Performance measurement and feedback in a public sector program

Establishing a framework for measuring the performance of public sector programs is fraught with dangers. Many public sector organisations are satisfied with measuring activity in programs and fail to see the need for establishing a framework that will meet the needs of participants and measure outcomes as well as activities. This paper explores how a government department in Queensland went about establishing a performance management framework to measure the outcomes and activities in a program that was a public private partnership. Findings indicate that using an iterative consultative approach performance measure can be put in place that are meaningful and assist the participants to review the program.

Paramedic knowledge of infectious disease aetiology and transmission in an Australian Emergency Medical System

Introduction: Paramedics and other emergency health workers are exposed to infectious disease particularly when undertaking exposure-prone procedures as a component of their everyday practice. This study examined paramedic knowledge of infectious disease aetiology and transmission in the pre-hospital care environment.--------- Methods: A mail survey of paramedics from an Australian ambulance service (n=2274) was conducted.--------- Results: With a response rate of 55.3% (1258/2274), the study demonstrated that paramedic knowledge of infectious disease aetiology and modes of transmission was poor. Of the 25 infectious diseases included in the survey, only three aetiological agents were correctly identified by at least 80% of respondents. The most accurate responses for aetiology of individual infectious diseases were for HIV/AIDS (91.4%), influenza (87.4%), and hepatitis B (85.7%). Poorest results were observed for pertussis, infectious mononucleosis, leprosy, dengue fever, Japanese B encephalitis and vancomycin resistant enterococcus (VRE), all with less than half the sample providing a correct response. Modes of transmission of significant infectious diseases were also assessed. Most accurate responses were found for HIV/AIDS (85.8%), salmonella (81.9%) and influenza (80.1%). Poorest results were observed for infectious mononucleosis, diphtheria, shigella, Japanese B encephalitis, vancomycin resistant enterococcus, meningococcal meningitis, rubella and infectious mononucleosis, with less than a third of the sample providing a correct response.--------- Conclusions: Results suggest that knowledge of aetiology and transmission of infectious disease is generally poor amongst paramedics. A comprehensive in-service education infection control programs for paramedics with emphasis on infectious disease aetiology and transmission is recommended.

Determinants of pre-hospital care non-usage for patients with emergency care needs [including commentary by Snooks H.]

Objective-To establish the demographic, health status and insurance determinants of pre-hospital ambulance non-usage for patients with emergency medical needs. Methods-Triage category, date of birth, sex, marital status, country of origin, method and time of arrival, ambulance insurance status, diagnosis, and disposal were collected for all patients who presented over a four month period (n=10 229) to the emergency department of a major provincial hospital. Data for patients with urgent (n=678) or critical care needs (n=332) who did not use pre-hospital care were analysed using Poisson regression. Results-Only a small percentage (6.6%) of the total sample were triaged as having urgent medical needs or critical care needs (3.2%). Predictors of usage for those with urgent care needs included age greater than 65 years (prevalence ratio (PR)=0.54; 95% confidence interval (CI)= 0.35 to 0.83), being admitted to intensive care or transferred to another hospital (PR=0.62; 95% CI=0.44 to 0.89) or ward (PR=0.72; 95% CI=0.56 to 0.93) and ambulance insurance status (PR=0.67; 95% CI=052 to 0.86). Sex, marital status, time of day and country of origin were not predictive of usage and non-usage. Predictors of usage for those with critical care needs included age 65 years or greater (PR=0.45; 95% CI=0.25 to 0.81) and a diagnosis of trauma (PR=0.49; 95% CI=0.26 to 0.92). A non-English speaking background was predictive of non-usage (PR=1.98; 95% CI=1.06 to 3.70). Sex, marital status, time of day, triage and ambulance insurance status were not predictive of non-usage. Conclusions-Socioeconomic and medical factors variously influence ambulance usage depending on the severity or urgency of the medical condition. Ambulance insurance status was less of an influence as severity of condition increased suggesting that, at a critical level of urgency, patients without insurance are willing to pay for a pre-hospital ambulance service.

