The knowledge and reuse practices of researchers utilising government health information assets, Victoria, Australia, 2008-2020.

BACKGROUND: Using government health datasets for secondary purposes is widespread; however, little is known on researchers' knowledge and reuse practices within Australia. OBJECTIVES: To explore researchers' knowledge and experience of governance processes, and their data reuse practices, when using Victorian government health datasets for research between 2008-2020. METHOD: A cross-sectional quantitative survey was conducted with authors who utilised selected Victorian, Australia, government health datasets for peer-reviewed research published between 2008-2020. Information was collected on researchers': data reuse practices; knowledge of government health information assets; perceptions of data trustworthiness for reuse; and demographic characteristics. RESULTS: When researchers used government health datasets, 45% linked their data, 45% found the data access process easy and 27% found it difficult. Government-curated datasets were significantly more difficult to access compared to other-agency curated datasets (p = 0.009). Many respondents received their data in less than six months (58%), in aggregated or de-identified form (76%). Most reported performing their own data validation checks (70%). To assist in data reuse, almost 71% of researchers utilised (or created) contextual documentation, 69% a data dictionary, and 62% limitations documentation. Almost 20% of respondents were not aware if data quality information existed for the dataset they had accessed. Researchers reported data was managed by custodians with rigorous confidentiality/privacy processes (94%) and good data quality processes (76%), yet half lacked knowledge of what these processes entailed. Many respondents (78%) were unaware if dataset owners had obtained consent from the dataset subjects for research applications of the data. CONCLUSION: Confidentiality/privacy processes and quality control activities undertaken by data custodians were well-regarded. Many respondents included data linkage to additional government datasets in their research. Ease of data access was variable. Some documentation types were well provided and used, but improvement is required for the provision of data quality statements and limitations documentation. Provision of information on participants' informed consent in a dataset is required.

What is the nature, extent and impact of bullying in surgical settings? Insights of surgeons in Australia and Aotearoa New Zealand.

BACKGROUND: A significant body of literature has examined the impact of verbal and non-verbal bullying in surgical settings, where a central focus has been on the experiences of trainee and junior members of the surgical team, women in surgery and other health professionals, such as nurses. Research on how surgeons' perceive or experience bullying is more limited. Therefore, this study aims to investigate the views of surgeons on negative and disrespectful verbal and non-verbal behaviour and bullying in surgical settings, including its impact on surgeons themselves and the surgical staff they oversee. METHODS: Semi-structured interviews were undertaken with surgeons between February and November 2019. Questions explored surgeons' perceptions of interpersonal communication and behaviour in their surgical workplaces in the preceding 6-months. A narrative analysis approach was used to code, interpret, and report the interview data. RESULTS: Thirty-one interviews were conducted with surgeons (19 male and 12 female), from Australia (26) and Aotearoa New Zealand (5) from 10 surgical specialties. Three themes were identified with associated subthemes: bullying (five subthemes), non-verbal bullying (seven subthemes), and impact and outcomes of bullying (six subthemes). CONCLUSION: This study revealed a notable shift in the reported verbal and non-verbal bullying behaviour among surgeons, demonstrating a decrease in intensity, physicality and violence for the 6-months prior to interviews conducted in 2019, when compared with surgeons' historic experiences. Despite reported behaviour being more subtle and indirect, it nonetheless continues to have a marked impact on many surgeons as well as the staff they oversee.

A conceptual framework to support hospitals to measure and realise financial benefits from process improvement programs: perspectives from Australia, USA and UK.

