Siva Ram Vemuri

A Delphi evaluation of the factors influencing length of stay in Australian hospitals

Using a modified Delphi method, the factors influencing length of inpatient stay (LOS) were explored. Row/column effects loglinear modelling was used to compare ratings between the first and second rounds, and between the clinical and non-clinical groups. Rating scale modelling was used to classify and determine the relative importance of each factor. Six important and 48 significant determinants of LOS were found, and four unimportant factors were identified. The relationship among these factors and the implications of this study are explored.

Mixture distribution analysis of length of hospital stay for efficient funding

This paper aims to demonstrate the importance of mixture distribution modelling in analysing the characteristics of inpatient length of stay (LOS), which has direct implications on health planning and formation of payment policy. It is found that mixture distribution analysis can confirm the homogeneity of certain Diagnosis Related Groups (DRGs). It can also reveal the heterogeneous patterns of other DRGs. For those DRGs exhibiting heterogeneity in LOS, related socio-economic factors influencing LOS are compared and contrasted between components by Poisson mixture regressions. Such an analysis provides an integrated framework to link funding with relevant influencing factors of LOS. A Poisson mixture regression model can give useful insights for state health institutions to initiate efficient casemix payments. It also benefits hospital managers and clinicians to manage LOS more effectively.

Social implications of bridging the gap through ‘caring for country’ in remote Indigenous communities of the Northern Territory, Australia

‘Caring for country’ is a term used to describe the complex spiritual affiliation that encompasses the rights and responsibilities that Aboriginal Australians have with their land. It includes their custodial responsibilities for keeping the land healthy and its species abundant. This ontology and associated practice of ‘caring for country’ continues across large sections of the Northern Territory of Australia through customary practice and through the Indigenous Ranger Program. This Program has been described as a ‘two toolbox approach’, which combines traditional ecological knowledge with more conventional land management practice, to manage landscapes for their natural and cultural values. Since 2007 there have been several policy initiatives which have changed the dynamics in Aboriginal communities which in turn has affected the structure of the Indigenous Ranger Program. In response to the dire social conditions facing Aboriginal communities in the Northern Territory, the Commonwealth Government initiated the Northern Territory Emergency Response, which was a ‘top down’ approach with very little community engagement. At around the same time there was a shift in the way Indigenous Rangers jobs were funded. The unintended impact of this was a reduction in the number of Aboriginal people connected to the Ranger Program and potentially less input from culturally appropriate decision makers for land management. Another influencing policy change involved a shift in Commonwealth funding for land management from Natural Heritage Trust to Caring For Our Country funding. This new funding is more targeted and has changed the nature of the Ranger Program to being less ‘program based’ and more ‘outcome based’ by packaging many land management activities as ‘Fee for Service’ contracts. The transformation is taking place in a prescriptive manner. In this paper we advocate a more community-based approach which allows for greater community involvement in planning, decision making and governance.

A discordancy test approach to identify outliers of length of hospital stay

A discordancy test approach is proposed to identify outliers of inpatient length of stay. This has implications not only for benchmarking service delivery but also for linking budget allocation procedures to efficiency of health service provisions. The effects of shifting trim point thresholds on hospital payments are assessed in a case study of a group of obstetrical patients.

Strategies for Improving Indigenous Financial Literacy in Schools

The Indigenous Australian population is not only considerably younger than the non-Indigenous population but is also on the rise. The challenge for many is to provide the kind of education that equips young Indigenous Australians with the necessary skills for managing their money. This challenge is further compounded, as the adult Indigenous population is not well versed in money management.This paper examines some of the strategies that are needed to improve Indigenous financial literacy in schools.

Diaspora Business Model Innovation

This paper explores how diasporans achieve business model innovation by using their unique resources. The hypothesis underlying the paper is that the unique backgrounds and resources of the diaspora businesses, due to different sources of information and experiences as well as multiple networks, contributes to business model innovation in a distinctive manner. We investigate the English school market in the Philippines which is established by East Asian diaspora who innovate a business model of conventional English schools. Two case studies were conducted with Japanese diaspora English schools. Their business is analyzed using a business model canvas (Osterwalder & Pigneur, 2010) and contrasted with the conventional business model. The empirical cases show that diaspora businesses use knowledge about their country of origin and engage with country of residence and multiple networks in different locations and constellations to identify unique opportunities, leading to a business model innovation.

