The historiography of a profession: The societal and political drivers of the health information management profession in Australia.

Health information permeates healthcare delivery from point-of-care, across the continuum of care and throughout the healthcare system's policy, population health, research, planning and funding arenas. Health information managers (HIMs) expertly manage that information. This commentary theorises the health information management profession for the first time. Its purpose is to identify and contextualise, via a historiographical account, the societal and political drivers that have shaped contemporary Australian health information management and HIMs' scientific work. It seeks to build our knowledge of the socio-political influences on the profession's emergence and development, and the projected drivers of its future. Eight critical, socio-political drivers were identified and are addressed in temporaneous order. Scientific medicine has reflected the influences on medicine in the past century and a half of the medical record and other technologies, laboratory-based sciences, evidence-based medicine and evidence-based health. Standardisation has underpinned and guided the profession's practice. The hegemony of non-medical healthcare managers and resource- and performance-related accountabilities emerged in the 1960s, as did the efficiencies of bureaucratisation in healthcare and post-bureaucratic shifts to textualisation and technogovernance. Technologisation has driven constant change in health information management, as have the forces of the fast-paced risk society. Since the 1980s, the health consumer movement has propelled regulatory mechanisms that accord patients' access rights to their medical records and mandate information privacy protections. Finally, a nascent commodification of health information has emerged. These forces exert ongoing impacts on the profession. They will, we conclude, singularly and collectively continue to shape its discourses and direction.

A Review of the User Fees Policy for Primary Healthcare Consultations in Botswana: Problems With Effective Planning, Implementation and Evaluation.

BACKGROUND: The Government of Botswana introduced user-fees for primary healthcare consultations in 1975. The policy has remained in place since then, although the fee has remained largely unaltered despite rising inflation. Early reviews of the policy pointed to problems in its implementation, but there has been no evaluation in the past 20 years. The aim of this study was to review the policy to assess whether documented issues with its implementation have been addressed. METHODS: This qualitative study involved interviews with 32 key informants: 18 policy-makers and 14 front-line revenue collectors. Data were analysed thematically using a template approach with constructs from an established organizational capacity assessment framework used as predetermined categories to guide data collection and analysis. RESULTS: Limited administrative and management capacity has been a major hindrance to effective implementation of the policy. The lack of infrastructure for effective revenue collection led to misappropriation of funds. Lack of clear guidelines for health facilities on how to implement the policy generated interdepartmental conflicts. Study participants believed the current policy was unlikely to be cost-effective since the cost of collecting fees probably exceeded the revenue it generated. CONCLUSION: If the Botswana Government persists with the policy then it needs to improve organizational capacity to collect and manage revenues efficiently. However, policy thinking since the turn of the century has turned away from user-charges in healthcare as they impede the move towards universal access. It is timely therefore to consider alternative financing approaches that are more effective and a more equitable means of paying for healthcare.

Factors contributing to under-reporting of patient safety incidents in Indonesia: leaders' perspectives.

Background: Understanding the causes of patient safety incidents is essential for improving patient safety; therefore, reporting and analysis of these incidents is a key imperative. Despite its implemention more than 15 years ago, the institutionalization of incident reporting in Indonesian hospitals is far from satisfactory. The aim of this study was to analyze the factors responsible for under-reporting of patient safety incidents in Indonesian public hospitals from the perspectives of leaders of hospitals, government departments, and independent institutions. Methods: A qualitative research methodology was adopted for this study using semi-structured interviews of key informants. 25 participants working at nine organizations (government departments, independent institutions, and public hospitals) were interviewed. The interview transcripts were analyzed using a deductive analytic approach. Nvivo 10 was used to for data processing prior to thematic analysis. Results: The key factors contributing to the under-reporting of patient safety incidents were categorized as hospital related and nonhospital related (government or independent agency). The hospital-related factors were: lack of understanding, knowledge, and responsibility for reporting; lack of leadership and institutional culture of reporting incidents; perception of reporting as an additional burden. The nonhospital-related factors were: lack of feedback and training; lack of confidentiality mechanisms in the system; absence of policy safeguards to prevent any punitive measures against the reporting hospital; lack of leadership. Conclusion: Our study identified factors contributing to the under-reporting of patient safety incidents in Indonesia. The lack of government support and absence of political will to improve patient safety incident reporting appear to be the root causes of under-reporting. Our findings call for concerted efforts involving government, independent agencies, hospitals, and other stakeholders for instituting reforms in the patient safety incident reporting system.

Comparison of Patient Safety Incident Reporting Systems in Taiwan, Malaysia, and Indonesia.

