A study was undertaken to identify the causes of unnecessary repeated medical imaging examinations. The repeat analysis study investigated repeated medical imaging examinations at two medium sized hospitals in Sydney, Australia. The analytical part of the study was conducted jointly by a radiologist and a radiographer. Overall there were 9.3% and 7.2% of total films repeated respectively at the two hospital sites. Unnecessary repeats were found to have been caused by numerous factors including: poor technical judgement, the adoption of unconventional techniques, non availability of radiologist for advice, patient movement or motion, equipment mishandling, disorganised practice and poor supervision of students. At both of the sites, senior radiographers were associated with 70.2% and 84.5% respectively of dark and light film errors, and 59.7% and 85.5% respectively of the repeated cases had students' involvement. On the other hand, junior radiographers were involved with 70.3% and 86.1 % respectively of positioning errors. It was recommended that major changes be introduced to radiographer practice including, quality control, radiological techniques, training, supervision and continuing professional development. It was also recommended that the radiologist takes a more active role in future guidance and training of radiographers.

The Blacktown Mt Druitt Hospital Imaging Department wanted to find a clinical practice improvement solution to the escalating endemic and common public hospital problem of long waiting times for x-rays, Access Block, cancelled examinations, inefficiency and poor service capacity. A multi-disciplinary team was formed, the workflow analyzed, request form and patient flow were mapped from time of requesting the x-ray examination to final report delivery. After the main causes were identified the steps deemed unnecessary were eliminated to create a revised request pathway (arriving with patient instead of prior) and patient flow. Patients arriving with the request form were given immediate access. Radiographers from other modalities methods provided support to ensure streamlined patient flow within the department. Patient Services Assistant (PSA) roles were redefined and the referring ward became responsible for contacting the PSA when patient was ready to be transported. This new process was called 'Open Access'. The issues identified were receiving and distribution of the request form to imaging areas providing x-ray service and the excessive, uneven workflow demands of the PSA. As a result of original request form pathway and the patient flow system, radiographers were inefficient and underused, many examinations were cancelled, service capacity was poor and imaging contributed to hospital Access Block. Through implementation of 'Open Access', average ward x-ray availability reduced from 15 to 1 h, with 91.9% of all examinations completed in less than 3 h. Average Emergency Department x-ray availability reduced from 3 h to 30 min. Average of 80 cancelled x-ray examinations/month reduced to zero. Patients requiring x-ray have immediate access to services when they arrive with the request form. 'Open Access' has led to efficient patient flow, improved availability of images, assisted patient clinical management, discharge processes from hospital and bed availability. 'Open Access' has reduced Emergency Department Access Block, allows more effective use of staff resources and higher staff, patient and referring ward satisfaction.

At the Gold Coast 2006 AMZAME Conference, Jenny Graham, Leon Cowen and Paul Orrock conducted a session on hypnotherapy, attracting significant interest across the health professions. Many ideas and viewpoints were shared and many questions were raised. The current health climate (with strong public interest in natural and complementary medicine and governments keen to contain burgeoning costs of health delivery) seems conducive to serious examination of the place of hypnotherapy in the preparation and/or continuing development of health professionals. The benefit of hypnotherapy as an effective rapid drug free intervention and one which can be coupled with and enhance other interventions (Cognitive Behavioural Therapy or counselling) is being recognised. As reported in 2006, a wide range of health practitioners are seeking training in hypnotherapy and there is a need to identify core competencies.

Many older people remain in hospital after the acute phase of their illness due to a delay in implementation of community services to respond to their ongoing needs for domiciliary care. The Macarthur Health Service has well-coordinated ambulatory and aged care services, which provide acute and subacute care in the home. The teams consist of medical, nursing, and allied health professionals. In spite of these services, some older people still cannot receive treatment in their own home due to the lack of acutely responsive domiciliary care. This support may only be needed on a short-term basis during the acute phase of their illness or as a bridging service whilst the longer term Home and Community Care (HACC) services are put into place. Carrington Temporary Aged Care Program (CTACP) has provided services that assist clients temporarily with personal care, domestic assistance, shopping, provision of meals, transport and psychosocial support, until the appropriate HACC service is available, for a maximum period of eight weeks. Thirty five patients discharged from Macarthur Health Service have received this service to date in 2002. Patient and carer satisfaction and quality of life measures indicate that this is a valuable and effective service to the client.

