Managing work health and safety : recent developments and future directions

Effective management of occupational health and safety ( OHS) continues to pose a challenge to many organisations. While significant advancement has occurred in knowledge about traditional workplace risks, organisational and labour market changes have created new risks, psychosocial risks are more prevalent, and the trend towards the adoption of OHS management systems has produced only mixed results. These issues are the focus of this review of recent developments in workplace health and safety. We argue there is a need for organisations to refocus systematically on a collaborative approach to identifying and controlling workplace risks, and on improving the integration of OHS into broader systems and every day management to better meet existing and future OHS challenges.

Identifying the core competencies of mental health telephone triage

Aims and objectives. The primary aim of this study was to identify the core competencies of mental health telephone triage, including key role tasks, skills, knowledge and responsibilities, in which clinicians are required to be competent to perform safe and effective triage.
Background. Recent global trends indicate an increased reliance on telephone-based health services to facilitate access to health care across large populations. The trend towards telephone-based health services has also extended to mental health settings, evidenced by the growing number of mental health telephone triage services providing 24-hour access to specialist mental health assessment and treatment. Mental health telephone triage services are critical to the early identification of mental health problems and the provision of timely, appropriate interventions. In spite of the rapid growth in mental health telephone triage and the important role these services play in the assessment and management of mental illness and related risks, there has been very little research investigating this area of practice.
Design. An observational design was employed to address the research aims.
Methods. Structured observations (using dual wireless headphones) were undertaken on 197 occasions of mental health telephone triage over a three-month period from January to March 2011.
Results. The research identified seven core areas of mental health telephone triage practice in which clinicians are required to be competent in to perform effective mental health telephone triage, including opening the call; performing mental status examination; risk assessment; planning and action; termination of call; referral and reporting; and documentation.
Conclusions. The findings of this research contribute to the evidence base for mental health telephone triage by articulating the core competencies for practice. Relevance to clinical practice. The mental health telephone triage competencies identified in this research may be used to define an evidence-based framework for mental health telephone triage practice that aims to improve the quality, consistency and accuracy of telephone-based mental health triage assessment.

Capacity building : just rhetoric, or a way forward in addressing health inequality?

Issue addressed: It is time to move beyond defining the problem of health inequality to taking action. The response required is complex and calls for system wide action. It is in this context that a discussion of increasing the capacity of the health system to respond to health inequality is both timely and essential. Methods: This paper looks at a capacity building framework that has been developed by the New South Wales Health Department and provides an example of a number of projects that have applied capacity building strategies. Conclusion: Addressing health inequality presents a significant challenge to health promotion practitioners. Emerging capacity building theory provides direction for strategies to build the capacity of a health system to address equity. It proposes a set of practical actions using the five focus areas of organisational development, workforce development, resource allocation, partnerships and leadership. So what?: A capacity building approach by itself will not provide the mandate and framework for the action that needs to be taken to address health inequality, but it helps to ensure that once potential solutions are identified the health system has the capacity to respond.

Engaging rural communities in health care through a paramedic expanded scope of practice

Introduction: This article explores how community engagement by paramedics in an expanded scope role contributes to both primary health care and to an overall improved emergency response capacity in rural communities. Understanding how expanded scope paramedics (ESP) can strengthen community healthcare collaborations is an important need in rural areas where low workforce numbers necessitate innovation.

Methods: Four examples of Australian rural ESP roles were studied in Tasmania, New South Wales, South Australia and Victoria to gather information on consistent elements that could inform a paramedic expanded scope model. Qualitative data were collected from semi-structured interviews with key stakeholders and organisational documents. Thematic analysis within and across cases found community engagement was a key element in the varied roles. This article relies heavily on data from the Victorian and Tasmanian case studies because community engagement was a particularly strong aspect of these cases.

Results: The ESP in the case studies increased interactions between ambulance services and rural communities with an overall benefit to health care through: increasing community response capacity; linking communities more closely to ambulance services; and increasing health promotion and illness prevention work at the community level. Leadership, management and communication skills are important for paramedics to successfully undertake expanded scope roles.

Conclusion: ESP in rural locations can improve health care beyond direct clinical skill by active community engagement that expands the capacity of other community members and strengthens links between services and communities. As health services look to gain maximum efficiency from the health workforce, understanding the intensification of effort that can be gained from practitioner and community coalitions provides important future directions.