OBJECTIVES: Incident reporting is one of the tools used to improve patient safety that has been widely used in health facilities in many countries. Incident reporting systems provide functionality to collect, analyze, and disseminate lessons learned to the wider community, whether at the hospital or national level. The aim of this study was to compare the patient safety incident reporting systems of Taiwan, Malaysia, and Indonesia to identify similarities, differences, and areas for improvement. METHODS: We searched the official Web sites and homepages of the responsible leading patient safety agencies of the three countries. We reviewed all publicly available guidelines, regulatory documents, government reports that included policies, guidelines, strategy papers, reports, evaluation programs, as well as scientific articles and gray literature related to the incident reporting system. We used the World Health Organization components of patient safety reporting system as the guidelines for comparison and analyzed the documents using descriptive comparative analysis. RESULTS: Taiwan had the most incidents reported, followed by Malaysia and Indonesia. Taiwan Patient Safety Reporting (TPR) and the Malaysian Reporting and Learning System had similar attributes and followed the World Health Organization components for incident reporting. We found differences between the Indonesian system and both of TPR and the Malaysian system. Indonesia did not have an external reporting deadline, analysis and learning were conducted at the national level, and there was a lack of transparency and public access to data and reports. All systems need to establish a clear and structured incident reporting evaluation framework if they are to be successful. CONCLUSIONS: Compared with TPR and Malaysian system, the Indonesian patient safety incident reporting system seemed to be ineffective because it failed to acquire adequate national incident reporting data and lacked transparency; these deficiencies inhibited learning at the national level. We suggest further research on the implementation at the hospital level to see how far national guidelines and policy have been implemented in each country.

Practical and Cultural Barriers to Reporting Incidents Among Health Workers in Indonesian Public Hospitals.

PURPOSE: This study investigated the practical and cultural barriers of reporting patient safety incidents in three accredited public hospitals in East Java, Indonesia. METHODS: This study employed a mixed methods approach using a convergent parallel design. We surveyed 1121 health workers and interviewed 27 managerial staff members from the sampled hospitals. A chi-square analysis was performed to evaluate differences in demographic factors, barriers to reporting, and practices of reporting between those who had reported an incident and those who had witnessed an incident but had not reported it. NVivo 11 software was used to perform the qualitative data analysis. RESULTS: This study had a 76.53% response rate. The quantitative evaluation identified significant differences in professions and work units and in participation in quality and safety training between the reporting group and the non-reporting group. The analysis of practical barriers displayed significant differences between the groups with the following responses: "did not know how to report," "did not know where to report," and "lack of feedback". For cultural barriers, a significant difference was shown only for the response "did not want conflict." In the qualitative assessment, most of the interview participants reported lack of knowledge and lack of socialization or training as practical barriers in reporting incidents. Furthermore, reluctance and fear to report were mentioned as cultural barriers by most of the interviewees. CONCLUSION: Because there were conflicting findings in the barriers of reporting incidents, these barriers must be identified, discussed, and resolved by health workers and their managers or supervisors to improve incident reporting. Managers must foster open communication and build positive connections with health workers. Further research is necessary to focus on possible ways of addressing the barriers to reporting.

Patient Safety Incident Reporting In Indonesia: An Analysis Using World Health Organization Characteristics For Successful Reporting.

BACKGROUND: Incident reporting is widely acknowledged as one of the ways of improving patient safety and has been implemented in Indonesia for more than ten years. However, there was no significant increase in the number of reported incidents nationally. The study described in this paper aimed at assessing the extent to which Indonesia's patient safety incident reporting system has adhered to the World Health Organization (WHO) characteristics for successful reporting. METHODS: We interviewed officials from 16 organizations at national, provincial and district or city levels in Indonesia. We reviewed several policies, guidelines and regulations pertinent to incident reporting in Indonesia and examined whether the WHO characteristics were covered in these documents. We used NVivo version 9 to manage the interview data and applied thematic analysis to organize our findings. RESULTS: Our study found that there was an increased need for a non-punitive system, confidentiality, expert-analysis and timeliness of reporting, system-orientation and responsiveness. The existing guidelines, policies and regulations in Indonesia, to a large extent, have not satisfied all the required WHO characteristics of incident reporting. Furthermore, awareness and understanding of the reporting system amongst officials at almost all levels were lacking. CONCLUSION: Despite being implemented for more than a decade, Indonesia's patient safety incident reporting system has not fully adhered to the WHO guidelines. There is a pressing need for the Indonesian Government to improve the system, by putting specific regulations and by creating a robust infrastructure at all levels to support the incident reporting.

