Capacity building for the principalship : new knowledges for leading and managing learning organisations in the new economy

This paper canvasses current proposals by Australian education departments for capacity building, school renewal, situated learning, resilience and ‘wellness’ in the principalship, and the reflections and responses of current Principals.

Journal impact factors: implications for the nursing profession

Background: The journal impact factor (IF) has become widely used as an absolute measure of the quality of professional journals. It is also increasingly used as a tool for measuring the academic performance of researchers and to inform decisions concerning the appointment and tenure of academic staff as well as the viability of their departments/schools. In keeping with these IF-related trends, nurse researchers and faculty the world over are being increasingly expected to publish only in journals that have a high IF and to abandon all other forms of publishing (including books and book chapters) that do not attract IF rankings.

Issues: The IF obsession is placing in jeopardy the sustainability and hence viability of nursing journals and academic nursing publication lists (academic texts). If nurse authors abandon their publishing agenda and publish only in 'elite' journals (many of which may be outside nursing), the capacity of the nursing profession to develop and control the cutting edge of its disciplinary knowledge could be placed at risk.

Actions: Other means for assessing the quality and impact of nursing journals need to be devised. In addition, other works (such as books and book chapters) need also to be included in quality metrics. Nurse authors and journal editors must work together and devise ways to ensure the sustainability and viability of nursing publications.

Adapting to rural communities by overseas-born health professionals

Introduction
As with other multicultural nations, cultural diversity is a prominent feature of Australian society that leads to intercultural awareness and respect through citizen interactions. While this enriching multicultural interaction is clearly seen in big cities like Sydney and Melbourne, it can be very different in the Australian rural context. Living in an isolated rural area is challenging for health professionals who were brought up in urban areas, particularly those born overseas as they experience two types of cultural and social adaptation: urban into rural and native culture into new culture.

As a result of workforce shortages, many overseas trained health professionals are recruited to work in Australia, particularly in rural areas. This has given rise to various initiatives and strategies developed to support and assist these health professionals in their dual cultural and social adaptation. These include University Departments of Rural Health and Rural Clinical Schools programs as well as the Rural Workforce Agencies. However, these programs do not extend to those health professionals who were born overseas and trained in Australia as they are ‘Australian graduates’. In this paper we argue that in ways similar to those born and trained overseas, overseas-born Australian-trained health professionals may require additional support during the acculturation process and making the transition to working in rural communities.

Aim
The aim of this study is to examine some aspects of the acculturation of overseas-born Australian trained health professionals working in rural areas. This study seeks to understand the particular issues that emerge as a result of cultural difference in order to propose strategies that may more adequately prepare these Australian graduates for their rural health experience.

Method
Six overseas-born Australian-trained health professionals were invited to participate in this qualitative study using snowball sampling. The interviews were recorded with the approval of the participants. The interview data were transcribed as raw data and later coded for thematic analysis, which includes topics and themes arising from the raw data as well as from the interview questions with a focus on issues and strategies of acculturation into a rural health context.

Results/conclusion
There were different factors which facilitated or hindered the acculturation of overseas-born health professionals into a rural workforce such as professional isolation, cultural shock, family pressure, and cultural identity. The acculturation process was also affected by the quality of their perceived ‘social and cultural capital’. Different coping strategies were employed to deal with the changes in a new rural environment. The paper discusses some implications of this study with focus on how to improve the living and working conditions of overseas-born Australian-trained health professionals in order to attract them to rural Australia.

Evaluating the efficiencies of university faculties : adjusted data envelopment analysis

Efficiency measurement is at the heart of most management accounting functions. Data envelopment analysis (DEA) is a linear programming technique used to measure relative efficiency of organisational units referred in DEA literature as decision making units (DMUs). Universities are complex organisations involving multiple inputs and outputs (Abbott & Doucouliagos, 2008). There is no agreement in identifying and measuring the inputs and outputs of higher education institutes (Avkiran, 2001). Hence, accurate efficiency measurement in such complex institutes needs rigorous research.

