Organizational factors in the diffusion of an industry standard: implementing an online documentation system for Australian exporters

At present, governments in many countries are actively engaged in the development of electronic trading and certification standards to enable the smooth operation of export markets. Standards and their usability underpin confidence in the operations of markets and their effective functioning. In institutional markets, an important role for government agencies lies in developing the initial specifications for standards for interoperable systems. Once these specifications are accepted, governments can then facilitate the eventual diffusion of a standard to the B2B marketplace. Acceptance of an industry standard can determine demand, which defines the viability of that market. In this paper, we describe an initiative by a government agency, the Australian Quarantine and Inspection Service (AQIS), in developing EXDOC, a standard for export documentation and the role that AQIS played in its implementation and diffusion. Our case study illustrates a successfully facilitated B2G implementation. It demonstrates how a standard can be supported and promulgated for the effective functioning of markets in the transition from manual to online export documentation. Once the overarching specifications for related industries have been established and diffused by government, opportunities arise for private sector markets to develop across these industries. Government agencies can promote the effective operation of standards for electronic markets. The EXDOC implementation and its iterations provide an exemplar of active engagement in the development of electronic trading and certification standards for an institutional market. Its successful diffusion provides a model of the implementation process for other export sectors and agencies.

Can written nursing practice standards improve documentation of initial assessment of ED patients?

Introduction: There is wide variation in emergency nursing practice in terms of initial patient assessment and the interventions implemented in response to these patient assessment findings. It is hypothesised that written ED nursing practice standards will reduce variability in documentation standards related to initial patient assessment.

Aim: This study aimed to examine the effect of written ED nursing practice standards augmented by an in-service education programme on the documentation of the initial nursing assessment.

Method: A pre-test/post-test design was used. Initial patient assessment was assessed using the Emergency Department Observation Chart. All adult patients (>18 years) who presented with chest pain and who were triaged to the general adult cubicles were eligible for inclusion in the study. Random sampling was used to select the patients for the pre-test (n = 78) and post-test groups (n = 74).

Results: There was significant improvement in documentation of all aspects of symptom assessment except quality and historical variables: pre-hospital care, cardiac risk factors, and past medical history. Improvements in documentation of elements of primary survey assessment were variable. There were significant increases in documentation of respiratory effort, chest auscultation findings, capillary refill and conscious state. There was a significant 18.3% decrease in the frequency of documentation of respiratory rate and no significant changes in documentation of oxygen saturation, heart rate or blood pressure.

Conclusion: Written ED nursing practice standards were effective in improving the documentation of some elements of initial nursing assessment for patients with chest pain. Active implementation strategies are important to ensure effective uptake of written practice standards and the relationship between nursing documentation and actual clinical practice warrants further consideration using a naturalistic approach in real practice settings.

AQIS, EXDOC and the 'meaties' : an interpretivist case study of an Australian export documentation system implementation

EXDOC is an on-line export documentation system implemented by the Australian Quarantine Inspection Service [AQIS] and used currently by 90% of meat exporters. At a time when governments world-wide are increasingly committed to introducing electronic service delivery [ESD], this is a timely exemplar of innovative practice. In this paper, we consider the initial implementation of EXDOC in the meat export sector in order to identify the factors that led to the successful adoption of this system.

We consider these factors in the context of diffusion of innovation literature supplemented with Bijker’s social constructivist framework. The theoretical flexibility provided by this combination of approaches enabled us to draw out a number of implications from the data that bear on strategy formulation.

Factors found to have significant bearing on the early adoption of EXDOC included: (1) idiosyncratic factors precipitating the initial implementation (2) the constraints based on accommodating user capabilities (3) the organisational role taken by AQIS (4) diffusion as a self-reinforcing and value-adding effect.

A standard represents both a problem as a requirement of such a system and a problem solving strategy eliciting compliance to the system requirements. Over the period of shaping and stabilizing of the industry standard, AQIS was required to act as facilitator in the coordination of the actors.

The implementation of systems like EXDOC enables users to identify what they want from a system, specifying their preferences and tradeoffs. Such implementations offer opportunities for systems redesign within export business sectors with major strategic implications for the industry.