At both the Commonwealth and state level, the agenda for healthcare reform is moving rapidly. The National Health and Hospitals Reform Commission (NHHRC) is currently reviewing the health system to make recommendations for sustainable Improvements to the performance of service delivery. Several states have also undertaken inquiries over the past two years in response to major issues identified in the delivery of patient care within the public health system. The need for improvement is evident. Rising health costs, the growing impact of chronic disease, an ageing population and the inefficiencies derived through a disjointed funding and policy mechanism, are Just a few of the many challenges ahead. Despite current national health expenditure being in excess of $94 billion, significant issues exist in terms of access and equity, safety and quality, poor health outcomes for Indigenous people and others with special needs, workforce shortages and a lack of focus on the promotion of health and wellbeing.

Purpose of the study: An assessment is provided of the opportunities and challenges that researchers and research teams face when they contemplate undertaking collaborative health management research. Introduction: The recently completed review by the National Health and Hospitals Reform Commission (2009) in Australia has made several important recommendations for greater investment in health policy, health services and health system research. Although research is deemed integral in advancing health system improvement, there are several challenges which include: a paucity of research exists, lack of support for collaborative work, and underinvestment in health management research and infrastructure (Hunter and Brown, 2007). Methods: The author largely draws upon the Australian context as documented in the literature, as well as personal experience in the field. It commences with an outline of current trends and challenges. Three collaborative health management research approaches are reviewed: organisation based research centre; cross-institutional research model ('Health Management Research Alliance' - HMRA, Day and Fulop, 2009), and the collaboration between institutions. Results: All three models were found to provide a sound framework for collaborative research work. It was also found that there is value in incorporating the recognised principles of engagement. The benefits and challenges were discussed in the broader context for proposed research collaboration in the Asia Pacific region. Conclusions: 1. Important to ensure collaborative health management research and innovation remains an integral part of the health system 2. The Conference provides the ideal opportunity for the formation of an Asia Pacific Health Management Network in research. It is recommended that this network is progressed through the development of a formal 'Declaration' at the Conference.

After studying this chapter, the reader should be able to: • Identify the context and environment that influences managing people in the health care industry. • Describe and analyse a framework of theories strategies and skills which can guide managers in thinking about developing their own systems and practices. • Demonstrate understanding of policies, procedures and practices in managing people in health care services. • Demonstrate understanding of how organisational goals are achieved through working with people. • Identify some of the common situations that managers face that call for interpersonal skills.

Since the emergence of digital imaging, there have been questions about the necessity of continuing reject analysis programs in imaging departments to evaluate performance and quality. As a marketing strategy, most suppliers of digital technology focus on the supremacy of the technology and its ability to reduce the number of repeats, resulting in less radiation doses given to patients and increased productivity in the department. On the other hand, quality assurance radiographers and radiologists believe that repeats are mainly related to positioning skills, and repeat analysis is the main tool to plan training needs to up-skill radiographers. A comparative study between conventional and digital imaging was undertaken to compare outcomes and evaluate the need for reject analysis. However, digital technology still being at its early development stages, setting a credible reject analysis program became the major task of the study. It took the department, with the help of the suppliers of the computed radiography reader and the picture archiving and communication system, over 2 years of software enhancement to build a reliable digital repeat analysis system. The results were supportive of both philosophies; the number of repeats as a result of exposure factors was reduced dramatically; however, the percentage of repeats as a result of positioning skills was slightly on the increase for the simple reason that some rejects in the conventional system qualifying for both exposure and positioning errors were classified as exposure error. The ability of digitally adjusting dark or light images reclassified some of those images as positioning errors.

After studying this chapter, the reader should be able to: • Define theories and concepts underpinning organisational performance improvement practices in health care. • Analyse international and local frameworks for improving organisational performance. • Demonstrate understanding of the steps required to implement a process for improving organisational performance. • Describe the advantages and limitations of standardised measures used to assess organisational performance. • Evaluate challenges and Opportunities for improving organisational performance.