Insight into the pain customer : how to improve the value proposition for community pharmacy

1. Shoppers Profiles- Are Grocery Shoppers any different to Pharmacy Shoppers? 2. Awaking the Sleeping Giants- Supermarkets push into OTC Medicines 3. Price versus Value for Money- What’s the Difference? Value and Perceived Quality 4. Consumer Decision Making Process- The Pharmacists ‘Trump’ Card

Degree of value alignment : a grounded theory of rural nurse resignations

INTRODUCTION: The shortage of nurses willing to work in rural Australian healthcare settings continues to worsen. Australian rural areas have a lower retention rate of nurses than metropolitan counterparts, with more remote communities experiencing an even higher turnover of nursing staff. When retention rates are lower, patient outcomes are known to be poorer. This article reports a study that sought to explore the reasons why registered nurses resign from rural hospitals in the state of New South Wales, Australia. METHODS: Using grounded theory methods, this study explored the reasons why registered nurses resigned from New South Wales rural hospitals. Data were collected from 12 participants using semi-structured interviews; each participant was a registered nurse who had resigned from a rural hospital. Nurses who had resigned due to retirement, relocation or maternity leave were excluded. Interviews were transcribed verbatim and imported into NVivo software. The constant comparative method of data collection and analysis was followed until a core category emerged. RESULTS: Nurses resigned from rural hospitals when their personal value of how nursing should occur conflicted with the hospital's organisational values driving the practice of nursing. These conflicting values led to a change in the degree of value alignment between the nurse and hospital. The degree of value alignment occurred in three dynamic stages that nurses moved through prior to resigning. The first stage, sharing values, was a time when a nurse and a hospital shared similar values. The second stage was conceding values where, due to perceived changes in a hospital's values, a nurse felt that patient care became compromised and this led to a divergence of values. The final stage was resigning, a stage where a nurse 'gave up' as they felt that their professional integrity was severely compromised. The findings revealed that when a nurse and organisational values were not aligned, conflict was created for a nurse about how they could perform nursing that aligned with their internalised professional values and integrity. Resignation occurred when nurses were unable to realign their personal values to changed organisational values - the organisational values changed due to rural area health service restructures, centralisation of budgets and resources, cumbersome hierarchies and management structures that inhibited communication and decision making, out-dated and ineffective operating systems, insufficient and inexperienced staff, bullying, and a lack of connectedness and shared vision. CONCLUSIONS: To fully comprehend rural nurse resignations, this study identified three stages that nurses move through prior to resignation. Effective retention strategies for the nursing workforce should address contributors to a decrease in value alignment and work towards encouraging the coalescence of nurses' and hospitals' values. It is imperative that strategies enable nurses to provide high quality patient care and promote a sense of connectedness and a shared vision between nurse and hospital. Senior managers need to have clear ways to articulate and imbue organisational values and be explicit in how these values accommodate nurses' values. Ward-level nurse managers have a significant responsibility to ensure that a hospital's values (both explicit and implicit) are incorporated into ward culture.

Protein-energy malnutrition exists and is associated with negative outcomes in morbidly obese hospital patients

Prevalence of protein-energy malnutrition (PEM), food intake inadequacy and associated health-related outcomes in morbidly obese (Body Mass Index ≥ 40 kg/m2) acute care patients are unknown. This study reports findings in morbidly obese participants from the Australasian Nutrition Care Day Survey (ANCDS) conducted in 2010. The ANCDS was a cross-sectional survey involving acute care patients from 56 Australian and New Zealand hospitals. Hospital-based dietitians evaluated participants’ nutritional status (defined by Subjective Global Assessment, SGA) and 24-hour food intake (as 0%, 25%, 50%, 75%, and 100% of the offered food). Three months later, outcome data, including length of stay (LOS) and 90-day in-hospital mortality, were collected. Of the 3122 participants, 4% (n = 136) were morbidly obese (67% females, 55 ± 14 years, BMI: 48 ± 8 kg/m2). Eleven percent (n = 15) of the morbidly obese patients were malnourished, and most (n = 11/15, 73%)received standard hospital diets without additional nutritional support. Malnourished morbidly obese patients had significantly longer LOS and greater 90-day in-hospital mortality than well-nourished counterparts (23 days vs. 9 days, p = 0.036; 14% vs. 0% mortality, p = 0.011 respectively). Thirteen morbidly obese patients (10%) consumed only 25% of the offered meals with a significantly greater proportion of malnourished (n = 4, 27%) versus well-nourished (n = 9, 7%) (p = 0.018). These results provide new knowledge on the prevalence of PEM and poor food intake in morbidly obese patients in Australian and New Zealand hospitals. For the first time internationally, the study establishes that PEM is significantly associated with negative outcomes in morbidly obese patients and warrants timely nutritional support during hospitalisation.

