Emergency Health Services (EHS) : demand and service delivery models. monograph 3 : patients’ reasons and perceptions

Executive Summary Emergency health is a critical component of Australia’s health system and emergency departments (EDs) are increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the perspectives of users of both ambulance services and EDs. The research reported here aimed to identify the perspectives of users of emergency health services, both ambulance services and public hospital Emergency Departments and to identify the factors that they took into consideration when exercising their choice of location for acute health care. A cross-sectional survey design was used involving a survey of patients or their carers presenting to the EDs of a stratified sample of eight hospitals. A specific purpose questionnaire was developed based on a novel theoretical model which had been derived from analysis of the literature (Monograph 1). Two survey versions were developed: one for adult patients (self-complete); and one for children (to be completed by parents/guardians). The questionnaires measured perceptions of social support, health status, illness severity, self-efficacy; beliefs and attitudes towards ED and ambulance services; reasons for using these services, and actions taken prior to the service request. The survey was conducted at a stratified sample of eight hospitals representing major cities (four), inner regional (two) and outer regional and remote (two). Due to practical limitations, data were collected for ambulance and ED users within hospital EDs, while patients were waiting for or under treatment. A sample size quota was determined for each ED based on their 2009/10 presentation volumes. The data collection was conducted by four members of the research team and a group of eight interviewers between March and May 2011 (corresponding to autumn season). Of the total of 1608 patients in all eight emergency departments the interviewers were able to approach 1361 (85%) patients and seek their consent to participate in the study. In total, 911 valid surveys were available for analysis (response rate= 67%). These studies demonstrate that patients elected to attend hospital EDs in a considered fashion after weighing up alternatives and there is no evidence of deliberate or ill-informed misuse. • Patients attending ED have high levels of social support and self-efficacy that speak to the considered and purposeful nature of the exercise of choice. • About one third of patients have new conditions while two thirds have chronic illnesses • More than half the attendees (53.1%) had consulted a healthcare professional prior to making the decision. • The decision to seek urgent care at an ED was mostly constructed around the patient’s perception of the urgency and severity of their illness, reinforced by a strong perception that the hospital ED was the correct location for them (better specialised staff, better care for my condition, other options not as suitable). • 33% of the respondent held private hospital insurance but nevertheless attended a public hospital ED. Similarly patients exercised considered and rational judgements in their choice to seek help from the ambulance service. • The decision to call for ambulance assistance was based on a strong perception about the severity of the illness (too severe to use other means of transport) and that other options were not considered appropriate. • The decision also appeared influenced by a perception that the ambulance provided appropriate access to the ED which was considered most appropriate for their particular condition (too severe to go elsewhere, all facilities in one spot, better specialised and better care). • In 43.8% of cases a health care professional advised use of the ambulance. • Only a small number of people perceived that ambulance should be freely available regardless of severity or appropriateness. These findings confirm a growing understanding that the choice of professional emergency health care services is not made lightly but rather made by reasonable people exercising a judgement which is influenced by public awareness of the risks of acute health and which is most often informed by health professionals. It is also made on the basis of a rational weighing up of alternatives and a deliberate and considered choice to seek assistance from a service which the patient perceived was most appropriate to their needs at that time. These findings add weight to dispensing with public perceptions that ED and ambulance congestion is a result of inappropriate choice by patients. The challenge for health services is to better understand the patient’s needs and to design and validate services that meet those needs. The failure of our health system to do so should not be grounds for blaming the patient, claiming inappropriate patient choices.

Adding SUGAR : service user and carer collaboration in mental health nursing research

‘SUGAR: Service users and carers group advising on research’ is an exciting initiative established to develop collaborative working in mental health nursing research between mental health service users, carers, researchers and practitioners at City University London, UK. This paper will describe the background to SUGAR and how and why it was established; how the group operates; some of the achievements to date including researcher reflections; and case studies of how this collaboration influences our research. Written reflective narratives of service user and carer experiences of SUGAR were analysed using constant comparative methods by the members. Common themes are presented with illustrative quotes. The article highlights the benefits and possible limitations identified so far by members of SUGAR; outlines future plans and considers the findings in relation to literature on involvement and empowerment. This paper has been written by staff and members of SUGAR and is the first venture into collaborative writing of the group and reflects the shared ethos of collaborative working.