The Role of Governments in the Implementation of Patient Safety and Patient Safety Incident Reporting in Indonesia: A Qualitative Study.

(1) Background: A patient safety incident reporting system was introduced in Indonesian hospitals in 2006; however, under-reporting of patient safety incidents is evident. The government plays a vital role in the implementation of a national system. Therefore, this study focuses on how the Indonesian government has been undertaking its role in patient safety at provincial and city/district levels, including incident reporting according to the National Guideline for Hospital Patient Safety. (2) Methods: This study employed a qualitative approach with interviews of 16 participants from seven organizations. The data were managed using NVivo and thematically analyzed. (3) Results: The findings revealed several problems at the macro-, meso-, and micro-level as the government was weak in monitoring and evaluation. The District Health Office (DHO) and Provincial Health Office (PHO) were not involved in incident reporting, and there was a lack of government support for the hospitals. (4) Conclusions: The DHO and PHO have not carried out their roles related to patient safety as mentioned in the national guidelines. Lack of commitment to and priority of patient safety, the complexity of the bureaucratic structure, and a lack of systematic partnership and collaboration are problems that need to be addressed by systematic improvement. To ensure effective and efficient national outcomes, the three levels of government need to work more closely.

Australia's Health Star Rating policy process: Lessons for global policy-making in front-of-pack nutrition labelling.

AIM: This study explored factors that shaped the development of Australia's Health Star Rating system for front-of-pack labelling (FoPL) on packaged foods and whether insights could be drawn from this experience to inform the development of global FoPL standards. METHODS: Ten individual semi-structured interviews were conducted with public health or consumer advocates, academics in the field of nutrition labelling and policy, a food industry employee, and Australian public servants. Thematic analysis was undertaken, guided by Kingdon's Multiple Streams Framework, to identify factors which shaped Australian and international FoPL policy processes. RESULTS: Senior Australian bureaucrats played the policy entrepreneur role to facilitate the development of the Health Star Rating system. The public health and consumer advocacy groups formed an alliance to counter-balance the influence of the food industry in the Health Star Rating development process. Public health and consumer groups have less influence at Codex Alimentarius, where policy-making is constrained by political alliances and consensus voting structures. CONCLUSIONS: Strong leadership, policy entrepreneurship and a coherent alliance between public health and consumer groups enabled the development of a FoPL system in Australia and could contribute to advancing FoPL standards at the international level.

Why Packaging Is Commercially Vital for Tobacco Corporations.

This study analyses what British American Tobacco (BAT) and its 4 publicly listed Asian subsidiary companies have told their shareholders about the commercial value of tobacco packaging. The discourse on packaging in BAT annual reports was analyzed, revealing themes of modernization, rejuvenation, internationalism, heritage, innovation, value for money, and competitive edge. Packaging was credited with providing existing brands with a competitive edge and enabling the successful "launch" of new ones. Since advertising, sponsorship, and free samples were prohibited in many countries, packaging has become more important for advertising. New brands and brand variants have proliferated. BAT companies have allocated considerable resources to regularly altering packaging for marketing purposes. Clearly, restrictions on packaging will substantially detract from the promotion of the company's brands. The findings provide further evidence from industry sources of the vital function of packaging and further justify plain packaging as an essential part of any comprehensive tobacco control policy.

Tobacco and the Malays: ethnicity, health and the political economy of tobacco in Malaysia.

OBJECTIVES: To identify the historical nexus between Malaysia's largest and politically dominant ethnic group and the political economy of tobacco, and to consider the implications of this connection for tobacco control. DESIGN: Primary and secondary documentary sources in both English and Malay were analysed to illuminate key events and decisions, and the discourse of industry and government. Sources included: speeches by Malaysian political and industry actors; tobacco industry reports, press releases and websites; government documents; World Health Organization (WHO) tobacco control literature; and press reports. RESULTS: Malays have the highest smoking prevalence among Malaysia's major ethnic groups. The tobacco industry has consistently been promoted as furthering Malay economic development. Malays play the major role in growing and curing. Government-owned Malay development trusts have been prominent investors in tobacco corporations, which have cultivated linkages with the Malay elite. The religious element of Malay ethnicity has also been significant. All Malays are Muslim, and the National Fatwa Council has declared smoking to be haram (forbidden); however, the Government has declined to implement this ruling. CONCLUSION: Exaggerated claims for the socio-economic benefits of tobacco production, government investment and close links between tobacco corporations and sections of the Malay elite have created a conflict of interest in public policy, limited the focus on tobacco as a health policy issue among Malays and retarded tobacco control policy. More recently, ratification of the WHO Framework Convention on Tobacco Control, regional free trade policies reducing the numbers of growers, concerns about smoking from an Islamic viewpoint, and anxieties about the effects of smoking upon youth have increasingly challenged the dominant discourse that tobacco furthers Malay interests. Nevertheless, the industry remains a formidable political and economic presence in Malaysia that is likely to continue to proclaim that its activities coincide with Malay socio-economic interests.

