Enhancing employment services for people with severe mental illness: the challenge of the Australian service environment

Objectives:  Comparatively few people with severe mental illness are employed despite evidence that many people within this group wish to obtain, can obtain and sustain employment, and that employment can contribute to recovery. This investigation aimed to: (i) describe the current policy and service environment within which people with severe mental illness receive employment services; (ii) identify evidence-based practices that improve employment outcomes for people with severe mental illness; (iii) determine the extent to which the current Australian policy environment is consistent with the implementation of evidence-based employment services for people with severe mental illness; and (iv) identify methods and priorities for enhancing employment services for Australians with severe mental illness through implementation of evidence-based practices. Method:  Current Australian practices were identified, having reference to policy and legal documents, funding body requirements and anecdotal reports. Evidence-based employment services for people with severe mental illness were identified through examination of published reviews and the results of recent controlled trials. Results:  Current policy settings support the provision of employment services for people with severe mental illness separate from clinical services. Recent studies have identified integration of clinical and employment services as a major factor in the effectiveness of employment services. This is usually achieved through co-location of employment and mental health services. Conclusions:  Optimal evidence-based employment services are needed by Australians with severe mental illness. Providing optimal services is a challenge in the current policy environment. Service integration may be achieved through enhanced intersectoral links between employment and mental health service providers as well as by co-locating employment specialists within a mental health care setting.

Diversified service provisioning in global business networks

Companies and their services are being increasingly exposed to global business networks and Internet-based ondemand services. Much of the focus is on flexible orchestration and consumption of services, beyond ownership and operational boundaries of services. However, ways in which third-parties in the “global village” can seamlessly self-create new offers out of existing services remains open. This paper proposes a framework for service provisioning in global business networks that allows an open-ended set of techniques for extending services through a rich, multi-tooling environment. The Service Provisioning Management Framework, as such, supports different modeling techniques, through supportive tools, allowing different parts of services to be integrated into new contexts. Integration of service user interfaces, business processes, operational interfaces and business object are supported. The integration specifications that arise from service extensions are uniformly reflected through a kernel technique, the Service Integration Technique. Thus, the framework preserves coherence of service provisioning tasks without constraining the modeling techniques needed for extending different aspects of services.

Factors influencing sustainability of health service innovation: Emergency nurse practitioner services

Introduction: Emergency department nurse practitioner services are one of the most frequently implemented service delivery models in Australian hospitals. This research examined factors influencing sustainability of this innovative service delivery model and offers some recommendations for future service integration. Background Many health service innovations have been implemented in an attempt to meet the growing demand for efficient, cost effective health care however, sustainability of many of these innovations has not been evaluated and is poorly understood. Aim The aim of the research was to identify factors that influence sustainability of emergency department nurse practitioner services and to operationalise a theoretical framework for evaluating innovation sustainability. Methodology The research used case study methodology. The case was emergency nurse practitioner services, and units of analysis were emergency department staff, emergency nurse practitioners and documents relating to nurse practitioner services. The data collection methods included, survey, one-on-one interviews, document analysis and telephone survey. Results This research shows that emergency nurse practitioner services partially comply with the factors of sustainability as described in the Sustainability of Innovation theoretical framework: Political, Organisational, Workforce, Financial and Innovation specific factors. Where services do not entirely meet the factors the existing benefits of the service may outweigh the barriers and other means of working around shortfalls are also implemented by staff to ensure patient safety. Conclusion The rapidly expanding emergency nurse practitioner service has been examined using case study methodology to find that certain factors may be threatening the sustainability of this health service innovation. Potentially an innovation may be sustained when only some factors are met in the short term, however, long term sustainability may be challenged if factors are not addressed and supported.

Articulating current service development practices: a qualitative analysis of eleven mental health projects.

BACKGROUND: The utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices. METHODS: Eleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices. RESULTS: Projects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation. CONCLUSIONS: This study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial.

