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Article
Publication date: 25 January 2011

Joanne F. Travaglia, Deborah Debono, Allan D. Spigelman and Jeffrey Braithwaite

This paper aims to explore the development of the concept of clinical governance as an international approach to addressing quality and safety issues in healthcare.

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Abstract

Purpose

This paper aims to explore the development of the concept of clinical governance as an international approach to addressing quality and safety issues in healthcare.

Design/methodology/approach

The authors reviewed and analysed published clinical governance abstracts from 1966 to 2009. Citations were identified through a systematic search of Medline, Embase and CINAHL databases. A time series analysis was undertaken on the citations. The contents of the abstracts were then examined using an automated data‐mining software package in order to identify underlying concepts.

Findings

A total of 2,000 publications which made direct mention of clinical governance were identified across the 43‐year search period. All were produced after 1998. This was when the concept was first seriously mobilised. Of the 2,000 citations, 2.3 per cent were published in 1998 and 6.3 per cent in 2008 (the last complete year available). The peak was reached in 2003, when 12.7 per cent of all clinical governance citations were published. The years 1998 to 2003 accounted for 59.2 per cent of all citations (to September 2009). There has been a steady decrease in the number of citations making direct reference to clinical governance since 2003.

Originality/value

This paper maps the development and peak of clinical governance as a mobilising concept in healthcare in the late twentieth and early twenty‐first centuries and shows how its conceptual underpinnings have been taken up by wider quality and safety agendas. Fads and fashions rise and fall in healthcare, as in other areas of life.

Details

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

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Article
Publication date: 9 October 2007

Jeffrey Braithwaite, Mary T. Westbrook, Joanne F. Travaglia, Rick Iedema, Nadine A. Mallock, Debbi Long, Peter Nugus, Rowena Forsyth, Christine Jorm and Marjorie Pawsey

The purpose of this study is to evaluate the effects of a health system‐wide safety improvement program (SIP) three to four years after initial implementation.

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1645

Abstract

Purpose

The purpose of this study is to evaluate the effects of a health system‐wide safety improvement program (SIP) three to four years after initial implementation.

Design/methodology/approach

The study employs multi‐methods studies involving questionnaire surveys, focus groups, in‐depth interviews, observational work, ethnographic studies, documentary analysis and literature reviews with regard to the state of New South Wales, Australia, where 90,000 health professionals, under the auspices of the Health Department, provide healthcare to a seven‐million population. After enrolling many participants from various groups, the measurements included: numbers of staff trained and training quality; support for SIP; clinicians' reports of safety skills acquired, work practices changed and barriers to progress; RCAs undertaken; observation of functioning of teams; committees initiated and staff appointed to deal with adverse events; documentation and computer records of reports; and peak‐level responses to adverse events.

Findings

A cohort of 4 per cent of the state's health professionals has been trained and now applies safety skills and conducts RCAs. These and other senior professionals strongly support SIP, though many think further culture change is required if its benefits are to be more fully achieved and sustained. Improved information‐handling systems have been adopted. Systems for reporting adverse incidents and conducting RCAs have been instituted, which are co‐ordinated by NSW Health. When the appropriate structures, educational activities and systems are made available in the form of an SIP, measurable systems change might be introduced, as suggested by observations of the attitudes and behaviours of health practitioners and the increased reporting of, and action about, adverse events.

Originality/value

Few studies into health systems change employ wide‐ranging research methods and metrics. This study helps to fill this gap.

Details

International Journal of Health Care Quality Assurance, vol. 20 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 9 October 2007

Mary T. Westbrook, Jeffrey Braithwaite, Joanne F. Travaglia, Debbi Long, Christine Jorm and Rick A. Iedema

Patient safety has been addressed since 2002 in the health system of New South Wales, Australia via a Safety Improvement Programme (SIP), which took a system‐wide…

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1292

Abstract

Purpose

Patient safety has been addressed since 2002 in the health system of New South Wales, Australia via a Safety Improvement Programme (SIP), which took a system‐wide approach. The programme involved two‐day courses to educate healthcare professionals to monitor and report incidents and analyse adverse events by conducting root cause analysis (RCA). This paper aims to predict that all professions would favour SIP but that their work and educational histories would result in doctors holding the least and nurses the most positive attitudes. Alternative hypotheses were that doctors' relative power and other professions' team‐working skills would advantage the respective groups when conducting RCAs.

Design/methodology/approach

Responses to a 2005 follow‐up questionnaire survey of doctors (n=53), nurses (209) and allied health staff (59), who had participated in SIP courses, were analysed to compare: their attitudes toward the course; safety skills acquired and applied; perceived benefits of SIP and RCAs; and their experiences conducting RCAs.