Development and Validation of a Measure of Quality of Life for the Young Elderly in Sri Lanka.

Sri Lanka has one of the fastest aging populations in the world. Measurement of quality of life (QoL) in the elderly needs instruments developed that encompass the sociocultural settings. An instrument was developed to measure QoL in the young elderly in Sri Lanka (QLI-YES), using accepted methods to generate and reduce items. The measure was validated using a community sample. Construct, criterion and predictive validity and reliability were tested. A first-order model of 24 items with 6 domains was found to have good fit indices (CMIN/df = 1.567, RMR = 0.05, CFI = 0.95, and RMSEA = 0.053). Both criterion and predictive validity were demonstrated. Good internal consistency reliability (Cronbach's α = 0.93) was shown. The development of the QLI-YES using a societal perspective relevant to the social and cultural beliefs has resulted in a robust and valid instrument to measure QoL for the young elderly in Sri Lanka.

Medical students' perspectives on gender and smoking: a mixed methodology investigation in Karachi, Pakistan.

OBJECTIVE: To explore the gender dimensions on influences of tobacco uptake on medical students using both qualitative and quantitative methods. METHODS: A phased mixed-method study design was used with in-depth interviews followed by a survey questionnaire in a 'smoke-free' medical college campus in a private university of Karachi. Eight in-depth interviews were conducted to under-pin themes that were further used for developing the questionnaire. Tabulation and analysis of the quantitative data was done using SPSS software version 12. All the ethical issues for the research were taken into consideration. RESULTS: One hundred and sixty-five (72 male, 93 female) students participated in the study. Mean age was 21.57 +/- 1.66 years. The survey results reported perceived reasons for male smoking as stress relief (74%), image (62%), companionship (54%), leisurely independence (46%) and male power and masculinity (44%). Among reasons for women for not smoking by the majority was that it was frowned upon (87%) while the reasons for smoking clustered around concepts of images (65%), western culture (66%), stress relief (51%) and advertising (36%). A large proportion (55%) of students felt bad and bothered by male and female smoking. CONCLUSION: Despite being medical students, the anti-tobacco future role models, traditional concepts of gender were frequently involved that explains smoking and non-smoking gendered behaviours.

Gender equity and tobacco control: bringing masculinity into focus.

Gender is a key but often overlooked--determinant of tobacco use, especially in Asia, where sex-linked differences in prevalence rates are very large. In this article we draw upon existing data to consider the implications of these patterns for gender equity and propose approaches to redress inequity through gender-sensitive tobacco control activities. International evidence demonstrates that, in many societies, risk behaviours (including tobacco use) are practised substantially more by men and boys, and are also viewed as expressions of masculine identity. While gender equity focuses almost exclusively on the relative disadvantage of girls and women that exists in most societies, disproportionate male use of tobacco has profound negative consequences for men (as users) and for women (nonusers). Surprisingly, health promotion and tobacco control literature rarely focus on the role of gender in health risks among boys and men. However, tobacco industry marketing has masterfully incorporated gender norms, and also other important cultural values, to ensure its symbols are context-specific. By addressing gender-specific risks within the local cultural context--as countries are enjoined to do within the Framework Convention's Guiding Principles--it may be possible to accelerate the impact of mechanisms such as tobacco pricing, restrictions on marketing, smoking bans and provision of accurate information. It is essential that we construct a new research-to-policy framework for gender-sensitive tobacco control. Successful control of tobacco can only be strengthened by bringing males, and the concept of gender as social construction, back into our research and discussion on health and gender equity.

The political economy of tobacco and poverty alleviation in Southeast Asia: contradictions in the role of the state.