Enhancing employment services for people with severe mental illness: the challenge of the Australian service environment

Objectives: Comparatively few people with severe mental illness are employed despite evidence that many people within this group wish to obtain, can obtain and sustain employment, and that employment can contribute to recovery. This investigation aimed to: (i) describe the current policy and service environment within which people with severe mental illness receive employment services; (ii) identify evidence-based practices that improve employment outcomes for people with severe mental illness; (iii) determine the extent to which the current Australian policy environment is consistent with the implementation of evidence-based employment services for people with severe mental illness; and (iv) identify methods and priorities for enhancing employment services for Australians with severe mental illness through implementation of evidence-based practices. Method: Current Australian practices were identified, having reference to policy and legal documents, funding body requirements and anecdotal reports. Evidence-based employment services for people with severe mental illness were identified through examination of published reviews and the results of recent controlled trials. Results: Current policy settings support the provision of employment services for people with severe mental illness separate from clinical services. Recent studies have identified integration of clinical and employment services as a major factor in the effectiveness of employment services. This is usually achieved through co-location of employment and mental health services. Conclusions: Optimal evidence-based employment services are needed by Australians with severe mental illness. Providing optimal services is a challenge in the current policy environment. Service integration may be achieved through enhanced intersectoral links between employment and mental health service providers as well as by co-locating employment specialists within a mental health care setting.

Integrating SOA into an Enterprise Architecture : a comparative analysis of alternative approaches

Enterprise Architectures have emerged as comprehensive corporate artefacts that provide structure to the plethora of conceptual views on an enterprise. The recent popularity of a service-oriented design of organizations has added service and related constructs as a new element that requires consideration within an Enterprise Architecture. This paper analyzes and compares the existing proposals for how to best integrate services into Enterprise Architectures. It uses the popular Zachman Framework as an example and differentiates the existing integration alternatives. This research can be generalized beyond service integration into an investigation onto how to possibly extend Enterprise Architectures with emerging constructs.

Facilitators of expanded and extended scope of paramedic practice - what makes them work?

Introduction Better integration of health services and redefinition of health workforce roles through expanding and extending traditional scope of clinical practice have been explored nationally and internationally. This paper aims to extend our earlier work by examining models of expanded and extended scope of paramedic practice for attributes which facilitate such a practice. Methods An exploratory multi-case study analysis of Australia, New Zealand, Canada and the United Kingdom expanded and extended paramedic practices were analysed. Results Successful models of advanced practice harness the capacity and personality of the paramedic practitioner, and are supported by enabling infrastructures, specifically: professional development/ education; clinical guideline and policy (boundary); access to physical infrastructure and clinical support from senior medical practitioners; and, ability to directly refer to other health services (service integration). The scope of advanced practice is however influenced by individual employers’ capacity, perceived needs and preference/ prioritises. The potential for advanced paramedic practice is equally applicable to urban as well as rural Australia. The Council of Ambulance Authorities’ Professional Competency Standard provides the form and functions for building on advanced paramedic practice. Recognition of such advanced paramedic practice provides a structure for professional growth, process for career progression and will support workforce retention. Conclusion The achievement of advanced knowledge and skills has positioned the paramedic profession to be recognized as a valuable clinician. The Council of Ambulance Authorities’ Professional Competency Standards provides the form and function for supporting advanced paramedic practice.

