Quality of occupational health provision: two rating scales and their determinants

Background To develop quality scales for occupational health services (OHSs) and describe and explain variation in quality across the UK university sector.

Methods Analysis of data from a national survey, to which 93 of 117 (79%) UK universities responded, and from the Higher Education Statistics Agency. Two quality scales were generated, one from the 1985 International Labour Organization recommendations on OHSs and one from clinicians’ perceptions (good, adequate, poor) about their OHS. The determinants examined were number of university staff, type of OHS (in-house, contracted, none/other), number of full-time equivalent occupational health doctors and nurses and OHS leadership (doctor, nurse, other).

Results There was wide variation in quality and a correlation (r = 0.65) between scales. In-house service, increasing service size and leadership by a doctor or nurse were determinants of higher quality; size of the university was not statistically significant after taking account of these factors.

Conclusions Some university OHSs may not be structured or operated to promote the highest quality of service. Inspection of individual quality scale items may be informative. These scales may be applicable in other employment sectors.

An empirical model of international student satisfaction

Purpose – Based on the theoretical framework of expectancy-disconfirmation paradigm, the purpose of this paper is to examine the differences in student perceptions of the level of satisfaction related to educational and non-educational services among four groups of international postgraduate business students from China, India, Indonesia and Thailand undertaking study in Australia.

Design/methodology/approach – The data used in this study were derived from a mail survey conducted among international postgraduate business students from Asia studying at five universities in the state of Victoria, Australia. A total of 573 usable responses were received. Analysis using structural equation modelling, multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA) was undertaken.

Findings – This study develops and tests a model of international postgraduate student satisfaction. Findings indicate that the importance of service quality factors related to both educational and non-educational services varies among nationality groups and, therefore, has a differential impact on student satisfaction.

Practical implications – The study provides insights into seven constructs related to educational and non-educational services that are perceived as important by postgraduate business students from Asia in satisfaction formation. Universities should develop a diversified strategic marketing plan that incorporates the differential needs of international postgraduate business students according to the educational and non-educational constructs developed in this paper.

Originality/value – This study makes a contribution by filling a void in academic research in the area of satisfaction in relation to postgraduate international business students from four nationality groups in Asia.

The impact of globalisation on building surveying in Europe

This research examined the impact of globalisation on building surveying in Europe. Globalisation has resulted in the emergence of three large trading blocs or a global economy depending on the view one takes. This has impacted on property in two ways, by creating transnational companies who operate in many countries but require branding of their property, and companies who wish to invest in property markets other than their country of origin.

Building Surveyors have professional expertise and knowledge valued in the UK since the 1960 and 1970s but until recently not recognised in Europe, partly due to poor awareness of Building Surveying (BS) expertise, legal constraints, and practises relating to the employment of professionals. This is changing with the establishment of European Surveying associations and the globalisation of the RICS.

The results showed four factors provided the reasons for the globalisation of BS skills. These were that Building Surveyors provided a consistent level of service for their clients. Secondly that English is the language of business. Thirdly, clients perceive Europe as a single trading bloc with a need for technical representation in each investment centre, providing them with a fast, knowledgeable service. Fourthly, clients perceive that UK Building Surveyors know what international, or transnational, investors want.

The finding on the current demand for the BS services in Europe is that though demand is large, few Building Surveyors are located in Europe. Secondly, both investors and occupiers require the services of Building Surveyors, and local companies / individuals are beginning to use their professional services. Finally, there is a diverse range of demand for the many BS skills.

Five key barriers to the practice of BS skills in Europe emerged from the research. Firstly, there was the problem of limited local legal and technical knowledge possessed by outsiders. Secondly, there are legal barriers to practice in some cases. Thirdly, other professionals can, and do, offer the services of the Building Surveyor. Fourthly, there can be cultural differences between ‘values’ and ‘norms’ required in business that constitute barriers. Finally there can be ‘communication’ problems when the Building Surveyor is not located in the country where the service is required.