Findings

Significant differences existed between professions' responses with nurses being the most and doctors the least affirming. Allied health responses resembled those of nurses more than those of doctors. The professions' experiences conducting RCAs (number conducted, leadership, barriers encountered, findings implemented) were similar.

Research limitations/implications

Observational studies are needed to determine possible professional differences in the conduct of RCAs and any ensuing culture change that this may be eliciting.

Practical implications

There is strong professional support for SIPs but less endorsement from doctors, who tend not to prefer the knowledge content and multidisciplinary teaching environment considered optimal for safety improvement education. This is a dilemma that needs to be addressed.

Originality/value

Few longer‐term SIPs' assessments have been realised and the differences between professional groups have not been well quantified. As a result of this paper, benefits of and barriers to conducting RCAs are now more clearly understood.

Details

International Journal of Health Care Quality Assurance, vol. 20 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 30 October 2009

Joanne F. Travaglia and Jeffrey Braithwaite

This paper aims to analyse the development of patient safety as a field within which patients are peripheral stakeholders.

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663

Abstract

Purpose

This paper aims to analyse the development of patient safety as a field within which patients are peripheral stakeholders.

Design/methodology/approach

The authors examined the patient safety movement from the perspective of a field in which agents struggle for control over various forms of capital, including economic, social, cultural and symbolic capital. In order to undertake this analysis the authors drew on the literature on errors and patient safety, key inquiries into patient safety, and research conducted with health professionals in New South Wales, Australia.

Findings

The patient safety movement has created a heightened sense of awareness of errors and risk across health systems, thereby attracting and creating significant amounts of capital. The authors argue that in the process of struggle to constitute and contain a new field of health, patients and their narratives are rendered vulnerable to appropriation and incorporation.

Research limitations/implications

By considering patient safety from a sociological rather than a technical framework, it is possible to gain new insights into why reducing the levels of medical errors have proven so difficult.

Practical implications

Improved knowledge of how patient safety operates as a field may contribute to more effective strategies in reducing those types of errors.

Originality/value

Despite the growth in the number of publications in patient safety there has been only minimal analysis of the field itself, rather than its technical or organisational components. This paper contributes to a new way of conceptualising and enacting patient safety, one that acknowledges the vulnerability of the parties involved, particularly patients.

Details

Journal of Health Organization and Management, vol. 23 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 15 May 2017

Sharlene Chadwick and Joanne Travaglia

During the past decade, there has been increased attention into bullying behaviours in workplaces. Research to date has varied in design, the definition of what…

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1493

Abstract

Purpose

During the past decade, there has been increased attention into bullying behaviours in workplaces. Research to date has varied in design, the definition of what constitutes bullying behaviour, as well as the methods used to collect data and measure bullying incidence and prevalence. Nonetheless, studies demonstrate that bullying is a significant issue, which warrants an increased research focus to develop greater understanding of the concept, its effects and implications in, and for, the workplace. The purpose of this paper is to focus on capturing a range of international and Australian literature regarding workplace bullying behaviours in a health context from a management perspective. As a result, this paper identified the gaps in the literature when expanded specifically to an Australian health context.

Design/methodology/approach

The purpose of this review is to summarise the existing literature, both internationally and in Australia which examines workplace bullying behaviours in a health context from a management perspective. This describes the review of the literature on workplace bullying in a health context undertaken from January to April 2014. The “Preferred Reporting Systematic Reviews and Meta-Analyses” method was used to structure the review, which covered a wide range of literature from databases including MEDLINE, Embase, CINAHL and InformIT, as well as reports, and grey literature.

Findings

The review included 62 studies that met the inclusion criteria and reported either: factors contributing to workplace bullying, at least one significant example of workplace bullying behaviour or the impact of workplace bullying behaviours in a health context.

Originality/value

There is limited data on workplace bullying behaviours in an Australian health context. The literature supports there is value in future research to develop consistent definitions, policies, procedures and frameworks, which could help to prevent or address workplace bullying behaviours based on work being undertaken internationally.

