Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

Purpose – The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A&E) unit of a Maltese hospital. Design/methodology/approach – The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients’ requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A&E unit of the hospital. Findings – The major and related problems being faced by the hospital under study were overcrowding at A&E and shortage of beds, respectively. The combined framework ensures better A&E services and patient flow. QFD identifies and analyses the issues and challenges of A&E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A&E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A&E unit. Practical/implications – The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Originality/value – Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A&E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.

The importance of environment for teacher professional learning in Malta and Scotland

Peer reviewed

Human motivation and professional practice: of knights, knaves and social workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self-interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy-makers have sought to effect such changes has been through the "new community care" of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide-ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self-interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client-centred ethos. The definitive version is available at www.blackwell-synergy.com

Legal Issues Relating to the Notification of Australian Data Breaches

Advances in information and communications technologies during the last two decades have allowed organisations to capture and utilise data on a vast scale, thus heightening the importance of adequate measures for protecting unauthorised disclosure of personal information. In this respect, data breach notification has emerged as an issue of increasing importance throughout the world. It has been the subject of law reform in the United States and in other international jurisdictions. Following the Australian Law Reform Commission’s review of privacy, data breach notification will soon be addressed in Australia. This article provides a review of US and Australian legal initiatives regarding the notification of data breaches. The authors highlight areas of concern based on the extant US literature that require specific consideration in Australia regarding the development of an Australian legal framework for the notification of data breaches.

Inducing shades of meaning by matrix methods : a first step towards thematic analysis of opinion

This article explores two matrix methods to induce the ``shades of meaning" (SoM) of a word. A matrix representation of a word is computed from a corpus of traces based on the given word. Non-negative Matrix Factorisation (NMF) and Singular Value Decomposition (SVD) compute a set of vectors corresponding to a potential shade of meaning. The two methods were evaluated based on loss of conditional entropy with respect to two sets of manually tagged data. One set reflects concepts generally appearing in text, and the second set comprises words used for investigations into word sense disambiguation. Results show that for NMF consistently outperforms SVD for inducing both SoM of general concepts as well as word senses. The problem of inducing the shades of meaning of a word is more subtle than that of word sense induction and hence relevant to thematic analysis of opinion where nuances of opinion can arise.

The importance of a new kind of learning in collaborative networks

There is wide agreement that in order to manage the increasingly complex and uncertain tasks of business, government and community, organizations can no longer operate in supreme isolation, but must develop a more networked approach. Networks are not ‘business as usual’. Of particular note is what has been referred to as collaborative networks. Collaborative networks now constitute a significant part of our institutional infrastructure. A key driver for the proliferation of these multiorganizational arrangements is their ability to facilitate the learning and knowledge necessary to survive or to respond to increasingly complex social issues In this regard the emphasis is on the importance of learning in networks. Learning applies to networks in two different ways. These refer to the kinds of learning that occur as part of the interactive processes of networks. This paper looks at the importance of these two kinds of learning in collaborative networks. The first kind of learning relates to networks as learning networks or communities of practice. In learning networks people exchange ideas with each other and bring back this new knowledge for use in their own organizations. The second type of learning is referred to as network learning. Network learning refers to how people in collaborative networks learn new ways of communicating and behaving with each other. Network learning has been described as transformational in terms of leading to major systems changes and innovation. In order to be effective, all networks need to be involved as learning networks; however, collaborative networks must also be involved in network learning to be effective. In addition to these two kinds of learning in collaborative networks this paper also focuses on the importance of how we learn about collaborative networks. Maximizing the benefits of working through collaborative networks is dependent on understanding their unique characteristics and how this impacts on their operation. This requires a new look at how we specifically teach about collaborative networks and how this is similar to and/or different from how we currently teach about interorgnizational relations.

A Knight without a Sword? The Effects of Audit Courts on Tax Morale

The intention of this paper is to analyse how audit courts affect tax morale, controlling in a multivariate analysis for a broad variety of potential factors. Switzerland, with its variety of audit-court competence among the cantons, has been analysed. With data from the ISSP [1998] (Swiss data 1999), evidence has been found that higher audit-court competence has a significantly positive effect on tax morale. Thus, the results in Switzerland suggest that in the cantons where audit courts are not just knights without swords; they help improve taxpayers' tax morale and thus citizens' intrinsic motivation to pay taxes.