The maternity journey in an organisational context : a case study

The transition to motherhood is a significant life event impacting on all spheres of a woman's life. In an organisational context, changes to women's relationships with their employer and to their social identity occur as they adjust to their new role. A case study was undertaken to describe and compare the workplace experiences of three female employees from one health organisation who were either preparing to commence, currently on or recently returned to work from maternity leave. At all stages of the maternity journey, women expected flexibility from their employer in negotiating their return to work and managing parenting responsibilities. Women's obligations to their employer included being open about their capacity to work and parenting situations which may interfere with their work, as well as maintaining their work performance. Within a supportive work environment that included a shared identity with managers who were also mothers, women's social identity as a worker was not significantly threatened and did not change. Social identity change may be most apparent during the transition to first-time motherhood.

Language, culture and health

This chapter provides an overview of the impact language and culture background can have on individuals' experience of illness and conceptualization of health. it also discusses cultural competency for health care personnel in the onctext of increasing diverse communities with specific reference to Australia and New Zealand.

Linking BI competency and assimilation through absorptive capacity: a conceptual framework

Business intelligence (BI) can help support decision-making processes and so contribute to improved BI assimilation and organisational performance. However, a BI undertaking may be effective and profitable for some organisations but not others. How can these differing outcomes be explained for those firms that have adopted BI systems? Drawing on the literature pertaining to absorptive capacity theory, IT competency, and BI assimilation we develop a conceptual framework to investigate the relationships between BI competency, absorptive capacity, and BI assimilation. This research provides insights for BI stakeholders in understanding the mediating role of organisational absorptive capacity within a complex BI environment, enabling many organisations that have implemented BI to leverage the benefits from their costly investments. The conceptual framework provides a sound basis for further research to shed light on the effects of BI competency and organisational absorptive capacity on BI assimilation. Contributions to research and practice are discussed.

Protecting and promoting mental health in the workplace : developing a systems approach to job stress

Issue addressed: Job stress has been linked to a wide range of adverse effects on mental, physical, and organisational health. Despite the evidence that systems approaches are most effective in reducing the adverse impact of job stress, prevalent practice is dominated by worker- or individual-focused strategies in the absence of commensurate intervention on working conditions. Methods: A literature review and cross-disciplinary conceptual synthesis were combined in the articulation of a systems approach to job stress. Results: An outline of the job stress process is followed by explanation of how a systems approach addresses the various steps in the stress process. Systems approaches to job stress emphasise primary prevention or focusing on stressors as the upstream determinants of job stress. Additionally, systems approaches integrate primary with worker-directed secondary and illness-directed tertiary intervention, include the meaningful participation of groups targeted by intervention, and are context- sensitive. Systems approach intervention principles are illustrated by concrete examples of intervention strategies and activities. Conclusions: Further efforts are needed to promote, disseminate, implement, and evaluate systems approaches to job stress and to improve cross-disciplinary cooperation in this effort. (author abtract)

Protecting and promoting mental health in the workplace: developing a systems approach to job stress

Issue addressed: Job stress has been linked to a wide range of adverse effects on mental, physical, and organisational health. Despite the evidence that systems approaches are most effective in reducing the adverse impact of job stress, prevalent practice is dominated by worker- or individual-focused strategies in the absence of commensurate intervention on working conditions. Methods: A literature review and cross-disciplinary conceptual synthesis were combined in the articulation of a systems approach to job stress. Results: An outline of the job stress process is followed by explanation of how a systems approach addresses the various steps in the stress process. Systems approaches to job stress emphasise primary prevention or focusing on stressors as the upstream determinants of job stress. Additionally, systems approaches integrate primary with worker-directed secondary and illness-directed tertiary intervention, include the meaningful participation of groups targeted by intervention, and are context- sensitive. Systems approach intervention principles are illustrated by concrete examples of intervention strategies and activities. Conclusions: Further efforts are needed to promote, disseminate, implement, and evaluate systems approaches to job stress and to improve cross-disciplinary cooperation in this effort.

Interventions to improve cultural competency in healthcare: a systematic review of reviews

Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area.

Staff experiences of providing support to students who are managing mental health challenges: a qualitative study from two Australian universities

The prevalence and consequences of mental health challenges amongst university students is now widely acknowledged and university staff provide an important but often hidden service to these students. While completing a university degree is important to the student’s long-term outcomes there remains a paucity of literature on the support role provided to these students by staff. To contribute to knowledge in this area, a qualitative exploratory study was completed with academic and professional staff at two Australian universities in 2013. Data were collected using semi-structured interviews with 26 participants to document their experiences and to identify the barriers and enablers to their support role to students. Data were analysed using thematic analysis and four themes emerged: (1) Factors that facilitate initiation of staff support; (2) barriers to providing support; (3) challenges facing staff; and (4) how universities support students with mental health challenges. Staff acknowledged the personal and organisational challenges they experienced but also highlighted the rewards they received associated with the role. The provision of training and the acknowledgement of the hidden role and workload by universities were important to ensuring positive outcomes for this group of students.

