of decision making and negotiation across and between layers of leadership within the network and the school, but for improvement to occur at the level of the student, the teacher’s pedagogical practices need to be r(e)negotiated to ensure that teaching practice meet the needs of the students.
However, evaluating teacher practice is risky business. Teachers can say, and believe, that their practices are providing the best for their students, but this is an area of uncertainty. Using a number of strategies including observation of teacher meetings, teacher interviews and video capture, the research will investigate the issue of how directives for change are translated into classroom practice. The observation of meetings of teachers will provide an indication of the type of change required and the proposed strategies. Video-capture, which is followed by teacher interviews, will provide further information about changing teaching practice.
With teacher permission, students in the research will also view the video snippets to indicate what particular pedagogy was instrumental in their learning, providing substantial feedback to the teacher on what works best for that cohort of students at that time. Teachers will be provided with the opportunity to reflect on and learn from their practice, using video-capture as a self-reflective tool. Teachers can employ video capture as a strategy to assess their management of students, their pedagogical approaches, teaching strategies and student responses and is an emerging area of research of interest to teachers and teacher educators (e.g. Seidel, Sturmer, Blomberg, Kobarg, Schwindt, 2011). The paper will provide examples of changed teacher practice through vignettes of a number of schools, teachers and classrooms and will explore the methodological reflexivity associated with this dual role of the research: to evaluate, and to support improvement.

The succession decision in Chinese–Australian family businesses : an exploratory study

This article explores the factors used to make succession choices as ethnic Chinese family business founders integrate into their host country, Australia. An empirical study of six Chinese–Australian family businesses was used to analyse what factors influence the succession decision-making process. Results show three broad factors influenced the founders’ decisions, including the aspirations and visions of the business founders, cultural and individual values shaped in the integration process, and the options that are available for succession. Findings challenge the anticipated option of intergenerational succession, with its emphasis on family-oriented collectivistic values as expectations. It provides future support for considering how the cultural value orientation (collectivistic, individualistic, or transitional) has impacted on the founder’s succession choices. Further research is required to understand how the flexible, changing, situational founder’s succession intentions are manifested among family businesses in cultural transition.

Assumptions of decision-making capacity: the role supporter attitudes play in the realisation of Article 12 for people with severe or profound intellectual disability

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) was the first legally binding instrument explicitly focused on how human rights apply to people with disability. Amongst their obligations, consistent with the social model of disability, the Convention requires signatory nations to recognise that “…persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life” and mandates signatory nations to develop “…appropriate measures to provide access by persons with disability to the support they may require in exercising their legal capacity”. The Convention promotes supported decision-making as one such measure. Although Australia ratified the UNCRPD in 2008, it retains an interpretative declaration in relation to Article 12 (2, 3, 4), allowing for the use of substituted decision-making in situations where a person is assessed as having no or limited decision-making capacity. Such an outcome is common for people with severe or profound intellectual disability because the assessments they are subjected to are focused on their cognition and generally fail to take into account the interdependent nature of human decision-making. This paper argues that Australia’s interpretative declaration is not in the spirit of the Convention nor the social model of disability on which it is based. It starts from the premise that the intention of Article 12 is to be inclusive of all signatory nations’ citizens, including those with severe or profound cognitive disability. From this premise, arises a practical need to understand how supported decision-making can be used with this group. Drawing from evidence from an empirical study with five people with severe or profound intellectual disability, this paper provides a rare glimpse on what supported decision-making can look like for people with severe or profound intellectual disability. Additionally, it describes the importance of supporters having positive assumptions of decision-making capacity as a factor affecting supported decision-making. This commentary aims to give a focus for practice and policy efforts for ensuring people with severe or profound cognitive disability receive appropriate support in decision-making, a clear obligation of signatory nations of the UNCRPD. A focus on changing supporter attitudes rather than placing the onus of change on people with disability is consistent with the social model of disability, a key driver of the UNCRPD.

Evaluation of deterministic and complex analytical hierarchy process methods for agricultural land suitability analysis in a changing climate

Land suitability analysis is employed to evaluate the appropriateness of land for a particular purpose whilst integrating both qualitative and quantitative inputs, which can be continuous in nature. However, in agricultural modelling there is often a disregard of this contiguous aspect. Therefore, some parametric procedures for suitability analysis compartmentalise units into defined membership classes. This imposition of crisp boundaries neglects the continuous formations found throughout nature and overlooks differences and inherent uncertainties found in the modelling. This research will compare two approaches to suitability analysis over three differing methods. The primary approach will use an Analytical Hierarchy Process (AHP), while the other approach will use a Fuzzy AHP over two methods; Fitted Fuzzy AHP and Nested Fuzzy AHP. Secondary to this, each method will be assessed into how it behaves in a climate change scenario to understand and highlight the role of uncertainties in model conceptualisation and structure. Outputs and comparisons between each method, in relation to area, proportion of membership classes and spatial representation, showed that fuzzy modelling techniques detailed a more robust and continuous output. In particular the Nested Fuzzy AHP was concluded to be more pertinent, as it incorporated complex modelling techniques, as well as the initial AHP framework. Through this comparison and assessment of model behaviour, an evaluation of each methods predictive capacity and relevance for decision-making purposes in agricultural applications is gained.