Publications by authors named "Ann Dadich"

49 Publications

E-mental health in child psychiatry during COVID-19: an initial attitudinal study.

Australas Psychiatry 2021 Jun 14:10398562211022748. Epub 2021 Jun 14.

Child and Adolescent and Forensic Psychiatry, Justice Health, Malabar, NSW, Australia.

Objective: COVID-19 propelled e-mental health within the Australian health system. It is important to learn from this to inform mental healthcare during future crises.

Method: A lexical analysis was conducted of clinician reflections during COVID-19 as they delivered psychiatry services to children and families in New South Wales ( = 6) and transitioned to e-mental health.

Results: E-mental health can extend the reach of, and access to psychiatry services, particularly for individuals disadvantaged by inequity. Yet e-mental health can be problematic. It is partly contingent on technological prowess, equipment, internet access as well as space and privacy. Relatedly, e-mental health can hinder clinician capacity to conduct examinations, monitor child development as well as assess risk and the need for child protection.

Conclusions: Given the benefits and limitations of e-mental health, a model that supports face-to-face mental healthcare and e-mental health may be of value. This model would require practical, yet flexible policies and protocols that protect the privacy of children and families, safeguard them from harm, and respect the needs and preferences of children, families and clinicians.
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http://dx.doi.org/10.1177/10398562211022748DOI Listing
June 2021

Positive Organisational Arts-Based Youth Scholarship: Redressing Discourse on Danger, Disquiet, and Distress during COVID-19.

Int J Environ Res Public Health 2021 May 25;18(11). Epub 2021 May 25.

Black Dog Institute, University of New South Wales (UNSW), Sydney, NSW 2031, Australia.

This methodological article argues for the potential of positive organisational arts-based youth scholarship as a methodology to understand and promote positive experiences among young people. With reference to COVID-19, exemplars sourced from social media platforms and relevant organisations demonstrate the remarkable creative brilliance of young people. During these difficult times, young people used song, dance, storytelling, and art to express themselves, (re)connect with others, champion social change, and promote health and wellbeing. This article demonstrates the power of positive organisational arts-based youth scholarship to understand how young people use art to redress negativity via a positive lens of agency, peace, collectedness, and calm.
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http://dx.doi.org/10.3390/ijerph18115655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199347PMC
May 2021

Management and sustainability of midwifery group practice: Thematic and lexical analyses of midwife interviews.

Women Birth 2021 May 26. Epub 2021 May 26.

School of Nursing and Midwifery Western Sydney University, Locked Bag 1797 Penrith NSW 2751 Australia. Electronic address:

Background: Although there is high-level evidence supporting positive perinatal outcomes for midwifery group practice (MGP) care, not all women can access this model due to a failure to implement or sustain it. The way that MGPs are managed could be an important factor in whether they are successful in the long-term.

Aim: To explore what determines optimal management of MGP in Australia, and the influence it has on sustainability of MGP.

Methods: Interviews were conducted with MGP midwives (n=8). Transcriptions of the audio recordings were analysed thematically and lexically for triangulation.

Findings: Following a thematic analysis of the data, an over-arching theme emerged - namely - being valued and supported, with three sub-themes: a nice little sweet spot, someone to stand up for you, and building relationships and support beyond the model. This revealed that value and support by all stakeholders, including the midwives themselves, was necessary to sustain an MGP. The lexical analysis revealed the themes: support, the system, and the caseload. This analysis highlighted the importance of the system - specifically, the impact of the institution on how MGP is operationalised.

Conclusion: For MGP to be sustained in Australia, it needs to be prioritised, nurtured, and embraced by the whole maternity care system. Management plays an important role in ensuring the right people are employed to pivotal positions and that midwifery-led models of care are valued and supported throughout the system.
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http://dx.doi.org/10.1016/j.wombi.2021.05.002DOI Listing
May 2021

Leadership and management in midwifery-led continuity of care models: A thematic and lexical analysis of a scoping review.

Midwifery 2021 Jul 11;98:102986. Epub 2021 Mar 11.

School of Business Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia. Electronic address:

Objective: Although midwifery-led continuity of care is associated with superior outcomes for mothers and babies, it is not available to all women. Issues with implementation and sustainability might be addressed by improving how it is led and managed - yet little is known about what constitutes the optimal leadership and management of midwifery-led continuity models.

Design: Following a systematic search of academic databases for relevant publications, 25 publications were identified. These were analysed, thematically to clarify (dis)similar themes, and lexically, to clarify how words within the publications travelled together.

Findings: The publications were replete with three key themes. First, leadership - important yet challenged. Second, management of organisational change; barriers and enhancers. Third, promotors of sustainable models of care. Complementarily, the lexical analysis suggests that references to midwives and leadership among the publications did not typically travel together, as reported in the publications and were distant to one another, although management was inter-connected to both and to change. Leadership and management were not closely coupled with midwives or relationships with women.

Key Conclusions: Midwifery leadership matters and can be enacted irrespective of position or seniority. Midwifery-led continuity of care models can be better managed via a multipronged approach. Improved leadership and management can help sustain such care. Although there was a perceived need for midwifery leadership, there did not seem to be an association between leadership and midwives in the lexical analysis. Many publications focused on the style theory of leadership and the transformational style theory.