Implementation of an audit with feedback knowledge translation intervention to promote medication error reporting in health care: a protocol.

BACKGROUND: Health professionals strive to deliver high-quality care in an inherently complex and error-prone environment. Underreporting of medical errors challenges attempts to understand causative factors and impedes efforts to implement preventive strategies. Audit with feedback is a knowledge translation strategy that has potential to modify health professionals' medical error reporting behaviour. However, evidence regarding which aspects of this complex, multi-dimensional intervention work best is lacking. The aims of the Safe Medication Audit Reporting Translation (SMART) study are to: 1. Implement and refine a reporting mechanism to feed audit data on medication errors back to nurses 2. Test the feedback reporting mechanism to determine its utility and effect 3. Identify characteristics of organisational context associated with error reporting in response to feedback METHODS/DESIGN: A quasi-experimental design, incorporating two pairs of matched wards at an acute care hospital, is used. Randomisation occurs at the ward level; one ward from each pair is randomised to receive the intervention. A key stakeholder reference group informs the design and delivery of the feedback intervention. Nurses on the intervention wards receive the feedback intervention (feedback of analysed audit data) on a quarterly basis for 12 months. Data for the feedback intervention come from medication documentation point-prevalence audits and weekly reports on routinely collected medication error data. Weekly reports on these data are obtained for the control wards. A controlled interrupted time series analysis is used to evaluate the effect of the feedback intervention. Self-report data are also collected from nurses on all four wards at baseline and at completion of the intervention to elicit their perceptions of the work context. Additionally, following each feedback cycle, nurses on the intervention wards are invited to complete a survey to evaluate the feedback and to establish their intentions to change their reporting behaviour. To assess sustainability of the intervention, at 6 months following completion of the intervention a point-prevalence chart audit is undertaken and a report of routinely collected medication errors for the previous 6 months is obtained. This intervention will have wider application for delivery of feedback to promote behaviour change for other areas of preventable error and adverse events.

Perceptions of fairness in the psychological contracts of allied health professionals

Purpose-The purpose of this paper is to investigate the relationships between components of the psychological contract, organisational justice, and negative affectivity (NA), with key employee outcomes (i.e. organisational commitment, job satisfaction, depression, and psychological distress) among allied health professionals. Design/methodology/approach-In total, 134 (response rate of 46 per cent) Australian allied health professional completed a questionnaire. Findings-Multiple regressions revealed that higher NA was associated with lower organisational commitment, lower job satisfaction, and higher levels of depression. The psychological contract variable, breach, was associated with depression. Informational justice was associated with organisational commitment. Distributive justice was associated with job satisfaction. Research limitations/implications-This research is limited by its cross-sectional design and that the data were self-reported. The results obtained suggest the potential utility of collecting longitudinal data to replicate and extend the results. Practical implications-While NA may be beyond management control, it may be ameliorated by attention to improving communication of management decisions and by sensitivity to the elements implicit in psychological contracts. The negative consequences of contract breach may be offset by informational and distributive justice. Originality/value-This study is one of the first to examine multiple measures of the psychological contract in addition to organisational justice and NA. Further, this study adds to the literature for allied health professionals, where little is known about factors contributing to their turnover.

Nutrition competencies in health professionals' education and training: a new paradigm

Most health care professionals are not adequately trained to address diet and nutrition-related issues with their patients, thus missing important opportunities to ameliorate chronic diseases and improve outcomes in acute illness. In this symposium, the speakers reviewed the status of nutrition education for health care professionals in the United States, United Kingdom, and Australia. Nutrition education is not required for educating and training physicians in many countries. Nutrition education for the spectrum of health care professionals is uncoordinated, which runs contrary to the current theme of interprofessional education. The central role of competencies in guiding medical education was emphasized and the urgent need to establish competencies in nutrition-related patient care was presented. The importance of additional strategies to improve nutrition education of health care professionals was highlighted. Public health legislation such as the Patient Protection and Affordable Care Act recognizes the role of nutrition, however, to capitalize on this increasing momentum, health care professionals must be trained to deliver needed services. Thus, there is a pressing need to garner support from stakeholders to achieve this goal. Promoting a research agenda that provides outcome-based evidence on individual and public health levels is needed to improve and sustain effective interprofessional nutrition education.