Patient Safety Law: From Silos to Systems

Patient safety has become a significant and pressing policy issue. Around the world, governments, the health care sector and the public are increasingly cognizant of the need to improve the safety of care delivered by their health systems. Pressure for change has been created by highly publicized incidents in a number of countries involving unsafe acts that were significant both in scale and consequence and a number of empirical studies that revealed the high rates of unsafe acts and their consequences. The costs of unsafe health care – both personal and fiscal – to individuals, their families and their communities and to the state are massive. In this research project we explored one particular avenue for change – that is, the use of legal instruments by governments to improve patient safety. We did this through a comparative review of the use of legal instruments or frameworks in other countries (specifically Australia, Denmark, New Zealand, the United Kingdom, and the United States) as well as two non-health care related sectors in Canada (transportation and occupational health and safety). We began this research by reviewing the legal instruments and undertaking extensive literature reviews. Further information was gathered through in-person interviews with policy-makers and academics in the countries studied, and from policy-makers and academics expert in the health, occupational health and safety, and transportation sectors in Canada. Once descriptions of the various countries and sectors were drafted, we held small-group meetings with local experts on particular aspects of patient safety. We then hosted a national consultation meeting. We subsequently drafted this final report and the appendices, which fully describe the results of the background research. Finally, we prepared a summary version of the report as well as posters and papers to be published and delivered at conferences and meetings with relevant groups.

Using participatory action research for heart self care amongst indigenous patients

This paper describes the initial phases of the Fluid Watchers Pacific Rim project: a participatory action research project that involves developing and trialling an iPad app to provide monitoring and self-care for Indigenous Australians with heart failure. The development phase involved working with health experts, an IT team and Indigenous heart-failure patients through three cycles of development and critical reflection. This was followed by a small pilot study to examine the app’s effectiveness. In this paper, the researchers explain why IT-supported health education can be successful in decreasing re-hospitalisation and improving self-management skills. They describe the steps they took to ensure community participation and ownership of the project and present the findings of their pilot study. This pilot project suggests that an iPad app may be a practical and successful way to provide health-care support for Indigenous Australian heart-failure patients.

Second international workshop on theory and applications of process visualization

The representation of business process models has been a continuing research topic for many years now. However, many process model representations have not developed beyond minimally interactive 2D icon-based representations of directed graphs and networks, with little or no annotation for information overlays. In addition, very few of these representations have undergone a thorough analysis or design process with reference to psychological theories on data and process visualization. This dearth of visualization research, we believe, has led to problems with BPM uptake in some organizations, as the representations can be difficult for stakeholders to understand, and thus remains an open research question for the BPM community. In addition, business analysts and process modeling experts themselves need visual representations that are able to assist with key BPM life cycle tasks in the process of generating optimal solutions. With the rise of desktop computers and commodity mobile devices capable of supporting rich interactive 3D environments, we believe that much of the research performed in computer human interaction, virtual reality, games and interactive entertainment have much potential in areas of BPM; to engage, provide insight, and to promote collaboration amongst analysts and stakeholders alike. We believe this is a timely topic, with research emerging in a number of places around the globe, relevant to this workshop. This is the second TAProViz workshop being run at BPM. The intention this year is to consolidate on the results of last year's successful workshop by further developing this important topic, identifying the key research topics of interest to the BPM visualization community.

Bayesian modelling of surveillance and proof of freedom : the mathematical, logical & psychological challenges

Keeping exotic plant pests out of our country relies on good border control or quarantine. However with increasing globalization and mobilization some things slip through. Then the back up systems become important. This can include an expensive form of surveillance that purposively targets particular pests. A much wider net is provided by general surveillance, which is assimilated into everyday activities, like farmers checking the health of their crops. In fact farmers and even home gardeners have provided a front line warning system for some pests (eg European wasp) that could otherwise have wreaked havoc. Mathematics is used to model how surveillance works in various situations. Within this virtual world we can play with various surveillance and management strategies to "see" how they would work, or how to make them work better. One of our greatest challenges is estimating some of the input parameters : because the pest hasn't been here before, it's hard to predict how well it might behave: establishing, spreading, and what types of symptoms it might express. So we rely on experts to help us with this. This talk will look at the mathematical, psychological and logical challenges of helping experts to quantify what they think. We show how the subjective Bayesian approach is useful for capturing expert uncertainty, ultimately providing a more complete picture of what they think... And what they don't!