Objective The objective of this research is to appraise current practice in hospitals against the 'Framework to achieve value in healthcare' (the Framework) and to identify additional contributory factors that support or hinder its application. Methods A multi-site case study was undertaken with five hospitals in Australia, the USA and UK using purposeful sampling to identify hospitals to participate. Data collection took place between September and November 2022. The hospitals included in the study had Process Improvement (PI) programs of more than 5 years duration, with strong executive engagement and broad outcomes measurement, including financial benefits. All hospitals were acute public hospitals or private, not for profit. Results All hospitals indicated current practice according to Steps 1-5 for some part of their PI programs. All hospitals indicated that they were more likely to include financial benefits measurement for activities aimed specifically at improving cost rather than reducing non-value adding activities or improving the value of clinical care. Step 5 (reinvestment of cost savings) of the Framework is dependent on the accomplishment of Step 4 (measurement and realisation of financial benefits) and the contributory elements are important in supporting hospitals to utilise the Framework. Conclusions The 'Framework to achieve value in healthcare' provides a practical guide for hospitals to reduce non-value adding activities, improve the value of clinical care and reduce costs. Further research is indicated to establish its reliability in hospitals in other countries and hospitals that do not have an established PI program.

A documentary analysis of Victorian Government health information assets' websites to identify availability of documentation for data sharing and reuse in Australia.

BACKGROUND: Health data sharing is important for monitoring diseases, policy and practice, and planning health services. If health data are used for secondary purposes, information needs to be provided to assist in reuse. OBJECTIVES: To review government health information asset websites to ascertain the extent of readily available, explanatory documentation for researcher sharing and reuse of these data. METHOD: Documentary analysis was undertaken on selected Victorian Government health information assets' websites in Australia. Data were obtained on nine information-categories: data custodian; data context; data dictionary; quality controls; data quality; limitations; access process; privacy/confidentiality/security and research requests/outputs. Information-categories were compared by dataset type (administrative or population-health) and by curating organisation (government or other agency). Descriptive statistics were used. RESULTS: The majority of the 25 websites examined provided information on data custodian (96%) and data context (92%). Two-thirds reported access process (68%) and privacy/confidentiality/security information (64%). Compared with population-health websites, administrative dataset websites were more likely to provide access to a data dictionary (67% vs 50%) and information on quality controls (56% vs 44%), but less likely to provide information on the access process (56% vs 75%) and on research requests/outputs (0% vs 56%, p = 0.024). Compared with government-curated websites, other agency websites were more likely to provide information on research requests/outputs (80% vs 7%, p < 0.001). CONCLUSION: There is inconsistent explanatory documentation available for researchers for reuse of Victorian Government health datasets. Importantly, there is insufficient information on data quality or dataset limitations. Research-curated dataset websites are significantly more transparent in displaying research requests or outputs.

A systematic review of the evidence of how hospitals capture financial benefits of process improvement and the impact on hospital financial performance.

BACKGROUND: Governments, funders and hospital managers around the world are looking for ways to address the continual growth in expenditure by reducing the level of waste in the healthcare delivery system and improving the value of care provided to patients. Process improvement methods are applied to increase high value care, reduce low value care and remove waste from care processes. The purpose of this study is to review the literature to identify the methods used by hospitals to measure and capture financial benefits from PI initiatives to identify best practice. The review also pursues the way hospitals collate these benefits at the enterprise level to achieve improved financial performance. METHODS: A systematic review was undertaken in line with the PRISMA process and employed qualitative research methods. Databases searched were Medline, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINHAL), Web of Science and SCOPUS. The initial search was conducted in in July 2021 with a follow up search conducted in February 2023 using the same search terms and databases to identify additional studies published in the intervening period. The search terms were identified through the PICO (Participants, Interventions, Comparisons and Outcomes) method. RESULTS: Seven papers were identified that reported reduction in care process waste or improvement of the value of care using an evidence-based PI approach and included financial benefits analysis. Positive financial impact was measured for the PI initiatives but none of the studies reported how these financial benefits were captured or applied at the enterprise level. Three of the studies suggested that sophisticated cost accounting systems were required to enable this. CONCLUSION: The study demonstrates the paucity of literature in the field of PI and financial benefits measurement in healthcare. Where financial benefits are documented, they vary in terms of cost inclusions and the 'level' at which the costs were measured. Further research on best practice financial measurement methods is needed to enable other hospitals to measure and capture financial benefits arising from their PI programs.