Electronic markets and service delivery: requisite competencies for virtual environments

Electronic markets have a short but dynamic history. How an electronic market can be successfully developed remains in dispute. There is a clear need to better understand the nature of electronic markets themselves and, in particular, to review important developments in their conceptualisation. To enable a deeper understanding of these issues, we decided to restrict our investigation to electronic markets in the agricultural export sector. Agribusiness is a natural early adopter of digital marketplaces because of the industry’s traditional reliance on markets and current take-up of global supply chain management (Wilkins, Swatman and Castleman, 2002). We review two portals from this sector that aimed to simplify access to regulatory documentation. The earlier implementation had its funding withdrawn after one year, whilst the more recently established portal is rapidly becoming a showcase project for the stakeholders. We use a composite theory based on Bijker (1995) and Nowotny et al (2001) to establish a framework for analysing our data. We also refer to a body of literature characterising intangible services and their design and its implications for emarket implementations. Our findings indicate that governance style is in fact closely related to the success or failure of specific sites. We also found support for earlier research indicating that expectations and understanding of electronic markets are still evolving.

Uptake of a newly implemented advance care planning program in a dementia diagnostic service

BACKGROUND: advance care planning (ACP) provides a framework for discussion and documentation of future care preferences when a person loses cognitive capacity. It can assist people in the early stages of dementia to document their preferences for care at later stages of the illness. METHOD: a three-stage project introduced ACP to clients with mild cognitive impairment (MCI) or recently diagnosed dementia and their families through a specialist memory clinic. Over 8 months, all English-speaking clients (n = 97) and carers (n = 92) were mailed a survey assessing completed documentation for future care; understanding of the principles of ACP and willingness to get further information about ACP (Stage 1). Participants wanting more information were invited to a seminar introducing the ACP program and service (Stage 2). Participants wanting to complete ACP documentation could make an appointment with the ACP clinicians (Stage 3). RESULTS: forty-eight (52.2%) carers and 34 clients (35.1%) responded to the survey. Most clients (62.1%) and carers (79.1%) expressed interest in ACP, and 78.6% of clients and 63.6% of carers believed that clients should be involved in their future medical decisions. Nine clients (26.5%; diagnoses: MCI = 5; AD = 3; mixed dementia = 1) and 9 carers (18.8%) attended the seminars, and 2/48 (4%) carers and 3/34 (8.8%) clients (diagnoses: MCI = 2; AD = 1) completed ACP. CONCLUSION: despite initial interest, ACP completion was low. The reasons for this need to be determined. Approaches that may better meet the needs of people newly diagnosed with MCI and dementia are discussed.

Nurses' documentation of physiological observations in three acute care settings

AIMS AND OBJECTIVES: To explore nurses' documentation of physiological observations in acute care; emergency department, medical and surgical units. BACKGROUND: In Australia, physiological observations include respiratory rate, oxygen saturation, heart rate, blood pressure, temperature and level of consciousness. There is a clear relationship between abnormal physiological observations and adverse events. Nurses have highest level of responsibility for accurate measurement, interpretation and documentation of physiological observations. DESIGN: A descriptive exploratory design was used and the study data were collected using a prospective point prevalence approach between 25 July 2012-22 August 2012. METHODS: The study was conducted in the emergency department, two 30-bed medical units and one 30-bed surgical unit of a 578 bed public health service in Melbourne, Australia. All adult patients aged ≥18 years present during data collection periods were eligible for inclusion. Patients in the emergency department resuscitation area were excluded. Patient characteristics and physiological observations for the preceding 24 hours in ward patients or eight hours in emergency department patients were collected. RESULTS: One hundred and seventy-eight patients were included; 38 emergency department patients, 84 medical patients and 56 surgical patients. The median age was 72·5 years and 43·8% were males. The most frequently documented physiological observations were respiratory rate, oxygen saturation, heart rate and systolic blood pressure. The least frequently recorded physiological observations were temperature and conscious state. One or more abnormal physiological parameters was documented in 79·8% (n = 142) patients; evidence of reporting abnormalities was documented in 19·7% of patients (n = 28/142). When controlled for length of stay, physiological observations were more frequently documented in the emergency department. CONCLUSIONS: There was variability in the number of parameters documented and frequency of physiological observations documented by nurses. RELEVANCE TO CLINICAL PRACTICE: Physiological abnormalities that do not necessarily fulfil rapid response team activation criteria are common in acute care patients and provide nurses with an opportunity for early recognition of deteriorating patients.