Contracting for infrastructure projects as credence goods

Large infrastructure projects are a major responsibility of urban and regional governments, who usually lack expertise to fully specify the demanded projects. Contractors, typically experts on such projects due to experience with similar projects elsewhere, advise of the needed design in their bids. Producing the right design is nevertheless costly. We model such infrastructure projects taking into account their credence goods feature and the costly design effort they require and examine the performance of commonly used contracting methods. We show that when building costs are homogeneous and public information, multi-stage competitive bidding involving shortlisting of two contractors and contingent compensation of both contractors on design efforts outperforms sequential search and the traditional Design-and-Build approach. If building costs are private information of the contractors and are revealed to them after design cost is sunk, sequential search may be superior to the other two methods.

Acquiring search expertise : learning experiences and threshold concepts

Expert searchers engage with information as information brokers, researchers, reference librarians, information architects, faculty who teach advanced search, and in a variety of other information-intensive professions. Their experiences are characterized by a profound understanding of information concepts and skills and they have an agile ability to apply this knowledge to interacting with and having an impact on the information environment. This study explored the learning experiences of searchers to understand the acquisition of search expertise. The research question was: What can be learned about becoming an expert searcher from the learning experiences of proficient novice searchers and highly experienced searchers? The key objectives were: (1) to explore the existence of threshold concepts in search expertise; (2) to improve our understanding of how search expertise is acquired and how novice searchers, intent on becoming experts, can learn to search in more expertlike ways. The participant sample drew from two population groups: (1) highly experienced searchers with a minimum of 20 years of relevant professional experience, including LIS faculty who teach advanced search, information brokers, and search engine developers (11 subjects); and (2) MLIS students who had completed coursework in information retrieval and online searching and demonstrated exceptional ability (9 subjects). Using these two groups allowed a nuanced understanding of the experience of learning to search in expertlike ways, with data from those who search at a very high level as well as those who may be actively developing expertise. The study used semi-structured interviews, search tasks with think-aloud narratives, and talk-after protocols. Searches were screen-captured with simultaneous audio-recording of the think-aloud narrative. Data were coded and analyzed using NVivo9 and manually. Grounded theory allowed categories and themes to emerge from the data. Categories represented conceptual knowledge and attributes of expert searchers. In accord with grounded theory method, once theoretical saturation was achieved, during the final stage of analysis the data were viewed through lenses of existing theoretical frameworks. For this study, threshold concept theory (Meyer & Land, 2003) was used to explore which concepts might be threshold concepts. Threshold concepts have been used to explore transformative learning portals in subjects ranging from economics to mathematics. A threshold concept has five defining characteristics: transformative (causing a shift in perception), irreversible (unlikely to be forgotten), integrative (unifying separate concepts), troublesome (initially counter-intuitive), and may be bounded. Themes that emerged provided evidence of four concepts which had the characteristics of threshold concepts. These were: information environment: the total information environment is perceived and understood; information structures: content, index structures, and retrieval algorithms are understood; information vocabularies: fluency in search behaviors related to language, including natural language, controlled vocabulary, and finesse using proximity, truncation, and other language-based tools. The fourth threshold concept was concept fusion, the integration of the other three threshold concepts and further defined by three properties: visioning (anticipating next moves), being light on one's 'search feet' (dancing property), and profound ontological shift (identity as searcher). In addition to the threshold concepts, findings were reported that were not concept-based, including praxes and traits of expert searchers. A model of search expertise is proposed with the four threshold concepts at its core that also integrates the traits and praxes elicited from the study, attributes which are likewise long recognized in LIS research as present in professional searchers. The research provides a deeper understanding of the transformative learning experiences involved in the acquisition of search expertise. It adds to our understanding of search expertise in the context of today's information environment and has implications for teaching advanced search, for research more broadly within library and information science, and for methodologies used to explore threshold concepts.