The suitability of government health information assets for secondary use in research: A fit-for-purpose analysis.

BACKGROUND: Governments have responsibility for ensuring the quality and fitness-for-purpose of personal health data provided to them. While these health information assets are used widely for research, this secondary usage has received minimal research attention. OBJECTIVE: This study aimed to investigate the secondary uses, in research, of population health and administrative datasets (information assets) of the Department of Health (DoH), Victoria, Australia. The objectives were to (i) identify research based on these datasets published between 2008 and 2020; (ii) describe the data quality studies published between 2008 and 2020 for each dataset and (iii) evaluate "fitness-for-purpose" of the published research. METHOD: Using a modified scoping review, research publications from 2008 to 2020 based on information assets related to health service provision and containing person-level data were reviewed. Publications were summarised by data quality and purpose-categories based on a taxonomy of data use. Fitness-for-purpose was evaluated by comparing the publicly stated purpose(s) for which each information asset was collected, with the purpose(s) assigned to the published research. RESULTS: Of the >1000 information assets, 28 were utilised in 756 publications: 54% were utilised for general research purposes, 14% for patient safety, 10% for quality of care and 39% included data quality-related publications. Almost 85% of publications used information assets that were fit-for-purpose. CONCLUSION: The DoH information assets were used widely for secondary purposes, with the majority identified as fit-for-purpose. We recommend that data custodians, including governments, provide information on data quality and transparency on data use of their health information assets.

A qualitative study of hospital clinical staff perceptions of their interactions with healthcare middle managers.

PURPOSE: The authors explored clinical staff perceptions of their interactions with middle management and their experiences of the uncongeniality of their working environment. DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews of clinical staff from an Australian public health service's Emergency, Surgery and Psychiatry departments. Volunteer interview transcripts were inductively coded using a reflexive thematic content analysis. FINDINGS: Of 73 interviews, 66 participants discussed their interactions with management. Most clinicians considered their interactions with middle management to be negative based on a violation of their expectations of support in the workplace. Collectively, these interactions formed the basis of clinical staff perceptions of management's lack of capacity and fit for the needs of staff to perform their roles. PRACTICAL IMPLICATIONS: Strategies to improve management's fit with clinicians' needs may be beneficial for reducing uncongenial workplaces for healthcare staff and enhanced patient care. ORIGINALITY/VALUE: This article is among the few papers that discuss interactions with management from the perspective of clinical staff in healthcare. How these perspectives inform the perception of workplace uncongeniality for clinicians contributes greater understanding of the factors contributing to adversarial relationships between clinicians and managers.

Return on investment of a model of access combining triage with initial management: an economic analysis.

OBJECTIVES: Timely access to outpatient services is a major issue for public health systems. To address this issue, we aimed to establish the return on investment to the health system of the implementation of an alternative model for access and triage (Specific Timely Appointments for Triage: STAT) compared with a traditional waitlist model. DESIGN: Using a prospective pre-post design, an economic analysis was completed comparing the health system costs for participants who were referred for community outpatient services post-implementation of STAT with a traditional waitlist comparison group. SETTING: Eight community outpatient services of a health network in Melbourne, Australia. PARTICIPANTS: Adults and children referred to community outpatient services. INTERVENTIONS: STAT combined targeted activities to reduce the existing waiting list and direct booking of patients into protected assessment appointments. STAT was compared with usual care, in which new patients were placed on a waiting list and offered appointments as space became available. OUTCOMES: Health system costs included STAT implementation costs, outpatient health service use, emergency department presentations and hospital admissions 3 months before and after initial outpatient appointment. Waiting time was the primary outcome. Incremental cost-effectiveness ratios (ICERs) were estimated from the health system perspective. RESULTS: Data from 557 participants showed a 16.9 days or 29% (p<0.001) reduction in waiting time for first appointment with STAT compared with traditional waitlist. The ICER showed a cost of $A10 (95% CI -19 to 39) per day reduction in waiting time with STAT compared with traditional waitlist. Modelling showed the cost reduced to $A4 (95% CI -25 to 32) per day of reduction in waiting, if reduction in waiting times is sustained for 12 months. CONCLUSIONS: There was a significant reduction in waiting time with the introduction of STAT at minimal cost to the health system. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12615001016527).

