Changing travel patterns and journeys to health services in Great Britain 1985-2012: An examination health service utilisation using the National Travel Survey

Background This paper examines changing patterns in the utilisation and geographic access to health services in Great Britain using National Travel Survey data (1985-2012). The National Travel Survey (NTS) is a series of household surveys designed to provide data on personal travel and monitor changes in travel behaviour over time. The utilisation rate was derived using the proportion of journeys made to access health services. Geographic access was analysed by separating the concept into its accessibility and mobility dimensions. Methods Variables from the PSU, households, and individuals datasets were used as explanatory variables. Whereas, variables extracted from the journeys dataset were used as dependent variables to identify patterns of utilisation i.e. the proportion of journeys made by different groups to access health facilities in a particular journey distance or time band or by mode of transport; and geographic access to health services. A binary logistic regression analysis was conducted to identify the utilisation rate over the different time periods between different groups. This analysis shows the Odds Ratios (ORs) for different groups making a trip to utilise health services compared to their respective counterparts. Linear multiple regression analyses were conducted to then identify patterns of change in the accessibility and mobility level. Results Analysis of the data has shown that that journey distances to health facilities were signi fi cantly shorter and also gradually reduced over the period in question for Londoners, females, those without a car or on low incomes, and older people. Although rates of utilisation of health services we re Oral Abstracts / Journal of Transport & Health 2 (2015) S5 – S63 S43 signi fi cantly lower because of longer journey times. These fi ndings indicate that the rate of utilisation of health services largely depends on mobility level although previous research studies have traditionally overlooked the mobility dimension. Conclusions This fi nding, therefore, suggests the need to improve geographic access to services together with an enhanced mobility option for disadvantaged groups in order for them to have improved levels of access to health facilities. This research has also found that the volume of car trips to health services also increased steadily over the period 1985-2012 while all other modes accounted for a smaller number of trips. However, it is dif fi cult to conclude from this research whether this increase in the volume of car trips was due to a lack of alternative transport or due to an increase in the level of car-ownership.

Empirical insights into the development of a service-oriented enterprise architecture

Organisations use Enterprise Architecture (EA) to reduce organisational complexity, improve communication, align business and information technology (IT), and drive organisational change. Due to the dynamic nature of environmental and organisational factors, EA descriptions need to change over time to keep providing value for its stakeholders. Emerging business and IT trends, such as Service-Oriented Architecture (SOA), may impact EA frameworks, methodologies, governance and tools. However, the phenomenon of EA evolution is still poorly understood. Using Archer's morphogenetic theory as a foundation, this research conceptualises three analytical phases of EA evolution in organisations, namely conditioning, interaction and elaboration. Based on a case study with a government agency, this paper provides new empirically and theoretically grounded insights into EA evolution, in particular in relation to the introduction of SOA, and describes relevant generative mechanisms affecting EA evolution. By doing so, it builds a foundation to further examine the impact of other IT trends such as mobile or cloud-based solutions on EA evolution. At a practical level, the research delivers a model that can be used to guide professionals to manage EA and continually evolve it.

Integrated Chronic Disease Nurse Practitioner Service: Evaluation Final Report

Executive Summary Queensland University of Technology (QUT) was contracted to conduct an evaluation of an integrated chronic disease nurse practitioner service conducted at Meadowbrook Primary Care Practice. This evaluation is a collaborative project with nurse practitioners (NP) from Logan Hospital. The integrated chronic disease nurse practitioner service is an outpatient clinic for patients with two or more chronic diseases, including chronic kidney disease (CKD), heart failure (HF), diabetes (type I or II). This document reports on the first 12 months of the service (4th June, 2014 to 25th May, 2015). During this period: • 55 patients attended the NP clinic with 278 occasions of service provided • Almost all (95.7%) patients attended their scheduled appointments (only 4.3% did not attend an appointment) • Since attending the NP clinic, the majority of patients (77.6%) had no emergency department visits related to their chronic disease; only 3 required hospital admission. • 3 patients under the service were managed with Hospital In the Home which avoided more than 25 hospital bed days • 41 patients consented to join a prospective cohort study of patient-reported outcomes and patient satisfaction • 14 patient interviews and 3 stakeholder focus groups were also conducted to provide feedback on their perceptions of the NP-led service innovation. The report concludes with seven recommendations.