A methodology to develop an urban transport disadvantage framework : the case of Brisbane, Australia

Most individuals travel in order to participate in a network of activities which are important for attaining a good standard of living. Because such activities are commonly widely dispersed and not located locally, regular access to a vehicle is important to avoid exclusion. However, planning transport system provisions that can engage members of society in an acceptable degree of activity participation remains a great challenge. The main challenges in most cities of the world are due to significant population growth and rapid urbanisation which produces increased demand for transport. Keeping pace with these challenges in most urban areas is difficult due to the widening gap between supply and demand for transport systems which places the urban population at a transport disadvantage. The key element in mitigating the issue of urban transport disadvantage is to accurately identify the urban transport disadvantaged. Although wide-ranging variables and multi-dimensional methods have been used to identify this group, variables are commonly selected using ad-hoc techniques and unsound methods. This poses questions of whether the current variables used are accurately linked with urban transport disadvantage, and the effectiveness of the current policies. To fill these gaps, the research conducted for this thesis develops an operational urban transport disadvantage framework (UTDAF) based on key statistical urban transport disadvantage variables to accurately identify the urban transport disadvantaged. The thesis develops a methodology based on qualitative and quantitative statistical approaches to develop an urban transport disadvantage framework designed to accurately identify urban transport disadvantage. The reliability and the applicability of the methodology developed is the prime concern rather than the accuracy of the estimations. Relevant concepts that impact on urban transport disadvantage identification and measurement and a wide range of urban transport disadvantage variables were identified through a review of the existing literature. Based on the reviews, a conceptual urban transport disadvantage framework was developed based on the causal theory. Variables identified during the literature review were selected and consolidated based on the recommendations of international and local experts during the Delphi study. Following the literature review, the conceptual urban transport disadvantage framework was statistically assessed to identify key variables. Using the statistical outputs, the key variables were weighted and aggregated to form the UTDAF. Before the variable's weights were finalised, they were adjusted based on results of correlation analysis between elements forming the framework to improve the framework's accuracy. The UTDAF was then applied to three contextual conditions to determine the framework's effectiveness in identifying urban transport disadvantage. The development of the framework is likely to be a robust application measure for policy makers to justify infrastructure investments and to generate awareness about the issue of urban transport disadvantage.

Shifting from asset dominant to service centric delivery systems: engaging users and communities

Research and practice has observed a shift toward service-oriented approaches that depend on input from users and community as co-producers of services. Yet, in delivering public infrastructure the focus is still on assets rather than services. The contribution of external stakeholders in the co-production of public services is still limited. Using the Policy Delphi with a panel of experts, we found that although practitioners understand the need for asset management to follow the service approach, guidelines and policies still lack that service-centric perspective. Findings revealed a range of obstacles to effective service delivery, related to the sub-optimal involvement of stakeholders’, asymmetric levels of power, the lack of accountability, transparency and availability of government, and the lack of genuine consultations between government and stakeholder groups. The paper concludes by offering directions and strategies for asset managers and policymakers to support and reconnect disengaged government-citizen relations for optimal service delivery outcomes in asset management.

A business engineering approach to client relationship management in a knowledge based firm

This thesis examines Customer Relationship Management and how the capabilities of an organisation to innovate can be enhanced via its implementation in a Knowledge Based Firm. The research identifies current customer knowledge components within an organisation and identifies for future use, CRM components for implementation within a Knowledge Based Firm. Opinions from a panel of experts' are identified for best practice customer relationship strategy, the most important CRM processes and identification of customer knowledge components that will form the basis of implementing a successful CRM to gain a competitive advantage through enhancing the innovative capability for a Knowledge Based Firm.

End-of-life care in the critical care setting : nurses' practices and factors affecting these practices