Emotional intelligence: predictor of employees' wellbeing, quality of patient care, and psychological empowerment.

BACKGROUND: The study explored the role of emotional intelligence (EI) on employees' perceived wellbeing and empowerment, as well as their performance, by measuring their quality of care. METHODS: The baseline data for the present project was collected from 78 staff of a Victorian aged care organization in Australia. Self-administered surveys were used to assess participants' emotional intelligence, general well-being, psychological empowerment, quality of care, and demographic characteristics. The model fit was assessed using structural equation modelling by AMOS (v 24) software. RESULTS: The evaluated model confirmed that emotional intelligence predicts the employees' psychological empowerment, wellbeing, and quality of care in a statistically significant way. CONCLUSIONS: The current research indicates that employees with higher EI will more likely deliver a better quality of patient care. Present research extends the current knowledge of the psychological empowerment and wellbeing of employees with a particular focus on emotional intelligence as an antecedent in an under-investigated setting like aged care setting in Australia.

A health management competency framework for Australia.

Objective This study examined whether the management competency framework for health service managers developed in the Victorian healthcare context is applicable to managers in other Australian states. Methods An online questionnaire survey of senior and middle-level health service managers in both community health services and hospitals was conducted in New South Wales and Queensland. Results The study confirmed that the essential tasks for senior and middle-level managers are consistent across health and social care sectors, as well as states. Core competencies for health services managers identified in the Victorian healthcare context are relevant to other Australian states. In addition, two additional competencies were incorporated into the framework. Conclusion The Management Competency Assessment Program competency framework summarises six competencies and associated behaviours that may be useful for guiding performance management and the education and training development of health service managers in Australia. What is known about the topic? The evidence suggests that competency-based approaches can enhance performance and talent management, and inform education and training needs, yet there has been no validated competency framework for Australian health service managers. What does the paper add? This paper explains the process of the finalisation of the first management competency framework for guiding the identification of the training and development needs of Australian health service managers and the management of their performance. What are the implications for practice? The Management Competency Assessment Program competency framework can guide the development of the health service management workforce in three Australian states, and may be applicable to other jurisdictions. Further studies are required in the remaining jurisdictions to improve the external validity of the framework.

Link of Patient Care Outcome to Occupational Differences in Response to Human Resource Management: A Cross-Sectional Comparative Study on Hospital Doctors and Nurses in China.

This study assessed the link of patient care outcome to occupational differences in response to human resource management. A cross-sectional survey was conducted in three large regional hospitals in China. A total of 700 questionnaires were distributed to doctors, nurses, allied health workers, and managers and 499 (71%) were completed. Data were analyzed using a final sample of 193 doctors and 180 nurses. Quality of patient care was rated by the participants using a modified version of the Victorian Patient Satisfaction Questionnaire. Human resource management was measured on seven aspects: job security, recruitment, training, transformational leadership, information sharing, job quality, and teams. The differences between doctors and nurses in response to the human resource management practices and their associations with quality of care were compared through independent samples t-tests, correlational analyses, and moderator regressions. Doctors gave a higher rating on quality of patient care than their nurse counterparts. 'Training', 'transformational leadership', and 'information sharing' were more likely to be associated with higher ratings on quality of patient care in nurses. By contrast, a greater association between 'teams' and quality of patient care was found in doctors. Although doctors and nurses in China are exposed to the same hospital management environment, professional differences may have led them to respond to management practices in different ways.

Hospital Staff Report It Is Not Burnout, but a Normal Stress Reaction to an Uncongenial Work Environment: Findings from a Qualitative Study.