On feasibility of regional frequency-based emergency control plans

Decentralized and regional load-frequency control of power systems operating in normal and near-normal conditions has been well studied; and several analysis/synthesis approaches have been developed during the last few decades. However in contingency and off-normal conditions, the existing emergency control plans, such as under-frequency load shedding, are usually applied in a centralized structure using a different analysis model. This paper discusses the feasibility of using frequency-based emergency control schemes based on tie-line measurements and local information available within a control area. The conventional load-frequency control model is generalized by considering the dynamics of emergency control/protection schemes and an analytic approach to analyze the regional frequency response under normal and emergency conditions is presented.

Linking early design decisions across multiple disciplines

The early stages of the building design process are when the most far reaching decisions are made regarding the configuration of the proposed project. This paper examines methods of providing decision support to building designers across multiple disciplines during the early stage of design. The level of detail supported is at the massing study stage where the basic envelope of the project is being defined. The block outlines on the building envelope are sliced into floors. Within a floor the only spatial divisions supported are the “user” space and the building core. The building core includes vertical transportation systems, emergency egress and vertical duct runs. The current focus of the project described in the paper is multi-storey mixed use office/residential buildings with car parking. This is a common type of building in redevelopment projects within and adjacent to the central business districts of major Australian cities. The key design parameters for system selection across the major systems in multi-storey building projects - architectural, structural, HVAC, vertical transportation, electrical distribution, fire protection, hydraulics and cost – are examined. These have been identified through literature research and discussions with building designers from various disciplines. This information is being encoded in decision support tools. The decision support tools communicate through a shared database to ensure that the relevant information is shared across all of the disciplines. An internal data model has been developed to support the very early design phase and the high level system descriptions required. A mapping to IFC 2x2 has also been defined to ensure that this early information is available at later stages of the design process.

Transitioning students to work through authentic employment-based training in an Australian senior secondary VET program.

A common challenge among OECD countries has been the development of education and training pathways that accommodate student needs and interests at the upper secondary level (OECD, 2000). The introduction of trade-focussed Australian Technical Colleges (ATCs) has met with mixed response. The ATCs aim to create a supported transition from school to work through dual pathway programs enabling students to follow a trade career while completing their upper secondary studies. There has been little explicit examination of the effectiveness of such senior secondary school arrangements. Using one such Australian Technical College as a case-study, this paper investigates the perceptions of the employers and students who were associated with the college. Using mixed-methods consisting of quantitative perception surveys and focus interviews, the results of this study show that students and employers are very satisfied with the College and illustrate that students have made significant gains in relating their learning to the workplace and everyday life.

Curriculum mapping of the Spatial Science Program, QUT : what was the cartography journey?

There are currently a number of issues of great importance affecting universities and the way in which their programs are now offered. Many issues are largely being driven top-down and impact both at a university-wide and at an individual discipline level. This paper provides a brief history of cartography and digital mapping education at the Queensland University of Technology (QUT). It also provides an overview of what is curriculum mapping and presents some interesting findings from the program review process. Further, this review process has triggered discussion and action for the review, mapping and embedding of graduate attributes within the spatial science major program. Some form of practical based learning is expected in vocationally oriented degrees that lead to professional accreditation and are generally regarded as a good learning exposure. With the restructure of academic programs across the Faculty of Built Environment and Engineering in 2006, spatial science and surveying students now undertake a formal work integrated learning unit. There is little doubt that students acquire the skills of their discipline (mapping science, spatial) by being immersed in the industry culture- learning how to process information and solve real-world problems within context. The broad theme of where geo-spatial mapping skills are embedded in this broad-based tertiary education course are examined with some focused discussion on the learning objectives, outcomes and examples of some student learning experiences

The research pathway to developing a health promotion intervention for the high school curriculum