Controlling routine front line service workers: an Australian retail supermarket case

Food retail is known for its use of flexible labour and for the centralisation of functions at head office, resulting in a reduction of managerial autonomy at store level. This article employs a typology of controls developed from labour process scholarship to explore how retail managers negotiate the control of their predominantly part-time workforce. Using an Australian supermarket chain as a case, and mixed methods, the article demonstrates that supermarkets use a multiplicity of forms of control across their workforce. For front line service workers, the article identifies a new configuration of controls which intersects with employment status and acts differentially for checkout operators on different employment contracts.

Development and validation of a questionnaire to measure health professionals' attitudes toward identification of female victimes of domestic violence

Background Domestic violence against women is a major public health problem and violations of women’s human rights. Health professionals could play an important role in screening for the victims. From the evidence to date, it is unclear whether health professionals do play an active role in identification of the victims. Objectives To develop a reliable and valid instrument to measure health professionals’ attitude to identifying female victims of domestic violence. Methods A primary questionnaire was constructed in accordance with established guidelines using the Theory of Planned Behaviour Ajzen (1975) to develop an instrument to measure health professionals’ attitudes in identifying female victim of DV. An expert panel was used to establish content validity. Focus groups amongst a group of health professionals (N = 5) of the target population were performed to confirm face validity. A pilot study (N = 30 nurses and doctors) was undertaken to elicit the feasibility and reliability of the questionnaire. The questionnaire was also administered a second time after one week to check the stability of the tests. Results Feedbacks of the expert panel’s and group discussion confirmed that the questionnaire had the content and face validity. Cronbach’s alpha values for all the items were greater than 0.7. Strong correlations between the direct and indirect measures confirmed that the indirect measures were well constructed. High test-retest correlations confirmed that the measures were reliable in the sense of temporal stability. Significance This tool has the potential to be used by researchers in expanding the knowledge base in this important area.

Domestic reflections, electric reflections: Towards design interventions against everyday energy mundanity in the home

For many years, Human-Computer Interaction and interaction design researchers have been exploring the potential for interactive technologies to encourage sustainable living practices. This paper examines existing literature concerning domestic energy feedback, interlacing past examples of domestic interventions into the discussion. It synthesises recent design research conducted around domestic energy-use and provides a discussion into household circumstances, everyday activities, and the use and role of design. The themes presented are threefold. First, the individual is contrasted to the household collective and in turn calls for the scope and scale of design interventions to be geared towards connection between household members. The second theme questions the everyday, and proposes new avenues of thought when designing for the mundanity of everyday life. Finally, I propose that a design approach which counteracts an affirmative design approach, such as critical design, is an appropriate fit when critiquing and evaluating the mundane, everyday aspects of domestic life.

Repositioning the innovation rationale for public service media

The values that gave rise to the ethos of public service broadcasting (PSB) almost a century ago, and which have provided the rationale for PSBs around the world across that time, are under question. This article argues that the process of reinvention of PSBs is enhanced through repositioning the innovation rationale for public service media (PSM). It is organized around a differentiation which is part of the standard repertoire of innovation studies – that between product, process and organizational innovation – as they are being practised by the two Australian PSBs, the Australian Broadcasting Corporation (ABC) and the Special Broadcasting Service (SBS). The article then considers the general problematics of innovation for PSBs through an analysis of the operations of the public value test in the context of European PSM, and its, to this stage, non-application in Australia. The innovation rationale is argued to be a distinctive via media between complementary and comprehensive roles for PSM, which in turn suggests an international, policy-relevant research agenda focusing on international circumstances in which the public broadcaster is not market dominant.

Leveraging of software as a service by small and medium enterprises: Information systems capabilities and organisational complementarities

This research explored how small and medium enterprises can achieve success with software as a service (SaaS) applications from cloud. Based upon an empirical investigation of six growth oriented and early technology adopting small and medium enterprises, this study proposes a SaaS for small and medium enterprise success model with two approaches: one for basic and one for advanced benefits. The basic model explains the effective use of SaaS for achieving informational and transactional benefits. The advanced model explains the enhanced use of software as a service for achieving strategic and transformational benefits. Both models explicate the information systems capabilities and organizational complementarities needed for achieving success with SaaS.