Background: Critical care units are designed and resourced to save lives, yet the provision of end-of-life care is a significant component of nursing work in these settings. Limited research has investigated the actual practices of critical care nurses in the provision of end-of-life care, or the factors influencing these practices. To improve the care that patients at the end of life and their families receive, and to support nurses in the provision of this care, further research is needed. The purpose of this study was to identify critical care nurses' end-of-life care practices, the factors influencing the provision of end-of-life care and the factors associated with specific end-of-life care practices. Methods: A three-phase exploratory sequential mixed-methods design was utilised. Phase one used a qualitative approach involving interviews with a convenience sample of five intensive care nurses to identify their end-of-life care experiences and practices. In phase two, an online survey instrument was developed, based on a review of the literature and the findings of phase one. The survey instrument was reviewed by six content experts and pilot tested with a convenience sample of 28 critical care nurses (response rate 45%) enrolled in a postgraduate critical care nursing subject. The refined survey instrument was used in phase three of this study to conduct a national survey of critical care nurses. Descriptive analyses, exploratory factor analysis and univariate general linear modelling was undertaken on completed survey responses from 392 critical care nurses (response rate 25%). Results: Six end-of-life care practice areas were identified in this study: information sharing, environmental modification, emotional support, patient and family-centred decision making, symptom management and spiritual support. The items most frequently identified as always undertaken by critical care nurses in the provision of end-of-life care were from the information sharing and environmental modification practice areas. Items least frequently identified as always undertaken included items from the emotional support practice area. Eight factors influencing the provision of end-of-life care were identified: palliative values, patient and family preferences, knowledge, preparedness, organisational culture, resources, care planning, and emotional support for nurses. Strong agreement was noted with items reflecting values consistent with a palliative approach and inclusion of patient and family preferences. Variation was noted in agreement for items regarding opportunities for knowledge acquisition in the workplace and formal education, yet most respondents agreed that they felt adequately prepared. A context of nurse-led practice was identified, with variation in access to resources noted. Collegial support networks were identified as a source of emotional support for critical care nurses. Critical care nurses reporting values consistent with a palliative approach and/or those who scored higher on support for patient and family preferences were more likely to be engaged in end-of-life care practice areas identified in this study. Nurses who reported higher levels of preparedness and access to opportunities for knowledge acquisition were more likely to report engaging in interpersonal practices that supported patient and family centred decision making and emotional support of patients and their families. A negative relationship was identified between the explanatory variables of emotional support for nurses and death anxiety, and the patient and family centred decision making practice area. Contextual factors had a limited influence as explanatory variables of specific end-of-life care practice areas. Gender was identified as a significant explanatory variable in the emotional and spiritual support practice areas, with male gender associated with lower summated scores on these practice scales. Conclusions: Critical care nurses engage in practices to share control with and support inclusion of families experiencing death and dying. The most frequently identified end-of-life care practices were those that are easily implemented, practical strategies aimed at supporting the patient at the end of life and the patient's family. These practices arguably require less emotional engagement by the nurse. Critical care nurses' responses reflected values consistent with a palliative approach and a strong commitment to the inclusion of families in end-of-life care, and these factors were associated with engagement in all end-of-life care practice areas. Perceived preparedness or confidence with the provision of end-of-life care was associated with engagement in interpersonal caring practices. Critical care nurses autonomously engage in the provision of end-of-life care within the constraints of an environment designed for curative care and rely on their colleagues for emotional support. Critical care nurses must be adequately prepared and supported to provide comprehensive care in all areas of end-of-life care practice. The findings of this study raise important implications, and informed recommendations for practice, education and further research.

Understanding and measuring information security culture in developing countries : case of Saudi Arabia

The purpose of the current study was to develop a measurement of information security culture in developing countries such as Saudi Arabia. In order to achieve this goal, the study commenced with a comprehensive review of the literature, the outcome being the development of a conceptual model as a reference base. The literature review revealed a lack of academic and professional research into information security culture in developing countries and more specifically in Saudi Arabia. Given the increasing importance and significant investment developing countries are making in information technology, there is a clear need to investigate information security culture from developing countries perspective such as Saudi Arabia. Furthermore, our analysis indicated a lack of clear conceptualization and distinction between factors that constitute information security culture and factors that influence information security culture. Our research aims to fill this gap by developing and validating a measurement model of information security culture, as well as developing initial understanding of factors that influence security culture. A sequential mixed method consisting of a qualitative phase to explore the conceptualisation of information security culture, and a quantitative phase to validate the model is adopted for this research. In the qualitative phase, eight interviews with information security experts in eight different Saudi organisations were conducted, revealing that security culture can be constituted as reflection of security awareness, security compliance and security ownership. Additionally, the qualitative interviews have revealed that factors that influence security culture are top management involvement, policy enforcement, policy maintenance, training and ethical conduct policies. These factors were confirmed by the literature review as being critical and important for the creation of security culture and formed the basis for our initial information security culture model, which was operationalised and tested in different Saudi Arabian organisations. Using data from two hundred and fifty-four valid responses, we demonstrated the validity and reliability of the information security culture model through Exploratory Factor Analysis (EFA), followed by Confirmatory Factor Analysis (CFA.) In addition, using Structural Equation Modelling (SEM) we were further able to demonstrate the validity of the model in a nomological net, as well as provide some preliminary findings on the factors that influence information security culture. The current study contributes to the existing body of knowledge in two major ways: firstly, it develops an information security culture measurement model; secondly, it presents empirical evidence for the nomological validity for the security culture measurement model and discovery of factors that influence information security culture. The current study also indicates possible future related research needs.

