Perceived safety, quality and cultural competency of maternity care for culturally and linguistically diverse women in Queensland

Various policies, plans, and initiatives have been implemented to provide safe, quality, and culturally competent care to patients within Queensland’s healthcare system. A series of models of maternity care are available in Queensland that range from standard public care to private midwifery care. The current study aimed to determine whether identifying as Culturally or Linguistically Diverse (CALD) was associated with the perceived safety, quality, and cultural competency of maternity care from a consumer perspective, and to identify specific needs and preferences of CALD maternity care consumers. Secondary analysis of data collected in the Having a Baby in Queensland Survey 2012 was used to compare the experiences of 655 CALD women to those of 4049 non-CALD women in Queensland, Australia, across three stages of maternity care: pregnancy, labour and birth, and after birth. After adjustment for model of maternity care received and socio-demographic characteristics, CALD women were significantly more likely than non-CALD women to experience suboptimal staff technical competence in pregnancy, overall perceived safety in pregnancy and labour/birth, and interpersonal sensitivity in pregnancy and labour/birth. Approximately 50% of CALD women did not have the choice to use a translator or interpreter, or the gender of their care provider, during labour and birth. Thirteen themes of preferences and needs of CALD maternity care consumers based on ethnicity, cultural beliefs, or traditions were identified, however, these were rarely met. Findings imply that CALD women in Queensland experience disadvantageous maternity care with regards to perceived staff technical competence, safety, and interpersonal sensitivity, and receive care that lacks cultural competence. Improved access to support persons, continuity and choice of carer, and staff availability and training is recommended.

Determining reverse salient types and evolutionary dynamics of technology systems with performance disparities

Technological system evolution is marked by the uneven evolution of constituent sub-systems. Subsequently, system evolution is hampered by the resulting state of unevenness, or reverse salience, which results from the presence of the sub-system that delivers the lowest level of performance with respect to other sub-systems, namely, the reverse salient. In this paper, we develop absolute and proportional performance gap measures of reverse salience and, in turn, derive a typology of reverse salients that distinguishes alternative dynamics of change in the evolving system. We subsequently demonstrate the applicability of the measures and the typology through an illustrative empirical study of the PC (personal computer) technological system that functions as a gaming platform. Our empirical analysis demonstrates that patterns of temporal dynamics can be distinguished with the measurement of reverse salience, and that distinct paths of technological system evolution can be identified as different types of reverse salients emerge over time.

Will the TPP destroy our healthcare system?

Could the TPP force Australia to adopt an American-style model of private health? Dr Matthew Rimmer, Professor of intellectual property and innovation law at QUT, explains. There has been much concern that Australian citizens and residents are being ripped off on the price of medicines by multinational pharmaceutical drug companies. And the problem is only likely to be exacerbated by global trade deals — like the Trans-Pacific Partnership. The Trans-Pacific Partnership is a regional agreement under negotiation at the moment, involving a dozen countries across the Pacific Rim, including Australia and the United States. The secret trade agreement covers a score of topics — including such matters as intellectual property, investment, transparency in health procedures, and trade in services. The Trans-Pacific Partnership will have a significant impact upon the health of everyone in the Pacific Rim — particularly their ability to buy affordable medicines.

The reach and rationale for community health fairs

Latinos living in the USA account for one third of the uninsured population and face numerous cultural, linguistic, and financial barriers to accessing healthcare services. Community health fairs have developed to address the unmet need for no- and low-cost services that target prevention and education among underserved communities. The current research describes an ongoing effort in a community in Southern California and examines the barriers to health care among participants registering to receive free breast health screenings, one of the major services offered at a 2010 health fair. A total of 186 adult Latina women completed a brief questionnaire assessing their healthcare utilization and self-reported barriers to engaging in preventive and screening services. Approximately two thirds of the participants reported never receiving or having more than 2 years passing since receiving a preventive health check-up. Participants identified cost (64.5 %) and knowledge of locations for services (52.3 %) as the primary barriers to engaging in routine healthcare services. Engaging with health professionals represents a leading way in which adults obtain health information; health fairs offering cancer health screenings represent a culturally appropriate venue for increased cancer health equity. Implications of the current research for future health fairs and their role in community cancer education are discussed.

Quality of information for quality of life: Healthcare big data analytics

Big data analysis in healthcare sector is still in its early stages when comparing with that of other business sectors due to numerous reasons. Accommodating the volume, velocity and variety of healthcare data Identifying platforms that examine data from multiple sources, such as clinical records, genomic data, financial systems, and administrative systems Electronic Health Record (EHR) is a key information resource for big data analysis and is also composed of varied co-created values. Successful integration and crossing of different subfields of healthcare data such as biomedical informatics and health informatics could lead to huge improvement for the end users of the health care system, i.e. the patients.