Infra-estrutura para portal internet integrador de serviços

Esta tese surge no contexto de sistemas e serviços web. O objectivo é propor uma solução para o problema da integração de informação de diversas fontes, numa plataforma web única, personalizável e adaptável ao utilizador. Nos casos de empresas ou organizações que tenham para diferentes tarefas, diferentes sistemas de informação independentes, o problema da integração de informação surge com a necessidade de integração destes numa única interface disponibilizada aos seus utilizadores. A integração de serviços numa mesma interface pressupõe que haja comunicação entre um sistema central (que fornece a interface) e os diversos sistemas existentes (que detêm a totalidade – ou parte – da informação a apresentar). Assim, será necessário garantir a identidade do utilizador a cada um dos serviços apresentados, bem como assegurar que cada utilizador tem à sua disposição de forma centralizada, apenas e só a informação e operações a que realmente tem acesso em cada um dos sistemas. Trata-se de uma plataforma que pretende por um lado, fornecer a informação correcta e orientada ao utilizador e, por outro lado, garantir que a organização que suporta o sistema consegue informar e interagir com os seus utilizadores de forma mais eficaz. O cenário adoptado é a Universidade de Aveiro. Esta pretende disponibilizar uma plataforma electrónica, onde os diferentes interlocutores (alunos, docentes, funcionários, ex-alunos, etc.) possam ter acesso a informação dirigida e orientada aos seus interesses e funções na Universidade. De modo a que cada utilizador seja realmente visto como um utilizador único, serão estudados e comparados serviços de modelação de utilizador e perfis de utilizador. Será proposto um serviço de modelação de utilizador e uma lógica de criação de perfis de utilizador, distintos do existente no estado de arte. Esta lógica conjuga a personalização da interface por parte do utilizador, com a gestão de operações e definição de políticas de segurança por parte da organização, de forma independente relativamente ao sistema de informação subjacente.

Arquitetura para execução segura de workflows de eGovernment dinâmicos

A integração de serviços na perspetiva dos cidadãos e empresas e a necessidade de garantir algumas características da Administração Pública como a versatilidade e a competitividade colocam alguns constrangimentos na conceção das arquiteturas de integração de serviços. Para que seja possível integrar serviços de forma a que se garanta a mutabilidade da Administração Pública, é necessário criar dinamicamente workflows. No entanto, a criação de dinâmica de workflows suscita algumas preocupações ao nível da segurança, nomeadamente em relação à privacidade dos resultados produzidos durante a execução de um workflow e em relação à aplicação de políticas de controlo de participação no workflow pelos diversos executores do mesmo. Neste trabalho apresentamos um conjunto de princípios e regras (arquitetura) que permitem a criação e execução de workflows dinâmicos resolvendo, através de um modelo de segurança, as questões referidas. A arquitetura utiliza a composição de serviços para dessa forma construir serviços complexos a que poderá estar inerente um workflow dinâmico. A arquitetura usa ainda um paradigma de troca de mensagens-padrão entre os prestadores de serviços envolvidos num workflow dinâmico. O modelo de segurança proposto está intimamente ligado ao conjunto de mensagens definido na arquitetura. No âmbito do trabalho foram identificadas e analisadas várias arquiteturas e/ou plataformas de integração de serviços. A análise realizada teve como objetivo identificar as arquiteturas que permitem a criação de workflows dinâmicos e, destas, aquelas que utilizam mecanismos de privacidade para os resultados e de controlo de participação dos executores desses workflows. A arquitetura de integração que apresentamos é versátil, escalável, permite a prestação concorrente de serviços entre prestadores de serviços e permite criar workflows dinâmicos. A arquitetura permite que as entidades executoras do workflow decidam sobre a sua participação, decidam sobre a participação de terceiros (a quem delegam serviços) e decidam a quem entregam os resultados. Os participantes são acreditados por entidades certificadores reconhecidas pelos demais participantes. As credenciais fornecidas pelas entidades certificadoras são o ponto de partida para a aplicação de políticas de segurança no âmbito da arquitetura. Para validar a arquitetura proposta foram identificados vários casos de uso que exemplificam a necessidade de construção de workflows dinâmicos para atender a serviços complexos (não prestados na íntegra por uma única entidade). Estes casos de uso foram implementados num protótipo da arquitetura desenvolvido para o efeito. Essa experimentação permitiu concluir que a arquitetura está adequada para prestar esses serviços usando workflows dinâmicos e que na execução desses workflows os executores dispõem dos mecanismos de segurança adequados para controlar a sua participação, a participação de terceiros e a privacidade dos resultados produzidos no âmbito dos mesmos.