Prior DEA studies have investigated the application of the technique at university (Avkiran, 2001; Abbott & Doucouliagos, 2003; Abbott & Doucouliagos, 2008) or department/school (Beasley, 1990; Sinuany-Stern, Mehrez & Barboy, 1994) levels. The organisational unit that has control and hence the responsibility over inputs and outputs is the most appropriate decision making unit (DMU) for DEA to provide useful managerial information. In the current study, DEA has been applied at faculty level for two reasons. First, in the case university, as with most other universities, inputs and outputs are more accurately identified with faculties than departments/schools. Second, efficiency results at university level are highly aggregated and do not provide detail managerial information.

Prior DEA time series studies have used input and output cost and income data without adjusting for changes in time value of money. This study examines the effects of adjusting financial data for changes in dollar values without proportional changes in the quantity of the inputs and the outputs. The study is carried out mainly from management accounting perspective. It is mainly focused on the use of the DEA efficiency information for managerial decision purposes. It is not intended to contribute to the theoretical development of the linear programming model. It takes the view that one does not need to be a mechanic to be a good car driver.

The results suggest that adjusting financial input and output data in time series analysis change efficiency values, rankings, reference set as well as projection amounts. The findings also suggest that the case University could have saved close to $10 million per year if all faculties had operated efficiently. However, it is also recognised that quantitative performance measures have their own limitations and should be used cautiously.

Assessing the risk of suicide at triage

Mental health related presentations to Australian emergency departments are steadily increasing. There is a growing incidence of depression, substance abuse, and other mental illnesses in the Australian population. Mental health problems will contribute 15% of the total world disease burden by 2020. Triage nurses are pivotal to the early detection and management of mental health problems.

The rapid assessment of mental health presentations at triage requires skill, knowledge, experience and confidence. One of the more complex aspects of triage is suicide risk assessment.

Building a culture

This study provides a case study of two higher educational institutions and their built environment discipline academic culture, with a specific focus on the impact of culture on the participation of females in the subject area. The two institutions, whilst both delivering built environment programmes, are very different. One is in the UK and is a new university, and the other is in Australia and in the top 200 universities of the world (THES, 2004). Comparative studies have become fashionable as a way of determining policy (Broadfoot, 2001) yet it is still important to acknowledge the character of the national policy within which the culture exists. Culture is a concept used to try and indicate the "climate and practices" developed within an organization to handle people, together with the values of the organization (Schein, 1997, p 3). The academic tribes have been described by Becher and Trowler (2001) in some detail, and they acknowledge the huge range of external forces now acting on academic cultures including a diversification of subject areas and the impact of gender on subject areas. Built environment education has traditionally been a gendered (male dominated) subject area and is making efforts to change (Greed, 1999; Turrell, Wilkinson, Astle and Yeo, 2002). The study will try to identify the cultural attributes that exist in each of the two built environment departments and programmes drawing on the signs and symbols that indicate the culture as well as drawing on staff / student experience. A comparative study will be carried out to determine differences and similarities, and potential lessons to be learned by each institution .

Patient safety ethics and human error management in ED contexts part I : development of the global patient safety movement

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end patient safety has become the focus of a world-wide endeavour aimed at reducing the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments. In this article (the first of a two-part discussion on the subject) an overview of the incidence and impact of preventable adverse events in ED contexts is explored. The development of a ‘culture of safety’ in other hazardous industries and the ‘lessons learned’ and applied to the health care industry are also briefly examined. In a second article (to be presented as Part II), some of the ethical tensions that have arisen in the context of implementing patient safety processes and their possible implications for ED contexts are explored.

Patient safety ethics and human error management in ED contexts Part II : Accountability and the challenge to change

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end, patient safety has become the focus of a world-wide endeavour – endorsed by the World Health Organisation – to reduce the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments, of which the Emergency Department is a prime example. In Part I of this article series, an overview of the incidence and impact of preventable adverse events in Emergency Department contexts and the development of the global patient safety movement was presented. In this second article brief attention is given to examining some of the ethical tensions that have arisen in response to the patient safety movement and their possible implications for Emergency Department contexts and staff.

