The boundaryless hospital.
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Forecasting↗
Biomedical subjects
J Braithwaite
Publications and source records attributed to J Braithwaite.
Why openness with health inspectors pays.
The effect of the quality of information obtained by Standards Monitoring Teams on the compliance of 410 Australian nursing homes with Commonwealth regulatory standards is explored. We find that information matters. Lack of openness is a hallmark of a poor quality facility, openness of a high quality facility. Secondly, open flow of information becomes a resource that does enable the regulatory process to improve the quality of care. From an industry perspective, therefore, openness pays because it 1. works against being marked off by an inspection team as a problem facility that is covering up; and 2. allows the facility to improve the quality of the service it delivers to the consumer.
Australia↗
How viable is Victoria's funding policy?
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Capital Financing↗
Smoking, pregnancy and the fetus.
Smoking may influence a women's reproductive ability by having adverse effects on fertility, the early embryo and the fetus. The ability to become pregnant and to maintain the pregnancy long enough for it to be clinically detected is reduced in smokers. Smoking can adversely influence several of the crucial steps within the reproductive process required for achieving a pregnancy. Despite the increased miscarriage rate in women that smoke there is no evidence to suggest that smoking can cause fetal abnormalities. The chemical composition of cigarette smoke is more closely related to reduction in fetal growth than the number of cigarettes smoked. In smokers, the placenta appears remarkably normal. The effects of smoking could be due to one or more of the hundreds of different chemical substances in tobacco smoke, but apart from carbon monoxide and nicotine, little is known about the effects of other toxins. Nicotine can adversely affect uterine and placental blood flow by causing constriction of the blood vessels. It can also affect both the maternal and fetal blood pressure and heart rate, but its action on the fetal cardiovascular system does not appear to be dependent on its effect on placental perfusion.
Abortion, Spontaneous↗
A study using working DRGs to examine variations in length of stay.
The results of a working DRG utilisation review study conducted at St Vincent's Hospital, Sydney in 1992 are described. The project aimed to allocate a working DRG to Cardiology and Orthopaedic patients. Working DRGs are defined as DRGs allocated on admission based on the presenting problem or provisional diagnosis. Patients were then concurrently reviewed until discharge. Actual length of stay (LOS) of patients was compared to the LOS predicted by the working DRG. Results indicated that a utilisation review program using a working DRG can predict a LOS reasonably well for large groups of patients but not for individual patients and that St Vincent's is a comparatively efficient provider of Cardiology and Orthopaedic Services. The paper describes the study design, methods and results. Medical Record Managers played an integral role in the preparation phase, design of the study, day to day coordination and analysis of results. Medical Record Managers' participation in the study is highlighted in this paper.
Cardiology Service, Hospital↗
America's health care reforms.
President Bill Clinton is currently proposing the most sweeping changes to American social policy since the New Deal by Roosevelt in the 1930s. Major concerns about escalating health care costs, a mushrooming health care bureaucracy and a growing proportion of the American population who can no longer afford adequate health care insurance coverage have motivated Clinton's plan for health care reform. Ideas about telemedicine, the electronic medical record and more comprehensive and advanced information systems are already being canvassed during the course of the debate. Australian clinicians and policy makers are following the American debate closely. So too, should health information managers. America watching should prove interesting, stimulating and professionally rewarding.
Australia↗
Strategic planning or muddling through? The relevance of the strategic planning process to the hospital sector.
We review some of the main themes in the literature about managerial strategy and strategic planning. Attention is paid to the limitations of strategic planning in the government sector generally and the public hospital system particularly. The alternative to strategic planning--to adapt a stance that is more pragmatic, incrementalist and iterative--is considered. A case study of a teaching hospital's approach to strategy over the last two years is used to provide an empirical complement to the literature analysis. We conclude that the rational planning approach has advantages over the adaptive, iterative approach through the information that it provides to hospital management about the strengths and weaknesses of the organisation.
Australia↗
Can resident-centred inspection of nursing homes work with very sick residents?
This paper seeks to address the issue of whether a resident-centred inspection process can be effective in a nursing home environment dominated by residents who require high levels of care. Two fundamental criticisms of the current Australian monitoring process are its reliance on standards that are subjective resident-centred standards and its reliance on the views of residents concerning the quality of care provided in the home. These criticisms are becoming all the more important as survival rates for the aged increase and the average level of disability of nursing home residents continues to worsen. Our data suggest that the resident-centred process, despite some difficulties, is both reliable and practical, regardless of the care needs of residents in the home. Data collected from inspection teams show that inspectors use a variety of sources to validate information, with residents being one component. These sources vary little in importance between homes with different levels of care needs or behavioural problems. Perhaps of more importance is the finding that a home's overall performance across 31 resident-centred standards is not affected by either the home's average level of total care needs or the number of residents with severe behavioural problems. There are some significant effects (in both directions) of resident disability on compliance with particular standards. Most notable is the finding that the standard requiring appropriate use of restraint is less likely to be met when there are large numbers of residents with high levels of disability or behavioural problems.
Attitude of Health Personnel↗
Strategic management and organisational structure: transformational processes at work in hospitals.
There is a substantial amount of organisational restructuring presently occurring in Australian public hospitals. However, there has been a lack of systematic research conducted about this phenomenon. In Australia most literature about organisational restructuring has employed a case study approach. Although there has been a great deal of support for product line management organisational arrangements in recent literature from overseas, little investigation into the adoption of product line management has taken place in Australia. In this paper, a discussion about the relationship between strategic management and organisational structure is presented. Survey results of a sample of nine teaching hospitals in New South Wales are reported. Taken together with other more descriptive literature about organisational restructuring in Australian health care, the evidence from this survey suggests that there are vigorous transformational processes at work, perhaps especially in the larger hospitals. Despite support for it in the literature, product line management is not being adopted on a widespread scale. The shift toward restructuring occurring within Australian hospitals at the moment represents a bout of experimentation with new organisational designs which seems destined to continue. A number of management theorists conclude that there need to be strong linkages between strategic planning and the choice of organisational structure. However, the empirical evidence reported here did not identify such strong linkages. This phenomenon warrants further investigation. The view is put that where these linkages are weak there is a risk that whatever structure is chosen will not be robust or flexible enough to cope with mooted or predicted policy changes to the Australian health system.