Implications For Practice: Instead of focusing on leaders and the presumption of a leadership scarcity, it might be more beneficial to start focusing within, looking with a new lens on leadership within midwifery at all levels. It might also be constructive for the profession to investigate a more progressive form of leadership, one that is relational and focuses on leadership rather than on the leader.
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http://dx.doi.org/10.1016/j.midw.2021.102986DOI Listing
July 2021

Implementation science in maternity care: a scoping review.

Implement Sci 2021 Feb 4;16(1):16. Epub 2021 Feb 4.

University of Technology Sydney, Broadway, PO Box 123, Ultimo, NSW, 2007, Australia.

Background: Despite wide recognition that clinical care should be informed by the best available evidence, this does not always occur. Despite a myriad of theories, models and frameworks to promote evidence-based population health, there is still a long way to go, particularly in maternity care. The aim of this study is to appraise the scientific study of methods to promote the systematic uptake of evidence-based interventions in maternity care. This is achieved by clarifying if and how implementation science theories, models, and frameworks are used.

Methods: To map relevant literature, a scoping review was conducted of articles published between January 2005 and December 2019, guided by Peters and colleagues' (2015) approach. Specifically, the following academic databases were systematically searched to identify publications that presented findings on implementation science or the implementation process (rather than just the intervention effect): Business Source Complete; CINAHL Plus with Full Text; Health Business Elite; Health Source: Nursing/Academic Edition; Medline; PsycARTICLES; PsycINFO; and PubMed. Information about each study was extracted using a purposely designed data extraction form.

Results: Of the 1181 publications identified, 158 were included in this review. Most of these reported on factors that enabled implementation, including knowledge, training, service provider motivation, effective multilevel coordination, leadership and effective communication-yet there was limited expressed use of a theory, model or framework to guide implementation. Of the 158 publications, 144 solely reported on factors that helped and/or hindered implementation, while only 14 reported the use of a theory, model and/or framework. When a theory, model or framework was used, it typically guided data analysis or, to a lesser extent, the development of data collection tools-rather than for instance, the design of the study.

Conclusion: Given that models and frameworks can help to describe phenomenon, and theories can help to both describe and explain it, evidence-based maternity care might be promoted via the greater expressed use of these to ultimately inform implementation science. Specifically, advancing evidence-based maternity care, worldwide, will require the academic community to make greater explicit and judicious use of theories, models, and frameworks.

Registration: Registered with the Joanna Briggs Institute (registration number not provided).
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http://dx.doi.org/10.1186/s13012-021-01083-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7860184PMC
February 2021

Paediatric tube-feeding: An agenda for care improvement and research.

J Paediatr Child Health 2021 02 5;57(2):182-187. Epub 2020 Dec 5.

Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia.

This article presents an agenda to improve the care and wellbeing of children with paediatric feeding disorder who require tube feeding (PFD-T). PFD-T requires urgent attention in practice and research. Priorities include: routine collection of PFD-T data in health-care records; addressing the tube-feeding lifecycle; and reducing the severity and duration of disruption caused by PFD-T where possible. This work should be underpinned by principles of involving, respecting and connecting families.
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http://dx.doi.org/10.1111/jpc.15286DOI Listing
February 2021

Parenting children who are enterally fed: How families go from surviving to thriving.

Child Care Health Dev 2020 11 10;46(6):741-748. Epub 2020 Sep 10.

School of Business, Western Sydney University, Penrith, New South Wales, Australia.

Background: Complex feeding difficulties requiring enteral (tube) feeding affect everyone around the child. Parents experience additional stress and are at risk of social isolation. This study investigated the strategies families develop and use to adjust and adapt to enteral feeding so they were not just surviving but thriving as a family.

Methods: Twenty parents whose children had been or continued to be enterally fed were interviewed, four of them twice as their experience of enteral feeding progressed. Learning theory was used to conceptualize findings in terms of changing use of tools that mediated parents' response to feeding-related challenges.

Results: Parents encountered dilemmas relating to enteral feeding: maintaining participation in everyday activities, managing responses to the use of tubes for feeding, and doing what feels right for their child. They used four kinds of mediating tools to overcome these: memory aids and readiness tools, metaphors and narratives, repurposed everyday objects and personalized routines and materialities.

Conclusions: This novel account of tool used to resolve dilemmas provides an empirically and theoretically grounded basis for supporting parents to thrive despite the challenges of enteral feeding. Specifically, it can guide information given to help parents anticipate and cope with dilemmas arising from enteral feeding.
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http://dx.doi.org/10.1111/cch.12808DOI Listing
November 2020

Using Twitter to promote a youth mental health agenda.

Health Promot Int 2021 Mar;36(1):235-249

School of Business, Western Sydney University, 169 Macquarie Street, Parramatta, New South Wales 2150, Australia.

Agenda-setting theory suggests the media shapes public perceptions. Guided by this theory, this study examines the effects of organizational Twitter accounts on public discourse in the Twittersphere. The tweets that mention one of three youth mental health organizations were theorized to emanate the particular focus of the organization mentioned. This was investigated by analysing: randomly selected tweets that mentioned one of three national mental health organizations-ReachOut, headspace or the Young and Well Cooperative Research Centre but not authored by these organizations (n = 600); and the population of tweets that mentioned one of these three organizations and authored by either of the two counterparts of the mentioned organization (n = 115). Findings supported anticipated patterns, whereby the tweets reflected the remit of the three organizations. These findings reveal the influential role of social media in setting a youth mental health agenda. The implications for practitioners and researchers are discussed.
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http://dx.doi.org/10.1093/heapro/daaa016DOI Listing
March 2021

What does it mean to conduct participatory research with Indigenous peoples? A lexical review.

