Implementation of the nurse practitioner role within a Victorian healthcare network : an organisational perspective

Objective
This paper presents a discussion of the development of a framework to implement and sustain the nurse practitioner (NP) role within one health service designed to strengthen the capacity of the health system and which could be readily transferable to other health services.
Setting
Eastern Health (EH) is a multi‑campus tertiary health care organisation servicing a population of approximately 800,000 people in the east and outer eastern suburbs of Melbourne, Australia. EH is committed to advancing the nursing profession and exploring innovative, research based models of practice that are responsive to the needs of the community it serves.
Primary argument
The Framework documents the processes of providing a new career pathway for advanced practice nurses that incorporates education and training, and utilises current evidenced‑based practice guidelines to define and promote the scope of practice.
Conclusion
Strong organisational support to facilitate interdisciplinary and multidisciplinary learning opportunities assists integration of the NP role into the healthcare team. Role clarity will assist interprofessional teams to understand and value the role NPs provide.

Applying outcomes of lifelong learning to organisational achievement

The focus of this doctoral research study is making the most what a person knows and can do, as an outcome from their lifelong learning, so as to better contribute to organisational achievement. This has been motivated by a perceived gap in the extensive literature linking knowledge with organisational achievement. Whereas there is a rich body of literature addressing the meta-philosophies giving rise to the emergence of learning organisations there is, as yet, scant attention paid to the detail of planning and implementing action which would reveal individual/organisational opportunities of mutual advantage and motivate, and sustain, participation at the day-to-day level of the individual. It is in this space that this dissertation seeks to contribute by offering a mechanism for bringing the, hindsight informed, response “but that’s obvious” into the abiding explicit realm at the level of the individual. In moving beyond the obvious which is prone to be overlooked, the emphasis on “better” in the introductory sentence, is very deliberately made and has a link to awakening latent individual, and hence organisational, capabilities that would otherwise languish. The evolved LCM Model – a purposeful integration valuing the outcomes from lifelong learning (the L) with nurturing a culture supporting this outcome (the C) and with responsiveness to potentially diverse motivations (the M) – is a reflective device for bringing otherwise tacit, and latent, logic into the explicit realm of action. In the course of the development of the model, a number of supplementary models included in this dissertation have evolved from the research. They form a suite of devices which inform action and lead to making the most of what an individual knows and can do within the formal requirements of a job and within the informal influences of a frequently invisible community of practice. The initial inquiry drew upon the views and experiences of water industry engineering personnel and training facilitators associated with the contract cleaning and waste management industries. However, the major research occurred as an Emergency Management Australia (EMA) project with the Country Fire Authority (CFA) as the host organisation. This EMA/CFA research project explored the influence of making the most of what a CFA volunteer knows and can do upon retention of that volunteer. In its aggregate, across the CFA volunteer body, retention is a critical community safety objective. A qualitative research, ethnographic in character, approach was adopted. Data was collected through interviews, workshops and outcomes from attempts at action research projects. Following an initial thirteen month scoping study including respondents other than from the CFA, the research study moved into an exploration of the efficacy of an indicative model with four contextual foci – i.e. the manner of welcoming new members to the CFA, embracing training, strengthening brigade sustainability and leadership. Interestingly, the research environment which forced a truncated implementation of action research projects was, in itself, an informing experience indicative of inhibitors to making the most of what people know and can do. Competition for interest, time and commitment were factors governing the manner in which CFA respondents could be called upon to explore the efficacy of the model, and were a harbinger of the influences shaping the more general environment of drawing upon what CFA volunteers know and can do. Subsequent to the development of the indicative model, a further 16 month period was utilised in the ethnographic exploration of the relevance of the model within the CFA as the host organisation. As a consequence, the model is a more fully developed tool (framework) to aid reflection, planning and action. Importantly, the later phase of the research study has, through application of the model to specific goals within the CFA, yielded operational insight into its effective use, and in which activity systems have an important place. The model – now confidently styled as the LCM Model – has three elements that when enmeshed strengthen the likelihood of organisational achievement ; and the degree of this meshing, as relevant to the target outcome, determines the strength of outcome. i.e. - • Valuing outcomes from learning: When a person recognises and values (appropriately to achievement by the organisation) what they know and can do, and associated others recognise and value what this person knows and can do, then there is increased likelihood of these outcomes from learning being applied to organisational achievement. • Valuing a culture that is conducive to learning: When a person, and associated others, are further developing and drawing upon what they know and can do within the context of a culture that is conducive to learning, then there is increased likelihood that outcomes from learning will be applied to organisational achievement. • Valuing motivation of the individual: When a person’s motivation to apply what they know and can do is valued by them, and associated others, as appropriate to organisational achievement then there is increased likelihood that appropriately drawing upon outcomes from learning will occur. Activity theory was employed as a device to scope and explore understanding of the issues as they emerged in the course of the research study. Viewing the data through the prism of activity theory led not only to the development of the LCM Model but also to an enhanced understanding of the role of leadership as a foundation for acting upon the model. Both formal and informal leadership were found to be germane in asserting influence on empowering engagement with learning and drawing upon its outcomes. It is apparent that a “leaderful organisation”, as postulated by Raelin (2003), is an environment which supports drawing upon the LCM model; and it may be the case that the act of drawing upon the model will move a narrowly leadership focused organisation toward leaderful attributes. As foreshadowed at the beginning of this synopsis, nurturing individual and organisational capability is the guiding mantra for this dissertation - “Capability embraces competence but is also forward-looking, concerned with the realisation of potential” (Stephenson 1998, p. 3). Although the inquiry focussed upon a need for CFA volunteer retention, it began with a broader investigation as part of the scoping foundation and the expanded usefulness of the LCM Model invites further investigation. The dissertation concludes with the encapsulating sentiment that “You have really got to want to”. With this predisposition in mind, this dissertation contributes to knowledge through the development and discussion of the LCM model as a reflective device informing transformative learning (Mezirow and Associates 1990). A leaderful environment (Raelin 2003) aids transformative learning – accruing to the individual and the organisation - through engendering and maintaining making the most of knowledge and skill – motivating and sustaining “the will”. The outcomes from this research study are a strong assertion that wanting to make the most of what is known and can be done is a hallmark of capability. Accordingly, this dissertation is a contribution to the “how” of strengthening the capability, and the commitment to applying that capability, of an individual and an organisation.

