Redesign and innovation in hospitals: foundations to making it happen

This paper describes key features of hospital redesign processes in Australia by analysing Victorian, NSW and other models. It discusses frameworks and drivers of large scale change in health systems including challenges and barriers to success.  The use of systems thinking and institutional entrepreneurship to support achieving change is described.   Insights are provided to enable policy development that can support innovation and system redesign. What is the problem? Australia\u27s demand for healthcare services is escalating, driven by an ageing population with complex health care needs, rising rates of chronic illness, increasing health care costs and rapid information technology innovation. These pressures may not be adequately met within the health system\u27s current and future economic capacity. Therefore, healthcare services and systems must achieve wide-ranging reform and redesign if they are to meet these challenges. The key questions for those working as health services leaders are: how can we support the innovation and change required to address this reality? and what should national policy makers do to support this work? What does the evidence say? Considerable evidence describes overlapping aspects of successful redesign in hospitals. These include: leadership to achieve change; the use of data to monitor and evaluate change; coherent alignment to organisational strategic plans; the development of organisational culture that is ready for change; and ensuring integration of change into routine practice. Systems thinking and institutional entrepreneurship offer approaches to change and redesign that take into consideration networks and relationships of individuals, teams and clinical disciplines working within it, resources and current processes and the cultural context of the organisation. What does this mean for health service leaders? In order to fully meet the requirements for redesign and innovation, health service leaders will need to address a number of key areas. First and foremost, leaders need to develop their organisational strategic vision around the concept of redesign and innovation and build staff understanding of the importance of these concepts. Staff must be given the capacity and confidence to pursue meaningful change in their everyday operations. Leaders must recognise the benefits of data and analytics and support the development of systems to utilise these tools. Innovative practices from outside of the health sector should be studied and adapted, and partnerships with industry and academia must be pursued. What does this mean for policy makers? Policy makers need to commit to investment in the concept of redesign and innovation. They should consider funding models that reward health services for innovation. Policy makers must support health services to pursue and sustain meaningful change while recognising that transformation requires time, perseverance and willingness to learn from success and failure

The anomaly of racial variance in female perpetrated spousal killing: a structural explanation

ABSTRACT Research investigating the relationship of structural factors to homicide abounds in the literature. There is also extant research on female perpetrated intimate partner killings (IPK). However this literature for the most part has examined the phenomenon itself, or has disaggregated the rates by race, where it was discovered that there is a racial anomaly in intimate killings, Black females kill their partners at a higher rate than White females. This research sought to determine how structural factors function to differentially amplify this rate, using classic controls for homicide and adding measures for the presence of female kin, the presence of children not related to the male, and doing this in a race specific manner. Using a sample of 234 MSA’s, Supplementary Homicide Report data was utilized to create these race and relationship specific models, which were analyzed with Poisson regression. Contrary to expectations, the presence of children was only found to have an effect on White spousal killings, and no effect in the other three models. Support was found for Sampson and Wilson’s (1995) racial invariance hypothesis in that the most significant findings in the Black models related to the confluence of high density housing and dissimilarity measures. This ‘spatial conflux’ served to explain the anomalous findings in regard to the Gini coefficient, in Black IPK models as the Gini decreased, homicides went up. Contrary to other studies, female headed households, as well as other standard predictors of homicide were not found to be significant in relation to IPK

The epidemiology of lost meaning: a study in the psychology of religion and existential public health

The existential dimension of spirituality has proven to be of great importance over the last two decades when it comes to studies of self-rated health and quality of life. We see the positive effects it has on blood pressure, depression and life expectancy for chemotherapy and HIV patients, to mention just a few examples. In the public health sector, it is interesting to note that this existential/spiritual dimension had already been present in the early years when the term public health first came into the Swedish language. In the year 1926 public health was defined as ‘a people’s physical and spiritual health’. During the intervening years of major medical and scientific technical improvements in the field, the existential/spiritual perspective had been put aside, but now once again this dimension has come into focus. The central question is, how does the existential dimension of health, understood as a person’s ability to create and maintain functional meaning making systems, affect the person’s self-rated health and quality of life? The working theories and basic perspectives in this article are drawn from health research with attention to the existential dimension, public health from the perspective of the psychology of religion, and object relations theory

Cooperating teachers as models of best practice: Student teachers\u27 perceptions