BMC Public Health 2019 Oct 29;19(1):1388. Epub 2019 Oct 29.

Academic Unit of Infant, Child, Adolescent Psychiatry South West Sydney, University of New South Wales, Sydney, Australia.

Background: To better understand and promote public health, participatory research with Indigenous peoples represents recommended practice, worldwide. However, due to the different ways such research is referred to, described, and used, it is unclear what might (and might not) warrant the term when collaborating with Indigenous peoples. As such, this article expands conceptual understandings of participatory research with Indigenous peoples, across timelines and regions.

Method: Following a systematic search of 29 academic databases in April 2018, a lexical analysis of the methods sections was conducted, which were sourced from 161 publications across 107 journals.

Results: The active involvement of Indigenous peoples in research that is expressly participatory is limited across all project phases. This might be because the ways in which Indigenous peoples were involved throughout were not reported - however, it might also be because Indigenous peoples were not involved in all project phases. Furthermore, descriptions differ by study location and publication timeframe - notably, studies in the region of the Americas chiefly refer to pandemics, surveyors, and art; and those published in the last two decades have given primacy to artifacts of interest.

Conclusions: Findings from this corpus of data suggest participatory research with Indigenous peoples is not always described across different project phases; furthermore, it differs according to study location and publication timeframe. This offers considerable opportunity to further this important research area via alternative methodologies that award primacy to Indigenous expertise and agency.
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http://dx.doi.org/10.1186/s12889-019-7494-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819462PMC
October 2019

Fundamental care for people with cognitive impairment in the hospital setting: A study combining positive organisational scholarship and video-reflexive ethnography.

J Clin Nurs 2020 Jun 7;29(11-12):1957-1967. Epub 2019 Oct 7.

Western Sydney University, Paramatta, NSW, Australia.

Aims And Objectives: To clarify how high-quality fundamentals of care for people with dementia and/or delirium were practised in a specialist geriatric evaluation and management unit.

Background: Older people with cognitive impairment represent a significant number of people who are admitted to hospital. They are at increased risk of dying, readmission and long hospital stays, relative to those without cognitive impairment. There is an urgent need to elucidate the conditions that underpin safe and high-quality fundamental care for these patients and their families.

Methods: Using the innovative methodologies of positive organisational scholarship in healthcare and video-reflexive ethnography, this 18-month study was conducted within an inpatient geriatric evaluation and management unit for people with dementia and/or delirium in South Australia. Patients, family members and staff members (managerial, clinical and nonclinical) participated by allowing researchers to document ethnographic fieldwork notes and film their practices and/or accounts thereof; and/or interpreting digital recordings with researchers in order to make sense of data in a process of co-analysis. This study is reported using Standards for Reporting Qualitative Research reporting guidelines.

Results: High-quality fundamental care for people with dementia and/or delirium in hospital and their families was associated with the special space of the hospital unit; an aptitude for people with dementia; a capacity to translate person-centred fundamentals of care from rhetoric to reality; and an appreciation for teamwork.

Conclusion: This study clarified how teams working in hospital can practise high-quality fundamentals of care for older people with dementia and/or delirium. Delivery of high-quality fundamental care in this setting was dependent, not only on nurses, but the entire ward team working cohesively in a "weave of commitment."

Relevance To Clinical Practice: Efforts to improve fundamental care for people with cognitive impairment need to encompass values and philosophy of person-centred care, including the contributions by all staff to care delivery.
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http://dx.doi.org/10.1111/jocn.15056DOI Listing
June 2020

Understanding practitioner perspectives of youth healthcare using thematic and lexical analyses.

Health Expect 2019 10 13;22(5):1144-1155. Epub 2019 Aug 13.

NSW Kids and Families, NSW Ministry of Health, North Sydney, NSW, Australia.

Background: Youth health issues represent a "wicked problem" - they are complex and multifaceted. Furthermore, they are likely to require novel approaches to understand their complexity and develop novel solutions.

Objective: Given the importance of youth healthcare, and the need for novel approaches, the aim of this article was to demonstrate the innovative use of two research methods - thematic and lexical analyses - to better understand practitioner perspectives of youth healthcare. It clarifies the factors that shape practitioner ability to support young people and opportunities to improve practice.

Design And Setting: Focus groups and interviews were conducted with 37 youth health practitioners. They represented government and non-government services; hospital and community services; and metropolitan and regional services.

Results: Thematic analysis highlighted the complexity of participants' work and the judgements made as they negotiated relationships with young people and ancillary services. Lexical analysis revealed two hitherto neglected dimensions of the complexity of youth healthcare - uncertainty and corporeality.

Discussion: In addition to affirming the complexities of youth healthcare, this study revealed how practitioners (can) negotiate these complexities. These findings were only possible because of the innovative use of the two research methods.

Conclusions: This study has important theoretical, methodological and practical implications. Theoretically, it is the first to view the complexities of youth healthcare through the wicked problem lens. Methodologically, it highlights the complementary value of thematic and lexical analyses. Practically, it reinforces the importance of policy support and professional development to enable practitioners to grasp the complexities of their work.
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http://dx.doi.org/10.1111/hex.12950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803407PMC
October 2019

Optimising refugee children's health/wellbeing in preparation for primary and secondary school: a qualitative inquiry.