Lived experience of gay men caring for others with HIV/AIDS : living, loving and dying in the era of HIV/AIDS

This thesis explored gay male carers’ experience of caring for their partner, brother or friend who had HIV/AIDS. Through using phenomenological methodology (van Manen, 1990), the day-to-day caring experiences were uncovered. The data gathered were then analysed through a nursing ‘lens’, with the concept of stigma as an anchoring point. The dual stigmas of homophobia and AIDS phobia impacted on the daily lives of these men as they cared for their loved one. The research identified six themes. These were: 1) the relationship; 2) coping with HIV and AIDS; 3) the corporal impact of HIV/AIDS; 4) experiences of carers including the absence of others; 5) living daily with the virus: Demands of people living with HIV/AIDS (PLWHA); and 6) saying goodbye, but wanting to keep the memory alive. The caring these men undertook, for which they were frequently unprepared, was intensive and complex, but because of their commitment and love they battled on. Because of a sense of shame associated with AIDS phobia on the part of the PLWHA, the carer often had to undertake this care in isolation, without support from family, friends or home health care agencies. The carers struggled with not only the demands of day-to-day care, but also with non-acceptance from family, both of the nature of the relationship with their partner and of their homosexuality. Family members were forced, often with great difficulty, to acknowledge the close commitment the men had to each other. Recognition that one had a terminal disease, HIV/AIDS was also required. The fear of potential transmission was high among carers, friends and family members. Notably, there was an absence of blame on the part of the carer towards his partner for contracting HIV/AIDS. The physical decline and marking of the body further stigmatised the PLWHA, which added to carers’ burdens. They endeavoured to minimise the physical decline in their partner, so he could continue to pass as healthy, and attempted to make the day-to-day living as normal as possible. The methods of combating weight loss and opportunistic infections meant frequent medical appointments, complex intensive medical procedures and help with personal care, which was undertaken at home largely without support from health care staff. Carers frequently struggled also with their partner’s denial of being ill. One strategy all carers used was to escape with their partners from their everyday life in Melbourne and attempt metaphorically to leave the HIV/AIDS behind; this was a time when they could rekindle their life together as it was before HIV/AIDS came into their lives. Some carers chose to holiday without their partner, to give themselves a break from the day-to-day caring, while others planned and took holidays with their partner. The decline of the health in the PLWHA meant that family members had to recognise and accept both the nature of the relationship and the presence of the disease. This recognition and acceptance often came only when the partner was very ill, even at the point of dying. Carers and their partners discussed the potential use of euthanasia, as a means of ending the final phase of life with some dignity. One carer and his partner used euthanasia, despite its illegal status. The main concern for all carers was providing comfort and a reduction in the pain associated with HIV/AIDS for the partner. The widespread grief associated with HIV/AIDS was evident amongst these carers. All had known other gay men who had died, some carers own partner had died, or was about to die. There was an overwhelming sense of grief, which at times was repressed as a means of coping day-to-day. All carers felt it was important and necessary to remember those lost to HIV/AIDS through the various public memorials, as they did not want their partner to be just another faceless person lost to this disease. This phenomenological study of carers’ experience highlights the need for health care workers to be aware of the differing strategies that gay men use to cope with HIV/AIDS. While it may seem that the carers are coping with care of their partner, the outer façade is not always an accurate portrayal of the true situation. Health care workers should enquire as to the assistance these carers need from health care services in order to continue to care for their loved one. Such assistance can be the simple recognition of the partner and acceptance of them as part of the PLWHA’s network; this inclusion and acceptance is half the battle.

