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The purpose of this paper is to contribute an Australian perspective to the debate on health system integration by identifying some key Australian challenges to integration, policy responses to enhance integration and potential insights from these for international policy makers, researchers and practitioners.

Drawing on the systems theory concept of entropy, the authors contend that there exist factors that contribute to system fragmentation. Whilst policy responses to these challenges are contextual, there are generalisable features worth exploring internationally.

The authors suggest that recognition of inherent system-based barriers is an important initial stage in moving towards integration. Whilst process and people factors are important contributors to integration, the political will to move in this direction is a necessary dynamic to energise the system through appropriate funding, incentives and governance structures.

The paper provides a fresh Australian perspective to the international discourse on barriers and opportunities to enhance health system integration.

This paper aims to examine the adoption of the open source library management system, Koha, amongst Australian special libraries.

The spread of Koha in Australian special libraries and the opinions of Koha users on the system have been examined by a survey distributed to all known Australian Koha users. A case study of the Greater Western Area Health Service (GWAHS) library network is also presented, demonstrating many of the practical issues involved in the decision to convert to an open source system.

The main reasons given for conversion to Koha were practical economic grounds, coupled with dissatisfaction with conventional library systems. Libraries found the conversion to Koha reasonably trouble‐free. Satisfaction ratings on most aspects of Koha performance were “above average” to “good”. Library expectations of value for money and overall cost savings appear to have been realised.

The sample of responding libraries (46.67 per cent of all Koha libraries found) included hosted and non‐hosted installations, and a representative mix of health and non‐health libraries, including three from the tertiary sector. Results were consistent across all groups. Many Koha installations have commenced operation since 2008, and a more comprehensive survey should be undertaken in the future, when the long‐term effects of open source adoption are more evident.

Koha has proved well suited to small health libraries, and the GWAHS experience has been successfully replicated amongst many other Australian special libraries.

The switch to open source has enabled many libraries to greatly enhance services to remote users. Financial restrictions which prevented many libraries establishing a web presence have been overcome by open source, resulting in greatly increased contact with library clients

Results of the first survey of Australian Koha users are presented. A case study of the first Australian health library network installation of Koha is also included.

Studies of high‐performing organisations have consistently reported a positive relationship between high performance work systems (HPWS) and performance outcomes. Although many of these studies have been conducted in manufacturing, similar findings of a positive correlation between aspects of HPWS and improved care delivery and patient outcomes have been reported in international health care studies. The purpose of this paper is to bring together the results from a series of studies conducted within Australian health care organisations. First, the authors seek to demonstrate the link found between high performance work systems and organisational performance, including the perceived quality of patient care. Second, the paper aims to show that the hospitals studied do not have the necessary aspects of HPWS in place and that there has been little consideration of HPWS in health system reform.

The paper draws on a series of correlation studies using survey data from hospitals in Australia, supplemented by qualitative data collection and analysis. To demonstrate the link between HPWS and perceived quality of care delivery the authors conducted regression analysis with tests of mediation and moderation to analyse survey responses of 201 nurses in a large regional Australian health service and explored HRM and HPWS in detail in three case study organisations. To achieve the second aim, the authors surveyed human resource and other senior managers in all Victorian health sector organisations and reviewed policy documents related to health system reform planned for Australia.

The findings suggest that there is a relationship between HPWS and the perceived quality of care that is mediated by human resource management (HRM) outcomes, such as psychological empowerment. It is also found that health care organisations in Australia generally do not have the necessary aspects of HPWS in place, creating a policy and practice gap. Although the chief executive officers of health service organisations reported high levels of strategic HRM, the human resource and other managers reported a distinct lack of HPWS from their perspectives. The authors discuss why health care organisations may have difficulty in achieving HPWS.

Leaders in health care organisations should focus on ensuring human resource management systems, structures and processes that support HPWS. Policy makers need to consider HPWS as a necessary component of health system reform. There is a strong need to reorient organisational human resource management policies and procedures in public health care organisations towards high performing work systems.

Integrated care is gaining popularity in Australian public policy as an acceptable means to address the needs of the unwell aged. The purpose of this paper is to investigate contemporary models of integrated care for community dwelling older persons in Australia and discuss how public policy has been interpreted at the service delivery level to improve the quality of care for the older person.

A scoping review was conducted for peer-reviewed and grey literature on integrated care for the older person in Australia. Publications from 2007 to present that described community-based enablement models were included.