Nutrient contribution to hyper-eutrophic wetlands in Perth, Western Australia

This thesis investigates nutrient contribution to six hyper-eutrophic lakes located within close proximity of each other on the Swan Coastal Plain and 20 kilometres south of the Perth Central Business District, Western Australia. The lakes are located within a mixed land use setting and are under the management of a number of state and local government departments and organisations. These are a number of other lakes on the Swan Coastal Plain for which the majority are less than 3 metres in depth and considered as an expression of the groundwater as their base is below the regional groundwater table throughout most of the year. The limited amount of water quality data available for these six lakes and the surface water and groundwater flowing into them has restricted a thorough understanding of the processes influencing the water quality of the lakes. Various private and public companies and organisations have undertaken studies on some of the individual wetlands and there is a wide difference in scientific opinion as to the major source of the nutrients to those wetlands. These previous studies failed to consider regional surface water and groundwater effects on the nutrient fluxes and they predominantly only investigated single wetland systems. This study attempts for the first time to investigate the regional contribution of nutrients to this system of wetlands existing on the Swan Coastal plain. As such, it also includes new research on the nutrient contribution to some of the remaining wetlands. The research findings indicate that the lake sediments represent a considerable store of nutrients (nitrogen and phosphorus). These sediments in turn control the nutrient status of the lake's water column. Surface water is found to contribute on an event-basis load of nutrients to the lakes whilst the groundwater surprisingly appears to contribute a comparatively low input of nutrients but governs the water depth. Analysis of the regional groundwater shows efficient denitrifying abilities as a result of denitrifying bacteria and the transport is localised. Management recommendations for the remediation of the social and environmental value of the lakes include treatment of the lake’s sediments via chemical bonding or atmospheric oxidation; utilising the regional groundwater’s denitrifying abilities to ‘treat’ the surface water via infiltration basins; and investigating the merits of managed or artificial aquifer recharge (MAR).

Changes in the Australian Commonwealth departmental machinery of government 1928-1982

The Commonwealth departmental machinery of government is changed by using Orders in Council to create, abolish or change the name of departments. Since 1906 governments have utilised a particular form of Order in Council, the Administrative Arrangements Order (AAO), as the means to reallocate functions between departments for administration. After 1928 successive governments from Scullin to Fraser gradually streamlined and increasingly used the formal processes for the executive to change departmental arrangements and the practical role of Parliament, in the process of change, virtually disappeared. From 1929 to 1982, 105 separate departments were brought into being, as new departments or through merger, and 91 were abolished, following the merger of their functions in one way or another with other departments. These figures exclude 6 situations where the change was simply that of name alone. Several hundred less substantial transfers of responsibilities were also made between departments. This dissertation describes, documents and analyses all these changes. The above changes can be distilled down to 79 events termed primary decisions. Measures of the magnitude of change arising from the decisions are developed with 157.25 units of change identified as occurring during the period, most being in the Whitlam and Fraser periods. The reasons for the changes were assessed and classified as occurring for reasons of policy, administrative logic or cabinet comfort. 47.2% of the units of change were attributed to policy, 34.9% to administrative logic, 17% to cabinet comfort. Further conclusions are drawn from more detailed analysis of the change and the reasons for the changes.

Effectiveness of the development of internal auditing in the Victorian Public Service (1982-1987)

The selection of an inappropriate regime by policy makers can thwart the effective implementation of public policy and lead to implementation failure. Competing values in the implementation process have a significant impact on the results of implementation, and the regime selected for implementation implies the choice of one value over another. Stoker has argued that on the one hand central leadership is valued for consistency, benefits of scale, co-ordination and cost sharing (instrumental model); and on the other, diffuse authority is valued as knowledge is particular and situational, and the task of analysis is to understand the problems, perspectives and interactions of implementation participants at the contact point between public programs and their clients (accommodation model). This study examines the implementation regime chosen by the Victorian Government for the introduction of a modern internal auditing function into the Victorian Public Service, using the Bureau of Internal Audit within its Department of Management and Budget. The selection of the Department of Management and Budget for the introduction of Internal Audit as a managerial accountability mechanism indicates that the instrumental model was held by the Victorian Government to be the most important in implementation. It is argued that use of a top-down central agency leadership approach resulted in implementation failure. Three propositions suggesting the mechanisms by which this result is brought about are examined: that lack of co-ordinated planning at the outset will result in inadequate definition of client needs as part of policy formulation; that intraorganisational conflict during the implementation success, as individual participants are likely to exercise their veto; and the increasing the number of participants contributes to complexity, so that they should only be involved in implementation when their presence is absolutely required. It is argued that the essential task of implementation is to create an environment where participants are likely to co-operate to achieve predetermined public policy goals; and that the introduction of a modern internal auditing approach into the Victorian Public Service required a more participatory implementation regime in order to facilitate policy outcomes and prevent implementation failure. It is also argued that the dominance of economic reform over accountability in Victoria restricted the ability of the Bureau of Internal Audit to implement change to internal audit practices within Victorian Government departments. The selection of an instrumental model of implementation by the Department of Management and Budget is examined in the context of the environment that existed in Victoria between 1982-1987; and while some of the values which Stoker associates with the top-down approach to policy making were observed, an alternative view to the development of internal auditing in the Victorian Public Service can be sustained.