Challenges of international design chain integration and cultural diversity : organisational reflexive capability

Increasingly project teams on international mega projects are composed of multiple partners from different countries forming joint ventures to achieve a higher level of strategic flexibility. Establishing and maintaining local business networks are critical to ensure the success of exporting firms. Firms who achieve competitive advantage in international markets and long term economic sustainability constantly adapt their business practices to achieve client satisfaction by a combination of self, market and project needs assessment. Successful firms ultimately achieve this in local markets but in international market this is intensified with the complexity of barriers grounded in cross-cultural contexts. The need for flexibility, adaptability and continual reassessment is enhanced as the market evolves in various localities. Reflexivity theory was used to develop a conceptual model to explain the way in which firms develop awareness, responsiveness and adaptability for long term success in diverse international markets. This paper summarizes the initial Australian study which developed the model grounded in empirical observations of design construction firms working on projects in developing countries and a second study of Malaysian firms which validated the model. The aim of this study was to develop a performance measurement framework for capabilities assessment of international collaborative partnerships. The study explored the joint venture partnerships between Australian and Malaysian property and construction professionals. Four Malaysian organizations were examined as case studies and two key activities of design management and knowledge management were analyzed in relation to social, cultural and intellectual capital transformation within the Reflexivity Capability Maturity Assessment Framework.

Corporate commitment to sustainability – is it all hot air? A review of the linkage between executive pay and sustainable performance

Across time, companies are increasingly making public commitments to sustainable development and to reducing their impacts on climate change. Management remuneration plans (MRPs) are a key mechanism to motivate managers to achieve corporate goals. We review the MRPs negotiated with key management personnel in a sample of large Australian carbon-intensive companies. Our results show that, as in past decades, the companies in our sample have MRPs in place that continue to fixate on financial performance. We argue that this provides evidence of a disconnection between the sustainability-related rhetoric of the sample companies, and their ‘real’ organisational priorities.