Performing Rural Masculinities : A Case Study of Diggers and Dealers

This chapter examines what Parpart and Zalewski (2008) label 'the man question' in terms of the rural. That is, 'how masculinity comes to be "made" as a continuing process within the social context' of rural places and spaces (Kerfoot and Knights 1993: 662). Our understanding of masculinities as discursively produced, relational, multiple and changing is given empirical force through a case study of the annual resource conference, Diggers and Dealers. The conference, held in the remote mining town of Kalgoorlie in Western Australia since 1992, is today the largest international meeting for the resource sector, attracting over 2000 attendees. Through an analysis of 120 texts related to the conference from 2006 to the present, including media repotis, blogs and conference programs and speeches, we demonstrate how, what is essentially a corporate event, is imported into the rural and constructed through the intersecting discourses of rurality, masculinity and heterosexuality. That is, though the first such meeting may have taken place spontaneously in Kalgoorlie, the delegates, and the 'skimpy' barmaids who serve patrons in their underwear or sometimes topless and are seen as central to the event, are flown into town for the conference. Kalgoorlie, as a working mining community on the edge of the deseti, provides both spectacle and conditions for the enactment of frontier masculinity not possible in the metropole.

A taxonomic approach to understanding managerial ethical decision making approaches of clinically and non-clinically trained healthcare managers in Australia

Objective To understand differences in the managerial ethical decision-making styles of Australian healthcare managers through the exploratory use of the Managerial Ethical Profiles (MEP) Scale. Background Healthcare managers (doctors, nurses, allied health practitioners and non-clinically trained professionals) are faced with a raft of variables when making decisions within the workplace. In the absence of clear protocols and policies healthcare managers rely on a range of personal experiences, personal ethical philosophies, personal factors and organizational factors to arrive at a decision. Understanding the dominant approaches to managerial ethical decision-making, particularly for clinically trained healthcare managers, is a fundamental step in both increasing awareness of the importance of how managers make decisions, but also as a basis for ongoing development of healthcare managers. Design Cross-sectional. Methods The study adopts a taxonomic approach that simultaneously considers multiple ethical factors that potentially influence managerial ethical decision-making. These factors are used as inputs into cluster analysis to identify distinct patterns of influence on managerial ethical decision-making. Results Data analysis from the participants (n=441) showed a similar spread of the five managerial ethical profiles (Knights, Guardian Angels, Duty Followers, Defenders and Chameleons) across clinically trained and non-clinically trained healthcare managers. There was no substantial statistical difference between the two manager types (clinical and non-clinical) across the five profiles. Conclusion This paper demonstrated that managers that came from clinical backgrounds have similar ethical decision-making profiles to non-clinically trained managers. This is an important finding in terms of manager development and how organisations understand the various approaches of managerial decision-making across the different ethical profiles.

Hybridisation of Australian chickpea cultivars with wild Cicer spp. increases resistance to root-lesion nematodes (Pratylenchus thornei and P. neglectus).

Australian and international chickpea (Cicer arietinum) cultivars and germplasm accessions, and wild annual Cicer spp. in the primary and secondary gene pools, were assessed in glasshouse experiments for levels of resistance to the root-lesion nematodes Pratylenchus thornei and P. neglectus. Lines were grown in replicated experiments in pasteurised soil inoculated with a pure culture of either P. thornei or P. neglectus and the population density of the nematodes in the soil plus roots after 16 weeks growth was used as a measure of resistance. Combined statistical analyses of experiments (nine for P. thornei and four for P. neglectus) were conducted and genotypes were assessed using best linear unbiased predictions. Australian and international chickpea cultivars possessed a similar range of susceptibilities through to partial resistance. Wild relatives from both the primary (C. reticulatum and C. echinospermum) and secondary (C. bijugum) gene pools of chickpea were generally more resistant than commercial chickpea cultivars to either P. thornei or P. neglectus or both. Wild relatives of chickpea have probably evolved to have resistance to endemic root-lesion nematodes whereas modern chickpea cultivars constitute a narrower gene pool with respect to nematode resistance. Resistant accessions of C. reticulatum and C. echinospermum were crossed and topcrossed with desi chickpea cultivars and resistant F(4) lines were obtained. Development of commercial cultivars with the high levels of resistance to P. thornei and P. neglectus in these hybrids will be most valuable for areas of the Australian grain region and other parts of the world where alternating chickpea and wheat crops are the preferred rotation.