(1) Background: The issue of burnout in healthcare staff is frequently discussed in relation to occupational health. In this paper, we report healthcare staff experiences of stress and burnout. (2) Methods: In total, 72 healthcare staff were interviewed from psychiatry, surgery, and emergency departments at an Australian public health service. The sample included doctors, nurses, allied health professionals, administrators, and front-line managers. Interview transcripts were thematically analyzed, with participant experiences interpreted against descriptors of burnout in Maslach's Burnout Inventory and the International Statistical Classification of Diseases and Related Health Problems (ICD-11). (3) Results: Staff experiences closely matched the ICD-11 description of stress associated with working in an uncongenial workplace, with few reported experiences which matched the ICD-11 descriptors of burnout. (4) Conclusion: Uncongenial workplaces in public health services contribute to healthcare staff stress. While previous approaches have focused on biomedical assistance for individuals, our findings suggest that occupational health approaches to addressing health care staff stress need greater focus on the workplace as a social determinant of health. This finding is significant as organizational remedies to uncongenial stress are quite different from remedies to burnout.

Differentiating between average and high-performing public healthcare managers: implications for public sector talent management.

Objective Ensuring sufficient qualified and experienced managers is difficult for public sector healthcare organisations in Australia, with a limited labour market and competition with the private sector for talented staff. Although both competency-based management and talent management have received empirical support in association with individual and organisational performance, there have been few studies exploring these concepts in the public healthcare sector. This study addresses this gap by exploring the perceived differences in demonstration of core competencies between average and higher-performing managers in public sector healthcare organisations. Methods Mixed methods were used to define and measure a set of competencies for health service managers. In addition, supervisors of managers were asked to identify the differences in competence between the average and high-performing managers reporting to them. Results Supervisors could clearly distinguish between average and higher-performing managers and identified related competencies. Conclusions The consistent pattern of competence among community health and hospital public sector managers demonstrated by this study could be used to develop a strategic approach to talent management for the public healthcare sector in Australia. What is known about this topic? Although there are validated competency frameworks for health service managers, they are rarely used in practice in Australia. What does this paper add? This paper illustrates the perceived differences in competencies between top and average health services managers using a validated framework. What are the implications for practitioners? The public health sector could work together to provide a more effective and efficient approach to talent management for public hospitals and community health services.

Guidance to implementing evidence-based initiatives to manage pandemics in healthcare services: a discussion paper.

Planning and implementing surge capacity in healthcare services is challenging. The evolving nature of viral transmission makes it difficult to predict the potential impact on the health system and the readiness of healthcare managers and professional staff in responding to system transformation and consequential impacts. This is compounded by sudden increased demands in the types of work required. Guidance for implementing targeted strategies for health systems and services should include evidence that considers the feasibility, appropriateness, meaningfulness and effectiveness of healthcare practices at both the system and organization level. This is consistent with the Joanna Briggs Institute (JBI) model of evidence synthesis and translation. Evidence-based decision-making is a core management competency for health service leadership and the mechanism for improving the quality of management decisions, and hence better service delivery, effectiveness and efficiency. Human resources are the most important asset in crisis management. Health managers must create responsive surge capacity by quantifying existent human and material resources and the shortfall needs required to meet anticipated additional demand. We believe a multifaceted approach is the key to developing systemic surge capacity within the heath sector when faced with the management of crises such as pandemics. We explore and discuss the desirability of strategies based on the JBI model of evidence synthesis and implementation with a view to encouraging the creation of registries and follow-up systems. We believe this will encourage the effective use of human resources including the upskilling in how future crises may be addressed.

Direct supervision of physiotherapists improves compliance with clinical practice guidelines for patients with hip fracture: a controlled before-and-after study.