BMC Public Health 2019 Jun 27;19(1):812. Epub 2019 Jun 27.

Academic Unit of Child Psychiatry South West Sydney (AUCS), University of New South Wales & Ingham Institute, Elizabeth Street, Liverpool, Sydney, 2170, Australia.

Background: Children from refugee backgrounds are less likely to access appropriate health and social care than non-refugee children. Our aim was to identify refugee children's health/wellbeing strengths and needs, and the barriers and enablers to accessing services while preparing for primary and secondary school, in a low socio-economic multicultural community in Australia.

Method: Ten focus groups were facilitated with Arabic-speaking refugee parents of children aged 2-5 years (n = 11) or in first year secondary school (n = 22); refugee adolescents starting high school (n = 16); and key service providers to refugee families (n = 27). Vignettes about a healthy child and a child with difficulties guided the discussions. Data was thematically analysed and feedback sought from the community via the World Café method.

Results: Personal resilience and strong family systems were identified as strengths. Mental health was identified as a complex primary need; and whilst refugees were aware of available services, there were issues in knowing how to access them. Opportunities for play/socialisation were recognised as unmet adolescent needs. Adults spoke of a need to support integration of "old" and "new" cultural values. Parents identified community as facilitating health knowledge transfer for new arrivals; whilst stakeholders saw this as a barrier when systems change. Most parents had not heard of early childhood services, and reported difficulty accessing child healthcare. Preschooler parents identified the family "GP" as the main source of health support; whilst parents of adolescents valued their child's school. Health communication in written (not spoken) English was a significant roadblock. Differences in refugee family and service provider perceptions were also evident.

Conclusions: Refugee families face challenges to accessing services, but also have strengths that enable them to optimise their children's wellbeing. Culturally-tailored models of care embedded within GP services and school systems may assist improved healthcare for refugee families.
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http://dx.doi.org/10.1186/s12889-019-7183-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6595577PMC
June 2019

Promotion of JUUL on Twitter.

J Adolesc Health 2018 11;63(5):525-526

School of Business, Western Sydney University, Werrington, New South Wales, Australia.

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http://dx.doi.org/10.1016/j.jadohealth.2018.08.006DOI Listing
November 2018

What can organisational theory offer knowledge translation in healthcare? A thematic and lexical analysis.

BMC Health Serv Res 2018 05 10;18(1):351. Epub 2018 May 10.

School of Humanities and Communication Arts, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.

Background: Despite the relative abundance of frameworks and models to guide implementation science, the explicit use of theory is limited. Bringing together two seemingly disparate fields of research, this article asks, what can organisational theory offer implementation science? This is examined by applying a theoretical lens that incorporates agency, institutional, and situated change theories to understand the implementation of healthcare knowledge into practice.

Methods: Interviews were conducted with 20 general practitioners (GPs) before and after using a resource to facilitate evidence-based sexual healthcare. Research material was analysed using two approaches - researcher-driven thematic coding and lexical analysis, which was relatively less researcher-driven.

Results: The theoretical lens elucidated the complex pathways of knowledge translation. More specifically, agency theory revealed tensions between the GP as agent and their organisations and patients as principals. Institutional theory highlighted the importance of GP-embeddedness within their chosen specialty of general practice; their medical profession; and the practice in which they worked. Situated change theory exposed the role of localised adaptations over time - a metamorphosis.

Conclusions: This study has theoretical, methodological, and practical implications. Theoretically, it is the first to examine knowledge translation using a lens premised on agency, institutional, and situated change theories. Methodologically, the study highlights the complementary value of researcher-driven and researcher-guided analysis of qualitative research material. Practically, this study signposts opportunities to facilitate knowledge translation - more specifically, it suggests that efforts to shape clinician practices should accommodate the interrelated influence of the agent and the institution, and recognise that change can be ever so subtle.
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http://dx.doi.org/10.1186/s12913-018-3121-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946475PMC
May 2018

Patient Involvement in Healthcare-Associated Infection Research: A Lexical Review.

Infect Control Hosp Epidemiol 2018 06 2;39(6):710-717. Epub 2018 Apr 2.

2Centre for Infectious Diseases and Microbiology,The Westmead Institute for Medical Research,Westmead,New South Wales,Australia.

OBJECTIVEThis review examines patient involvement in healthcare-associated infection (HAI) research. Healthcare-associated infections represent an intractable issue with considerable implications for patients and staff. Participatory methodologies that involve patients in healthcare research are associated with myriad benefits.DESIGNLexical review.METHODSPubMed was searched to identify all publications on patient involvement in HAI research since 2000; publications were also identified from the cited references. A lexical analysis was conducted of the methods sections of 148 publications.RESULTSThe findings reveal that HAI research that actively involves patients and members of the public is limited.CONCLUSIONSPatient involvement is largely limited to recruitment to HAI studies rather than extended to patient involvement in research design, implementation, analysis, and/or dissemination. As such, there is considerable opportunity to further this important research area via alternative methodologies that award primacy to patient expertise and agency.Infect Control Hosp Epidemiol 2018;39:710-717.
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http://dx.doi.org/10.1017/ice.2018.62DOI Listing
June 2018

Using Positive Organizational Scholarship in Healthcare and Video Reflexive Ethnography to Examine Positive Deviance to New Public Management in Healthcare.

Qual Health Res 2018 07 24;28(8):1203-1216. Epub 2018 Feb 24.