Descriptive epidemiology of Australian football injuries presenting to sports medicine clinics

Sports injury prevention has been the focus of a number of recent public health initiatives due to the acknowledgement that sports injuries are a significant public health problem in Australia Whilst Australian football is one of the most popular participation sports in the country, only very limited data is available about football injuries The majority of sports injury data available for this sport is from hospital emergency departments and elite-level injury surveillance Overall there is a paucity of data from treatment settings other than hospitals In particular, there is a lack of information about the injuries sustained by community-level, junior and recreational Australian football participants. One good potential source of football injury data is sports medicine clinics. Analysis of injury presentations to sports medicine clinics was undertaken to provide a detailed description of the epidemiology of Australian football injuries that present to this treatment setting and to determine the implications for injury prevention in this sport. In addition, the data from sports medicine clinics was compared with existing sources of Australian football injury data to determine how representative sports medicine clinic data is of other football injury data sources and to provide recommendations for future injury surveillance n Australian football. The results contained in this thesis show that Australian football is the sport most associated with injury presentation at sports medicine clinics. The majority of injured Australian football players presenting to sports medicine clinics are community-level or junior participants which suggests that sports medicine clinics are a good source of information on the injuries sustained by sub-elite football participants. Competition is the most common context in which Australian football players presenting to sports medicine clinics are injured. The major causes of injuries to Australian football players are being struck by another player, collisions and overuse. Injuries to Australian football players predominantly involve the lower limb. Adult players, players who stopped participating immediately after noticing their injury and players with overuse injuries are the most likely to sustain a more severe injury (i.e. more than four weeks before a full return to football participation and a moderate/significant amount of treatment expected). The least experienced players (five or less years of participation) are more likely to require a significant amount of treatment than the more experienced players. The prevention of lower limb injuries, injuries caused by body contact and injuries caused by overuse should be a priority for injury prevention research in Australian football due to the predominance of these injury types in the pattern of Australian football injuries Additionally, adult players, as a group, should be a focus of injury prevention activities in Australian football due to the association between age and injury severity. Overall, the pattern of Australian football injuries presenting to sports medicine clinics appears to be different than reported by club-based and hospital emergency department injury surveillance activities. However, detailed comparison of sports medicine clinic Australian football data with other sources of Australian football injury data is difficult due to the variable methods of collecting and reporting injury information used by hospital emergency department and club-based injury surveillance activities. The development of a standardised method for collecting and reporting injury data in Australian football is strongly recommended to overcome the existing limitations of data collection in this sport. In summary, sports medicine clinics provide a rich source of Australian football injury data, especially from the community and junior levels of participation. The inclusion of sports medicine clinic data provides a broader epidemiological picture of Australian football injuries. This broader understanding of the pattern of Australian football injuries provides a better basis for the development of injury prevention measures in this sport.