Family caregivers of the mentally ill and adaptive coping

The issue investigated in this thesis concerned the adaptive coping strategies that caregivers of the mentally ill adopt at different stages of encounter with their family member’s illness. Specifically, family caregivers’ responses to the illness were investigated within the parameters of the Spaniol and Zipple (1994) 4-stage model of the evolution of caregivers’ responses to mental illness. The accuracy of the model’s representation of the experience of caregivers across all kinship relationships to the care-recipient was evaluated. Spaniol and Zipple proposed four stages which they termed (1) Discovery/Denial, (2) Recognition/Acceptance, (3) Coping and (4) Personal/Political Advocacy. The first stage is characterised by persistent denial of mental illness and seeking answers from multiple sources. The second stage involves caregivers’ expectations of professionals providing answers when the illness is recognised. At this stage caregivers experience guilt, embarrassment and blame. The cyclical nature of the illness impedes acceptance and caregivers experience a deep sense of loss and crisis of meaning as they gradually accept the reality of the situation. In the third stage coping replaces grieving and the issues encountered include loss of faith in professionals, disruption to family life and recurrent crises. Belief in family expertise grows and the focus of coping changes. The fourth stage proposes that caregivers become more assertive, self-blame decreases and the focus is upon changing the system. New meanings and values are integrated. This study found that the model did not accurately describe the experience of all caregivers. Caregiver did not deny mental illness and adaptive coping occurred throughout all stages. Coping evolved as the issues encountered changed and was independent of resolution of grief. The issues encountered were more extensive than the model proposed and differed according to kinship relationship to the care recipient. The ways in which adaptive coping evolved were identified, as were the issues and their accompanying responses. Caregivers coped by adaptively responding to the requirements of care provision, maintaining a sense of self worth and generating positive effect.

Women, words, and work : a study of change and reconstruction in adult TESOL

My dissertation asserts that the discourses which at the present time construct the world of work for teachers in adult TESOL, are no longer adequate to represent the field in these new and rapidly changing times. For the last forty years the discourses that have constructed the field present a totalising, gender free, liberal humanist view of TESOL, rendering women's experience invisible, no longer speaking to or for women teachers who make up more than ninety percent of the teachers in Victorian adult TESOL programs (Cope & Kalantzis 1993, Brodkey 1991, Fine 1992, Peirce 1995). I begin by exploring the work of women teachers in adult TESOL, focusing on women teaching in the fast growing de-institutionalised settings of adult TESOL programs, which remain marginalised from the central programs in terms of administrative policy and practice. I report the findings of a series of projects undertaken by the teachers and the researcher by which new insights and understandings of teachers beliefs about their work and the changes which are currently reconstructing the field of adult language and literacy education in Australia, have been gained. I questions the discourses of applied linguistics which have for the past forty years constructed the field of adult TESOL in Australia and suggests that these lack a social theory (Candlin 1989). From the research findings I questions the possibility of continuing to work in the ways of the past, in the current climate of reconstruction of the field, rapid policy change and continued erosion of resources. I suggest that the previously loose system which held this field of work together, the ways of working, the understandings of practice, have in the light of these new times, been stretched to the limit and are in real danger of collapse. For the women working in TESOL this continued incursion of the systems into their work and the changes that have taken place, the denial of their ways of working, their local knowledge and gendered experiences, can be read against Habermas' concept of the colonisation of the lifeworld of language teaching (Habermas 1987).

Examining the development of the Victorian Certificate of Applied Learning and its implications for schools and teacher education in Australia

The Victorian Certificate of Applied Learning (VCAL) is a very successful senior secondary school qualification introduced in the Australian state of Victoria in 2002. Applied learning in the VCAL engages senior students in a combination of work-based learning, service-learning, and project-based learning and aims to provide them with the skills, knowledge, and attitudes to make informed choices regarding pathways to work and further education. The program has enjoyed rapid growth and its system-wide adoption by Victorian secondary schools, Technical and Further Education (TAFE) institutions, Registered Training Organizations (RTOs), and Adult and Community Education (ACE) providers has broadened significantly the range of senior schooling pathway options for young people. This paper will examine reasons for developing an applied learning senior secondary certificate and its rapid growth in Victoria since 2002. The authors draw on a number of case studies to profile the unique nature of applied learning in the VCAL, including its dimensions of service learning, work-based learning, and project-based learning. These case studies are also used to discuss a number of implications that have emerged from the use of applied learning in the VCAL, including approaches to teaching and assessment that will support applied learning and the development of new partnerships between VCAL providers and community partners. Finally, the paper considers significant implications the VCAL has created for teacher education in Victoria by discussing the new Graduate Diploma of Education (Applied Learning) developed by Deakin University.

