Editorial: An Urgent Need for Investment in Health Management Education
Internationally the agenda for healthcare reform has moved rapidly. In Australia, the health care system has recently undergone significant structural changes to target sustainable improvements to the performance of health service delivery. Throughout this process there has been growing attention to the importance that leadership and management can play in the ultimate success of improved health service delivery. The quality of the management and leadership education within the health services and state health authorities has been shown to be crucial to better patient outcomes. Despite leadership being integral to the success of reform, the national strategies have failed to address the leadership and management education, development and training needed at the health care and health services level. The Australian health service reforms ignore the critical issues of planning and investment towards the education and development required for a system targeting management and decision making at the hospital level. The two prominent professional bodies which nationally promote health management education, research and professional development are the Society for Health Administration Programs in Education (SHAPE) and the Australasian College of Health Service Management (ACHSM). Both groups have recently sought commitment from the government, health departments and healthcare providers to invest in health management education through supporting the continuing professional development and training of the health management workforce.
Uncovering the causes of unnecessary repeated medical imaging examinations, or part of, in two hospital departments
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 Declaration: New strategic thinking to advancing health leadership and management through collaboration across the Asia Pacific region
BACKGROUND: Collaborations between organisations from developed and developing nations in the Asia Pacific region have secured partnerships in education, training, research and professional development that target enhancement of capacity building in health management. Although 'Declarations' supporting various social, political, economic and health collaborative activities have gained prominence over the years, it is only a relatively new area of strategic thinking and application for health management. METHOD: The study analyses the formation and overall value of two recent Declarations used to promote and advance health management as a profession - the SHAPE Declaration and the Phitsanulok Declaration. It analyses the descriptive data and other information derived from structured interviews with key stakeholders. RESULTS: The elements critical to the preparation of the Declarations included partner champions, strong and representative leadership group, mutually beneficial exchange of knowledge and expertise, wide stakeholder dialogue, the contribution of key Colleges (ACHSE and SHAPE) and, an appropriately designed conference structure and numerous social activities that support partners working closely together. The Declaration development engaged and included new partners and new professional development opportunities. CONCLUSIONS: Cross-cultural collaboration provides new and challenging patterns of networking for health management. The Declarations were found to be a powerful new tool in building dialogue and expressing agreement for promoting the principles and actions required for a positive culture of reform and change in Australia and the Asia Pacific region.
Managing people in the health care industry
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.
Leading and Managing the Implementation Process: the key to successful national health reform
Introduction: The Australian Government recently announced major reforms to the health system - A National Health and Hospitals Network for Australia's Future. The national health reform plan involves substantial structural change which the Government expects will deliver 'better health and hospitals' for future generations. Approach: A review is undertaken of the proposed set of reforms to determine whether its frame of reference can contribute to the effective achievement of the desired health and hospitals outcomes. Findings: The national health reform plan was found to have two striking weaknesses. Firstly, it fails to account for the political, cultural, behavioural and professional aspects of change. Secondly, it fails to position leadership and health management as central to the implementation of reform. Conclusion: The complexity of major structural change is such that major health reform strategies need to incorporate proper assessment of organisational behaviour aspects within a system which values the central roles of leadership and health management. A new leadership model for introducing health reform is presented.
Open access
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.
National Health Reform Success: It's all about Leadership and Management
The Australian Labor Government recently announced a significant change to the structure of the Australian health care system - 'A National Health and Hospitals Network for Australia's Future'. The proposed reforms involve major structural change to the current health and economic systems so as to allow the required financing and governance foundations. It is widely recognised as the most significant health reform since Medicare was set up. Despite evidence from the United Kingdom, Europe, United States and Canada that health reform strategies rarely realise planned efficiencies and improvements, the Australian Government has created high expectations that it will deliver better outcomes and sustainable improvements in hospitals and health care. One likely impediment to success is that it is widely recognised that the Commonwealth and States generally lack the capacity and capability to lead such a major implementation process for reform. Unfortunately, this lack of skill and capacity is not just confined centrally, but exists at the local health service level among the health care professionals who are expected to provide leadership, management and support for the new arrangements in governance. Recent research in Australia indicates that appropriately qualified and experienced health managers are of central importance to the successful implementation of reform. However, the proposed reform package fails to account for this. This article aims to review the proposed national health reforms and to determine whether these new arrangements can contribute to or preclude the desired achievement of better health and improved hospital care for us all.
The Pathology Workforce Crisis: future solutions
Introduction: A recently released report, the National Survey of Pathology Workforce 2011, has painted a bleak future for clinical pathology services in terms of a looming major workforce shortage. Approach: A review is undertaken of the current pathology workforce situation to determine the key contributing issues, future demands, workforce needs and strategic solutions. Findings: A workforce crisis in pathology is upon us, with approximately a third of the total workforce expected to leave within the next five years. This represents a real threat to the future capacity of the workforce to sustain quality services at current levels and the likely growth of demand for pathology testing into the future. Conclusion: Four strategies are recommended to address the future pathology workforce needs in Australia through leadership and workforce development. These are; increasing supply of the workforce; redistributing the workforce from areas of lower to higher demand; improving productivity; and reducing demand for pathology services.
Working on the Edge: Positive Organisational Scholarship in Healthcare (POSH) and Looking for What's Good in Healthcare
As part of a larger research program on brilliant healthcare, this paper introduces positive organisational scholarship (POS) and discusses how it has influenced a new approach to theory and research in healthcare, titled POSH. The paper outlines how appreciative inquiry, a key approach in POSH, was used to inform an investigation of what is good in healthcare. Reflective practice is discussed as the central methodology used to explore public domain narrative evidence. The paper illustrates the use of reflective practice and introduces new understandings and insights garnered from using POSH. The paper concludes with a consideration of the implications of a POSH agenda for researchers and practitioners.
Competencies & Skills for Management of Systemic Changes in Australian Health Services: A predisposing, enabling and transforming framework
• Academic enhancement of management competencies/skills. The best method of imparting/acquiring the competencies/skills identified might not be academic. Examination of the three courses learning outcomes shows low content. - Innovative thinking - Managerial behaviour style and practice - Management of clinical practice (except risk management)