Modeling data processing activity to assess the internal control function

This thesis describes research that was conducted into the potential of modeling the activities of the Data Processing Department as an aid to the computer auditor. A methodology is composed to aid in the evaluation of the Internal Controls, particularly the General Controls relative to computer processing. Consisting of three major components, the methodology enables the auditor to model the presumed activities of the Data Processing Department against the actual activities, as recorded on the Operating System Log. The first component of the methodology is the construction and loading of a model of the presumed activities of the Data Processing Department from its verbal, scheduled, and reported activities. The second component is the generation of a description of the actual activities of the Data Processing Department from the information recorded on the Operating System Log. This is effected by reducing the Operating System Log to the format described by the Standard Audit File concept. Finally, the third component in the methodology is the modeling process itself. This is in fact a new analysis technique proposed for use by the EDP auditor. The modeling process is composed of software that compares the model developed and loaded in the first component, with the description of actual activity as collated by the second component. Results from this comparison are then reviewed by the auditor, who determines if they adequately depict the situation, or whether the models description as specified in the first component requires to be altered, and the modeling process re-initiated. In conducting the research, information and data from a production installation was used. Use of the ‘real-world’ input proved both the feasibility of developing a model of the reported activities of the Data Processing Department, and the adequacy of the operating system log as a source of information to report the departments actual activities. Additionally, it enabled the involvement and comment of practicing auditors. The research involved analysis of the effect of EDP on the audit process, structure of the EDP audit process, data reduction, data structures, model formalization, and model processing software. Additionally, the Standard Audit File concept was verified through its use by practising auditors, and expanded by the development of an indexed data structure, which enabled its analysis to be conducted interactively. Results from the trial implementation of the research software and methodology at a production installation confirmed the research hypothesis that the activities of the Data Processing Department could be modelled, and that there are substantial benefits from the EDP auditor in analysing this process. The research in fact provides a new source of information, and develops a new analysis technique for the EDP auditor. It demonstrates the utilization of computer technology to monitor itself for the audit function, and reasserts auditor independence by providing access to technical detail describing the processing activities of the computer.

A note on work-related values, budget emphasis and managers’ organisational commitment

Managers’ work-related values (WRVs) have important implications for designing appropriate management accounting systems (MAS) in organisations. This paper examines the effect of the interaction between managers’ WRV for innovation and budget emphasis (an integral part of MAS) on their organisational commitment. The sample consisted of 109 managers from production, marketing and support departments within Australian manufacturing firms. Hypotheses were tested using both quantitative and qualitative data collected by a questionnaire survey and post-survey interviews. The results indicate that the adoption of low budget emphasis led to high organisational commitment when managers’ WRV for innovation was high, but not when managers’ WRV for innovation was low. The results also indicate that marketing managers held higher WRV for innovation than production managers. The post-survey interviews provide further insight into how a more customer- and competitor-focused subculture of marketing managers and a more technical- and efficiency-focused subculture of production managers may promote the difference in their WRV for innovation, and affect their attitudes towards budget emphasis. The findings of the study have implications for design of performance evaluation systems for managers in functionally differentiated organisations.

Improving the communication between care providers of individuals who may require joint replacement surgery (JRS) a framework for referral

Aims & rationale/Objectives : The objective of the project was to specify the information required in referrals to public hospital orthopaedic outpatient departments in order to streamline the care and prioritisation of individuals who may require JRS. It was envisaged that an evidence-based GP-Orthopaedic derived referral system would assist in ensuring that the right person accessed the right care at the right time.

Methods : In collaboration with the RACGP and the Commonwealth Department of Health and Ageing, a national stakeholder working group was convened. A scoping document was prepared with input from key stakeholders. A review of primary research was undertaken as well as a review of relevant guidelines. Information on the implementation and evaluation of similar programs in Australia and overseas also informed the referral specification.

Principal findings : The initial scoping processes with key stakeholders provided clear information on core components of the referral. These were the use of standardised and respected assessment tools to determine the severity of arthritis, fitness for surgery and willingness of affected individuals to undergo surgery.

Discussion : About 20,000 JRS occur each year in public hospitals which emanate from 5 to 10 fold number of referrals. Arthritis and musculoskeletal diseases are a national health priority area reflecting the high burden of disease associated with these conditions. Various initiatives are being undertaken to address the quality of life of affected individuals. This project has revealed areas of potential improvement in the communication between care providers of individuals who may need JRS.

Implications : The project will result in the development of a standard referral form and guidelines to assist referring practitioners to communicate more effectively with the multidisciplinary care team, in particular orthopaedic care providers. The guidelines will be piloted in a large rural setting.