Janna Anneke Fitzgerald

Using visual analytics to improve hospital scheduling and patient flow

The increasing demand for hospital emergency services has important implications for the allocation of limited public resources and the management of healthcare services. Although reform is an oft-cited way to improve the healthcare system, it has a limited ability to readily address this increasing demand. This paper presents an innovative approach to identify and translate feasible solutions to improve the efficiency of hospitals. Premised on visual analytics, the paper describes the way a software program was used to represent sonography department processes within a virtual environment. The processes were represented by collecting and assembling information about room capacity, room use, patient-scheduling practices, staff capacity, and equipment availability. The resulting model helped to identify areas for improvement and simulate viable options to improve these areas. This was associated with two clear benefits - it allowed solutions to be considered without making changes to the physical environment, and it provided a way to clearly demonstrate to staff the relationship between process change and improved efficiency. The paper concludes with directions for future research.

The association between cognitive impairment and community service use patterns in older people living in Australia

Family plays a vital role in supporting individuals with dementia to reside in the community, thus delaying institutionalisation. Existing research indicates that the burden of care-giving is particularly high for those caring for a person with dementia. Yet, little is known about the uptake of community services by people with a diagnosis of dementia. Therefore, this study aims to better understand the relationship between cognitive impairment and the receipt of community care services. In order to examine the relationship, secondary data collected across Queensland, Australia, from 59,352 home-care clients aged 65 and over during 2007-2008 are analysed. This cross-sectional study uses regression analyses to estimate the relationship between cognitive impairment and service mix, while controlling for socio-demographic characteristics. The dependent variables include formal services, informal care and total home-care service hours during a 12-month period. The findings of this study demonstrate that cognitive impairment is associated with accessing more hours of respite and day centre care but fewer hours of other formal care services. Additionally, the likelihood of support from an informal caregiver increases when a client becomes cognitively impaired. Therefore, this study demonstrates that there is an increased need for respite programmes to support informal caregivers in the future, as the population of people living with dementia increases. These findings support the need for investigations of new and innovative respite models in the future.

How best practices are copied, transferred, or translated between health care facilities: a conceptual framework

Introduction: In spite of significant investment in quality programs and activities, there is a persistent struggle to achieve quality outcomes and performance improvements within the constraints and support of sociopolitical parsimonies. Equally, such constraints have intensified the need to better understand the best practice methods for achieving quality improvements in health care organizations over time. This study proposes a conceptual framework to assist with strategies for the copying, transferring, and/or translation of best practice between different health care facilities. Purpose: Applying a deductive logic, the conceptual framework was developed by blending selected theoretical lenses drawn from the knowledge management and organizational learning literatures. Findings: The proposed framework highlighted that (a) major constraints need to be addressed to turn best practices into everyday practices and (b) double-loop learning is an adequate learning mode to copy and to transfer best practices and deuteron learning mode is a more suitable learning mode for translating best practice. We also found that, in complex organizations, copying, transferring, and translating new knowledge is more difficult than in smaller, less complex organizations. We also posit that knowledge translation cannot happen without transfer and copy, and transfer cannot happen without copy of best practices. Hence, an integration of all three learning processes is required for knowledge translation (copy best practice–transfer knowledge about best practice–translation of best practice into new context). In addition, the higher the level of complexity of the organization, the more best practice is tacit oriented and, in this case, the higher the level of K&L capabilities are required to successfully copy, transfer, and/or translate best practices between organizations. Practice Implications: The approach provides a framework for assessing organizational context and capabilities to guide copy/transfer/translation of best practices. A roadmap is provided to assist managers and practitioners to select appropriate learning modes for building success and positive systemic change.

Business and research forms of debate: argumentation and dissent as barriers to the commercialisation of innovations in hybrid industry-research organisations

Commercialisation activities combining the discoveries of one occupational group, such as scientists, with the commercial skills of managers involve interactions across occupational cultures. This article considers how dissent can be interpreted as a sign of dysfunction or cause for concern. The context of the study is Australian hybrid industry-research organisations composed of academic, government and industry personnel. Semi-structured interviews of a total of 20 scientists, engineers and managers focused on their experiences and perceptions of occupational culture, including styles of debate, and the potential of assumptions and norms to facilitate or obstruct commercialisation. Distinctive patterns of argumentation were identified as typical of commercial and research occupations. In addition, the interviewees confirmed that occupational forms of argumentation could influence the outcomes of commercialisation.