Civil service HRM reforms in a new democracy: The case of Bhutan

This research investigates Bhutan Civil Service Human Resource Management strategies, policies and practices, and their contribution to achieving the national goal of Gross National Happiness. The study finds that the HRM of the Bhutanese civil service is meeting its strategic objective of contributing to GNH. The civil service in Bhutan plays an important role in socio-economic development, influences private sector practices, strengthens good governance and provides continuity to the government. Participants in the study were government ministers and senior, highly experienced civil servants. A model of civil service HRM in Bhutan is developed.

An Integrated Assessment Of The Suitability Of Domestic Solar Still As A Viable Safe Water Technology For India

Improving access to safe drinking water can result in multi-dimensional impacts on people's livelihood. This has been aptly reflected in the Millennium Development Goals (MDG) as one of the major objectives. Despite the availability of diverse and complex set of technologies for water purification, pragmatic and cost-effective use of the same is impeding the use of available sources of water. Hence, in country like India simple low-energy technologies such as solar still are likely to succeed. Solar stills would suffice the basic minimum drinking water requirements of man. Solar stills use sunlight, to kill or inactivate many, if not all, of the pathogens found in water. This paper provides an integrated assessment of the suitability of domestic solar still as a viable safe water technology for India. Also an attempt has been made to critically assess the operational feasibility and costs incurred for using this technology in rural India.

Factors influencing sustainability of health service innovation: Emergency nurse practitioner services

Introduction: Emergency department nurse practitioner services are one of the most frequently implemented service delivery models in Australian hospitals. This research examined factors influencing sustainability of this innovative service delivery model and offers some recommendations for future service integration. Background Many health service innovations have been implemented in an attempt to meet the growing demand for efficient, cost effective health care however, sustainability of many of these innovations has not been evaluated and is poorly understood. Aim The aim of the research was to identify factors that influence sustainability of emergency department nurse practitioner services and to operationalise a theoretical framework for evaluating innovation sustainability. Methodology The research used case study methodology. The case was emergency nurse practitioner services, and units of analysis were emergency department staff, emergency nurse practitioners and documents relating to nurse practitioner services. The data collection methods included, survey, one-on-one interviews, document analysis and telephone survey. Results This research shows that emergency nurse practitioner services partially comply with the factors of sustainability as described in the Sustainability of Innovation theoretical framework: Political, Organisational, Workforce, Financial and Innovation specific factors. Where services do not entirely meet the factors the existing benefits of the service may outweigh the barriers and other means of working around shortfalls are also implemented by staff to ensure patient safety. Conclusion The rapidly expanding emergency nurse practitioner service has been examined using case study methodology to find that certain factors may be threatening the sustainability of this health service innovation. Potentially an innovation may be sustained when only some factors are met in the short term, however, long term sustainability may be challenged if factors are not addressed and supported.

Exploring university-community partnerships in arts-based service learning with Australian First Peoples and Arts Organizations

In this chapter we focus on the importance of partnerships in arts-based service learning with Australian First Peoples and community arts organizations. Drawing on six years of our own partnership and a wide body of literature, this chapter aims to act as a trigger for further reflection on ways to engage in meaningful partnerships with First Peoples and arts organizations. In particular, the continuum between transactional and transformational types of relationships provides a useful means for understanding our work and for positioning the various benefits and challenges associated with university-community partnerships more broadly.

Strike Hard, Strike Sure - Operation Musketeer : British Military Planning during the Suez Crisis, 1956