Australian businesses in China : examining motivations and influences on entry modes for service providers

Purpose : The purpose of this paper is to examine the explanatory power of internationalisation theory for service firms internationalising into China.

Design/Methodology/Approach : Interviews were conducted with Australian based 23 service businesses that had entered China. Internationalisation theory was examined in this research. A number of constructs were investigated, which included the type of service (hard or soft), internationalisation motivation/pathways, previous international experience and whether companies plan or not. A number of propositions were tested in relation to these constructs.

Findings : The research found that soft services were more likely to choose full control modes, and hard services choose lower control modes. The most common motivation for entering China was to seek markets there, and these resulted in lower involvement modes. There was no relationship found between having international experience and entry mode, and it was found that businesses with low levels of planning still engaged high control modes. Internationalisation theory was partially supported in the research and was found to correctly predict the progression of equity in Chinese businesses owned by Australian companies.

Research Limitations/Implications : The limitation of the research was the small sample size, and future research should consider the constructs over a larger sample.

Practical Implications : The implications for other Australian service businesses is they should consider the type of service they have (hard or soft), and then make appropriate entry mode choices.

Originality/Value : There is limited research on the internationalisation of service businesses, and no other research has examined Australian service providers going to China.

The use of contracting out : a case study of decision-making and organisational learning in local government

One objective of government is to provide services at least cost whilst maintaining or improving service quality. While this may be an important objective, questions are being asked whether services can be provided more efficiently and effectively by the private rather than by the government sector. The shift of service provision from the public to the private sector is known as outsourcing or contracting out. The objective in this study is to critically examine whether the contracting out of services by local government to the private sector is an efficient management practice.

The contracting out of Parks and Grounds Maintenance services for the City of Kingston in the State of Victoria, Australia, is used as an exploratory case study to identify the variables associated with management decision-making in the contracting out process. Factors relevant to the contracting out decision such as the criteria used in selecting a contractor; the evaluation of a contractor’s performance; and any subsequent changes to management practice relating to the contracting out of the services are identified and discussed.

Political forces were found to be an important consideration in the initial contracting out decision, and the selection of a contractor was influenced by the potential to avoid costs. It was also found that under-bidding and associated cost /profit constraints lead to contractors engaging in non-sustainable environmental practices which resulted in the degradation of the local government’s Parks and Gardens assets. A sustainable asset management philosophy as opposed to an avoidable costs approach now underpins the contracting out process to ensure the preservation of such assets. Further, administrative processes have been revised to make tender specifications more prescriptive, critical components of services have been brought back in-house, and management practices have been amended so that a greater degree of control is exercised over contractors’ activities.

A new dimension of organizational justice : procedural voice

Dimensionality of the Colquitt justice measures was investigated across a wide range of service occupations. Structural equation modeling of data from 410 survey respondents found support for the 4-factor model of justice (procedural, distributive, interpersonal, and informational), although significant improvement of model fit was obtained by including a new latent variable, “procedural voice,” which taps employees’ desire to express their views and feelings and influence results. The model was confirmed in a second sample (N = 505) in the same organization six months later.

Simulation-based input loading condition optimisation of airport baggage handling systems

Scheduling check-in station operations are a challenging problem within airport systems. Prior to determining check-in resource schedules, an important step is to estimate the Baggage Handling System (BHS) operating capacity under non-stationary conditions. This ensures that check-in stations are not overloaded with bags, which would adversely affect the system and cause cascade stops and blockages. Cascading blockages can potentially lead to a poor level of service and in worst scenario a customer may depart without their bags. This paper presents an empirical study of a multiobjective problem within a BHS system. The goal is to estimate near optimal input operating conditions, such that no blockages occurs at check-in stations, while minimising the baggage travel time and maximising the throughput performance measures. We provide a practical hybrid simulation and binary search technique to determine a near optimal input throughput operating condition. The algorithm generates capacity constraint information that may be used by a scheduler to plan check-in operations based on flight arrival schedules.