Formation of Diaspora Entrepreneurs

“Diaspora entrepreneurs are people with a foot in two countries but by definition they live outside of the country of their origin, at least part of the time” (Winkel, 2010). They exist and their numbers are on the rise. The contemporary human landscape is dramatically changing. As diaspora become trans-national and trans-functional, increasingly governments of all echelons in several countries simultaneously consider them a valuable asset. There is evidence of competition in and between countries to engage with diaspora entrepreneurs. Rapid rises in business activities through global migration in recent years, coupled with the burden of aging populations, has created a sense of urgency for exploring the contribution diaspora entrepreneurs (DE) make to the local, national, and international economies. However, managing DE is increasingly becoming a challenge for contemporary economies; including the potential for human-made disasters as distinct voices emerge due to exacerbation of differences in class, gender, race, ethnicity, cultural affinity and relationship to the past, present and future. Part of the managerial challenge is recognising changing trends in global migration, technological advancement, ageing populations and emerging markets. These changes have extraordinary implications in terms of equity, efficiency and effectiveness. Maximising value from the operations of DE can no longer simply rely on conventional managerial practices. The underlying conditions leading to the creation of DE are the focus of this paper. These conditions allow us to categorise DE to enable policy that responds to these differences and allows for greater holistic, i.e. social, environmental, economic, individual, national and global, benefit.

Organizing mobility: a case study of Bukharian Jewish diaspora

The contemporary rate and pace of increased migration flows and diaspora formation are creating challenges for the individuals, society and the private and public sector organizations in an unprecedented manner. The literature responses are both discipline and area centric and mostly considered the migrant as a recipient of migration policies and programmes. Studies range from migrants being considered a ‘liability’ and cost to being an ‘asset’, that is, talent or brain. There are a very few investigations in the area how the migrants and diasporas are organizing themselves to overcome migrant being a disadvantage. This paper examines how migrants and diasporas are organizing themselves to overcome alienation and unemployment. It presents a case study of the Post-Soviet era Bukharian Jewish diaspora. This diaspora, particularly its Post-Soviet wave, provides a theoretically interesting example of migrant integration and organization due to its refugee characteristics and instrumental nature. The findings present efficient informal and formal methods of resource employment across generations, and context-specific organizational structures, such as the Bukharian Jewish World Congress, and activities supporting integration while maintaining the cultural heritage, such as the Bukharian Teen Lounge. The Bukharian Jewish diaspora illustrate the role of diasporic agency, resilience and values that foster resource employment and entrepreneurship despite impediments and difficulties. The paper contributes to understanding of how diaspora can self-organize human resource utilization and better employment of its inherent talent, and thus benefit both host and home countries. Further research examining successful cases of integrative diaspora organization and international resource development emphasizing diaspora’s emic view is required for better policy-making.

The Healing Qualities of Silence (Uganda)

World musician and humanitarian Samite Mulondo sees silence as an essential feature of communication. Whether he is working in refugee camps, in schools for former child soldiers, or in nursing homes for people with dementia, he often finds that silence expresses a lack of hope. In his work, he carefully manages silence in order to enhance communication and promote healing and peace. He sees his work of healing as a methodology of silence, specifically of attentive listening. For Samite, silence is integrally linked with both hope and hopelessness. In a noisy and violent world, it is often hard to hear hope. One way to deal with hopelessness is to use silence to help open a channel to healing, by giving people hope.

How Many Layers of Silence Can One Context Hold? (Micronesia)

The topic here concerns silence in relation to time, in four ways. Firstly, silence expresses influences of the past on the present: tension between modernity and tradition, and between traditional and changing gender roles. Next, two kinds of “present” silence were noted: (a) between an NGO and the values and expectations of the indigenous people they serve, and then (b) silence with regard to how certain individuals conducted themselves with others within the group. Lastly, silence looks toward the future, to climate change and uncertainty about sustainable practices. Moreover, in this case silence is encountered from the inside out, as the context within which an individual begins and within which she must establish herself.