Organisational change: communicating to Schein's operator, engineer and executive occupational subcultures

There has been substantial academic interest surrounding innovation, change management and the individual attributes that permit and promote learning, organisational change and innovative behaviour. This research uses a psychometric tool known as the Instinctive Drives System® to measure preferred working styles in 3943 employees from a range of international companies. These employees were then classified into three groups (engineers, operators and executives) following Scheins classification of occupational subcultures. This study reveals significant differences between the occupational subcultures, suggesting that executives are more inclined towards variety, flexibility and change rather than routine and structure. In contrast, operators and engineers demonstrated preferences for logic and certainty. These results have a range of implications, for researchers and practitioners. Researchers can extend the results of this study, and further explore the differences found between executives and managers from different subcultures. Practitioners may use the results to initiate change to integrate preferred working styles.

Respite service use among caregivers of older people: comparative analysis of family dementia caregivers with musculoskeletal and circulatory system disorder caregivers

ABSTRACT Objectives: To identify the main drivers of the use of respite services and the need for respite services among caregivers of people experiencing dementia relative to family caregivers of people with other health conditions. Method: Based on nationally representative secondary data regression analysis was used to test the association between selected health conditions and the utilisation of and need for respite services. Results: For a person living with dementia the odds of using respite care are higher than for a person with either a musculoskeletal or circulatory condition. Family caregivers of people living with dementia report the odds of the need for more respite as 5.3 times higher than for family caregivers of people with musculoskeletal conditions and 7.7 times higher than for family caregivers of people with circulatory conditions. The main reason for never using respite services is largely driven by the type of health condition, age of care recipient, existence of a spouse, and level of disability. Conclusions: Respite services that cater to the specific needs of families experiencing dementia at home should become a higher priority within the aged care sector. Alternative models of respite care that focus on prevention and early intervention would be cost effective.

Patient journey modelling: using students as a vehicle for the diffusion of innovation.

This paper describes a case study involving third-year undergraduate computing students and their conduct of a patient journey modeling project for the Ambulatory Care department of a Regional Hospital in New South Wales, Australia. The goal of the research was to determine if students, given minimal training in an emerging patient journey modeling tool known as Essomenic, could be an effective vehicle for the diffusion of innovation to operational staff involved in a healthcare improvement project. Under academic supervision, students interacted directly with staff to develop models of the current system of care from GP referral to the completion of the patient consultation. The methodology also included model validation, identification of opportunities for improvement, investigation of alternative solutions and solution recommendations. Outcomes of the project, conducted over a 14 week semester, demonstrate that the students found the technique quick and easy to learn and that they could transfer their new found knowledge of this innovation to healthcare staff for the purposes of developing true and accurate representations of the current state patient journey. Staff were then able to interact directly with the student team, using the models as a communication medium, to identify opportunities for improvement and understand more deeply, how changes would impact their daily tasks and increase patient satisfaction in service delivery.

Brilliant health service management: challenging perceptions and changing HR practices in health services

To redress the scholarly preoccupation with problems, there is a need to focus on practices that exceed expectation. This study is the first to explicate healthcare professionals’ perceptions of brilliance within their health service. Via online discussions, 78 postgraduate health management students from an Australian university shared their experiences with, and perceptions of brilliant health services in their organisation. Researchers thematically analysed the text and workshopped the findings to extend current understandings of human resource management using positive organisational scholarship in health‐care (POSH). Preliminary codes organised well into six key themes – teamwork, leadership, innovation, exceptional individuals, empowerment and patient‐centred care. Although the results reflect health service management research, POSH helped to clarify those aspects of people management that are associated with brilliant health services. These include developing interagency networks; adopting an understanding of innovation; and recognising the extraordinary in the seemingly ordinary.

Intergenerational care: an exploration of consumer preferences and willingness to pay for care

ABSTRACT Objectives: To identify feasible models of intergenerational care programmes, that is, care of children and older people in a shared setting, to determine consumer preferences and willingness to pay. Method: Feasible models were constructed in extensive consultations with a panel of experts using a Delphi technique (n = 23) and were considered based on their practical implementation within an Australian setting. This informed a survey tool that captured the preferences and willingness to pay for these models by potential consumers, when compared to the status quo. Information collected from the surveys (n = 816) was analysed using regression analysis to identify fundamental drivers of preferences and the prices consumers were willing to pay for intergenerational care programmes. Results: The shared campus and visiting models were identified as feasible intergenerational care models. Key attributes of these models included respite day care; a common educational pedagogy across generations; screening; monitoring; and evaluation of participant outcomes. Although parents were more likely to take up intergenerational care compared to the status quo, adult carers reported a higher willingness to pay for these services. Educational attainment also influenced the likely uptake of intergenerational care. Conclusions: The results of this study show that there is demand for the shared campus and the visiting campus models among the Australian community. The findings support moves towards consumer-centric models of care, in line with national and international best practice. This consumer-centric approach is encapsulated in the intergenerational care model and enables greater choice of care to match different consumer demands.