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Health-care systems currently face great challenges, including an increasing elderly population. To respond to this problem, a hospital emergency department, three municipalities, and self-employed general practitioners in Denmark decided to collaborate with the aim of reorganizing treatment of elderly acute ill patients. By establishing a small-scale collaborative community and through an action research process, we show, how to jointly explore and develop a new organization design for in-home hospital treatment that enables the health professionals to collaborate in new ways, and at the same time to investigate and improve this cocreation process and codesign of knowledge among multiple different stakeholders.

The purpose of this paper is to describe the development, implementation and initial evaluation of the Geriatric Flying Squad's reciprocal referral pathways with emergency responders including New South Wales Ambulance, Police and Fire and Rescue. These innovative pathways and model of care were developed to improve access to multidisciplinary services for vulnerable community dwelling frail older people with the intent of improving health and quality of life outcomes by providing an alternative to hospital admission.

This is a case study describing the review of the Geriatric Flying Squad's referral database and quality improvement initiative to streamline referrals amongst the various emergency responders in the local health district. The implementation and initial evaluation of the project through online survey are further described.

Sustainable cross-sector collaboration can be achieved through building reciprocal pathways between an existing rapid response geriatric outreach service and emergency responders including Ambulance, Police, Fire and Rescue. Historically, emergency services would have transferred this group to the emergency department. These pathways exemplify person-centred care, underpinned by a multidisciplinary, rapid response team, providing an alternative referral pathway for first responders, with the aim of improving whole of health outcomes for frail older people.

Enablers of these pathways include a single point of contact for agencies, extended hours to support referral pathways, education to increase capacity and awareness, comprehensive and timely comprehensive assessment and ongoing case management where required and contemporaneous cross-sector collaboration to meet the medical and psychosocial needs of the client.

The Geriatric Flying Squad reciprocal pathways are a unique model of care with a multi-agency approach to addressing frail older people's whole of health needs.

The purpose of this paper is to develop the case for studying non-interaction in networks, particularly instances of intentional avoidance of interaction.

The paper is based on the analysis of instances of interaction avoidance across four case studies in medical technology development, food product development, food distribution network change, and regional innovation in construction.

Some answers are provided to the questions of why and how actors may seek to avoid interaction. Five modes of interaction avoidance are identified and outlined. Within these modes, interaction avoidance took place in order to protect knowledge, enforce progress, economise in business networks, avoid wasting resources, and maintain opportunities respectively. This list is not seen to be exhaustive of the theme, and further studies are encouraged.

Few inter-organisational network studies have dealt explicitly with interaction avoidance or non-interaction.

A new tier of intermediate care services for older people is being introduced in England and one function of these services will be district general hospital (DGH) admission avoidance. Concern has been expressed that this situation might compromise a prompt medical assessment. Reports recent experience with the medical assessment of directly admitted patients to a community hospital. The records of 81 of 87 patients admitted directly to the community hospital were available. The expected contributions to the medical assessment were not achieved by general practitioners in 27 patients (33 per cent); by hospital practitioners in 56 patients (69 per cent); and by consultants in 18 patients (22 per cent). Eight patients (10 per cent) had illnesses of greater complexity than initially considered and required transfer to the DGH. Concludes that, it can be difficult to ensure a timely medical assessment for patients admitted directly to an intermediate care service and critical incident reporting of patients who require transfer to a DGH should become a routine clinical governance activity for these services.

Parental satisfaction with paediatric home care has previously been found to be high and the results presented here confirm this finding. This study is unique in that a well defined population from one geographical area was studied before and after the introduction of the new home care service. Referrers included general practitioners, doctors in emergency care and out‐patient clinics, referring children for a wide range of acute conditions. Compared with hospital admission only half the number of adverse effects on children and families were reported by parents. Interest has been increasing in alternative service provision to prevent or reduce paediatric hospital admissions to avoid adverse effects on children and families. This study examined the views of parents experiencing hospital at home compared with hospital referral between 1999 and 2001 across the whole spectrum of acute clinical conditions. Hospital at home was the preferred service for a wide range of illnesses. Parents and carers identified extension of hospital at home to 24‐hour cover as a future preference. Parental preference for paediatric hospital at home for acute illness was confirmed.

This case study describes a community-based urgent care clinic in a general practitioner (GP) super clinic in South East Queensland.

This retrospective chart audit describes patient demographic characteristics, types of presentations and management for Sundays in 2015.

The majority of patients (97%) did not require admission to hospital or office investigations (95%) and presented with one condition (94%). Of the presentations, 66.5% were represented by 30 conditions. Most patients received a prescription (57%), some were referred to the pathology laboratory (15%) and some were referred to radiology (12%). A majority (54%) of patients presented in the first three hours. Approximately half (51%) of patients presenting were aged under 25. More females (53%) presented than males. A majority (53%) lived in the same postcode as the clinic. The three most common office tests ordered were urinalysis, electrocardiogram (ECG) and urine pregnancy test. Some patients (19%) needed procedures, and only 3% were referred to hospital.

The study offers analysis of the client group that can be served by an urgent care clinic in a GP super clinic on a Sunday. The study provides an option for emergency department avoidance.

Despite calls for more research into community-based urgent care clinics, little is known in Australia about what constitutes an urgent care clinic. The study proposes a classification system for walk-in presentations to an urgent care clinic, which is comparable to emergency department presentations.

