Improving collaboration between private psychiatrists, the public mental health sector and general practitioners : evaluation of the Partnership Project

Objectives: We describe the evaluation of the Partnership Project, which was designed to improve linkages between public and private sector mental health services. We consider the Project's key elements: a Linkage Unit, designed to improve collaborative arrangements for consumers and promote systems-level and cultural change; and the expansion of private psychiatrists' roles to include supervision and training, case conferencing and secondary consultation. The evaluation aimed to describe the impacts and outcomes of these elements.

Method: The evaluation used de-identified data from the Linkage Unit database, the Project's billing system, and the Health Insurance Commission (HIC). It drew on consultations with key stakeholders (semistructured interviews with 36 key informants, and information from a forum attended by over 40 carers and a meeting of five public sector and three private sector psychiatrists) and a series of case studies.

Results: The Linkage Unit facilitated 224 episodes of collaborative care, many of which had positive outcomes for providers, consumers and carers. It had a significant impact at a systems level, raising consciousness about collaboration and influencing procedural changes. Thirty-two private psychiatrists consented to undertaking expanded roles, and the Project was billed $78 032 accordingly. Supervision and training were most common, involving 16 psychiatrists and accounting for approximately 80% of the total hours and cost. Commonwealth expenditure on private psychiatrists' participation in the expanded roles was not associated with a reduction in benefits paid by the HIC. Key informants were generally positive about the expanded roles.

Conclusions: The Project represented a considered, innovative approach to dealing with poor collaboration between the public mental health sector, private psychiatrists and GPs. The Linkage Unit achieved significant systems-level and cultural change, which has the potential to be sustained. Expanded roles for private psychiatrists, particularly supervision and training, may improve collaboration, and warrant further exploration in terms of costs and benefits.

Public and private psychiatry : can they work together and is it worth the effort?

OBJECTIVE: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative 'shared care' arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems.

METHOD: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area.

RESULTS: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: 'Difficulty communicating' endorsed by 71.4% of public clinicians and 72% of private psychiatrists, 'Confusion of roles and responsibilities' endorsed by 62.9% and 66%, respectively, and 'Different treatment approach' by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors.

CONCLUSIONS: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.

The role and contribution of private land in Victoria to biodiversity conservation and the protected area system

The distribution and attributes of properties involved in three major programs for biodiversity protection on private land in Victoria, Australia, was investigated to determine their role in relation to the reserve system. Overlaying of dowsets in a geographic information system, with particular emphasis on property distribution in relation to bioregional and population centres, was undertaken. Land for Wildlife agreements had greater numbers of properties and total area protected in all bioregions throughout the State, yet average protected area sizes were lower than those of conservation covenants and Trust for Nature reserves. A combination of large bioregional area and human population size tended to attract more private conservation properties and, to a lesser extent, the total area they protected. The potential contribution that such properties made to biodiversity conservation varied between bioregions. Inclusion of properties within a national reserve framework is proposed to improve the coordination and effectiveness of conservation measures.

The meaning of professional excellence for private practitioners in occupational therapy

OT AUSTRALIA's Accredited Occupational Therapist Program is promoted using the message 'Assuring professional excellence'. It is widely assumed that professional excellence is understood. Yet, this concept encompasses complex themes, including competence and clinical reasoning. In this paper, the meaning of professional excellence is examined by investigating the perspectives of private practitioners. Private practitioners were chosen as they represent the diversity of the occupational therapy field, and may pre-empt trends within broader practice. Sixteen key informants were interviewed to obtain their perspectives on professional excellence. Common themes that arose from the findings include the significance of experience in practice, and the importance of understanding one's limitations in knowledge and expertise. Findings are discussed in relation to OT AUSTRALIA's aim to assure standards of practice.

The effect of private school competition on public school performance in Georgia

This article presents estimates of the effect of private school competition on public school performance. Using data on school districts in Georgia, the authors estimate models relating tenth- and third-grade test scores for either reading or mathematics to the level of private school competition. Test scores are not measurably or significantly higher in areas with greater private school competition, a result robust through multiple estimations using three measures of private school competition and a variety of control variables. The authors address the possible endogeneity between test scores and private school competition using instrumental variables estimators, with percentage of the population that is Catholic, county population in 1980, lagged competition, and various other measures as alternative instruments.

Private protected areas? Assessing the suitability for incorporating conservation agreements over private land into the National Reserve System : a case study of Victoria

All Australian governments are committed to the establishment of a  comprehensive, adequate and representative system of conservation  reserves. Many of the most threatened species and communities throughout Australia occur mainly or wholly on private land. A range of mechanisms has been developed to achieve conservation on private land. This article  assesses the legal security, permanence and management intent of such mechanisms in Victoria, in relation to protected area criteria. The  implications of this analysis for the Australian National Reserve System and landowners with these mechanisms on their properties are discussed.

