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Article
Publication date: 1 June 1992

Michael Lung and David Braithwaite

Focuses on a period of major organizational change in a school ofnursing from 1989 until the present. Describes internal and externalpressures for change and explores the…

Abstract

Focuses on a period of major organizational change in a school of nursing from 1989 until the present. Describes internal and external pressures for change and explores the reasons for a need to shift from a collegial to a more mechanistic and bureaucratic culture. Outlines the method chosen to analyse the change process, which was focused interviewing with a stratified sample of teaching staff, to enable a retrospective evaluation of the change process and to learn whether the changes were successful or not. Pays particular attention to the relationship between leadership style, structure and culture, describes tensions arising from the policy changes and debates lessons for the future.

Details

Health Manpower Management, vol. 18 no. 2
Type: Research Article
ISSN: 0955-2065

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Article
Publication date: 12 June 2017

Anne Hogden, David Greenfield, Mark Brandon, Deborah Debono, Virginia Mumford, Johanna Westbrook and Jeffrey Braithwaite

Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to…

Abstract

Purpose

Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to identify factors influencing quality of residential aged care, and the role and influence of an aged care accreditation programme.

Design/methodology/approach

Focus groups were held with 66 aged care staff from 11 Australian aged care facilities. Data from semi-structured interviews were analysed to capture categories representing participant views.

Findings

Participants reported two factors stimulating change: developments in the aged care regulatory and policy framework, and rising consumer expectations. Four corresponding effects on service quality were identified: increasing complexity of resident care, renewed built environments of aged care facilities, growing focus on resident-centred care and the influence of accreditation on resident quality of life. The accreditation programme was viewed as maintaining minimum standards of quality throughout regulatory and social change, yet was considered to lack capacity of itself to explicitly promote or improve resident quality of life.

Research limitations/implications

For an increasingly complex aged care population, regulatory and societal change has led to a shift in service provision from institutional care models to one that is becoming more responsive to consumer expectations. The capacity of long-established and relatively static accreditation standards to better accommodate changing consumer needs comes into question.

Originality/value

This is the first study to examine the relationship between accreditation and residential aged care service quality from the perspectives of staff, and offers a nuanced view of “quality” in this setting.

Details

Quality in Ageing and Older Adults, vol. 18 no. 2
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 3 October 2018

Peter Nugus, Geetha Ranmuthugala, Josianne Lamothe, David Greenfield, Joanne Travaglia, Kendall Kolne, Julia Kryluk and Jeffrey Braithwaite

Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers…

Abstract

Purpose

Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of “street-level bureaucracy” has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice.

Design/methodology/approach

This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics.

Findings

Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing “assimilist” from “externalist” positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients’ personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work.

Originality/value

A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.

Details

Journal of Health Organization and Management, vol. 32 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 June 1969

M.R. Denning, L.J. Salmon and L.J. Winn

March 13, 1969 Trade union — Amalgamation — Pending appeals — Provision for appeal from executive decision to expel member — Rules providing for appeal to be heard at…

Abstract

March 13, 1969 Trade union — Amalgamation — Pending appeals — Provision for appeal from executive decision to expel member — Rules providing for appeal to be heard at specified time — Expelled member setting down notice of appeal — Union amalgamating with another union before appeal heard — New rules for amalgamated unions not covering pending appeals — Expelled member's appeal not heard at specified date — Attempt by new executive to provide for later hearing of pending appeals — Validity — Whether expulsion should be set aside.

Details

Managerial Law, vol. 6 no. 3
Type: Research Article
ISSN: 0309-0558

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Abstract

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History & Crime
Type: Book
ISBN: 978-1-80117-699-6

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Abstract

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The Sustainability of Restorative Justice
Type: Book
ISBN: 978-1-78350-754-2

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Book part
Publication date: 12 November 2018

Fiona Pacey

This study is a considered interpretation of the National Registration and Accreditation Scheme for the health professions, which commenced operations in Australia in…

Abstract

This study is a considered interpretation of the National Registration and Accreditation Scheme for the health professions, which commenced operations in Australia in 2010. The development of the Scheme and its operational elements (namely the Australian Health Practitioner Regulation Agency and 14 profession-specific national Boards) are positioned within the context of regulatory capitalism. Regulatory capitalism merges the experience of neoliberalism with an attentiveness to risk, particularly by the State. Nationally consistent legislation put in place a new set of arrangements that enabled the continuity of governments’ role in health workforce governance. The new arrangements resulted in an entity which is neither exclusively subservient to nor independent of the State, but rather “quasi-independent.” In exploring this arrangement, specific consideration is given to how the regulatory response matched the existing reality of a global (and national) health workforce market. This study considers this activity by the State as one of consolidation, as opposed to fracturing, against a backdrop of purposeful regulatory reform.

