Dual disability : the inherent difficulties in service provision and client management

Dual disability is a particularly important area of study, as the co-occurence of intellectual and psychiatric disability presents signficant challenges to professionals within the health and disability services. Four case studies are presented.

Self-service technologies and consumer complaining behaviour : an empirical investigation

Consumers often report dissatisfaction with technology-based services. This thesis, for the first time, examines consumer complaining behaviour with regard to these services, and identifies the factors that influence it. Complaint management strategies are recommended that benefit both organisations and consumers in this evolving service context.

Health service systems and comorbidity: stepping up to the mark

Clients with co-occurring substance use and mental health disorders are not well served in traditional health care systems where specialist services offer segregated interventions and the client is left to negotiate required treatment across both systems. In recent years, policy change guiding the treatment of dual diagnosis in the United States, United Kingdom, Australia and elsewhere has triggered the development of diverse models of treatment, each of which function at different points on a continuum from serial to fully integrated care. This paper outlines key models and provides examples, while considering their potential for appropriately addressing the needs of this client group. Consideration is given to the benefits of an interaction between stepped care and the chosen model, as a means of enhancing care efficiency while retaining the focus on positive outcomes.

Problems of political transition in Ukraine : leadership failure and democratic consolidation

Democratisation and consolidation of a political system encompass a range of complex challenges, for which effective leadership is pivotal. However, the skills that a leader requires to break through and introduce change are not necessarily the same as those needed to maintain stability. This article examines the case of Viktor Yushchenko as president of Ukraine following the Orange Revolution. The negotiated transfer of power from the previous semi-authoritarian regime rendered consolidation difficult by limiting opportunities for a complete break. Within the residual 'grey area', a number of actors continued to participate and create tension. The regime that emerged was characterised by political infighting and instability, leading to the defeat of candidates associated with the Orange Revolution in the 2010 presidential elections. This article argues that the inability to move towards a consolidated democratic political system was due to the failure of the transitional leader, rather than the political and institutional configuration.

Government food service policies and guidelines do not create healthy school canteens

Objective
In 2006, the Victorian Government adopted the School Canteens and other school Food Services (SCFS) Policy that bans the sale of sweet drinks and confectionary and recommends the proportions of menu items based on a traffic light system of food classification. This study aims to determine whether compliance with the policy improves the nutritional profile of the menus.
Methods
Items from food service menus were assessed for compliance with the SCFS policy and categorised as ‘everyday’ (‘green’), ‘select carefully’ (‘amber’) or ‘occasionally’ (‘red’) (n=106). Profile analysis assessed differences in the nutritional profile of the menus between sub-groups.
Results
Overall, 37% of menus contained items banned under the policy. The largest proportion of items on the assessed menus were from the ‘amber’ category (mean: 51.0%), followed by ‘red’ (29.3%) and ‘green’ (20.3%). No menus met the traffic light-based recommendations and there was no relationship between policy compliance and the proportion of items in each of the three categories.
Conclusions and implications
To increase the healthiness of the school food service we recommend a greater investment in resources and infrastructure to implement existing policies, and establishing stronger monitoring and support systems.

Health system costs of diseases and injury in Australia 1993-94 : an analysis of costs, service use and mortality for major disease and injury groups

Provides a systematic analysis of the health system use and costs associated with specific disease and injury groups in Australia in 1993-94. The estimates are presented in a consistent format and are derived using a methodology that ensures the results add across disease, age and sex groups to total Australian health expenditures for 1993-94.

Dedicated emergency theatres improve service delivery and surgeons' job satisfaction

Background
There are well-described benefits to separating emergency and elective surgery. Geelong Hospital lacked the resources to implement a separate acute surgical unit, but instituted daily dedicated emergency general surgery operating sessions, managed by an on-site consultant. This study aims to assess the impact of this on service delivery and surgeons' job satisfaction.
Methods
From 1 February 2011, daily half-day operating lists were allocated for general surgical emergencies. Patients treated on these lists were studied prospectively until 31 December 2011. Theatre waiting times and hospital stay were compared with the previous year. A quality-of-life questionnaire was administered to participating surgeons before the project commenced and after 6 months.
Results
A total of 966 patients underwent surgery during an emergency general surgery admission in the control period, and 984 underwent surgery during the study period. The median time from arrival in the emergency department (ED) to surgery was reduced from 19 (18–21) h in the control group to 18 (17–19) h in the study group (P = 0.033). The time from booking surgery to operation was reduced from 4.8 (4.3–5.4) h to 3.9 (3.5–4.3) h (P < 0.0001). For patients undergoing emergency laparotomy, the time from booking to surgery was reduced from 3.1 (2.2–4.1) to 2.4 (1.8–2.9) h, and hospital stay was reduced from 13 (11–15) to 10 (9–12) days (P = 0.0089). The surgeons' responses to the questionnaires showed improvement in job satisfaction (P < 0.0001).
Conclusion
This intervention has improved service delivery for emergency surgery patients, and improved the participating surgeons' job satisfaction.

Time series analysis of air transportation service quality and travel demand in Japan

The evolution of domestic air travel service in Japan is a product of many factors including airline responses to the changing aviation market, government interventions in terms of regulatory/deregulatory policies, infrastructure investments, and changes in market structure. This paper presents an empirical investigation of the changing quality of passenger airline service and its implications in the domestic aviation market in Japan using qualitative review and a time series analysis of the domestic airline markets from 1986 to 2003. The results show that to meet the ultimate aim of deregulation to increase air passengers’ welfare gain, there is a need to instill measures to correct service imbalance and to create innovative airport demand-capacity management measures.