3 The University of Adelaide, Adelaide, South Australia, Australia.

Following increased interest in and use of new public management (NPM), greater regulation has been introduced into many Western health systems. Yet, the effects have revealed the negative aspects of NPM. Positive organizational scholars have argued that adversity can give rise to positive deviance. Yet as a form of noncompliance, positive deviance can be difficult to examine. This methodological article demonstrates how the combined methodologies of positive organizational scholarship in healthcare (POSH) and video reflexive ethnography (VRE) can help examine positive deviance. This study illustrates the methodological utility of POSH VRE to respectfully study the impact of NPM-inspired expectations on public health clinicians, positively reframe how clinicians constructively respond to and manage obstruction, and reveal the unintended effects of NPM-inspired expectations. As a participatory methodology, POSH VRE can promote trust between researchers and clinicians, thereby unveiling instances of positive deviance to NPM in healthcare.
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http://dx.doi.org/10.1177/1049732318759492DOI Listing
July 2018

Positive emotion in knowledge creation.

J Health Organ Manag 2017 Apr;31(2):162-174

School of Business, Western Sydney University , Parramatta, Australia.

Purpose Despite the importance of evidence-based practice, the translation of knowledge into quality healthcare continues to be stymied by an array of micro, meso and macro factors. The purpose of this paper is to suggest a need to consider different - if not unconventional approaches - like the role of positive emotion, and how it might be used to promote and sustain knowledge translation (KT). Design/methodology/approach By reviewing and coalescing two distinct theories - the broaden-and-build theory of positive emotions and the organisational knowledge creation theory - this paper presents a case for the role of positive emotion in KT. Findings Theories pertaining to positive emotion and organisational knowledge creation have much to offer KT in healthcare. Three conceptual "entry points" might be particularly helpful to integrate the two domains - namely, understanding the relationship between knowledge and positive emotions; positive emotions related to Nonaka's concept of knowledge creation; and the mutual enrichment contained in the parallel "upward spiralling" of both theories. Research limitations/implications This is a conceptual paper and as such is limited in its applicability and scope. Future work should empirically explore these conceptual findings, delving into positive emotion and KT. Originality/value This is the first paper to bring together two seemingly disparate theories to address an intractable issue - the translation of knowledge into quality healthcare. This represents an important point of departure from current KT discourse, much of which continues to superimpose artefacts like clinical practice guidelines onto complex healthcare context.
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http://dx.doi.org/10.1108/JHOM-06-2016-0108DOI Listing
April 2017

Developing an evaluation framework for clinical redesign programs: lessons learnt.

J Health Organ Manag 2016 Sep;30(6):950-70

Patient Pathways, Royal Adelaide Hospital, Adelaide, Australia.

Purpose The purpose of this paper is to present lessons learnt through the development of an evaluation framework for a clinical redesign programme - the aim of which was to improve the patient journey through improved discharge practices within an Australian public hospital. Design/methodology/approach The development of the evaluation framework involved three stages - namely, the analysis of secondary data relating to the discharge planning pathway; the analysis of primary data including field-notes and interview transcripts on hospital processes; and the triangulation of these data sets to devise the framework. The evaluation framework ensured that resource use, process management, patient satisfaction, and staff well-being and productivity were each connected with measures, targets, and the aim of clinical redesign programme. Findings The application of business process management and a balanced scorecard enabled a different way of framing the evaluation, ensuring measurable outcomes were connected to inputs and outputs. Lessons learnt include: first, the importance of mixed-methods research to devise the framework and evaluate the redesigned processes; second, the need for appropriate tools and resources to adequately capture change across the different domains of the redesign programme; and third, the value of developing and applying an evaluative framework progressively. Research limitations/implications The evaluation framework is limited by its retrospective application to a clinical process redesign programme. Originality/value This research supports benchmarking with national and international practices in relation to best practice healthcare redesign processes. Additionally, it provides a theoretical contribution on evaluating health services improvement and redesign initiatives.
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http://dx.doi.org/10.1108/JHOM-07-2015-0109DOI Listing
September 2016

Empirical exploration of brilliance in health care: perceptions of health professionals.

Aust Health Rev 2017 Jul;41(3):336-343

Griffith Business School, Gold Coast Campus, Griffith University, Parklands Drive, Southport, Qld 4215, Australia. Email: ;

Objective The aim of the present study was to develop a positive organisational scholarship in health care approach to health management, informed by health managers and health professionals' experiences of brilliance in health care delivery. Methods A sample of postgraduate students with professional and/or management experience within a health service was invited to share their experiences of brilliant health services via online discussions and a survey running on the SurveyMonkey platform. A lexical analysis of student contributions was conducted using the individual as the unit of analysis. Results Using lexical analysis, the examination of themes in the concept map, the relationships between themes and the relationships between concepts identified 'care' as the most important concept in recognising brilliance in health care, followed by the concepts of 'staff' and 'patient'. Conclusions The research presents empirical material to support the emergence of an evidence-based health professional perspective of brilliance in health management. The findings support other studies that have drawn on both quantitative and qualitative materials to explore brilliance in health care. Pockets of brilliance have been previously identified as catalysts for changing health care systems. Both quality, seen as driven from the outside, and excellence, driven from within individuals, are necessary to produce brilliance. What is known about the topic? The quest for brilliance in health care is not easy but essential to reinvigorating and energising health professionals to pursue the highest possible standards of health care delivery. What does this paper add? Using an innovative methodology, the present study identified the key drivers that health care professionals believe are vital to moving in the direction of identifying brilliant performance. What are the implications for practitioners? This work presents evidence on the perceptions of leadership and management practices associated with brilliant health management. Lessons learned from exceptionally well-delivered services contain different templates for change than those dealing with failures, errors, misconduct and the resulting negativity.
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http://dx.doi.org/10.1071/AH16047DOI Listing
July 2017

Communication channels to promote evidence-based practice: a survey of primary care clinicians to determine perceived effects.