Of the members of the Association of Southeast Asian Nations (ASEAN), all but Indonesia have embraced the Framework Convention on Tobacco Control and all endorse some form of tobacco control policy. Nevertheless, except for Brunei, all these states are, to varying degrees, complicit in investing in or promoting the tobacco industry, often using the justification of poverty alleviation. Tobacco use is the major preventable cause of illness and death among the populations of these countries. Claims that tobacco alleviates poverty in developing countries have increasingly been discredited: thus continuing state support for the industry represents a fundamental paradox. Using primary documents from governments and the tobacco industry, and published studies investigating tobacco and poverty, this article explores the contradictions inherent in the state seeking to prevent tobacco use in the interests of health, while actively promoting tobacco for the economic benefit of its citizens. These contradictions result in both symbolic and substantial harm to tobacco control efforts: tobacco production is legitimized, rational policy principles are violated, direct cooperation between the state and multinational tobacco corporations is made possible with associated opportunities for mollifying control policies, and different state agencies work at cross purposes. Although tobacco exports within the Association of Southeast Asian Nations (ASEAN) also threaten the group's health solidarity, it is argued that divestiture of state ownership of capital in tobacco corporations and a commitment by states not to promote tobacco are urgently required if the Convention is to have full effect both in the countries of the region and in other states that have ratified it.

Smoking among future doctors in a "no-smoking" university campus in Karachi, Pakistan: issues of tobacco control.

OBJECTIVE: To determine the level of tobacco-related attitudes and practices among medical students who study in a designated 'No-Smoking University' in Pakistan's largest city, Karachi. It further highlighted some challenges for tobacco control at the university. METHODS: The study design adopted mixed methods. It commenced with an initial qualitative phase using in-depth interviews with medical students and university staff to refine and expand areas of enquiry for the development of a structured cross-sectional survey among second and fifth (final) year students. Thematic analysis was used to analyse qualitative data, while descriptive statistics and various statistical tests were applied to investigate differences along a number of parameters in the survey data. RESULTS: Overall smoking prevalence across both years was 14.5%; however, there was a sharp disparity along sex lines, with 32% of males and just 1% of females self-identifying as current or occasional smokers. Importantly, the majority of smokers initiated smoking after starting their medical education. Despite students' expressed expectations that they can and should be future non-smoking role models and advocates, their actual knowledge and practices - for males at least - were disappointing. Significantly fewer second year than final year students knew that Hamdard had been designated a 'No-Smoking University', and about half of the participants believed the university had 'effectively' controlled tobacco use on campus. A large majority supported stronger tobacco control measures at the university and in the wider society. CONCLUSION: This study highlights weaknesses in the measures taken for tobacco control on the university campus through the picture it provides of the presence of tobacco use, the on-campus initiation of smoking and the increase in smoking rates among final year students by comparison to those in the initial years of medical studies.

A grim contradiction: the practice and consequences of corporate social responsibility by British American Tobacco in Malaysia.

In the wake of the World Health Organization Framework Convention on Tobacco Control, corporate social responsibility (CSR) is among the few remaining mechanisms for tobacco corporations publicly to promote their interests. Health advocates may be unaware of the scale, nature and implications of tobacco industry CSR. This investigation aimed to construct a typology of tobacco industry CSR through a case study of the evolution and impact of CSR activities of a particular tobacco corporation in one country - British American Tobacco, Malaysia (BATM), the Malaysian market leader. Methods included searching, compiling and critically appraising publicly available materials from British American Tobacco, BATM, published literature and other sources. The study examined BATM's CSR strategy, the issues which it raises, consequences for tobacco control and potential responses by health advocates. The investigation found that BATM's CSR activities included assistance to tobacco growers, charitable donations, scholarships, involvement in anti-smuggling measures, 'youth smoking prevention' programs and annual Social Reports. BATM has stated that its model is predominantly motivated by social and stakeholder obligations. Its CSR activities have, however, had the additional benefits of contributing to a favourable image, deflecting criticism and establishing a modus vivendi with regulators that assists BATM's continued operations and profitability. It is imperative that health advocates highlight the potential conflicts inherent in such arrangements and develop strategies to address the concerns raised.

Health imperatives in foreign policy: the case of Malaysia.

Malaysia's global, regional and bilateral international health relations are surveyed against the historical backdrop of the country's foreign policy. Malaysia has always participated in multilateral agencies, most notably the World Health Organization, as such agencies are part of the longstanding fabric of "good international citizenship". The threats of infectious diseases to human health and economic activity have caused an intensification and an organizational formalization of Malaysian health diplomacy, both regionally and bilaterally. Such diplomacy has also established a basis for developing a wider set of cooperative relationships that go beyond responding to the threat of pandemics. As Malaysia approaches "developed" status, its health sector is becoming increasingly integrated into the global economy through joint research and development ventures and transnational investment. At the same time, it will have the technological, financial and human resources to play an expanded altruistic role in global and regional health.