The purpose of the paper is to determine the impact of cultural values on the success of TQM implementation in Isfahan University Hospitals (IUHs), Iran, 2004.

In this paper survey questionnaires were used to elicit responses from hospital managers and employees. Data collected included the characteristics of organizational culture in IUHs and the degree of TQM success and its implementation problems in these hospitals.

The paper finds that TQM success in IUHs was medium. Implementation of TQM was very low, low, medium and highly successful respectively in 16.7, 16.7, 58.3 and 8.3 percent of hospitals. TQM had the most effect on process management, focus on customers and leadership and management and less effect on focus on suppliers, performance results, strategic planning and focus on material resources. Human resource problems, performance appraisal and strategic problems were the most important obstacles to TQM success respectively. A total of 75 and 25 percent of hospitals had mechanistic and organic structure respectively. In total 41.6 percent of hospitals had weak organizational culture versus 58.4 percent medium culture. The success of TQM in hospitals with organic organizational structure and medium organizational culture was higher than mechanistic and bureaucratic hospitals with weak organizational culture (p<0.05).

The paper shows that TQM requires a quality‐oriented organizational culture supported by senior management commitment and involvement, organizational learning and entrepreneurship, team working and collaboration, risk taking, open communication, continuous improvement, customers focus (both internal and external), partnership with suppliers, and monitoring and evaluation of quality. By replicating this study in different countries and contexts the results could be very helpful for developing a model of TQM that can be implemented successfully in a cross‐cultural context.

Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults, paediatric HAH has been developed more recently. Specificities of paediatric care make it difficult to directly extend an adult HAH model to the paediatric population. The objective of this study is to compare the organisation of paediatric HAH in four countries: France, Australia (states of Victoria and New South Wales), the Netherlands and Belgium. Ultimately, lessons can be drawn for further development in the countries analysed and/or for implementation in other countries.

Legal documents and other grey literature were analysed to describe the legal context for the provision of paediatric HAH in the selected countries. In addition, semi-structured in-depth interviews were conducted with key informants from paediatric HAH organisations in these countries, addressing the following topics: historical background, legal framework, functioning of HAH models, workforce, number of services, profile of children, type of care activities, funding, coordination with other providers and quality of care. Results were reviewed by a content expert from the respective country.

Organisational differences were highlighted in terms of coordinating actor (hospital or home nursing care services), decision-making process, range of clinical conditions treated, territorial organisation, qualifications and expertise of the team members, medical expertise, financing, responsibilities, etc.

There is no single preferred model for the provision of HAH care for children. There is a large variety in almost all aspects of organisation. There are, however, also some common characteristics across the different models. Notably, paediatric expertise of nurses within the HAH team was considered indispensable in all programmes.

The purpose of this paper is to determine which factors are associated with 6,065 patient presentations with non-life-threatening urgent conditions (NLTUCs) to an after-hours general practice, an urgent care clinic (UCC) and an emergency department (ED) on Sundays in Southeast Queensland (Qld).

A retrospective, comparative and observational study was conducted involving the auditing of medical records of patients with NLTUCs consulting three medical services between 0,800 and 1,700 h, on Sundays, over a one-year period. The study was limited to 6,065 patients.

There were statistically significant differences in choice of location according to age, number of postcodes from the patient's residence, time of the day, season, patient presentations for infection and injury, non-infectious, non-injurious conditions of the circulatory, gastrointestinal and genitourinary systems, and need for imaging, pathology, plastering/back-slab application, splinting and wound closure. Older adults were more likely to be admitted to the hospital and Ed Short Stay Unit, compared with other age groups.

Based on international models of UCC healthcare systems in United Kingdom (UK), USA and New Zealand (NZ) and the results of this study, it is recommended that UCCs in Australia have extended hours, walk-in availability, access to on-site radiology, ability to treat fractures and wounds and staffing by medical practitioners able to manage these conditions. Recommendations also include setting a national standard for UCC operation (National Urgent Care Centre Accreditation, 2018; NHS, 2020; RNZCUC, 2015) and requirements for vocational registration for medical practitioners (National Urgent Care Centre Accreditation, 2018; RNZCUC, 2015; The Royal College of Surgeons of Edinburgh, 2021a, b).

This study has highlighted three key areas for future research: first, research involving general practitioners (GPs), emergency physicians, urgent care physicians, nurse practitioners, urgent care pharmacists and paramedics could help to predict the type of patients more accurately, patient presentations and associated comorbidities that might be encouraged to attend or be diverted to Urgent Care Clinics. Second, larger studies of more facilities and more patients could improve the accuracy and generalisability of the findings. Lastly, studies of public health messaging need to be undertaken to determine how best to encourage patients with NLTUCs (especially infections and injuries) to present to UCCs.

The Urgent Care Clinic model has existed in developed countries since 1973. The adoption of this model in Australia close to a patient's home, open extended hours and with onsite radiology could provide a community option, to ED, for NLTUCs (especially patient presentations with infections and injuries).

This study reviewed three types of medical facilities for the management of NLTUCs. They were an after-hours general practice, an urgent care clinic and an emergency department. This study found that the patient choice of destination depends on the ability of the service to manage their NLTUCs, patient age, type of condition, postcodes lived away from the facility, availability of testing and provision of consumables. This study also provides recommendations for the development of an urgent care healthcare system in Australia based on international models and includes requirements for extended hours, walk-in availability, radiology on-site, national standard and national requirements for vocational registration for medical professionals.