Information Accountability of Healthcare Big Data

Huge amount of data are generated from a variety of information sources in healthcare while the data sources originate from a veracity of clinical information systems and corporate data warehouses. The data derived from the above data sources are used for analysis and trending purposes thus playing an influential role as a real time decision-making tool. The unstructured, narrative data provided by these data sources qualify as healthcare big-data and researchers argue that the application of big-data in healthcare might enable the accountability and efficiency.

Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language

Background Miscommunication in the healthcare sector can be life-threatening. The rising number of migrant patients and foreign-trained staff means that communication errors between a healthcare practitioner and patient when one or both are speaking a second language are increasingly likely. However, there is limited research that addresses this issue systematically. This protocol outlines a hospital-based study examining interactions between healthcare practitioners and their patients who either share or do not share a first language. Of particular interest are the nature and efficacy of communication in language-discordant conversations, and the degree to which risk is communicated. Our aim is to understand language barriers and miscommunication that may occur in healthcare settings between patients and healthcare practitioners, especially where at least one of the speakers is using a second (weaker) language. Methods/Design Eighty individual interactions between patients and practitioners who speak either English or Chinese (Mandarin or Cantonese) as their first language will be video recorded in a range of in- and out-patient departments at three hospitals in the Metro South area of Brisbane, Australia. All participants will complete a language background questionnaire. Patients will also complete a short survey rating the effectiveness of the interaction. Recordings will be transcribed and submitted to both quantitative and qualitative analyses to determine elements of the language used that might be particularly problematic and the extent to which language concordance and discordance impacts on the quality of the patient-practitioner consultation. Discussion Understanding the role that language plays in creating barriers to healthcare is critical for healthcare systems that are experiencing an increasing range of culturally and linguistically diverse populations both amongst patients and practitioners. The data resulting from this study will inform policy and practical solutions for communication training, provide an agenda for future research, and extend theory in health communication.

Network security metrics and performance for healthcare systems management

While enhanced cybersecurity options, mainly based around cryptographic functions, are needed overall speed and performance of a healthcare network may take priority in many circumstances. As such the overall security and performance metrics of those cryptographic functions in their embedded context needs to be understood. Understanding those metrics has been the main aim of this research activity. This research reports on an implementation of one network security technology, Internet Protocol Security (IPSec), to assess security performance. This research simulates sensitive healthcare information being transferred over networks, and then measures data delivery times with selected security parameters for various communication scenarios on Linux-based and Windows-based systems. Based on our test results, this research has revealed a number of network security metrics that need to be considered when designing and managing network security for healthcare-specific or non-healthcare-specific systems from security, performance and manageability perspectives. This research proposes practical recommendations based on the test results for the effective selection of network security controls to achieve an appropriate balance between network security and performance

Adopting healthcare big data in Sri Lankan healthcare sector

The concept of big data has already outperformed traditional data management efforts in almost all industries. Other instances it has succeeded in obtaining promising results that provide value from large-scale integration and analysis of heterogeneous data sources for example Genomic and proteomic information. Big data analytics have become increasingly important in describing the data sets and analytical techniques in software applications that are so large and complex due to its significant advantages including better business decisions, cost reduction and delivery of new product and services [1]. In a similar context, the health community has experienced not only more complex and large data content, but also information systems that contain a large number of data sources with interrelated and interconnected data attributes. That have resulted in challenging, and highly dynamic environments leading to creation of big data with its enumerate complexities, for instant sharing of information with the expected security requirements of stakeholders. When comparing big data analysis with other sectors, the health sector is still in its early stages. Key challenges include accommodating the volume, velocity and variety of healthcare data with the current deluge of exponential growth. Given the complexity of big data, it is understood that while data storage and accessibility are technically manageable, the implementation of Information Accountability measures to healthcare big data might be a practical solution in support of information security, privacy and traceability measures. Transparency is one important measure that can demonstrate integrity which is a vital factor in the healthcare service. Clarity about performance expectations is considered to be another Information Accountability measure which is necessary to avoid data ambiguity and controversy about interpretation and finally, liability [2]. According to current studies [3] Electronic Health Records (EHR) are key information resources for big data analysis and is also composed of varied co-created values [3]. Common healthcare information originates from and is used by different actors and groups that facilitate understanding of the relationship for other data sources. Consequently, healthcare services often serve as an integrated service bundle. Although a critical requirement in healthcare services and analytics, it is difficult to find a comprehensive set of guidelines to adopt EHR to fulfil the big data analysis requirements. Therefore as a remedy, this research work focus on a systematic approach containing comprehensive guidelines with the accurate data that must be provided to apply and evaluate big data analysis until the necessary decision making requirements are fulfilled to improve quality of healthcare services. Hence, we believe that this approach would subsequently improve quality of life.