Reproducibility of subjective appetite ratings and ad libitum test meal energy intake in overweight and obese males

Background To determine whether changes in appetite and energy intake (EI) can be detected and play a role in the effectiveness of interventions, it is necessary to identify their variability under normal conditions. We assessed the reproducibility of subjective appetite ratings and ad libitum test meal EI after a standardised pre-load in overweight and obese males. Methods Fifteen overweight and obese males (BMI 30.3 ± 4.9 kg/m2, aged 34.9 ± 10.6 years) completed two identical test days, 7 days apart. Participants were provided with a standardised fixed breakfast (1676 kJ) and 5 h later an ad libitum pasta lunch. An electronic appetite rating system was used to assess subjective ratings before and after the fixed breakfast, and periodically during the postprandial period. EI was assessed at the ad libitum lunch meal. Sample size estimates for paired design studies were calculated. Results Appetite ratings demonstrated a consistent oscillating pattern between test days, and were more reproducible for mean postprandial than fasting ratings. The correlation between ad libitum EI on the two test days was r = 0.78 (P < 0.01). Using a paired design and a power of 0.8, a minimum of 12 participants would be needed to detect a 10 mm change in 5 h postprandial mean ratings and 17 to detect a 500 kJ difference in ad libitum EI. Conclusion Intra-individual variability of appetite and ad libitum test meal EI in overweight and obese males is comparable to previous reports in normal weight adults. Sample size requirements for studies vary depending on the parameter of interest and sensitivity needed.

On the efficacy of key corporate governance recommendations in mid-tier companies : window-dressing or value-adding?

This paper examins the relationship between firm performance and key board and audit committee variables in a sample of mid-tier listed Australian firms. Unlike the UK where the corporate governance Code specifically outlines special arrangements for companies outside the FTSE 350 index, the ASX Corporate Governance recommendations make no special provisions for mid-tier companies. Consequently, mid-tier Australian companies may be expending scarce resources in conforming with recommendations that are not value-creating.

The value of tail risk hedging in defined contribution plans: What does history tell us

Hedging against tail events in equity markets has been forcefully advocated in the aftermath of recent global financial crisis. Whether this is beneficial to long horizon investors like employees enrolled in defined contribution (DC) plans, however, has been subject to criticism. We conduct historical simulation since 1928 to examine the effectiveness of active and passive tail risk hedging using out of money put options for hypothetical equity portfolios of DC plan participants with 20 years to retirement. Our findings show that the cost of tail hedging exceeds the benefits for a majority of the plan participants during the sample period. However, for a significant number of simulations, hedging result in superior outcomes relative to an unhedged position. Active tail hedging is more effective when employees confront several panic-driven periods characterized by short and sharp market swings in the equity markets over the investment horizon. Passive hedging, on the other hand, proves beneficial when they encounter an extremely rare event like the Great Depression as equity markets go into deep and prolonged decline.

Contextualising co-creation of value in electronic personal health records

This conceptual paper is a preliminary part of an ongoing study into take-up of electronic personal health records (ePHRs). The purpose of this work is to contextually ‘operationalise' Grönroos’ (2012) model of value co-creation in service for ePHRs. Using findings in the extant literature we enhance theoretical and practical understanding of the potential for co-creation of value with ePHRs for relevant stakeholders. The research design focused on the selection and evaluation of relevant literature to include in the discussion. The objective was to demonstrate which articles can be used to 'contextualise' the concepts in relation to relevant healthcare providers and patient engagement in the co-creation of value from having shared ePHRs. Starting at the service concept, that is, what the service provider wants to achieve and for whom, there is little doubt that there are recognised benefits that co-create value for both healthcare providers and healthcare consumers (i.e. patients) through shared ePHRs. We further highlight both alignments and misalignments in the resources and activities concepts between stakeholder groups. Examples include the types of functionalities as well as the interactive and peer communication needs perceived as useful for healthcare providers compared to healthcare consumers. The paper has implications for theory and practice and is an original and innovative approach to studying the co-creation of value in eHealth delivery.