Buzz in motion pictures : what is buzz and how can marketing create it?

In the movie industry, the extraordinarily successful theatrical performance of certain films is largely attributed to buzz. Despite longstanding commentary about the role of buzz in successful movie marketing and the belief that it accelerates new product diffusion, limited scholarly evidence exists to support these assertions. This is primarily due to the lack of conceptual distinction of buzz from word-of-mouth, which is often used as the main basis for conceptualising buzz. However, word-of-mouth does not fully explain the buzz surrounding films such as 'Gone With The Wind', 'The Dark Knight' and 'Avatar'. Informed by valuable insights from key experts who have launched some of the most successful movies in box office history, as well as a range of moviegoers, this thesis developed a deeper understanding of what buzz is and how it is created. This thesis concludes that buzz is not the same as word-of-mouth.

Development and formative evaluation of a motorcycle rider training intervention to address risk taking

The need to address on-road motorcycle safety in Australia is important due to the disproportionately high percentage of riders and pillions killed and injured each year. One approach to preventing motorcycle-related injury is through training and education. However, motorcycle rider training lacks empirical support as an effective road safety countermeasure to reduce crash involvement. Previous reviews have highlighted that risk-taking is a contributing factor in many motorcycle crashes, rather than merely a lack of vehicle-control skills (Haworth & Mulvihill, 2005; Jonah, Dawson & Bragg, 1982; Watson et al, 1996). Hence, though the basic vehicle-handling skills and knowledge of road rules that are taught in most traditional motorcycle licence training programs may be seen as an essential condition of safe riding, they do not appear to be sufficient in terms of crash reduction. With this in mind there is considerable scope for the improvement of program focus and content for rider training and education. This program of research examined an existing traditional pre-licence motorcycle rider training program and formatively evaluated the addition of a new classroom-based module to address risky riding; the Three Steps to Safer Riding program. The pilot program was delivered in the real world context of the Q-Ride motorcycle licensing system in the state of Queensland, Australia. Three studies were conducted as part of the program of research: Study 1, a qualitative investigation of delivery practices and student learning needs in an existing rider training course; Study 2, an investigation of the extent to which an existing motorcycle rider training course addressed risky riding attitudes and motives; and Study 3, a formative evaluation of the new program. A literature review as well as the investigation of learning needs for motorcyclists in Study 1 aimed to inform the initial planning and development of the Three Steps to Safer Riding program. Findings from Study 1 suggested that the training delivery protocols used by the industry partner training organisation were consistent with a learner-centred approach and largely met the learning needs of trainee riders. However, it also found that information from the course needs to be reinforced by on-road experiences for some riders once licensed and that personal meaning for training information was not fully gained until some riding experience had been obtained. While this research informed the planning and development of the new program, a project team of academics and industry experts were responsible for the formulation of the final program. Study 2 and Study 3 were conducted for the purpose of formative evaluation and program refinement. Study 2 served primarily as a trial to test research protocols and data collection methods with the industry partner organisation and, importantly, also served to gather comparison data for the pilot program which was implemented with the same rider training organisation. Findings from Study 2 suggested that the existing training program of the partner organisation generally had a positive (albeit small) effect on safety in terms of influencing attitudes to risk taking, the propensity for thrill seeking, and intentions to engage in future risky riding. However, maintenance of these effects over time and the effects on riding behaviour remain unclear due to a low response rate upon follow-up 24 months after licensing. Study 3 was a formative evaluation of the new pilot program to establish program effects and possible areas for improvement. Study 3a examined the short term effects of the intervention pilot on psychosocial factors underpinning risky riding compared to the effects of the standard traditional training program (examined in Study 2). It showed that the course which included the Three Steps to Safer Riding program elicited significantly greater positive attitude change towards road safety than the existing standard licensing course. This effect was found immediately following training, and mean scores for attitudes towards safety were also maintained at the 12 month follow-up. The pilot program also had an immediate effect on other key variables such as risky riding intentions and the propensity for thrill seeking, although not significantly greater than the traditional standard training. A low response rate at the 12 month follow-up unfortunately prevented any firm conclusions being drawn regarding the impact of the pilot program on self-reported risky riding once licensed. Study 3a further showed that the use of intermediate outcomes such as self-reported attitudes and intentions for evaluation purposes provides insights into the mechanisms underpinning risky riding that can be changed by education and training. A multifaceted process evaluation conducted in Study 3b confirmed that the intervention pilot was largely delivered as designed, with course participants also rating most aspects of training delivery highly. The complete program of research contributed to the overall body of knowledge relating to motorcycle rider training, with some potential implications for policy in the area of motorcycle rider licensing. A key finding of the research was that psychosocial influences on risky riding can be shaped by structured education that focuses on awareness raising at a personal level and provides strategies to manage future riding situations. However, the formative evaluation was mainly designed to identify areas of improvement for the Three Steps to Safer Riding program and found several areas of potential refinement to improve future efficacy of the program. This included aspects of program content, program delivery, resource development, and measurement tools. The planned future follow-up of program participants' official crash and traffic offence records over time may lend further support for the application of the program within licensing systems. The findings reported in this thesis offer an initial indication that the Three Steps to Safer Riding is a useful resource to accompany skills-based training programs.