This study analyses British military planning and actions during the Suez Crisis in 1956. It seeks to find military reasons for the change of concepts during the planning and compares these reasons with the tactical doctrines of the time. The thesis takes extensive advantage of military documents preserved in the National Archives, London. In order to expand the understanding of the exchange of views during the planning process, the private papers of high ranking military officials have also been consulted. French military documents preserved in the Service Historique de la Defence, Paris, have provided an important point of comparison. The Suez Crisis caught the British armed forces in the middle of a transition phase. The main objective of the armed forces was to establish a credible deterrence against the Soviet Union. However, due to overseas commitments the Middle East playing a paramount role because of its economic importance the armed forces were compelled to also prepare for Limited War and the Cold War. The armed forces were not fully prepared to meet this demand. The Middle Eastern garrison was being re-organised after the withdrawal from the Canal Base and the concept for a strategic reserve was unimplemented. The tactical doctrines of the time were based on experiences from the Second World War. As a result, the British view of amphibious operations and the subsequent campaigns emphasised careful planning, mastery of the sea and the air, sufficient superiority in numbers and firepower, centralised command and extensive administrative preparations. The British military had realized that Nasser could nationalise the Suez Canal and prepared an outline plan to meet this contingency. Although the plan was nothing more than a concept, it was accepted as a basis for further planning when the Canal was nationalised at the end of July. This plan was short-lived. The nominated Task Force Commanders shifted the landing site from Port Said to Alexandria because it enabled faster expansion of the bridgehead. In addition, further operations towards Cairo the hub of Nasser s power would be easier to conduct. The operational concept can be described as being traditional and was in accordance with the amphibious warfare doctrine. This plan was completely changed at the beginning of September. Apparently, General Charles Keightley, the Commander-in-Chief, and the Chairman of the Chiefs of Staff Committee developed the idea of prolonged aerial operations. The essence of the concept was to break the Egyptian will to resist by attacking the oil facilities, the transportation system and the armed forces. This victory through air concept would be supported by carefully planned psychological operations. This concept was in accordance with the Royal Air Force doctrine, which promoted a bomber offensive against selected target categories. General Keightley s plan was accepted despite suspicions at every planning level. The Joint Planning Staff and the Task Force Commanders opposed the concept from the beginning to the end because of its unpredictability. There was no information that suggested the bombing would persuade the Egyptians to submit. This problem was worsened by the fact that British intelligence was unable to provide reliable strategic information. The Task Force Commanders, who were responsible for the tactical plans, were not able to change Keightley s mind, but the concept was expanded to include a traditional amphibious assault on Port Said due to their resistance. The bombing campaign was never tested as the Royal Air Force was denied authorisation to destroy the transportation and oil targets. The Chiefs of Staff and General Keightley were too slow to realise that the execution of the plan depended on the determination of the Prime Minister. However, poor health, a lack of American and domestic support and the indecisiveness of the military had ruined Eden s resolve. In the end, a very traditional amphibious assault, which was bound to succeed at the tactical level but fail at the strategic level, was launched against Port Said.

Workplace belongingness, psychological distress and resilience in emergency service workers

- Objective Ambulance personnel provide emergency medical services to the community, often attending to highly challenging and traumatic scenes in complex and chaotic circumstances. Currently the assessment of predictors of psychological well-being remains limited. The current study investigated whether workplace belongingness was significant in predicting psychological distress as well as the presence of resilience in ambulance personnel whilst controlling for more routinely examined factors. - Method Australian ambulance officers (N = 740) completed a survey battery including the Kessler 10 (Kessler & Mroczek, 1994), Brief Resilience Scale (Smith et al., 2008) and Psychological Sense of Organisational Membership (Cockshaw & Shochet, 2010) scale. - Results Controlling for more commonly examined factors such as severity of trauma exposure and length of service, hierarchical multiple regression analyses demonstrated that workplace belongingness was significantly associated with reduced distress levels and enhanced resilience levels. - Conclusions Results suggest that strategies to enhance a sense of workplace belongingness in emergency service organisations could promote the well-being of emergency workers despite routine exposure to potentially traumatic events.

No Wrong Door: The Salvation Army Doorways Case Management Service

The primary aim of the evaluation project was to determine the impact of The Salvation Army Doorways case management model in relation to client satisfaction and meeting client needs. Specifically, the project sought to: • Provide an overview of structural barriers confronting individuals who are entrenched in enduring poverty; • Provide an overview of the specific issues encountered by individuals, including insight into personal challenges, hopes and dreams; • Analyse the effectiveness of Doorways interventions, specifically: o How important is the relationship with staff at the Doorways centre? o What skills and knowledge do staff need? o What Doorways activities are the most successful in breaking the cycle of poverty? o How important are community connections? • Provide information to The Salvation Army on what works well in Doorways and how Doorways might be improved or enhanced.