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Article
Publication date: 6 December 2018

Michel Lu and Allan D. Spigelman

A significant subset of patients (12 per cent) with triple negative breast cancer (TNBC) is BRCA mutation carriers, which can be identified through genetic testing. The…

Abstract

Purpose

A significant subset of patients (12 per cent) with triple negative breast cancer (TNBC) is BRCA mutation carriers, which can be identified through genetic testing. The purpose of this paper is to evaluate the referral practice for TNBC patients with reference to New South Wales (NSW) referral guidelines at the time of diagnosis and to assess the effectiveness of such guidelines in identifying BRCA mutations. Robust health governance requires monitoring of adherence to evidence-based guidelines such as those that underpin referral for cancer genetic testing in this clinical scenario.

Design/methodology/approach

The authors conducted a retrospective clinical audit of identified TNBC patients at St Vincent’s Hospital (SVH) between 2006 and 2016 in NSW, comparing referral practice to guidelines extant at the time of diagnosis. Family history was considered for age guideline-inappropriate referrals to SVH while the results of BRCA gene testing were assessed for all referred.

Findings

Overall, of the 17 patients eligible for referral based on the age criterion, 10 (58.5 per cent) were referred appropriately; however, there were substantial improvements from 2012 with 100 per cent referred. Of note, 12 (33.4 per cent) of 36 patients referred to SVH were referred outside of guidelines, pointing to other reasons for referral, such as patient age (OR 0.945; 95% CI 0.914–0.978) and calendar year (OR: 1.332; 95% CI: 1.127–1.575) at TNBC diagnosis. Referral guidelines captured 66.67 per cent of identified deleterious BRCA mutations in those tested.

Originality/value

Substantial under-referral of guideline-eligible patients was identified, with evidence-based guidelines effective in identifying high-risk individuals for BRCA mutation testing. There was, however, a substantial proportion of guideline-inappropriate referrals.

Details

International Journal of Health Governance, vol. 24 no. 1
Type: Research Article
ISSN: 2059-4631

Keywords

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Article
Publication date: 17 September 2019

Shane Rendalls, Allan D. Spigelman, Catherine Goodwin and Nataliya Daniel

The purpose of this paper is to provide an overview of consumer and community engagement in health service planning, quality improvement and programme evaluation in…

Abstract

Purpose

The purpose of this paper is to provide an overview of consumer and community engagement in health service planning, quality improvement and programme evaluation in Australia, and key components and importance of a strong suite of tools for achieving effective outcomes.

Design/methodology/approach

This paper is a non-systematic review of Australian national, state and territory websites in relation to policy commitment to consumer engagement, best practice framework for consumer engagement and recent project example.

Findings

Consumer engagement is a recognised component of the Australian health system. It is reflected in the national and state health policy and is a mandatory requirement of hospital accreditation. The application of co-design principles is gaining increasing popularity in health service planning and programme evaluation. Co-design is an important enabler of patient/community-centred service planning and evaluation; however, on its own it may lead to poorer outcomes. Co-design must occur within a broader systemic framework.

Practical implications

The research identifies a conceptual framework, approaches and tools of value to health service management and planners.

Originality/value

Consumer and community engagements are critical to the development of consumer-centric services. However, this should complement and add value to, not divert attention away from established principles of service planning, continuous quality improvement and programme evaluation. To do so may result in poorer quality health and well-being outcomes, reduced efficiency and ultimately reduced consumer and community satisfaction with services. This paper examines consumer and community engagement within the broader planning and quality improvement framework and practical implications for keeping planning, research and evaluation on track.

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Article
Publication date: 11 October 2018

Ashley K. Kable and Allan D. Spigelman

The purpose of this paper is to draw attention to the problem of second victims involved in adverse events and their need for adequate support.

Abstract

Purpose

The purpose of this paper is to draw attention to the problem of second victims involved in adverse events and their need for adequate support.

Design/methodology/approach

The impact on second victims involved in adverse events and implications for organisational support were determined from previous studies and relevant publications about this problem.

Findings

The impact of adverse events on health professionals who are involved in them can be profound. These second victims can suffer extreme emotional distress, anxiety regarding perceptions of their competence and professional isolation, and may endure long-term professional and personal consequences. Some of the more severe outcomes include leaving the profession, symptoms of post-traumatic stress disorder and suicide. Many studies report a substantial lack of organisational support for second victims. Key strategies have been recommended for organisations to implement to support second victims.

Originality/value

The authors note that recently published studies continue to report that organisational support is inadequate for second victims. Improved mechanisms of support would prevent the loss of second victims from the workforce, and ameliorate the severity and duration of the impact on second victims.

Details

International Journal of Health Governance, vol. 23 no. 4
Type: Research Article
ISSN: 2059-4631

Keywords

Content available
Article
Publication date: 8 August 2008

Allan D. Spigelman

Abstract

Details

Clinical Governance: An International Journal, vol. 13 no. 3
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 5 September 2016

Allan D. Spigelman, Shane Rendalls, Mary-Louise McLaws and Ashleigh Gray

The purpose of this paper is to provide an overview of the context for strategies to overcome antimicrobial resistance in Australia, which may provide valuable learnings…

Abstract

Purpose

The purpose of this paper is to provide an overview of the context for strategies to overcome antimicrobial resistance in Australia, which may provide valuable learnings for other jurisdictions.

Design/methodology/approach

Non-systematic review of literature from websites of national, state and territory health departments and interviews with key stakeholders for Australian strategies to reduce antimicrobial resistance.