Project governance : ethical decision making in project procurement in the Malaysian public sectors

Managing public sector projects in Malaysia is a unique challenge. This is because of the ethical issues involved during the project procurement process. These ethical issues need attention because they will have an impact on the quality, cost and time of the project itself. The ethical issues here include conflict of interest, bid shopping, collusive tendering, bid cutting, corruption and the payment game. In 2006, 17.3% of 417 Malaysian government contract projects were considered sick due to contractors' performances that failed to conduct the project according to the project plan. Some of the sick projects from these statistics are due to the ethical issues involved. These construction projects have low quality due to the selection of the contractors, done unethically due to personal relationships instead of professional qualifications. That is why it is important to govern the project procurement processes to ensure the accountability and transparency of the decision making process to ensure that these ethical issues can be avoided. Extensive research has been conducted on the ethical issues in the tendering process or the award phase of project management. There is a lack of studies looking at the role of clients, including the government client, in relation to unethical practice in project procurement in the public sector. It is important to understand that ethical issues not only involve the contractors and suppliers but also the clients. Even though there are codes of ethics in the public sectors, ethical issues still arise. Therefore, this research develops a project governance framework (PGEDM) for ethical decision making in the Malaysian public sectors. This framework combines the ethical decision making process together with the project governance principals in guiding the public sectors with ethical decision making in project procurement. A triangulation of questionnaire survey and Delphi study was employed in this research to collect required qualitative and quantitative data. A questionnaire survey was conducted among the public officials (the practitioners) who are currently working in the procurement area in the Malaysian public sectors, in identifying the ethical behaviours and factors influencing further ethical behaviour to occur. A Delphi study was also conducted with the assistance of a panel of experts consisting of practitioners that have expertise in the area of project governance and project procurement as well as academician, which further considered the relationship and the influence of the criteria and indicators of ethical decision making (EDM) and project governance (project criteria, organisational culture, contract award criteria, individual criteria, client's requirements, government procedures and professional ethics). Through the identification and integration of the factors and EDM criteria as well as the project governance criteria and EDM steps for ethical issues, a PGEDM framework was developed to promote, and drive consistent decision outcome in project procurement in the public sector. The framework contributes significantly to ethical decision making in the project procurement process. These findings not only give benefit to the people involved in project procurement but also to the public officials in guiding them to be more accountable in handling ethical issues in the future and to have a more transparent decision making process.

From science to management : using Bayesian networks to learn about Lyngbya

Toxic blooms of Lyngbya majuscula occur in coastal areas worldwide and have major ecological, health and economic consequences. The exact causes and combinations of factors which lead to these blooms are not clearly understood. Lyngbya experts and stakeholders are a particularly diverse group, including ecologists, scientists, state and local government representatives, community organisations, catchment industry groups and local fishermen. An integrated Bayesian Network approach was developed to better understand and model this complex environmental problem, identify knowledge gaps, prioritise future research and evaluate management options.