Search results

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

This paper aims to explore how surveying benefits accreditation surveyors and the organisations in which they are regularly employed. The purpose is to examine from the perspective of senior executives who pursue this form of secondary professional activity, what they seek from being surveyors and what they believe they gain from the experience.

The data were collected from recorded interviews with three senior area health executives who also serve as accreditation surveyors for the Australian Council on Healthcare Standards. The interviews comprised a series of open‐ended, semi‐structured questions. One hour was allocated for each interview. The questions were designed to explore why senior executive health professionals seek secondary professional activity as surveyors and their perceptions of the benefits they gain from surveying.

The benefits derived from surveying as a secondary professional activity fall into four categories. First, it exposes the surveyor to new methods and innovations. Second, it provides a unique form of ongoing learning. Third, it serves as a resource for acquiring expertise to enhance quality within the institutions in which the participants were regularly employed and, finally, it provides opportunities to contribute to the process of quality improvement and enhance public health beyond the organisations in which the participants were regularly employed.

This research identifies a key aspect of the accreditation process that has not been the focus of previous research. It provides a reference point for understanding the value of surveying to the surveyor and to the institutions in which they are regularly employed.

The paucity of existing literature on the role of the surveyor – both pre and post accreditation – makes this topic timely and significant. This study is important because almost all accreditation programs world wide rely on external surveyors, and yet we know little about them.

This paper aims to investigate how health care accreditation surveyors enact their role with a view to identifying a surveyor styles typology.

This study was conducted in two phases. First, observational research was used to examine the conduct of a small survey team during the 2005 accreditation survey of a rural health service in Australia. The survey team was from the Australian Council on Healthcare Standards (ACHS), the major health care accreditation agency in Australia. Second, the emerging typology was reviewed by an expert panel of ACHS surveyors.

A typology comprising three unique surveyor styles is identified – interrogator; explorer; and discusser. Additionally, a further style, the questioner, is hypothesised.

The typology has application for development by accreditation agencies to be used with surveyors as a self‐reflection tool to improve learning and development. The knowledge gained about surveyors' styles can be used to match more effectively survey teams to organisations seeking accreditation. Further research is necessary to confirm these styles and examine whether other styles are apparent.

This study is an important step in examining the conduct of surveyors and opening up health care accreditation surveyor inter‐rater reliability for further investigation.

Health systems are changing at variable rates. Periods of significant change can create new challenges or amplify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability.

Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards.

Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy; accrediting agency management of the accreditation process, including the program’s framework; survey coordinators; survey team dynamics; individual surveyors; and healthcare organizations’ approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain.

Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.

The purpose of this article is to test whether healthcare accreditation survey processes are reliable.

The study uses multiple methods to document stakeholder experiences and views on accreditation survey reliability. There were 29 research activities, comprising 25 focus groups, three interviews and a survey questionnaire. In total, 193 stakeholders participated; 134 in face‐to‐face activities and 56 via questionnaire. All were voluntary participants. Using open‐ended questioning, stakeholders were asked to reflect upon accreditation survey reliability.

Stakeholders perceived healthcare accreditation surveys to be a reliable activity. They identified six interrelated factors that simultaneously promoted and challenged reliability: the accreditation program, including organisational documentation and surveyor accreditation reports; members' relationship to the accrediting agency and survey team; accreditation agency personnel; surveyor workforce renewal; surveyor workforce management; and survey team conduct including coordinator role. The six factors realised shared expectations and conduct by accreditation stakeholders; that is, they enabled accreditation stakeholder self‐governance.

Knowledge gained can be used to improve accreditation program reliability, credibility and ongoing self‐governance.

The paper is a unique examination of healthcare accreditation surveys the reliability. The findings have potential application to reliability in other healthcare areas.