Purpose: To determine if the addition of direct supervision to usual clinical supervision practice of physiotherapists can improve compliance with clinical practice guidelines and post-surgical outcomes for inpatients with hip fracture.Methods: A controlled before-and-after study was conducted on two acute orthopedic wards. Junior and mid-level physiotherapists on one ward were provided with direct supervision during their post-operative management of patients with hip fracture. Physiotherapists on the comparison ward received usual reflective supervision. The primary outcome was patient compliance with the hip fracture guideline to mobilize on the day following surgery. Secondary patient outcomes included physical function on the fifth post-operative day.Results: Data were collected from 290 patients with acute hip fracture. Patients at the direct supervision site were more likely to mobilize on the day after surgery [OR 3.14, 95% confidence interval (CI) 1.41-7.01; p = 0.005] and by the second post-operative day (OR 4.62, 95% CI 2.31-9.23; p < 0.001) compared to patients at the comparison site. Patients walked further on the fifth post-operative day (p < 0.001) with less assistance from therapists (p = 0.044).Conclusions: The addition of direct supervision improved physiotherapists' compliance with hip fracture guidelines and walking endurance and independence in hospitalized patients with hip fracture.Implications for rehabilitationThe addition of a direct supervision model, where physiotherapists are directly observed in their management of patients with hip fracture, to usual practice supervision improved early mobilization of patients with hip fractureDirect supervision appears to be an effective guideline implementation strategy that can improve care and outcomes for hospitalized patients with hip fracture.

Psychosocial aspects of the lived experience of multiple sclerosis: personal perspectives.

Purpose: To explore participants' personal perspectives: on psychosocial aspects of living with multiple sclerosis (MS) following inpatient rehabilitation; and on experiences of the rehabilitation hospital stay and discharge to home.Methods: One-on-one, semi-structured in-depth interviews, were conducted with 15 people with various forms of MS, post discharge from a rehabilitation hospital. Thematic analysis of the data was undertaken.Results: The emergent themes were: Fatigue, Independence and Dependence, Loss, Provision of Care, and Perceptions of Care. The first three themes shared a focus on the lived experience of MS and are the subject of this paper. Each of the two remaining themes were essentially independent of the other themes, with one being centred on experiences of the rehabilitation hospital stay, and the other on aspects of general medical care.Conclusions: Personal perspectives on living with MS following inpatient rehabilitation focussed on: the negative impacts of physical and mental fatigue; the desire to maximise independence in activities of daily living and to minimise reliance on others; and perceptions of loss. These findings shed new light on psychosocial aspects of the lived experience of MS and, as such, have potential applications in rehabilitation for those with MS.Implications for RehabilitationPhysical and mental fatigue is central to the lived experience of multiple sclerosis, as it has an all pervading negative influence on most aspects of life, and can be considerably debilitating.The severe and debilitating effects of multiple sclerosis-related fatigue mandate an explicit focus, of rehabilitation, on fatigue, and, in particular, on the fostering of the development of strategies that serve to minimise the multitude of negative impacts of fatigue.For those with multiple sclerosis, considerable importance is placed on maintaining or regaining independence in activities of daily living, and in daily personal care activities, in particular, partly because a need to rely on an intimate partner or other family member for support with such activities can be problematic.The high importance of independence in activities of daily living, and in daily personal care activities in particular, is indicative of the need for multiple sclerosis rehabilitation to have an explicit focus on this domain, in terms of interventions that aim to maximise independence in such activities.

The effects of emotional intelligence training on the job performance of Australian aged care workers.

BACKGROUND: Emotional intelligence (EI) training is popular among human resource practitioners, but there is limited evidence of the impact of such training on health care workers. PURPOSE: In the current article, we examine the effects of EI training on quality of resident care and worker well-being and psychological empowerment in an Australian aged care facility. We use Bar-On's (1997) conceptualization of EI. METHODOLOGY/APPROACH: We used a quasiexperimental design in 2014-2015 with experimental (training) and control (nontraining) groups of 60 participants in each group in two geographically separate facilities. Our final poststudy sample size was 27 participants for the training group and 17 participants for the control group. Over a 6-month period, we examined whether staff improved their well-being, psychological empowerment, and job performance measured as enhanced quality of care (self-rated and client-rated) by applying skills in EI. RESULTS: The results showed significant improvement among workers in the training group for EI scores, quality of care, general well-being, and psychological empowerment. There were no significant differences for the control group. PRACTICE IMPLICATIONS: Through examining the impact of EI training on staff and residents of an aged care facility, we demonstrate the benefits of EI training for higher quality of care delivery. This study demonstrates the practical process through which EI training can improve the work experiences of aged care workers, as well as the quality of care for residents.