“We’re not like these weird feather boa-covered AIDS-spreading monsters” : How LGBT young people and service providers think riskiness informs LGBT youth–police interactions

Research has suggested that lesbian, gay, bisexual and transgender (LGBT) young people are “at-risk” of victimization and/or legally “risky.” Relatively few studies have examined the social construction of risk in “risk factor” research and whether risk as a concept influences the everyday lives of LGBT young people. This article reports how 35 LGBT young people and seven service provider staff in Brisbane, Queensland, Australia perceived LGBT youth–police interactions as reflecting discourses about LGBT riskiness and danger. The participants specifically note how they thought looking at-risk and/or looking risky informed their policing experiences. The article concludes with recommendations for improving future policing practice.

Commentary on Nutrition and older Indigenous Australians : service delivery implications in remote communities. A narrative review

Indigenous Australians are the most socially and economically disadvantaged population group in Australia and have the poorest health status. The statistics describe and highlight the degree of sicknesses and disadvantage along with lower life expectancy, elevated mortality rate and increased risk of cardiovascular disease, cancer, diabetes, respiratory disease and kidney disease. While these statistics reflect poor health status and a high level of illness within Indigenous communities, it is known that individual, family and community behaviours play a key role in Indigenous health and wellbeing outcomes. These behavioural issues include use of tobacco, alcohol and other substances along with lack of physical activity and poor nutrition. The paper Nutrition and older Indigenous Australians: Service delivery implications in remote communities. A narrative view explores some of the issues specific to nutrition. Bronwyn Fredericks was invited to provide this commentary by the Editor of the Australasian Journal on Aging.

The primary school as a logic machine

This paper makes a case for thinking about the primary school as a logic machine (apparatus) as a way of thinking about processes of in-school stratification. Firstly we discuss related literature on in-school stratification in primary schools, particularly as it relates to literacy learning. Secondly we explain how school reform can be thought about in terms of the idea of the machine or apparatus. In which case the processes of in-school stratification can be mapped as more than simply concerns about school organisation (such as students grouping) but also involve a politics of truth, played out in each school, that constitutes school culture and what counts as ‘good’ pedagogy. Thirdly, the chapter will focus specifically on research conducted into primary schools in the Northern Suburbs of Adelaide, one of the most educationally disadvantaged regions in Australia, as a case study of the relationship between in-school stratification and the reproduction of inequality. We will draw from more than 20 years of ethnographic work in primary school in the northern suburbs of Adelaide and provide a snapshot of a recent attempt to improve literacy achievement in a few Northern Suburbs public primary schools (SILA project). The SILA project, through diagnostic reviews, has provided a significant analysis of the challenges facing policy and practice in such challenging school contexts that also maps onto existing (inter)national research. These diagnostic reviews said ‘hard things’ that required attention by SILA schools and these included: · an over reliance on whole class, low level, routine tasks and hence a lack of challenge and rigour in the learning tasks offered to students ; · a focus on the 'code breaking' function of language at the expense of richer conceptualisations of literacy that might guide teachers’ understanding of challenging pedagogies ; · the need for substantial shifts in the culture of schools, especially unsettling deficit views of students and their communities ; · a need to provide a more ‘consistent’ approach to teaching literacy across the school; · a need to focus School Improvement Plans in order to implement a clear focus on literacy learning; and, · a need to sustain professional learning to produce new knowledge and practice . The paper will conclude with suggestions for further research and possible reform projects into the primary school as a logic machine.

How does innovation happen in the upstream oil & gas industry? Insights from a global survey

Few would argue that the upstream oil & gas industry has become more technology-intensive over the years. But how does innovation happen in the industry? Specifically, what ideas and inputs flow from which parts of the sector’s value network, and where do these inputs go? And how do firms and organizations from different countries contribute differently to this process? This paper puts forward the results of a survey designed to shed light on these issues. A joint research initiative between the Society of Petroleum Engineers and the Queensland University of Technology, the survey was sent to 469 executives and senior managers who played a significant role with regards to R&D and/or technology deployment in their respective business units. A total of 199 responses were received from a broad range of organizations and countries around the world. Several interesting themes and trends emerge from the results, including: (1) service companies tend to file considerably more patents per innovation than other types of organization; (2) over 63% of the deployed innovations reported in the survey originated in service companies; (3) neither universities nor government-led research organizations are considered to be valuable sources of new information and knowledge in the industry’s R&D initiatives; and (4) despite the increasing degree of globalization in the marketplace, the USA still plays an extremely dominant role in the industry’s overall R&D and technology deployment activities. By providing a detailed snapshot of how innovation happens in the upstream oil & gas sector, this paper provides a valuable foundation for future investigations and discussions aimed at improving how R&D and technology deployment are managed within the industry.