The impact of a congestion pricing exemption on the demand for new energy efficient vehicles in Stockholm

As governments seek to transition to more efficient vehicle fleets, one strategy has been to incentivize ‘green’ vehicle choice by exempting some of these vehicles from road user charges. As an example, to stimulate sales of Energy-Efficient Vehicles (EEVs) in Sweden, some of these automobiles were exempted from Stockholm’s congestion tax. In this paper the effect this policy had on the demand for new, privately-owned, exempt EEVs is assessed by first estimating a model of vehicle choice and then by applying this model to simulate vehicle alternative market shares under different policy scenarios. The database used to calibrate the model includes owner-specific demographics merged with vehicle registry data for all new private vehicles registered in Stockholm County during 2008. Characteristics of individuals with a higher propensity to purchase an exempt EEV were identified. The most significant factors included intra-cordon residency (positive), distance from home to the CBD (negative), and commuting across the cordon (positive). By calculating vehicle shares from the vehicle choice model and then comparing these estimates to a simulated scenario where the congestion tax exemption was inactive, the exemption was estimated to have substantially increased the share of newly purchased, private, exempt EEVs in Stockholm by 1.8% (+/- 0.3%; 95% C.I.) to a total share of 18.8%. This amounts to an estimated 10.7% increase in private, exempt EEV purchases during 2008 i.e. 519 privately owned, exempt EEVs.

Renewing the Sustainable Energy Curriculum – Providing Internationally Relevant Skills for a Carbon Constrained Economy : Final Report 2014

The aims of the project were to scope and develop sustainable energy curriculum frameworks for Australian higher education Institutions that meet the needs of Australian and international student graduates and employers, both now and into the near future. The focus was on student centred learning and outcomes and to support graduates with the knowledge, skills and generic attributes required to work in the rapidly expanding sustainable energy industry in Australia and globally. The outputs of the project are designed to be relevant to specialist Sustainable Engineering and Energy Studies programs, as well as conventional engineering, science and humanities and social science programs that have a sustainable energy focus or major.

Renewing the Sustainable Energy Curriculum : Curriculum Frameworks and Guidance for Course Delivery

This guide is to support institutions in developing and teaching tertiary level programmes for sustainable energy professionals. Ongoing curriculum renewal is more difficult but vital for multidisciplinary courses preparing graduates to work in a specialised rapidly changing field. After more than 15 years of offering tertiary level “sustainable energy” qualifications in Australian Universities there was a clear need to assess how these courses are taught and develop curriculum frameworks to guide Universities designing/redesigning programs and courses to provide graduates with the relevant skills, knowledge and attributes (capabilities) seen by graduates and employers as required to work in this rapidly changing field. This guide presents the sustainable energy curriculum frameworks developed by the “Renewing the sustainable energy curriculum – providing internationally relevant skills for a carbon constrained economy” project, which was conducted over a two-and-a-quarter year period.

The impact of Cool Roof applications on energy performance : results from Australian sub-tropical and tropical field studies

Cool roof coatings are identified by their solar reflectance index. They have been reported to have multiple benefits, the extent of which are strongly dependent on the peculiarities of the local climate, building stock and electricity network. This paper presents measured and simulated data from residential, educational and commercial buildings involved in recent field trials in Australia. The purpose of the field trials was to evaluate the impact of such coatings on electricity demand and load and to assess their potential application to improve comfort whilst avoiding the need for air conditioners. Measured reductions in temperature, power (kW) and energy (kWh) were used to develop a predictive model that correlates ambient temperature distribution profiles, building demand reduction profiles and electricity network peak demand times. Combined with simulated data, the study indicates the types of buildings that could be targeted in Demand Management programs for the mutual benefit of electricity networks and building occupants.