Health Res Policy Syst 2016 Aug 11;14(1):62. Epub 2016 Aug 11.

Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.

Background: Research suggests that the channels through which evidence-based practices are communicated to healthcare professionals can shape the ways they engage with, and use, this information. For instance, there is evidence to suggest that information should be communicated via sources that are deemed to be credible, like government departments, professional bodies and peers. This article examines the contention that information should be communicated via credible sources. More specifically, the article examines the different communication channels through which primary care clinicians learnt of resources on evidence-based sexual healthcare - namely, clinical aides and online training programs. Furthermore, the article determines whether these communication channels influenced the perceived impact of the resources.

Methods: Primary care clinicians in Australia (n = 413), notably General Practitioners (n = 214) and Practice Nurses (n = 217), were surveyed on the GP Project - a suite of resources to promote evidence-based sexual healthcare within primary care. Survey items pertained to the source of information about the resources (or communication channel), perceived usefulness of the resources, frequency of use, subsequent contact with the Sexual Health Infoline and a sexual health clinic, as well as the perceived impact of the resources. To determine the relationships between the different communication channels and the perceived impact of the resources, a one-way ANOVA using Tukey's post-hoc test, an independent sample t-test, a χ(2) test, and a Kruskal-Wallis H test were performed where appropriate.

Results: Of the respondents who were aware of the clinical aides (49.9%), the largest proportion became aware of these through an educational event or a colleague. Of those who were aware of the online training programs (36.9%), the largest proportion became aware of these through a professional body or government organisation, either directly or via their website. Although both resource types were reported to improve clinical practice, the reported use and the perceived impact of the resources were not influenced by the way the clinicians learnt of the resources.

Conclusions: These findings cast doubt on the suggestion that the channels through which evidence-based practices are communicated to healthcare professionals shape the ways they engage with, and use, this information, as well as the perceived impact of this information. Given the importance of evidence-based practices, these curious findings suggest that the source of this information might be of little consequence.
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http://dx.doi.org/10.1186/s12961-016-0134-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982010PMC
August 2016

Evaluation of a sexually transmissible infections education program: Lessons for general practice learning.

Aust Fam Physician 2016 Mar;45(3):123-8

MBBS, MMed, FRACGP is the Peter Brennan Chair of General Practice, School of Medicine, University of Western Sydney, New South Wales.

Background: The New South Wales (NSW) Sexually Transmissible Infections Program Unit (STIPU) produced nine resources to support the diagnosis and management of sexually transmissible infections (STIs) in general practice.

Objective: In this study, we explored the processes of developing the resources and outcomes achieved.

Methods: We analysed project documents and undertook a focus group interview with the STIPU Working Group to evaluate resource development and dissemination. Interviews with general practitioners (GPs) and practice nurses (PNs), combined with previously reported survey findings, provided an outcomes evaluation.

Results: STIPU used a rigorous, multimodal approach to develop evidence-based clinical resources. GPs and PNs received information opportunistically rather than through targeted searches unless they had a particular interest. GPs were less aware of online re-sources.

Discussion: STIPU's best practice translation of clinical guidelines could be enhanced by promotion of online resources, links through general practice software, strong engagement with general practice organisations, and developing the role of PNs.
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March 2016

Cross-cultural integration affects attitudes towards people with HIV/AIDS in Australia.

Sex Health 2016 04;13(2):182-9

School of Business, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.

Background: The stigma associated with HIV/AIDS represents a significant issue. It can hinder help-seeking behaviours, fracture relationships, conceal prevalence rates and curtail public health initiatives to reduce HIV/AIDS. Culture is known to shape this stigma - it influences how individuals and the communities they represent understand the causes of HIV/AIDS, how it can and should be treated, and how people living with HIV/AIDS (PLWHA) should be regarded. Following recent increases in both HIV/AIDS and cross-cultural migration, this study determines the effect of cross-cultural integration on the tendency to stigmatise PLWHA.

Methods: This was achieved by surveying adults who are at the nexus of two dissimilar cultures - adults from the Australian-Iranian community (n=236). While the Iranian culture is largely collectivistic, the Australian culture is largely individualistic.

Results: Survey results indicated the respondents represented a collectivistic (44.1%), transitional (33.5%) or an individualistic (22.4%) culture. Those within the collectivistic culture held the most stigmatising views about PLWHA, supporting coercive policies and reporting they would avoid PLWHA. Those within the individualistic culture held the most positive attitudes. Furthermore, regression analysis indicated that movement from a collectivistic to an individualistic culture significantly reduced stigmatising attitudes towards PLWHA.

Conclusions: This study is the first to demonstrate the benefits afforded by an individualist culture, particularly for PLWHA. The article concludes with a discussion on the implications associated with these findings, particularly for researchers and practitioners within the health promotion field.
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http://dx.doi.org/10.1071/SH15199DOI Listing
April 2016

Strategies to promote practice nurse capacity to deliver evidence-based care: An example from sexual healthcare.