Care co-ordination is popular in assisting the older person to bridge the gap between existing, disparate health and social care services. The role of primary care is respected but communication with the general practitioner and introduction of new roles into an existing system is challenging. Older persons value the role of the care co-ordinator and while robust model evaluation is rare, there is evidence of integrated care reducing emergency department presentations and stabilising quality of life of participants. Technology is an underutilised facilitator of integration in Australia. Innovative funding solutions and a long-term commitment to health system redesign is required for integrated care to extend beyond care co-ordination.

This scoping review summarises the contemporary evidence base for integrated care for the community dwelling older person in Australia and proposes the barriers and enablers for consideration of implementation of any such model within this health system.

The COVID-19 pandemic has created a crisis for healthcare systems worldwide. There have been significant challenges to managing public and private health care and related services systems’ capacity to cope with testing, treatment and containment of the virus. Drawing on the foundational research by Frow et al. (2019), the paper explores how adopting a service ecosystem perspective provides insight into the complexity of healthcare systems during times of extreme stress and uncertainty.

A healthcare framework based on a review of the service ecosystem literature is developed, and the COVID-19 crisis in Australia provides an illustrative case.

The study demonstrates how the service ecosystem perspective provides new insight into the dynamics and multilayered nature of a healthcare system during a pandemic. Three propositions are developed that offer directions for future research and managerial applications.

The research provides an understanding of the relevance of managerial flexibility, innovation, learning and knowledge sharing, which offers opportunities leading to greater resilience in the healthcare system. In particular, the research addresses how service providers in the service ecosystem learn from this pandemic to inform future practices.

The service ecosystem perspective for health care offers fresh thinking and an understanding of how a shared worldview, institutional practices and supportive and disruptive factors influence the systems’ overall well-being during a crisis such as COVID-19.

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.

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.

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.

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.

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

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.

The purpose of this paper is to call for strong medical co-leadership in transforming the Australian health system. The paper discusses how Health LEADS Australia, the Australian health leadership framework, offers an opportunity to engage medical clinicians and doctors in the leadership of health services.

The paper first discusses the nature of medical leadership and its associated challenges. The paper argues that medical leaders have a key role in the design, implementation and evaluation of healthcare reforms, and in translating these reforms for their colleagues. Second, this paper describes the origins and nature of Health LEADS Australia. Third, this paper discusses the importance of the goal of Health LEADS Australia and suggests the evidence-base underpinning the five foci in shaping medical leadership education and professional development. This paper concludes with suggestions on how Health LEADS Australia might be evaluated.

For the well-being of the Australian health system, doctors need to play an important role in the kind of leadership that makes measurable differences in the retention of clinical professions; improves organisational cultures; enhances the engagement of consumers and their careers; is associated with better patient and public health outcomes; effectively addresses health inequalities; balances cost effectiveness with improved quality and safety; and is sustainable.

This is the first article addressing Health LEADS Australia and medical leadership. Australia is actively engaging in a national approach to health leadership. Discussions about the mechanisms and intentions of this are valuable in both national and global health leadership discourses.

This chapter explores the ethics of a critical vulnerability suffered by migrant health professionals (MHPs): the problem of ‘pathways to nowhere’. This problem arises from dynamic change in the processes, practices and policies governing how migrant professionals achieve accreditation, training and employment in destination countries, whereby established pathways to professional practice are unexpectedly altered or removed. The authors detail the significance of this phenomenon in Australian and Canadian contexts. Drawing on the literature on legitimate expectations and the rule of law, the authors outline the ethical stakes and responsibilities that attach to states creating and then disappointing people’s legitimate expectations, and discuss how these considerations apply to destination countries’ treatment of MHPs.

Using the Occupational Stress Indicator, the results from this study provided a comparative overview of Australian and UK hospital workers’ perceived responses to organizational sources of pressure, use of coping strategies plus outcomes of job satisfaction, mental and physical ill health. The broad picture that emerged was that the Australian hospital workers appeared to have a more favourable working environment as their organization presented fewer sources of pressure. Despite lower levels of contributory pressure, it was apparent that Australian hospital workers perceived similar long‐term outcomes to organizational sources of pressure as the UK hospital worker sample. The Australian hospital workers reported significantly higher perceived physical ill health, and second, similar levels of mental ill health and job satisfaction when compared to the UK hospital workers. In addition, the Australian hospital workers reported increased use of coping strategies. The discussion takes into consideration the context and time frame of the two operating environments.

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.

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.

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.

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.

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.

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