Floristic composition and pasture condition of Aristida/Bothriochloa pastures in central Queensland. I. Pasture floristics

A survey was conducted in central inland Queensland, Australia of 108 sites that were deemed to contain Aristida/Bothriochloa native pastures to quantitatively describe the pastures and attempt to delineate possible sub-types. The pastures were described in terms of their floristic composition, plant density and crown cover. There were generally ~20 (range 5–33) main pasture species at a site. A single dominant perennial grass was rare with three to six prominent species the norm. Chrysopogon fallax (golden-beard grass) was the perennial grass most consistently found in all pastures whereas Aristida calycina (dark wiregrass), Enneapogon spp. (bottlewasher grasses), Brunoniella australis (blue trumpet) and Panicum effusum (hairy panic) were all regularly present. The pastures did not readily separate into broad floristic sub-groups, but three groups that landholders could recognise from a combination of the dominant tree and soil type were identified. The three groups were Eucalyptus crebra (narrow-leaved ironbark), E. melanophloia (silver-leaved ironbark) and E. populnea (poplar box). The pastures of the three main sub-groups were then characterised by the prominent presence, singly or in combination, of Bothriochloa ewartiana (desert bluegrass), Eremochloa bimaculata (poverty grass), Bothriochloa decipiens (pitted bluegrass) or Heteropogon contortus (black speargrass). The poplar box group had the greatest diversity of prominent grasses whereas the narrow-leaved ironbark group had the least. Non-native Cenchrus ciliaris (buffel grass) and Melinis repens (red Natal grass) were generally present at low densities. Describing pastures in terms of frequency of a few species or species groups sometimes failed to capture the true nature of the pasture but plant abundance for most species, as density, herbage mass of dry matter or plant crown cover, was correlated with its recorded frequency. A quantitative description of an average pasture in fair condition is provided but it was not possible to explain why some species often occur together or fail to co-exist in Aristida/Bothriochloa pastures, for example C. ciliaris and E. bimaculata rarely co-exist whereas Tragus australianus (small burrgrass) and Enneapogon spp. are frequently recorded together. Most crown cover was provided by perennial grasses but many of these are Aristida spp. (wiregrasses) and not regarded as useful forage for livestock. No new or improved categorisation of the great variation evident in the Aristida/Bothriochloa native pasture type can be given despite the much improved detail provided of the floristic composition by this survey.

Financing And Cooperation For Sustainable Development In The Mediterranean, Sophia Antipolis, France, 3-4 June 2004: Volume II: Technical Report of the Workshop

(263 page document)

How far from Jerusalem? Tropical customs and the question of race in the Book of John Mandeville

The Book of John Mandeville, while ostensibly a pilgrimage guide documenting an English knight’s journey into the East, is an ideal text in which to study the developing concept of race in the European Middle Ages. The Mandeville-author’s sense of place and morality are inextricably linked to each other: Jerusalem is the center of his world, which necessarily forces Africa and Asia to occupy the spiritual periphery. Most inhabitants of Mandeville’s landscapes are not monsters in the physical sense, but at once startlingly human and irreconcilably alien in their customs. Their religious heresies, disordered sexual appetites, and monstrous acts of cannibalism label them as fallen state of the European Christian self. Mandeville’s monstrosities lie not in the fantastical, but the disturbingly familiar, coupling recognizable humans with a miscarriage of natural law. In using real people to illustrate the moral degeneracy of the tropics, Mandeville’s ethnography helps shed light on the missing link between medieval monsters and modern race theory.

Documentando a experiência urbana carioca: o Rio de Janeiro pelas fotografias de Augusto Malta e do Rio

Nesse trabalho é apresentada uma análise sobre o papel da fotografia em dois momentos distintos da história da cidade do Rio de Janeiro: com Augusto Malta, fotógrafo oficial da prefeitura de Francisco Pereira Passos, no início do século XX (1902-1906), e com o projeto colaborativo via Instagram Rio 365, na atual gestão de Eduardo Paes (século XXI). Ao estabelecer uma relação anacrônica entre os dois períodos históricos e modelos fotográficos, estes cenários são aproximados de forma a perceber questões (semelhanças e diferenças) que os perpassam. Para tentar apreender as imagens, são investigadas as redes sociotécnicas nas quais a fotografia atua e se insere, articulando aspectos relacionados à memória, às materialidades e linguagens.