J Health Organ Manag 2015 ;29(7):988-1010

School of Business, Western Sydney University, Parramatta, Australia.

Purpose: Evidence-based practice is pivotal to effective patient care. However, its translation into practice remains limited. Given the central role of primary care in many healthcare systems, it is important to identify strategies that bolster clinician-capacity to promote evidence-based care. The purpose of this paper is to identify strategies to increase Practice Nurse capacity to promote evidence-based sexual healthcare within general practice.

Design/methodology/approach: A survey of 217 Practice Nurses in an Australian state and ten respondent-interviews regarding two resources to promote evidence-based sexual healthcare - namely, a clinical aide and online training.

Findings: The perceived impact of both resources was determined by views on relevance and design - particularly for the clinical aide. Resource-use was influenced by role and responsibilities within the workplace, accessibility, and support from patients and colleagues.

Research Limitations/implications: This is the first Australian study to reveal strategies to promote evidence-based sexual healthcare among Practice Nurses. The findings provide a platform for future research on knowledge translation processes, particularly among clinicians who might be disengaged from sexual healthcare.

Practical Implications: Given the benefits of evidence-based practices, it is important that managers recognize their role, and the role of their services, in promoting these. Without explicit support for evidence-based care and recognition of the Practice Nurse role in such care, knowledge translation is likely to be limited.

Originality/value: Knowledge translation among Practice Nurses can be facilitated by: resources-deemed informative, relevant, and user-friendly, as well as support from patients, colleagues, and their workplace.
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http://dx.doi.org/10.1108/JHOM-05-2013-0089DOI Listing
February 2017

The profile of patients with chronic kidney disease who regularly present at an Australian general practice.

Curr Med Res Opin 2016 17;32(1):183-9. Epub 2015 Nov 17.

a a Melbourne Clinical School , School of Medicine Sydney University of Notre Dame , Werribee, VIC , Australia.

Background: Chronic kidney disease (CKD) is a common, serious and mostly asymptomatic condition that places considerable burden on the Australian healthcare system. Yet there is limited information on the patients with CKD who present to Australian primary care services, which represent the gateway to specialized care.

Methods: Data pertaining to 31,897 patients who presented to a general practice in Western Australia, from 1 January 2013 to 30 June 2014 (inclusive), were extracted for review. Data included attendance records, comorbidities, diagnoses, and demographic details. Binary logistic regression was used to compare patients diagnosed with CKD by the consulting general practitioner with those without this diagnosis.

Results: Of the 8629 patients who regularly attended the practice, 184 (2%) were diagnosed with CKD (mean age: 77.7 years; male: 57.1%). The stage of CKD was recorded in only 8.4% of cases. Patients with CKD averaged 11 more consultations in the past 18 months (mean difference 10.8, 95% CI [9.3, 12.3], p < .001). They were also more likely to: be male; be ex-smokers; be widowed; and to have a carer. Their most common comorbidities included acute infections, cerebrovascular or ischemic heart disease, osteopenia or osteoporosis, and cancer; 8.7% had died within the previous year.

Conclusions: Despite the prevalence of CKD, only one in five cases were recorded within this large practice. This reveals lost opportunities to monitor and manage patients with this chronic and common disease. Although this represents an important finding, this study is limited by the reliance on practice records, some of which were incomplete. Nevertheless, this study reveals two key findings. First, this disease is under-diagnosed and/or under-recorded. Second, patients with CKD have other, potentially unrelated, problems that may warrant attention.
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http://dx.doi.org/10.1185/03007995.2015.1109505DOI Listing
September 2016

Finding brilliance using positive organizational scholarship in healthcare.

J Health Organ Manag 2015 ;29(6):750-77

Macquarie Graduate School of Management, Macquarie University, Ryde, Australia.

Purpose: Positive organizational scholarship in healthcare (POSH) suggests that, to promote widespread improvement within health services, focusing on the good, the excellent, and the brilliant is as important as conventional approaches that focus on the negative, the problems, and the failures. POSH offers different opportunities to learn from and build resilient cultures of safety, innovation, and change. It is not separate from tried and tested approaches to health service improvement--but rather, it approaches this improvement differently. The paper aims to discuss these issues.

Design/methodology/approach: POSH, appreciative inquiry (AI) and reflective practice were used to inform an exploratory investigation of what is good, excellent, or brilliant health service management.

Findings: The researchers identified new characteristics of good healthcare and what it might take to have brilliant health service management, elucidated and refined POSH, and identified research opportunities that hold potential value for consumers, practitioners, and policymakers.

Research Limitations/implications: The secondary data used in this study offered limited contextual information.

Practical Implications: This approach is a platform from which to: identify, investigate, and learn about brilliant health service management; and inform theory and practice.

Social Implications: POSH can help to reveal what consumers and practitioners value about health services and how they prefer to engage with these services.

Originality/value: Using POSH, this paper examines what consumers and practitioners value about health services; it also illustrates how brilliance can be theorized into health service management research and practice.
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http://dx.doi.org/10.1108/JHOM-11-2013-0256DOI Listing
January 2017

How do general practitioners manage patients with cancer symptoms? A video-vignette study.

BMJ Open 2015 Sep 14;5(9):e008525. Epub 2015 Sep 14.

Department of Medical Education, Curtin University, Perth, Western Australia, Australia.

Objectives: Determine how general practitioners (GPs) manage patients with cancer symptoms.