Factors to drive clinical practice improvement in a Malaysian intensive care unit : assessment of organisational readiness using a mixed method approach

This study assessed organisational readiness and factors to drive clinical practice improvement for VAP, CRBSI and PU in a Malaysian intensive care unit (ICU). A mixed method study approach was undertaken in a 16-bed ICU in regional Malaysia using an environmental scan, key informant interviews, staff surveys, and patient audit to elucidate factors contributing to planning for clinical practice improvement. Measurements of sustainability of practice and regard for the practice environment were assessed using validated measures. An environmental scan demonstrated high patient occupancy and case load. Nineteen percent of ICU patients developed complications according to validated measures. Survey results indicated that the majority of nurses had a good knowledge of strategies to prevent ICU complications and a positive attitude toward change processes. Engaging executive leadership was identified as crucial in priming the clinical site for practice change. Providing nurses with tools to monitor their clinical practice and empowering them to change practices are important in improving clinical outcomes.

Why do companies not produce sustainability reports?

Sustainability reporting emerged on the corporate scene nearly 30 years ago as a key mechanism through which business organisations would manage a transition to a new business landscape dominated by greater concern and consciousness about sustainability. While it has become something of a feature on the corporate agenda in some parts of the world, the majority of business organisations do not undertake this type of reporting. This paper explores why 23 of Australia's top 200 companies do not undertake sustainability reporting. The study is situated in the context of a considerable literature that promised numerous benefits to be derived from this type of reporting. The paper uncovers various social and organisational factors that raise some new questions about legitimacy theory, corporate accountability and the spread and uptake of this organisational practice.

Inter-organisational knowledge sharing in regional sustainable development communities

There has been an increasing interest in the use of inter-organisational groups to address regional implications in sustainable development. These groups bring together local knowledge and expertise and span boundaries between government and industry organisations. Our focus is in understanding how knowledge is shared in such inter-organisational groups. Utilising interviews, observations and social network analysis, we examine the knowledge sharing implications derived from the mixed membership, multilevel interaction, and the need to span boundaries with external organisations in these collaborations.

Sustainability reporting and non-reporters : understanding why companies do not produce sustainability reports

 This report explores the social and organisational factors that help to explain why some ASX200 listed companies, in selected industries, do not provide detailed and comprehensive stand-alone sustainabilty reports. 

Sustainability and integrated reporting : a study of the inhibitors and enablers of integrated reporting

 Integrated Reporting is an emerging phenomenon that promises to bring together the material information about an organisation's strategy, governance, performance and prospects in a way that reflects the commercial, social and environmental context within which it operates. This report captures the variety of organisational factors that are relevant to decisions about Integrated Reporting in Australia. 

Knowledge management view of environmental sustainability in manufacturing SMEs in the Philippines

This study highlights the role of knowledge management (KM) in enabling small and medium enterprises (SMEs) in a manufacturing industry in a developing country to engage in environmentally sustainable business. Drawing on the knowledge-based view of the firm, it argues that resource-constrained SMEs rely on their relational capital to augment their capability to innovate in order to find better and environmentally sound ways of doing business. However, SMEs need to harness their KM orientation in order to leverage the knowledge-based resources emanating from their relational capital towards building their innovation capability. This capability is essential in integrating effective environmental management practices in business. The findings from our analysis of data from a survey of 241 manufacturing SMEs in the Philippines support these hypotheses and underscore the importance of developing an organisational capability to engage in KM in order to adopt sustainable business practices. The implications of the findings are also discussed.

Is the grass greener on the other side? a review of the Asia-Pacific sport industry’s environmental sustainability practices

In recent years, sport entities have begun to prioritise environmental sustainability (ES) initiatives in their business strategies with the aim of minimising their environmental impact and engaging stakeholders within the ES movement. There has been minimal academic consideration of the ES movement in professional sport, particularly outside of North America and Europe. The aim of the present study is to provide an overview of the type and profile of ES initiatives being undertaken and communicated to stakeholders in the Asia-Pacific region by the industry bodies. Further, the study offers a conceptual model of the global-, country-, industry- and organisational-level forces impacting these sporting organisations’ ES practices. Various communication mediums of 114 professional sport teams from seven countries—Australia, India, New Zealand, Japan, China, Taiwan and Korea—were evaluated using content analysis. The results reveal low communication of ES practices by professional sport teams in the Asia-Pacific region compared to North America. Extended findings on the existing global profile of ES engagement provide a descriptive understanding of the ES movement in the Asia-Pacific region, and contribute to the identification of possible antecedents and correlatives to be evaluated in future research.