The association between effectiveness of clinical supervision of allied health professionals and improvement in patient function in an inpatient rehabilitation setting.

Purpose: Clinical supervision is widely accepted as an important element of practice for allied health professionals to ensure a high quality of patient care. However, it is unknown whether effective clinical supervision of allied health professionals improves patients' outcomes. This study investigated whether effective clinical supervision of allied health professionals is associated with improved patient functional independence. Methods: A prospective longitudinal study design and multi-level regression analysis were used to explore the association between effective clinical supervision and patient functional independence. The effectiveness of clinical supervision was assessed using the Manchester Clinical Supervision Scale. Functional improvement in patients treated by allied health professionals was measured utilising the mobility and self-care subscales of the functional independence measure.Results: Physiotherapists (n = 27) and occupational therapists (n = 26) in inpatient rehabilitation were recruited and the medical records of their patients (n = 1846) audited. The effectiveness of clinical supervision of physiotherapists was positively associated with improvement in personal care. Therapist variables accounted for less than 2.5% of the variation in patient improvement in functional independence.Conclusions: Effectiveness of a reflective model of clinical supervision of physiotherapists and occupational therapists was not associated with an improvement in their patients' mobility or personal care, respectively.Implications for rehabilitationEffective clinical supervision of physiotherapists and occupational therapists using a reflective model of practice is a poor predictor of improved functional independence in rehabilitation inpatients.Patient variables, such as the intensity of therapy, were more important predictors of patient functional improvement than effective clinical supervision.Initiatives aimed at increasing intensity of therapy will likely have a greater effect on improving patient functional independence compared with initiatives aimed at improving the effectiveness of clinical supervision using a reflective model of practice.Initiatives to improve the effectiveness of clinical supervision in improving quality of care could explore the use of a direct model of practice where supervisors directly observe and support supervisees during patient treatment sessions.

Staff perspectives of a model of access and triage for reducing waiting time in ambulatory services: a qualitative study.

BACKGROUND: Specific Timely Appointments for Triage (STAT) is an intervention designed to reduce waiting time in community outpatient health services, shown to be effective in a large stepped wedge cluster randomised controlled trial. STAT combines initial strategies to reduce existing wait lists with creation of a specific number of protected appointments for new patients based on demand. It offers an alternative to the more traditional methods of demand management for these services using waiting lists with triage systems. This study aimed to explore perceptions of clinicians and administrative staff involved in implementing the model. METHOD: Semi-structured interviews with 20 staff members who experienced the change to STAT were conducted by an independent interviewer. All eight sites involved in the original trial and all professional disciplines were represented in the sample. Data were coded and analysed thematically. RESULTS: Participants agreed that shorter waiting time for patients was the main advantage of the STAT model, and that ongoing management of caseloads was challenging. However, there was variation in the overall weight placed on these factors, and therefore the participants' preference for the new or previous model of care. Perceptions of whether the advantages outweighed the disadvantages were influenced by five sub-themes: staff perception of how much waiting matters to the patient, prior exposure to the management of waiting list, caseload complexity, approach and attitude to the implementation of STAT and organisational factors. CONCLUSIONS: The STAT model has clear benefits but also presents challenges for staff members. The findings of this study suggest that careful preparation and management of change and active planning for known fluctuations in supply and demand are likely to help to mitigate sources of stress and improve the likelihood of successful implementation of the STAT model for improving waiting times for patients referred to community outpatient services.

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.