Adsorption thermodynamics and kinetics study for the self-assembly of 1,8,15,22-tetraaminophthalocyanatocobalt(II) on glassy carbon surface

Spontaneous adsorption of 1,8,15,22-tetraaminophthalocyanatocobalt(II) (4α-CoIITAPc) on glassy carbon (GC) electrode leads to the formation of a stable self-assembled monolayer (SAM). Since the SAM of 4α-CoIITAPc is redox active, its adsorption on GC electrode was followed by cyclic voltammetry. SAM of 4α-CoIITAPc on GC electrode shows two pairs of well-defined redox peaks corresponding to CoIII/CoII and CoIIIPc−1/CoIIIPc−2. The surface coverage (Γ) value, calculated by integrating the charge under CoII oxidation, was used to study the adsorption thermodynamics and kinetics of 4α-CoIITAPc on GC surface. Cyclic voltammetric studies show that the adsorption of 4α-CoIITAPc on GC electrode has reached the saturation coverage (Γs) within 3 h. The Γs value for the SAM of 4α-CoIITAPc on GC electrode was found to be 2.37 × 10−10 mol cm−2. Gibbs free energy (ΔGads) and adsorption rate constant (kad) for the adsorption of 4α-CoIITAPc on GC surface were found to be −16.76 kJ mol−1 and 7.1 M−1 s−1, respectively. The possible mechanism for the self-assembly of 4α-CoIITAPc on GC surface is through the addition of nucleophilic amines to the olefinic bond on the GC surface in addition to a meager contribution from π stacking. The contribution of π stacking was confirmed from the adsorption of unsubstituted phthalocyanatocobalt(II) (CoPc) on GC electrode. Raman spectra for the SAM of 4α-CoIITAPc on carbon surface shows strong stretching and breathing bands of Pc macrocycle, pyrrole ring and isoindole ring. Raman and CV studies suggest that 4α-CoIITAPc is adopting nearly a flat orientation or little bit tilted orientation.

Developing affordable and sustainable housing through energy, transport, and building utility integration

Housing affordability and sustainable development are not polarised ideologies as both are necessary with increasing urbanisation. We must bridge the gap between current median house pricing and target affordable house pricing whilst pursuing sustainability. This paper examines the potential of initial construction cost and ongoing utilities and transport cost reduction through the integration of sustainable housing design and transit oriented development principles in a Commuter Energy and Building Utilities System (CEBUS). It also introduces current research on the development of a Dynamic Simulation Model for CEBUS applications in the Australian property development and construction industry.

Aggregating energy supply and demand

Energy usage in general, and electricity usage in particular, are major concerns internationally due to the increased cost of providing energy supplies and the environmental impacts of electricity generation using carbon-based fuels. If a "systems" approach is taken to understanding energy issues then both supply and demand need to be considered holistically. This paper examines two research projects in the energy area with IT tools as key deliverables, one examining supply issues and the other studying demand side issues. The supply side project used hard engineering methods to build the models and software, while the demand side project used a social science approach. While the projects are distinct, there was an overlap in personnel. Comparing the knowledge extraction, model building, implementation and interface issues of these two deliverables identifies both interesting contrasts and commonalities.

Power and paradigms : the Dutch response to pressures for shareholder value

In recent years, research aimed at identifying and relating the antecedents and consequences of diffusing organizational practices/ideas has turned its attention to debating the international adoption and implementation of the Anglo-American model of corporate governance, i.e., a shareholder-value-orientation (SVO). While financial economists characterize the adoption of an SVO as necessary and performance-enhancing, behavioral scientists have disputed such claims, invoking institutional contingencies in the appropriateness of an SVO. Our study seeks to provide some resolution to the debate by developing an overarching socio-political perspective that links the antecedents and consequences of the adoption of the contested practice of SVO. We test our framework using extensive longitudinal data from 1992-2006 from the largest listed corporations in the Netherlands, and we find a negative relationship between SVO adoption and subsequent firm performance, although this effect is attenuated when accompanied by greater SVO-alignment among major owners and a firm’s visible commitment to an SVO. This study extends prior research on the diffusion of contested organizational practices that has taken a socio-political perspective by offering an original contingency perspective that addresses how and why the misaligned preferences of corporate owners will affect (i) a company’s inclination to espouse an SVO, and (ii) the performance consequences of such misalignment.This study suggests when board members are considering the adoption of new ideas/practices (e.g., SVO), they should consider the contextual fitness of the idea/practice with the firm’s owners and their interests.