Design: GPs reviewed 24 video-vignettes and case notes on patients with cancer symptoms and indicated whether they would refer the patient and/or prescribe medication, and/or undertake further investigation. According to available guidelines, all cases warranted a referral to a specialist or further investigations.

Setting: Australian primary care sector.

Participants: 102 practising GPs participated in this study, including trainees.

Interventions: The research was part of a larger randomised controlled trial testing a referral pro forma; however, this paper reports on management decisions made throughout the study.

Primary And Secondary Outcome Measures: This paper reports on how the participants would manage the patients depicted in each vignette.

Results: In more than one-in-eight cases, the patient was not investigated or referred. Patient management varied significantly by cancer type (p<0.001). For two key reasons, colorectal cancer was the chosen referent category. First, it represents a prevalent type of cancer. Second, in this study, colorectal cancer symptoms were managed in a similar proportion of options-that is, prescription, referral or investigation. Compared with vignettes featuring colorectal cancer participants were less likely to manage breast, bladder, endometrial, and lung cancers with a 'prescription only' or 'referral only' option. They were less likely to manage prostate cancer with a 'prescription only', yet more likely to manage it with a 'referral with investigation'. With regard to pancreatic and cervical cancers, participants were more likely to manage these with a 'referral only' or a 'referral with investigation'.

Conclusions: Some patients may receive a delayed cancer diagnosis, even when they present with typical cancer symptoms to a GP who can access relevant diagnostic tests.

Trial Registration Number: ACTRN12611000760976.
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http://dx.doi.org/10.1136/bmjopen-2015-008525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4577966PMC
September 2015

How professional identity shapes youth healthcare.

J Health Organ Manag 2015 ;29(3):317-42

School of Business, University of Western Sydney, Parramatta, Australia.

Purpose: The primary care sector is experiencing considerable change. How change and uncertainty are accommodated by the professional identity of medicine has not been examined. The purpose of this paper is to address the youth healthcare as an exemplar as this field is often a source of uncertainty for general practitioners (GPs).

Design/methodology/approach: Using heterogeneity sampling, 22 GPs participated in focus groups to explore perceptions of youth healthcare, factors that help and hinder it, and training needs. Analysis of the research material was guided by a theoretical model on professional identity.

Findings: GPs described tensions that challenged their professional identity - the challenges of working with young people and their complex issues, the extent to which youth healthcare sits within the purview of general practice, and the scope of training required. These tensions appeared to destabilise professional identity. Some participants had customised their identity by enriching understandings of and approach to general practice. Participants also reported work customisation as a way of managing the complex demands of the general practice role. Deepened insight appeared to bolster perceived capacity to support a complex patient cohort. Research limitations/implications - Participants are not representative of the primary care sector - furthermore, the methodology limits the generalisability of the findings.

Practical Implications: To bolster youth health, mere clinician training is insufficient. Youth health requires explicit support from governments and training providers to be incorporated into the healthcare landscape.

Originality/value: This study extends current research on professional identity by examining youth healthcare within the changing context of primary care.
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http://dx.doi.org/10.1108/JHOM-06-2012-0096DOI Listing
September 2015

Trialability, observability and risk reduction accelerating individual innovation adoption decisions.

J Health Organ Manag 2015 ;29(2):271-94

Griffith University.

Purpose: The purpose of this paper is to provide a retrospective analysis of computer simulation's role in accelerating individual innovation adoption decisions. The process innovation examined is Lean Systems Thinking, and the organizational context is the imaging department of an Australian public hospital.

Design/methodology/approach: Intrinsic case study methods including observation, interviews with radiology and emergency personnel about scheduling procedures, mapping patient appointment processes and document analysis were used over three years and then complemented with retrospective interviews with key hospital staff. The multiple data sources and methods were combined in a pragmatic and reflexive manner to explore an extreme case that provides potential to act as an instructive template for effective change.

Findings: Computer simulation of process change ideas offered by staff to improve patient-flow accelerated the adoption of the process changes, largely because animated computer simulation permitted experimentation (trialability), provided observable predictions of change results (observability) and minimized perceived risk.

Research Limitations/implications: The difficulty of making accurate comparisons between time periods in a health care setting is acknowledged.

Practical Implications: This work has implications for policy, practice and theory, particularly for inducing the rapid diffusion of process innovations to address challenges facing health service organizations and national health systems. Originality/value - The research demonstrates the value of animated computer simulation in presenting the need for change, identifying options, and predicting change outcomes and is the first work to indicate the importance of trialability, observability and risk reduction in individual adoption decisions in health services.
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http://dx.doi.org/10.1108/JHOM-08-2013-0171DOI Listing
September 2015

Combining patient journey modelling and visual multi-agent computer simulation: a framework to improving knowledge translation in a healthcare environment.

Stud Health Technol Inform 2014 ;204:25-31

University of Western Sydney, New South Wales, Australia.

This article focuses on a framework that will investigate the integration of two disparate methodologies: patient journey modelling and visual multi-agent simulation, and its impact on the speed and quality of knowledge translation to healthcare stakeholders. Literature describes patient journey modelling and visual simulation as discrete activities. This paper suggests that their combination and their impact on translating knowledge to practitioners are greater than the sum of the two technologies. The test-bed is ambulatory care and the goal is to determine if this approach can improve health services delivery, workflow, and patient outcomes and satisfaction. The multidisciplinary research team is comprised of expertise in patient journey modelling, simulation, and knowledge translation.
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April 2015
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