Adding paths to resilience and daily accounts to an already rich field of inquiry: A brief commentary on James Jackson's "Social structure and health disparities"

In absolute terms, there have been improvements in social resources for all racial and ethnic groups in the United States. The rise in education levels among blacks and Hispanics, for instance, suggests a lessening of the gap between classes, beginning in the later part of the 1960’s (Kao & Thompson, 2003). Yet the divide in income and to a lesser extent education between peoples who differ in gender, skin color and ethnic origin continues and in many ways is greater now than ever (Danziger & Gottschalk, 1997); (Gottschalk, 1997). The psychological distance between those high and those low in social-economic status continues unabated and threatens to undermine the capacity of communities to foster the positive architecture of hope, optimism and equal opportunity that holds us together as a nation...

Differences in identifying healthcare associated infections using clinical vignettes and the influence of respondent characteristics: A cross-sectional survey of Australian infection prevention staff

Background Australia has commenced public reporting and benchmarking of healthcare associated infections (HAIs), despite not having a standardised national HAI surveillance program. Annual hospital Staphylococcus aureus bloodstream (SAB) infection rates are released online, with other HAIs likely to be reported in the future. Although there are known differences between hospitals in Australian HAI surveillance programs, the effect of these differences on reported HAI rates is not known. Objective To measure the agreement in HAI identification, classification, and calculation of HAI rates, and investigate the influence of differences amongst those undertaking surveillance on these outcomes. Methods A cross-sectional online survey exploring HAI surveillance practices was administered to infection prevention nurses who undertake HAI surveillance. Seven clinical vignettes describing HAI scenarios were included to measure agreement in HAI identification, classification, and calculation of HAI rates. Data on characteristics of respondents was also collected. Three of the vignettes were related to surgical site infection and four to bloodstream infection. Agreement levels for each of the vignettes were calculated. Using the Australian SAB definition, and the National Health and Safety Network definitions for other HAIs, we looked for an association between the proportion of correct answers and the respondents’ characteristics. Results Ninety-two infection prevention nurses responded to the vignettes. One vignette demonstrated 100 % agreement from responders, whilst agreement for the other vignettes varied from 53 to 75 %. Working in a hospital with more than 400 beds, working in a team, and State or Territory was associated with a correct response for two of the vignettes. Those trained in surveillance were more commonly associated with a correct response, whilst those working part-time were less likely to respond correctly. Conclusion These findings reveal the need for further HAI surveillance support for those working part-time and in smaller facilities. It also confirms the need to improve uniformity of HAI surveillance across Australian hospitals, and raises questions on the validity of the current comparing of national HAI SAB rates.

Borrowing from the geeks: What can healthcare facility design learn from IT?

People get into healthcare because they want to help society. And when a new hospital is briefed, everyone tries to do their best, but the process is mired by the impossibility of the task. Stakeholders rarely understand the architectural process, nobody can predict the future, and the only thing for certain is that everything will change as the project unfolds, revealing errors in initial assumptions and calculations, shifts in needs, new technologies etc. Yet there’s always pressure to keep to the programme and to press on regardless. This chaos leads eventually to suboptimal results: hospitals the world over are riddled with inefficiencies, idiosyncrasies, incredible wastage and features that lead to poor clinical outcomes. This talk will sketch out the basics of Scrum, the most popular open-source Lean/Agile methodology. It will discuss what healthcare designers can learn from the geeks in Silicon Valley reduce risk, meet deadlines and deliver the highest possible value for the budget despite the uncertainty.

The lean paradox : How can healthcare facilities shrink while clinical spaces expand?

Lean principles create highly efficient healthcare facilities by maximising the clinical value of every part of a facility and by removing everything else. In order that clinical accommodation can be used for a diverse set of functions including unexpected tasks and processes that haven’t even been invented, they have to be big. But somewhat surprisingly, whole facilities tend to shrink in terms of gross floor areas by disposing of non-clinical spaces when designed using Lean principles. And with the whole unit – the building costs shrink too. Using examples from the UK and the USA, this talk explores the unexpected solutions and improved outcomes when designers use a Lean approach to design.

Response to: Electronic health records and healthcare identifiers : legislation discussion paper

Public submission # 029 to a Australian federal parliamentary committee considering proposed legislative changes to the Commonwealth's Healthcare Identifiers Act 2010 and the Personally Controlled Electronic Health Records Act 2012.