Details

Applied Ethics in the Fractured State
Type: Book
ISBN: 978-1-78769-600-6

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Book part
Publication date: 10 October 2007

Ann Skelton

Abstract

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Crime and Human Rights
Type: Book
ISBN: 978-0-85724-056-9

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Article
Publication date: 22 May 2009

David Greenfield, Jeffrey Braithwaite, Marjorie Pawsey, Brian Johnson and Maureen Robinson

Inquiries into healthcare organisations have highlighted organisational or system failure, attributed to poor responses to early warning signs. One response, and…

Abstract

Purpose

Inquiries into healthcare organisations have highlighted organisational or system failure, attributed to poor responses to early warning signs. One response, and challenge, is for professionals and academics to build capacity for quality and safety research to provide evidence for improved systems. However, such collaborations and capacity building do not occur easily as there are many stakeholders. Leadership is necessary to unite differences into a common goal. The lessons learned and principles arising from the experience of providing distributed leadership to mobilise capacity for quality and safety research when researching health care accreditation in Australia are presented.

Design/methodology/approach

A case study structured by temporal bracketing that presents a narrative account of multi‐stakeholder perspectives. Data are collected using in‐depth informal interviews with key informants and ethno‐document analysis.

Findings

Distributed leadership enabled a collaborative research partnership to be realised. The leadership harnessed the relative strengths of partners and accounted for, and balanced, the interests of stakeholder participants involved. Across three phases, leadership and the research partnership was enacted: identifying partnerships, bottom‐up engagement and enacting the research collaboration.

Practical implications

Two principles to maximise opportunities to mobilise capacity for quality and safety research have been identified. First, successful collaborations, particularly multi‐faceted inter‐related partnerships, require distributed leadership. Second, the leadership‐stakeholder enactment can promote reciprocity so that the collaboration becomes mutually reinforcing and beneficial to partners.

Originality/value

The paper addresses the need to understand the practice and challenges of distributed leadership and how to replicate positive practices to implement patient safety research.

Details

Journal of Health Organization and Management, vol. 23 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 25 January 2011

David Greenfield, Peter Nugus, Greg Fairbrother, Jacqueline Milne and Deborah Debono

This paper aims to examine an organisation's enactment of clinical governance through applying and advancing a theoretical model.

Abstract

Purpose

This paper aims to examine an organisation's enactment of clinical governance through applying and advancing a theoretical model.

Design/methodology/approach

The research site was a large organisation within an autonomous jurisdiction. The study focused on one organisational division. There were nine interviews and 15 focus groups (118 participants). Ethnographic observations totalled 60.5 hours. Document analysis was conducted with organisational reports and website. Data were examined against the model's four attributes and 24 elements, and used to conduct an organisational culture analysis.

Findings

Analysis showed that a majority of elements, 17 of 24, were strongly identifiable. The remainder were identifiable but not strongly so. Analysis suggested two additions to the model: the inclusion of two elements to an existing attribute and a new attribute and defining elements. This showed that the organisation was working towards, but not yet having achieved, a positive quality and safety culture. In particular, a schism in understanding between managers and frontline staff was noted.

Research limitations/implications

The study empirically applied and refined a health service theory. The new model, the “clinical governance practice model”, can be broadly applied, and can continue to be developed to expand the evidence base for the field.

Practical implications

Substantively, the study accounts for differences in managerial and frontline staff actions in applying clinical governance. Investigations to understand and identify strategies to bridge the differences are required.

Originality/value

The study is an original application and refinement of a health service theory. The study identifies that the interpretation of clinical governance, whilst different in different places, gives rise to similar disagreements.

Details

Clinical Governance: An International Journal, vol. 16 no. 1
Type: Research Article
ISSN: 1477-7274

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