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Biomedical subjects

J Braithwaite

Publications and source records attributed to J Braithwaite.

At least 19 recordsLinked to original sources
PubMed2001

Practice management: observations, issues, and empirical evidence.

BACKGROUND: The primary objective of this study is to provide objective, empirical, evidence-based practice management information. This is a hitherto under-researched area of considerable interest for both the practitioner and educator. METHODS: A questionnaire eliciting a mix of structured and free text responses was administered to a random sample of 480 practitioners who are members of the American Academy of Periodontology. Potential respondents not in private practice were excluded and the next listed person substituted. RESULTS: The results provide demographic and descriptive information about some of the main issues and problems facing practice managers, central to which are information technology (IT), financial, people management, and marketing. Human resource and marketing management appear to represent the biggest challenges. CONCLUSIONS: Periodontists running practices would prefer more information, development, and support in dealing with IT, finance, marketing, and people management. The empirical evidence reported here suggests that although tailored educational programs on key management issues at both undergraduate and postgraduate levels have become ubiquitous, nevertheless some respondents seek further training opportunities. Evidence-based practice management information will be invaluable to the clinician considering strategic and marketing planning, and also for those responsible for the design and conduct of predoctoral and postdoctoral programs.

Attitude of Health Personnel↗
PubMed1999

Empowerment and the performance of health services.

Addresses the issue of empowerment and its possible role in promoting the effectiveness of health services. Empowerment represents the ability of people within organisations to use their own initiative to further organisational interests. However, despite its apparent simplicity, the concept turns out to be quite complex and to have unanticipated implications. We explore some of these implications in health service organisations, and their consequences for health policy. Our conclusion is that many health policies may well act to degrade the empowerment of health service workers, and hence the performance of health service organisations.

Conflict, Psychological↗
PubMed1998

Casemix funding in Australia.

Casemix funding for hospitals with the use of diagnosis-related groups (DRGs), which organise patients' conditions into similar clinical categories with similar costs, was introduced in Australia five years ago. It has been applied in different ways and to a greater or lesser extent in different Australian States. Only Victoria and South Australia have implemented casemix funding across all healthcare services. Attempts have been made to formally evaluate its impact, but they have not met the required scientific standards in controlling for confounding factors. Casemix funding remains a much-discussed issue. In this Debate, Braithwaite and Hindle take a contrary position, largely to stimulate policy debate; Phelan defends the casemix concept and advocates retaining its best features; and Hanson adds a plea for consumer input.

Diagnosis-Related Groups↗
PubMed1998

The end of professionalism?

Increasingly questions are being raised about the ability of many current health reforms to address the challenges that are facing health systems. We investigate this situation by exploring the role of professionalism in the delivery of health services. In contrast to the dominant approach of considering professionalism as a social phenomenon, professionalism is considered as primarily a task-related phenomenon. The characteristics of the task are identified as being high levels of uncertainty and complexity. These characteristics are shown to lead naturally to the key social features that typify professionalism. Hence, the close link between professionalism and the nature of the task is argued. However, health reforms threaten professionalism. They have been based on considerable dissatisfaction with the performance of professionals as well as the emergence of a number of new challenges. In addition, the reforms have been developed without significant consideration of the central role that professionalism has played, and reformers have adopted a simplified view of the task. Thus, the centrality of professionalism has intrinsically been downgraded. However, this simplification can be shown to be inconsistent with the realities and complexities of health service provision, and thus the downgrading of professionalism is unwarranted. This inconsistency generates many of the conflicts and contradictions being reported. The future of health service reform depends on an effective understanding of the nature of the task, recognition of the central role of professionalism and the development of professional and organisational structures that support each other.

Health Care Reform↗
PubMed1997

The obstetric experience of carriers of haemophilia.

OBJECTIVE: To review the obstetric problems, pregnancy outcome and management of carriers of haemophilia. DESIGN: Retrospective review of haemophilia and maternity unit records. SETTING: Haemophilia Comprehensive Care Centre. PARTICIPANTS: Thirty-two carriers of haemophilia (24 haemophilia A, eight haemophilia B) who had their obstetric care at the Royal Free Hospital over a 10-year period (1985-1995). MAIN OUTCOME MEASURES: Uptake and results of prenatal diagnosis, changes in factor levels during pregnancy, effect of knowledge of fetal gender on obstetric management and neonatal outcome, and maternal haemorrhagic complications. RESULTS: There were 82 pregnancies and 32 resulted in miscarriage or social abortion. The option of prenatal diagnosis was taken up in only 35% (17/48) of pregnancies. There were five affected male fetuses diagnosed prenatally but only three women opted for termination of the pregnancy. Knowledge of fetal gender was unavailable to the attending obstetrician in 46% (21/46) of pregnancies. A fetal scalp electrode was applied in eight, fetal blood sampling was performed in four, and ventouse delivery was conducted in one of these pregnancies. No adverse effects were reported from the first two procedures, but the ventouse delivery was associated with a huge cephalhaematoma requiring blood transfusion. On the other hand, in five cases fetal blood sampling was withheld because fetal gender was unknown. Four of the eight caesarean sections performed might have been avoided if the gender had been known. The incidence of primary and secondary postpartum haemorrhage was high, 22% (including two cases with massive haemorrhage) and 11%, respectively. CONCLUSION: Carriers of haemophilia A and B require special obstetric care with close liaison with the haemophilia centre, and management guidelines should be available and observed. Knowledge of fetal gender is very valuable for management in labour and should be determined antenatally even if the mother declines prenatal diagnosis.

Abortion, Induced↗
PubMed1995

Organizational change, patient-focused care: an Australian perspective.

Hospitals throughout the world are attempting to improve organizational performance through a variety of means. The focus in this paper is on a leading teaching hospital in Australia for a review of current management strategy. In a time of shrinking resources, management adopted a multi-faceted change management program including restructuring the organization, becoming more patient-focused via a product-line management approach and emphasising efficiency and cost-reduction measures. The next stage in management thinking is to place greater emphasis on patient-focused care. It is concluded this has the propensity to yield substantial further benefits, including improved financial and quality of care outcomes, in the Australian as well as the British and wider Organization for Economic Co-operation and Development (OECD) context. 'Professionally, we have committed ourselves to creating caring environments that promote healing. We cannot meet this goal until we make a commitment to be patient-focused and give up being nurse-focused or facility-focused' (Kerfort and LeClair, 1991). 'In a customer-driven [organization], the distribution of roles is different. The organization is decentralized, with responsibility delegated to those who until now have comprised the order-obeying bottom level of the pyramid. The traditional, hierarchical corporate structure, in other words, is beginning to give way to a flattened, more horizontal structure' (Carlzon, 1987).

Australia↗
PubMed1994

Victorian public hospitals: taking a sledgehammer...?

Until relatively recently, there have been few attempts to introduce strong forms of competition into publicly funded hospital systems, whether in Australia or elsewhere. The Victorian government has done so by implementing a casemix funding formula from July 1993 and in the process has foreshadowed that the least efficient hospitals will close. While it is of vital importance to improve the efficiency of Australian hospitals, and a key factor is to use casemix funding to achieve microeconomic reform, it is not appropriate to use competition to close hospitals. Arguments against using marketplace forces to determine the fate of hospitals include: the difficulties that could ensue with an inappropriate distribution of hospitals in Victoria; the necessity to provide hospital services for the public good; whether reducing the public sector is actually economically beneficial; and the conclusion reached by many in the United States, that health care should not be treated as a commodity. I argue for the development of a more sophisticated policy than one which uses the principles of laissezfaire and relative efficiency to close public hospitals.

Cost Control↗