Physical activity and health-related quality of life among physiotherapists : a cross sectional survey in an Australian hospital and health service

Background Physiotherapists are a professional group with a high rate of attrition and at high risk of musculoskeletal disorders. The purpose of this investigation was to examine the physical activity levels and health-related quality of life of physiotherapists working in metropolitan clinical settings in an Australian hospital and health service. It was hypothesized that practicing physiotherapists would report excellent health-related quality of life and would already be physically active. Such a finding would add weight to a claim that general physical activity conditioning strategies may not be useful for preventing musculoskeletal disorders among active healthy physiotherapists, but rather, future investigations should focus on the development and evaluation of role specific conditioning strategies. Methods A questionnaire was completed by 44 physiotherapists from three inpatient units and three ambulatory clinics (63.7% response rate). Physical activity levels were reported using the Active Australia Survey. Health-related quality of life was examined using the EQ-5D instrument. Physical activity and EQ-5D data were examined using conventional descriptive statistics; with domain responses for the EQ-5D presented in a frequency histogram. Results The majority of physiotherapists in this sample were younger than 30 years of age (n = 25, 56.8%) consistent with the presence of a high attrition rate. Almost all respondents exceeded minimum recommended physical activity guidelines (n = 40, 90.9%). Overall the respondents engaged in more vigorous physical activity (median = 180 minutes) and walking (median = 135 minutes) than moderate exercise (median = 35 minutes) each week. Thirty-seven (84.1%) participants reported no pain or discomfort impacting their health-related quality of life, with most (n = 35,79.5%) being in full health. Conclusions Physical-conditioning based interventions for the prevention of musculoskeletal disorders among practicing physiotherapists may be better targeted to role or task specific conditioning rather than general physical conditioning among this physically active population. It is plausible that an inherent attrition of physiotherapists may occur among those not as active or healthy as therapists who cope with the physical demands of clinical practice. Extrapolation of findings from this study may be limited due to the sample characteristics. However, this investigation addressed the study objectives and has provided a foundation for larger scale longitudinal investigations in this field.

Transit Capacity and Quality of Service Manual (TCQSM) applications for education

Relevant Education Contexts, Examples of TCQSM Applicability to Undergraduate Disciplines, Why Teach with the TCQSM?, TCQS Teaching Tools, Theory Curriculum Example: Examination Question, Problem Based Learning Example: Senior Year Semester Team Project, Honors Dissertation Example Topics, Where to From Here?

How transit route passenger load and distance can together influence quality of service

This paper investigates: - correlation between transit route passenger loading and travel distance - its implications on quality of service (QoS) and resource productivity. It uses Automatic Fare Collection (AFC) data across a weekday on a premium bus line in Brisbane, Australia. A composite load-distance factor is proposed as a new measure for profiling transit route on-board passenger comfort QoS. Understanding these measures and their correlation is important for planning, design, and operational activities.

How transit route passenger load and distance can together influence quality of service

This paper investigates quality of service and resource productivity implications of transit route passenger loading and travel distance. Weekday Automatic Fare Collection data for a premium radial bus route in Brisbane, Australia, is used to investigate correlation between load factor and distance factor. Relationships between boardings and transit work indicate that distance factor generally increases with load factor. Time series analysis is then presented by examining each direction on an hour by hour basis. Inbound correlation is medium to strong across the entire span of service and strong for daytime services up to 19:30, while outbound correlation is strong across the entire span. Passengers tend to be making longer distance, peak direction commuter trips under the least comfortable conditions under stretched peak schedules than off-peak. Therefore productivity gains may be possible by adjusting fleet utilization during off-peak times. Weekday profiles by direction are established for a composite load-distance factor. A threshold corresponding to standing passengers on the Maximum Load Segment reveals that on-board loading and travel distance combined are more severe during the morning inbound peak than evening outbound peak, although the sharpness of the former suggests that encouraging shoulder peak travel during the morning would be more effective than evening peak. Further research suggested includes: consideration of travel duration factor, relating noise within hour to Peak Hour Factor, profiling load-distance factor across a range of case studies, and relating load-distance factor threshold to line length.