Introduction: Schools provide the opportunity to reach a large number of adolescents in a systematic way however there are increasing demands on curriculum providing challenges for health promotion activities. This paper will describe the research processes and strategies used to design an injury prevention program.----- Methods: A multi-stage process of data collection included: (1) Surveys on injury-risk behaviours to identify targets of change (examining behaviour and risk/ protective factors among more than 4000 adolescents); (2) Focus groups (n= 30 high-risk adolescents) to understand and determine risk situations; (3) Hospital emergency outpatients survey to understand injury types/ situations; (4) Workshop (n= 50 teachers/ administrators) to understand the target curriculum and experiences with injury-risk behaviours; (5) Additional focus groups (students and teachers) regarding draft material and processes.----- Results: Summaries of findings from each stage are presented particularly demonstrating the design process. The baseline data identified target risk and protective factors. The following qualitative study provided detail about content and context and with the hospital findings assisted in developing ways to ensure relevance and meaning (e.g. identifying high risk situations and providing insights into language, culture and development). School staff identified links to school processes with final data providing feedback on curriculum fit, feasibility and appropriateness of resources. The data were integrated into a program which demonstrated reduced injury.----- Conclusions: A comprehensive research process is required to develop an informed and effective intervention. The next stage of a cluster randomised control trial is a major task and justifies the intensive and comprehensive development.

The NOURISH randomised control trial : positive feeding practices and food preferences in early childhood - a primary prevention program for childhood obesity

Background Primary prevention of childhood overweight is an international priority. In Australia 20-25% of 2-8 year olds are already overweight. These children are at substantially increased the risk of becoming overweight adults, with attendant increased risk of morbidity and mortality. Early feeding practices determine infant exposure to food (type, amount, frequency) and include responses (eg coercion) to infant feeding behaviour (eg. food refusal). There is correlational evidence linking parenting style and early feeding practices to child eating behaviour and weight status. A focus on early feeding is consistent with the national focus on early childhood as the foundation for life-long health and well being. The NOURISH trial aims to implement and evaluate a community-based intervention to promote early feeding practices that will foster healthy food preferences and intake and preserve the innate capacity to self-regulate food intake in young children. Methods/Design This randomised controlled trial (RCT) aims to recruit 820 first-time mothers and their healthy term infants. A consecutive sample of eligible mothers will be approached postnatally at major maternity hospitals in Brisbane and Adelaide. Initial consent will be for re-contact for full enrolment when the infants are 4-7 months old. Individual mother- infant dyads will be randomised to usual care or the intervention. The intervention will provide anticipatory guidance via two modules of six fortnightly parent education and peer support group sessions, each followed by six months of regular maintenance contact. The modules will commence when the infants are aged 4-7 and 13-16 months to coincide with establishment of solid feeding, and autonomy and independence, respectively. Outcome measures will be assessed at baseline, with follow up at nine and 18 months. These will include infant intake (type and amount of foods), food preferences, feeding behaviour and growth and self-reported maternal feeding practices and parenting practices and efficacy. Covariates will include sociodemographics, infant feeding mode and temperament, maternal weight status and weight concern and child care exposure. Discussion Despite the strong rationale to focus on parents’ early feeding practices as a key determinant of child food preferences, intake and self-regulatory capacity, prospective longitudinal and intervention studies are rare. This trial will be amongst to provide Level II evidence regarding the impact of an intervention (commencing prior to age 12 months) on children’s eating patterns and behaviours. Trial Registration: ACTRN12608000056392

A participative education program to reduce speeding in a group of work-related drivers

A number of intervention approaches have been developed to improve work-related driving safety. However, past interventions have been limited in that they have been data-driven, and have not been developed within a theoretical framework. The aim of this study is to present a theory-driven intervention. Based on the methodology developed by Ludwig and Geller (1991), this study evaluates the effectiveness of a participative education intervention on a group of work-related drivers (n = 28; experimental group n = 19, control n = 9). The results support the effectiveness of the intervention in reducing speeding over a six month period, while a non significant increase was found in the control group. The results of this study have important implications for organisations developing theory-driven interventions designed to improve work-related driving behaviour.