Health Policy↗
Progress in assessing the quality of Australian nursing home care.
This paper critically examines the clarity, practicality, desirability and validity of the 31 outcome standards that the Commonwealth Government introduced to assess quality of care in Australian nursing homes. Key features of the Australian system in an international context are its focus on outcomes, the limited number of standards used, and the comparatively subjective nature of some standards. Directors of nursing from 410 nursing homes in the Brisbane, Sydney, Melbourne and Adelaide metropolitan areas were interviewed as part of the Nursing Home Regulation in Action Project. The overwhelming majority reported the standards as clear and desirable. In the minority of cases where problems were raised, practicability was the basis for concern. A factor analysis of the ratings given by standards monitoring teams to these 410 homes failed to demonstrate redundancy across standards or grouping of standards by objectives. Nevertheless, the standards were sufficiently highly interrelated to justify summing to produce an overall compliance score. This study shows that the 31 standards hold up well under scrutiny, both from the perspectives of key actors in the monitoring process, and from a psychometric point of view.
Australia↗
Japanese workplace productivity: what can health care managers learn from this phenomenon?
In this paper, factors which have contributed to the high levels of workplace productivity in Japan are examined. On any number of productivity indicators, Japan outperforms Australia. A summary of the debate about whether Australia can learn from Japanese workplace productivity practices is presented. An analysis of what health care managers can learn from Japanese workplace productivity is conducted. Six Japanese-influenced measures are identified as having utility, or potential utility, for Australian health care. It is concluded that the adoption of some or all of these measures should be given careful consideration by health care managers.
Australia↗
Beyond management by objectives: the implementation of a goal-directed performance management system in an Australian teaching hospital.
This paper describes management by objectives (MBO) as an approach by which organisations can be managed, with particular reference to health care institutions. An evaluation of MBO is presented and the disadvantages of MBO are discussed. A more comprehensive performance management system than MBO is advocated. The experience of St Vincent's Hospital, Sydney, in designing and implementing a goal-directed performance management program which builds on MBO methodology, is described. This experience provides guidelines by which senior managers may successfully implement goal-directed performance management programs in health care institutions in order to enhance organisational effectiveness and the goal-oriented behaviour of managers.
Employee Performance Appraisal↗
A survey of senior managers' participation in performance review programs in NSW public hospitals.
A performance review program is a management tool for enhancing the performance of employees. Such systems have been widely adopted by both private and public organisations during the last decade. Management writers strongly advocate the involvement of senior managers in performance review programs. In order to investigate the extent to which senior managers within public hospitals in New South Wales are presently involved in such programs, a survey was conducted. The aims of the survey were: to determine the number of senior hospital managers currently participating in a performance review program; to investigate the methodologies being used within hospitals to evaluate the performance of senior managers; to examine the reasons why hospitals with a formal performance review program in place had implemented that system; and to ascertain the reasons why some hospitals had failed to establish a formal performance review system for senior managers. The most frequently used methodology employed was based on the management-by-objectives model. The findings indicate that further education of those who influence the management of hospitals regarding the benefits of involving senior executives in performance review programs is necessary.
Employee Performance Appraisal↗
St Vincent's Hospital: a case study. Quality improvement programme in the Division of Corporate Services.
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Cost Control↗
A clinical evaluation of the Accutracker--a lightweight ambulatory blood pressure monitor.
An evaluation of the 'Accutracker', a new lightweight ambulatory blood pressure monitor, has been carried out in 14 subjects. Using a cross-over study design, BP readings obtained by the monitor were compared with BP measurements carried out in the opposite arm by a random zero sphygmomanometer. Both the systolic and diastolic blood pressures obtained by the 'Accutracker' were lower than the corresponding mercury sphygmomanometer readings (mean bias -5.6 and -7.0 mmHg respectively). The reproducibility of the monitor readings was significantly and substantially poorer than those obtained with the sphygmomanometer even when machine-flagged suspect values were excluded from the analysis. The results suggest that the data obtained from this device should be interpreted with caution.
Adult↗
Infant chlamydial pneumonia.
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Chlamydia Infections↗
Strategic constraints in health informatics: are expectations realistic?
In response to demands to enhance the efficiency and accountability of health systems, a range of different information technologies are being promoted. These technologies include integrated hospital systems, community health information networks and data repositories. However, the record of such technologies inside and outside the health industry suggest that such technologies cannot necessarily be relied on. The reason identified is that information systems are inherently logical and rational systems, and often come into conflict with the less rational social systems of organizations. Health information is identified in terms of three basic dimensions of information; that associated with managers; with professionals; and, with patients. The information of these dimensions are focused on very different objectives, have different structures and functions and are controlled by very different social processes. The information is also very complex and diverse within the dimensions. In the clinical encounter the clinician draws on specialist expertise, satisfies administrative requirements, and provides a clinical record. Thus, these dimensions converge at that point. However, collecting information is costly, and an efficient service demands economy in data collection. However, the technologies being promoted demand 'complete' data acquisition based on consistent and stable data definitions and data structures. The article argues that there is, thus, a conflict between the requirements of these technologies, and the realities of providing efficient services within a changing organizational, professional and social environment.
Clinical Medicine↗