Learning processes in creative service teams : towards a dynamic systems theory

The fastest-growing segment of jobs in the creative sector are in those firms that provide creative services to other sectors (Hearn, Goldsmith, Bridgstock, Rodgers 2014, this volume; Cunningham 2014, this volume). There are also a large number of Creative Services (Architecture and Design, Advertising and Marketing, Software and Digital Content occupations) workers embedded in organizations in other industry sectors (Cunningham and Higgs 2009). Ben Goldsmith (2014, this volume) shows, for example, that the Financial Services sector is the largest employer of digital creative talent in Australia. But why should this be? We argue it is because ‘knowledge-based intangibles are increasingly the source of value creation and hence of sustainable competitive advantage (Mudambi 2008, 186). This value creation occurs primarily at the research and development (R and D) and the marketing ends of the supply chain. Both of these areas require strong creative capabilities in order to design for, and to persuade, consumers. It is no surprise that Jess Rodgers (2014, this volume), in a study of Australia’s Manufacturing sector, found designers and advertising and marketing occupations to be the most numerous creative occupations. Greg Hearn and Ruth Bridgstock (2013, forthcoming) suggest ‘the creative heart of the creative economy […] is the social and organisational routines that manage the generation of cultural novelty, both tacit and codified, internal and external, and [cultural novelty’s] combination with other knowledges […] produce and capture value’. 2 Moreover, the main “social and organisational routine” is usually a team (for example, Grabher 2002; 2004).

Prevalence of health behaviours in pregnancy at service entry in a Queensland health service district

Objective: Limited prevalence data for unhealthy pregnancy health behaviours make it difficult to prioritise primary prevention efforts for maternal and infant health. This study's objective was to establish the prevalence of cigarette smoking, sufficient fruit and vegetable intake and sufficient physical activity among women accessing antenatal clinics in a Queensland (Australia) health service district. Method: Cross-sectional self-reported smoking status, daily fruit and vegetable intake, weekly physical activity and a range of socio-demographic variables were obtained from women recruited at their initial antenatal clinic visit, over a three-month recruitment phase during 2007. Results: Analyses were based on 262 pregnant women. The study sample was broadly representative of women giving birth in the district and state, with higher representation of women with low levels of education and high income. More than one quarter of women were smoking. Few women met the guidelines for sufficient fruit (9.2%), vegetables (2.7%) or physical activity (32.8%) during pregnancy. Conclusions: There were low levels of adherence to health behaviour recommendations for pregnancy in this sample. Implications: There is a clear need to develop and evaluate effective pregnancy behaviour interventions to improve primary prevention in maternal and infant health. Brief minimal contact interventions that can be delivered through primary care to create a greater primary prevention focus for maternal and infant health would be worth exploring.

Academic legal research and academic research capacity enhancement working topic : "purposes and objectives of law schools beyond educating students (research, capacity building,community service and outreach)"

One of the main objectives of law schools beyond educating students is to produce viable legal research. The comments in this paper are basically confined to the Australian context, and to examine this topic effectively, it is necessary to briefly review the current tertiary research agenda in Australia. This paper argues that there is a need for recognition and support for an expanded legal research framework along with additional research training for legal academics. There also needs to be more effective methods of measuring and recognising quality in legal research. This method needs to be one that can engender respect in an interdisciplinary context.

Race matters : Indigenous employment in the Australian public service

This thesis demonstrated that race mattered as a contributing factor to the low Indigenous participation rates within the Australian Public Service. The thesis showed that the public service reproduced social relations privileging non-Indigenous executives while positioning Indigenous executives as deficient. The thesis explains how the everydayness of racism assumes the racial neutrality of institutions because the concept of race is externalised as only having relevance to the racial other. Non-Indigenous executives regard Indigeneity as being synonymous with inferiority to explain Indigenous disadvantage. Consequently, the Indigenous experience of everyday racism is perpetuated and contributes to declining rates of employment.