Details

Journal of Health Organization and Management, vol. 31 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 28 November 2019

Deborah Debono, Hamish Robertson and Joanne Travaglia

Significant, sustained improvement in patient safety has proved an intractable goal. Attempts to address persistent problems have largely focused on technical solutions to…

Abstract

Purpose

Significant, sustained improvement in patient safety has proved an intractable goal. Attempts to address persistent problems have largely focused on technical solutions to issues conceptualised as clinical, cultural or system based. While communication is at the core of many remediation strategies, the focus has remained largely on communication between clinicians or between clinicians and patients, and on creating centralised guidelines as communicative mechanisms to transmit approved practice. Yet, current attempts at improvement have had limited impact. The purpose of this paper is to highlight vital new ways of conceptualising and exploring the relations and actions that are meant to constitute safety within organisations.

Design/methodology/approach

Utilising theory from social sciences, the authors reconceptualise trespass and transgression, traditionally positioned as infringements, as acts of resistance: mechanisms for intrusion which intentionally or unintentionally disrupt the territorial claims of professions and organisations to enhance patient safety.

Findings

Drawing on the literature, research and professional experience, two forms of trespass are discussed: the intrusion of largely invisible and understudied ancillary staff into the world of clinicians; and the use of workarounds by clinicians themselves. In both cases, transgressors intend to increase rather than decrease patient safety and may, upon further examination, prove to do so.

Originality/value

Trespasses and transgressions considered in this light offer the opportunity to make visible people, relationships and actions which have previously remained hidden in our understanding of, and therefore proposed solutions to, patient safety.

Details

Journal of Health Organization and Management, vol. 33 no. 7/8
Type: Research Article
ISSN: 1477-7266

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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: 30 October 2018

Patricia Bradd, Joanne Travaglia and Andrew Hayen

The purpose of this paper is to present findings from a mixed methods study investigating leadership development of allied health practitioners within a large public…

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1099

Abstract

Purpose

The purpose of this paper is to present findings from a mixed methods study investigating leadership development of allied health practitioners within a large public healthcare organization in Australia.

Design/methodology/approach

The South Eastern Sydney Local Health District Allied Health Leadership Development Program was undertaken with an allied health cohort (n=16) between May 2014 and March 2015 and comprised all-day workshops, action learning sets and individual coaching. Using experiential learning, the program tested whether practice development methods and action learning approaches developed the leadership skills of participants compared with a control group (n=17). Descriptive statistics were collected to evaluate participant and program outcomes. Leadership, workplace culture and engagement measures were analyzed as part of the study.

Findings

The Allied Health Leadership Development Program received high ratings by participants. They reported enhanced skills in leading self and others through mechanisms such as critical reflection and facilitation, and greater confidence managing change and with engaging staff, colleagues and patients in decision making, affecting the quality and safety of healthcare. Statistically significant differences were found with transformational leadership elements, leadership outcomes, and measures of workplace culture and engagement after program completion for intervention group participants, compared with the control group.

Research limitations/implications

Results provide new empirical evidence about the effectiveness of using practice development for allied health leadership development.

Practical implications

This low-cost leadership program can be replicated by other organizations.

Originality/value

Outcomes from an Allied Health Leadership Development Program have not been previously reported in the literature.

Details

Journal of Health Organization and Management, vol. 32 no. 7
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 12 October 2012

Joanne Kelleher and Eilish McAuliffe

Clinical governance has become internationally recognised as a whole‐system framework for the continuous improvement of quality in health service delivery. This study aims…

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1015

Abstract

Purpose

Clinical governance has become internationally recognised as a whole‐system framework for the continuous improvement of quality in health service delivery. This study aims to explore the issues in implementing a comprehensive clinical governance framework in an organisation that provides services to children and adults with intellectual disabilities supported by a wide range of clinical interventions and therapies.

Design/methodology/approach

This was an action research study that utilised a co‐operative inquiry approach because of its capacity to facilitate engagement in a collaborative “bottom‐up” meets “top‐down” process amalgamating theory with organisational priorities to achieve practical and planned change. Action research methodologies use a problem solving approach, focus on real‐life issues, and are open and inclusive. The study aimed to identify current practices in inter‐disciplinary team working including the measurement and monitoring of quality, and to design collaboratively an integrated team‐based service delivery model that focuses on continuous improvement in the quality of clinical services.

Findings

The study highlights the benefit of adopting a co‐operative inquiry approach to the development of a clinical governance framework. Staff at all levels began to take ownership of the clinical governance agenda. The systemic perspective promoted collaboration across clinical and non‐clinical disciplines and it is anticipated that it will result in new approaches to service quality in the organisation in the future.

Originality/value

This case study demonstrates how the practical and participatory approach of the action research and co‐operative inquiry methodologies can contribute to the resolution of a real organisational issue and enable transformational change in the infrastructure of clinical services.

Details

Clinical Governance: An International Journal, vol. 17 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

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