Professional competence for private practitioners in occupational therapy

The aim of the present study was to investigate the meaning of professional competence for occupational therapy private practitioners and their experience of the barriers to professional competence. Semi-structured interviews with 16 key informants from private practice in Victoria elicited diverse opinions and experiences. However, the difficulty of assessing competence, and the lack of standards that identify competent practice for occupational therapy were major themes in the findings. The role of theory in competent practice was evident in discussion but it was not clearly articulated by many participants. Experiences of professional socialisation varied yet participants perceived input from peers as contributing to assuring competence. Major barriers to professional competence were identified as professional isolation, time and finances. The present study highlights the complexity of current attempts to assess professional competence for practising occupational therapists including the implementation of an accreditation program by The Australian Association of Occupational Therapists Inc. (OT AUSTRALIA), the peak body representing occupational therapists.

Integrated governance: a possible solution for a sustainable private sector led development in Bangladesh?

In the quest for 'good governance', the developing countries have embarked on ambitious NPM style market-oriented reform policies mainly advocated by international development agencies (IDA) over the last two decades. Bangladesh has been pursuing decades of market-oriented reforms advocated by IDAs with the prime objectives of achieving an efficient, cost effective service delivery through increased involvement of the private sector. The shift towards marketisation has led to a complex, horizontal and networked structure of partnerships between state and non state actors. The private sector and NOOs are now delivering goods and services which were once the exclusive domain of the state. These changes have however, not been associated with changes in institutional arrangements, safeguards and regulation required to support the private sector led development, which is not sustained independently of the context in which it operates. Using the agriculture input sector as an exemplar, this paper explores the constraints of sustainable private sector led development. The paper argues that the main impediment to private sector led development in this sector centre on lack of good governance. In addition, lack of an integrated market structure, market information, capacity and awareness building are other factors that are inhibiting the private sector led development. We argue that a functional governance model is required in Bangladesh that engages the state, civil society and the private sector to work effectively in a participatory approach to deal with the constraints of private sector led development and for improving good governance.

Institutions and policies for growth and poverty reduction: the role of private sector development

This paper goes over some of the recent discussions on the effects on growth and poverty of institutions and policies, especially those that relate to the functioning of the private sector. It examines the empirical relationship between various measures of institutional quality and regulatory policies, and economic growth and poverty. The results suggest that good governance, as measured by a strong commitment to the rule of law, among other things, matters for poverty reduction largely through its effect on economic growth. In terms of business regulations, the paper finds that less restrictive regulations pertaining to starting a business are associated with higher economic growth as well as lower rates of $2-a-day poverty. Political freedom is not associated with either higher growth or lower poverty. Taken together, the evidence here seems to suggest that the delivery of good governance and policies that facilitate the creation of new enterprises are more relevant for growth and poverty reduction than the nature of the political system per se.

Investigating codes of ethics within the largest private sector organizations in Sweden and Turkey

The aim of the study was to examine the ways that private sector organizations in Sweden and Turkey communicated the intent of their codes of ethics to their employees. Primary data was obtained via a self-administered mail questionnaire distributed to a census of the top 500 private sector organizations in each country based on revenue. The study identified some interesting results that showed that the small group of companies in Turkey that have a code may be more advanced in ethics artefacts usage than Sweden. Such a conclusion is counterintuitive as one would have expected a developed nation like Sweden to be more advanced in these measures than a developing nation such as Turkey. The culture of one's country may playa large role in the implementation of ethics artefacts in corporations and could be a major reason for this difference.

Government revenue, private welfare, and tax reform in a small open economy

This paper examines the welfare and revenue effects of consumption and income taxes in a general equilibrium model with variable supply of labour and public goods. We derive the optimal consumption and income tax rates for such an economy. It is established that it is better to lower the income tax rate and increase the rate of consumption tax when this economy is in a downturn.

Issues in the implementation of cross-cultural management in Australia-evidence from a study of selected public and private sector organisations

This study examines the current status of cross-cultural management (CCM) in Australia.

The study is based on Reyes' (2004) Ph.D research of a qualitative nature in five organisations in the public and private sectors selected from a sample of organisations which appear to lead the field in Australia in respect of CCM. Literature is also surveyed to present a picture of the current legal and institutional setting of CCM in Australia and provide a context for the study.

Analysis of the findings highlights the gap between cross-cultural rhetoric and action in workplace situations. Problems are identified leading to incomplete and inadequate implementation of CCM in the respondent organisations. The study argues for the need for management to take a systems approach to the formulation and implementation of CCM. Some suggestions are made for improvements in the future.