Findings

In July 2015 all states and territories in Australia adopted the National Antimicrobial Resistance Strategy 2015-2019, which is built on the World Health Organization policy package to combat antimicrobial resistance. This strategy represents “the collective, expert views of stakeholders on how best to combat antimicrobial resistance in Australia. It will also support global and regional efforts, recognising that no single country can manage the threat of antimicrobial resistance alone”. It combines quantitative and qualitative monitoring strategies with frameworks and guidelines to improve management of the use of antimicrobial resistant drugs. Prior to this, health services and states developed and implemented initiatives aimed at monitoring and improving prescribing practices. Development of the national strategy has encouraged and fostered debate within the Australian health system and a raft of new policy initiatives.

Research limitations/implications

Surveillance strategies are in place to monitor impact and trends at jurisdictional and sector levels. However, actual impact on antimicrobial resistance and prescribing practices remains to be seen as existing initiatives are expanded and new initiatives implemented.

Practical implications

This overview of key Australian initiatives balancing quantitative and qualitative surveillance, accreditation, research, education, community awareness and price signals on antibiotic prescribing practices may be valuable to health systems in developing local strategies.

Originality/value

The authors provide an up to date overview of the context, strategies and aims of antimicrobial stewardship in Australia.

Details

International Journal of Health Governance, vol. 21 no. 3
Type: Research Article
ISSN: 2059-4631

Keywords

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Article
Publication date: 9 August 2011

Allan D. Spigelman

This article's aim is to report on the influence of changing of the political guard on health care and health care policy.

Abstract

Purpose

This article's aim is to report on the influence of changing of the political guard on health care and health care policy.

Design/methodology/approach

This is an observational piece.

Findings

Governments orchestrate change but whether change leads to improvement remains to be seen.

Originality/value

The article reports the effect of Government.

Details

Clinical Governance: An International Journal, vol. 16 no. 3
Type: Research Article
ISSN: 1477-7274

Keywords

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Article
Publication date: 7 April 2015

Allan D Spigelman and Shane Rendalls

The purpose of this paper is to overview, background and context to clinical governance in Australia, areas for further development and potential learnings for other…

Abstract

Purpose

The purpose of this paper is to overview, background and context to clinical governance in Australia, areas for further development and potential learnings for other jurisdictions.

Design/methodology/approach

Commentary; non-systematic review of clinical governance literature; review of web sites for national, state and territory health departments, quality and safety organisations, and clinical colleges in Australia.

Findings

Clinical governance in Australia shows variation across jurisdictions, reflective of a fragmented health system with responsibility for funding, policy and service provision being divided between levels of government and across service streams. The mechanisms in place to protect and engage with consumers thus varies according to where one lives. Information on quality and safety outcomes also varies; is difficult to find and often does not drill down to a service level useful for informing consumer treatment decisions. Organisational stability was identified as a key success factor in realising and maintaining the cultural shift to deliver ongoing quality.

Research limitations/implications

Comparison of quality indicators with clinical governance systems and processes at a hospital level will provide a more detailed understanding of components most influencing quality outcomes.

Practical implications

The information reported will assist health service providers to improve information and processes to engage with consumers and build further transparency and accountability.

Originality/value

In this paper the authors have included an in depth profile of the background and context for the current state of clinical governance in Australia. The authors expect the detail provided will be of use to the international reader unfamiliar with the nuances of the Australian Healthcare System. Other studies (e.g. Russell and Dawda, 2013; Phillips et al., n.d.) have been based on deep professional understanding of clinical governance in appraising and reporting on initaitives and structures. This review has utilised resources available to an informed consumer seeking to understand the quality and safety of health services.

Details

Clinical Governance: An International Journal, vol. 20 no. 2
Type: Research Article
ISSN: 1477-7274

Keywords

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Article
Publication date: 26 January 2010

Allan D. Spigelman

The purpose of this paper is to describe Health Reform proposals in Australia.

Abstract

Purpose

The purpose of this paper is to describe Health Reform proposals in Australia.

Design/methodology/approach

The approach to this subect is observational.

Findings

A total of 123 recommendations amounting to significant reform are proposed. It remains to be seen how many of these recommendations survive an extensive consultation process.

Originality/value

The paper describes one nation's attempt to address universal challenges in healthcare delivery and gives an update of health reform proposals.

Details

Clinical Governance: An International Journal, vol. 15 no. 1
Type: Research Article
ISSN: 1477-7274

Keywords

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Article
Publication date: 25 April 2008

Allan D. Spigelman

The purpose of this paper is to describe early developments in the Australian healthcare agenda stemming from a recent change in national government.

Abstract

Purpose

The purpose of this paper is to describe early developments in the Australian healthcare agenda stemming from a recent change in national government.

Design/methodology/approach

The approach is to give the perspectives of an interested observer and stakeholder.

Findings

Healthcare looms large in any democratic election agenda. Promises are made that possess international echoes. Delivery of health care reform in the first few months of the new Australian Labor [sic] Government comply with these suppositions. Plus ça change, plus c'est la même chose=the more things change, the more they stay the same.

Originality/value

Health care changes in Australia are drawn to the attention of an international audience.

Details

Clinical Governance: An International Journal, vol. 13 no. 2
Type: Research Article
ISSN: 1477-7274

Keywords

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Article
Publication date: 7 August 2009

Allan D. Spigelman

This paper aims to present an exemplar of patient enquiry concerning choice of surgeon and progress regarding individual surgeon performance reporting.

Abstract

Purpose

This paper aims to present an exemplar of patient enquiry concerning choice of surgeon and progress regarding individual surgeon performance reporting.

Design/methodology/approach

The paper takes an observational approach.

Findings

The study finds that there is room for improvement concerning choice of surgeon and progress regarding individual surgeon performance reporting.

Originality/value

The paper presents an anecdotal observation confirming that there is room for improvement.

Details

Clinical Governance: An International Journal, vol. 14 no. 3
Type: Research Article
ISSN: 1477-7274

Keywords

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