Seeking the views of health professionals on translating chronic disease self-management models into practice

Abstract
Few studies have investigated the views of health professionals with respect to their use of chronic disease self-management (CDSM) in the workplace.
Objective
This qualitative study, conducted in an Australian health care setting, examined health professional's formal self-management (SM) training and their views and experiences on the use of SM techniques when working with people living with a chronic illness.
Methods
Purposive sample of 31 health care professionals from a range of service types participated in semi-structured interviews.
Results
The majority of participants (65%) had received no formal training in SM techniques. Participants reported a preference for an eclectic approach to SM, relying primarily on five elements: collaborative care, self-responsibility, client's individual situation, structured support and linking with community agencies. Problems with CDSM centred on medication management, complex measuring devices and limited efficacy with some patient groups.
Conclusion
This study provides valuable information with respect to the use of CDSM within the workplace from the unique perspective of a range of healthcare providers within an Australian health care setting.
Practice implications
Training implications, with respect to CDSM and patient care, are discussed, together with how these findings contribute to the debate concerning how SM principles are translated into healthcare settings.

Factors influencing consistency of triage using the Australasian triage scale : implications for guideline development

Objective: To examine the influence of the nurse, the type of patient presentation and the level of hospital service on consistency of triage using the Australasian Triage Scale.

Methods: A secondary analysis of survey data was conducted. The main study was undertaken to measure the reliability of 237 scenarios for inclusion in a national training programme. Nurses were recruited from a quota sample of Australian ED according to peer group. Analysis was performed to determine concordance: the percentage of responses in the modal triage category. Analysis of variance (anova) and Pearson correlations were used to investigate associations between the explanatory variables and concordance.

Results: A total of 42/50 (84%) participants returned questionnaires, providing 9946 scenario responses for analysis. Significant differences in concordance were observed by variables describing the type of patient presentation and level of urgency. Mean scores for the comparison group (adult pain; 70.7%) were higher than the groups involving a mental health or pregnancy presentations (61.4%; P≤ 0.001; 65.0%; P= 0.02). Modal responses at the extreme ends of the scale were higher than in the middle categories (P≤ 0.001). There was a significant main effect on concordance by type of service according to peer group (P= 0.03). Of the nine variables that described nurse characteristics, age was the only factor to influence the outcome (P= 0.05).

Conclusion: We identified significant problems with the consistency of triage for mental health and pregnancy presentations. Further research is needed to improve the guidelines on the implementation of the Australasian Triage Scale for these populations.

Multi-criteria content adaptation service selection broker

In this paper, we propose a service-oriented content adaptation framework and an approach to the Content Adaptation Service Selection (CASS) problem. In particular, the problem is how to assign adaptation tasks (e.g., transcoding, video summarization, etc) together with respective content segments to appropriate adaptation services. Current systems tend to be mostly centralized suffering from single point failures. The proposed algorithm consists of a greedy and single objective assignment function that is constructed on top of an adaptation path tree. The performance of the proposed service selection framework is studied in terms of efficiency of service selection execution under various conditions. The results indicate that the proposed policy performs substantially better than the baseline approach.

Medical tourism : a comparison of Australian, French and South Korean medical and health tourists to Thailand.

The high cost of surgery in Western countries has led to an increase in the demand for surgery in developing countries (York, 2008). The objective of this article is to examine the utilization and satisfaction with medical and health services purchased by Australian, French and South Korean visitors to Thailand. In late 2006 a face-to-face survey was conducted with 1,200 randomly selected tourists who had visited Thailand. Results show substantial usage of medical and health services. Satisfaction levels vary across type of service provided and by country of origin of tourist. Recommendations are provided to the national tourism authority. Future research directions are discussed.