Integrated practice in the early years in Australia: The assumptions, omissions and contradictions of policy reform

The aim of this article is to examine current national early years’ policy reform, which emphasises the importance of service integration, national quality standards and a quality knowledge base for educators concerning the provision of early childhood education and care. Using Queensland, Australia, as an example, a policy discourse analysis identifies two problematics of implementing current national policy – the early childhood education and care problematic and the integration problematic. The article argues that speedy implementation of a national policy in order to meet national targets has unintended consequences for the knowledge base of educators and the possibility of collaboration within service provision. Although government commitment in this area is evident, these consequences and the current difficulties surrounding integration are the result of the lack of a specific integration strategy, and government investment focussed on the development of an integrated workforce.

A educação permanente em saúde na ótica dos cirurgiões dentistas

This study aimed to examine the perception of dentist-surgeon about the Permanent Education in Health (PEH). It is characterized as a qualitative research with focus in the field of public health policies. It refers specifically to the development of Permanent Education policy in Health in the state of Rio Grande do Norte. They were participants of this research 42 dentist surgeons and 83.3% females and 16.7% males, participants in Specialization courses approved and agreed by the Permanent Education Center in Health (PEC-RN) in the period 2005 to 2007. These professionals are part of the Family Health Strategy (FHS), and 11.9% work in management at the central level and 88.1% are directly related to oral health care in the Basic Health Units of the Family, 30 cities in the state. Data collection was through a questionnaire, with questions that guided the research development and achieve the objectives proposed. The socio-demographic data were analyzed using the descriptive statistics and subjective content was subjected to content analysis by Bardin. The emerging categories from the textual material generated by respondents were: program content, methodological approach and concepts of Permanent Education in Health. The subjects surveyed reported that the program content is more comprehensive and directs to the reflection of everyday practices, with regard to the methodological approach, concern that occurs through discussion and reflection with dynamic, participative, varied and constructive activities, questioning and putting as the main focus. As for understanding of the concepts of the PEH, there was a consensus that define as education stable strategies which contributing to transform and improve the health workers to have the upgrade, improvement of practices, being based on everyday experience and taking into account the accumulation and renewal of these experiences. Therefore, results presented showed that there is a clear understanding of the subjects on the proposals and guidelines of the PEH. It was concluded that lack continuous access to the policies proposed by Ministry of Health involving health workers, managers, communities, through social control and the teaching-service integration and that they are worked within the health system and can classify all these segments of society favor the existence of a more participatory, effective, fair and better quality health service

Projetos políticos pedagógicos dos cursos de Odontologia do RN : formação profissional e a perspectiva da atenção à terceira idade

Brazil has been undergoing major demographic change.According to IBGE, the next 20 years the country's elderly population may reach over 30 million people. This tariff provides specifics regarding the process of health / disease. It is essential that higher education institutions are committed to this demand in view of the integrated training of health needs of society. The aim of this study is to analyze the Pedagogical Political Projects (PPP) of courses in dentistry in Rio Grande do Norte (RN), according to the national curriculum guidelines (DCNS) and training from the perspective of health care for the elderly. This is an exploratory study with a qualitative approach: with records and interviews. The study subjects were an Assistant Professor in the development of PPPs for each institution. The scenario in this study were dental training institutions in the newborns. Initially, the analysis of the PPP was by using the Alceste 4.9 software. The interpretation of the contents of interviews with teachers was done through content analysis of Bardin (2010). The PPPs are based on the DCNS, meet the characteristics of regional and seek a generalist, but still strongly directed to technical and scientific aspects of professional practice. Efforts and institutional approaches, involving teachers and students of the courses are being mobilized for training with more articulated network of health services. However, the emphasis on content pertaining to the health care of the elderly, is still limited when compared to those targeted content inherent in children and adolescents in all three curricular structures. It is reasonable to conclude that the historical, political, scientific, cultural and social, present in society, influence the formation of the dental professional RN. The greater participation of society in the process of vocational training in dentistry is needed. This can be done from the involvement of universities with health councils, bodies representing the dental profession and other segments of civil society in order to induce changes that generate ideas and educational practices integrative and interdisciplinary, with emphasis on continuing education for teachers, servants, employees and students. Containing conduct this process inherent flexibility of curriculum, teaching-service integration and coordination abilities and professional skills that are essential to understanding the human being and its complexities