The selection of expert, effective cooperating teachers who can foster successful student teacher experiences and serve as primary role models for teacher candidates is central to the success of student teaching. However, a lack of consensus exists among education professionals on a standardized definition of effective cooperating teachers. The purpose of this dissertation study was to determine if student teachers\u27 perceptions of cooperating teachers\u27 modeled actions of professional standards differed across four certification grade bands: (a) early childhood certification (grades PK-3), (b) elementary certification (grades 1-5), (c) secondary content (grades 6-12) certification in English, mathematics, science, and social studies, and (d) K-12 certification in art, special education, music education, and health and physical education. The researcher collected data using the Ohio Student Teachers\u27 Perceptions of Cooperating Teachers\u27 Enactment of National Board Core Propositions and Teacher Educator Standards to Promote Student Teacher Learning. Findings revealed significant differences existed between elementary and K-12 certification student teachers\u27 perceptions of cooperating teachers\u27 modeling of professional standards. Recommendations included development of cooperating teachers\u27 identity as teacher educators and intentional collaboration between university faculty and cooperating teachers. The need for collaboration and professional development, especially in K-12 certification areas, was indicated to address expectations unique to the disciplines and to promote improvements and alignment with programmatic efforts

Wait time in the classroom

The purpose of this study was to evaluate the effects of increasing wait time, the time interval after a teacher poses a verbal question to students and when a teacher calls on a student, as it affects the amount of class participation. There were two phases of the study: phase one was teaching using unmodified wait time for five days, and phase two was modified wait time, extending it to a minimum of three second for an additional five day period. In this study I played both roles of teacher and researcher. The teaching sessions were observed and recorded during the daily twenty minute language arts lesson. Wait time was modified with the help of a large timer placed in the rear of the classroom to insure that the three second time period was provided. The study found that the average amount of wait time given during the first phase was only 1.376 seconds and the class responded averaging 2.452 hands raised. With the implementation of a three second wait time after each question, the amount of class participation increased dramatically with an increase of over 300% in the amount of students responding to questioned by raising their hands. After completing this study, I feel that implementing increased wait time into the everyday practice of the classroom will increase the amount of classroom participation, as it did in my classroom

Synthesis and Photochemistry of Tetracyclo[6.2.2.23,6.02,7]tetradeca 4,9,11,13-tetraene Based Systems

C14H14 tetracyclic tetraene 1 and its benzoanellated derivatives 2, 3 are sought as versatile intermediates. Preparatively useful syntheses have been worked out for the key intermediates (diketones 10-12). From 10, 11 the compounds 1, 2 are obtained. These unsaturated hydrocarbons undergo regioselectively [2 + 2]- (quantitative) and [6 + 2]- (2:1 equilibrium) cycloaddition, respectively, upon excitation with monochromatic λ = 254 nm light

Integrating the complexity of healthcare improvement with implementation science:a longitudinal qualitative case study

Background: Implementation science seeks to enable change, underpinned by theories and frameworks such as the Consolidated Framework for Implementation Research (CFIR). Yet academia and frontline healthcare improvement remain largely siloed, with limited integration of implementation science methods into frontline improvement where the drivers include pragmatic, rapid change. Using the CIFR lens, we aimed to explore how pragmatic and complex healthcare improvement and implementation science can be integrated. Methods: Our research involved the investigation of a case study that was undertaking the implementation of an improvement intervention at a large public health service. Our research involved qualitative data collection methods of semi-structured interviews and non-participant observations of the implementation team delivering the intervention. Thematic analysis identified key themes from the qualitative data. We examined our themes through the lens of CFIR to gain in-depth understanding of how the CFIR components operated in a ‘real-world’ context. Results: The key themes emerging from our research outlined that leadership, context and process are the key components that dominate and affect the implementation process. Leadership which cultivates connections with front line clinicians, fosters engagement and trust. Navigating context was facilitated by ‘bottom-up’ governance. Multi-disciplinary and cross-sector capability were key processes that supported pragmatic and agile responses in a changing complex environment. Process reflected the theoretically-informed, and iterative implementation approach. Mapping CFIR domains and constructs, with these themes demonstrated close alignment with the CFIR. The findings bring further depth to CFIR. Our research demonstrates that leadership which has a focus on patient need as a key motivator to engage clinicians, which applies and ensures iterative processes which leverage contextual factors can achieve successful, sustained implementation and healthcare improvement outcomes. Conclusions: Our longitudinal study highlights insights that strengthen alignment between implementation science and pragmatic frontline healthcare improvement. We identify opportunities to enhance the relevance of CFIR in the ‘real-world’ setting through the interconnected nature of our themes. Our study demonstrates actionable knowledge to enhance the integration of implementation science in healthcare improvement.</p

Syntheses, Electrode Preparations, Electrolytes and Two Fundamental Questions

The efficient catalysis of the four-electron oxidation of water to molecular oxygen is a central challenge for the development of devices for the production of solar fuels. This is equally true for artificial leaf-type structures and electrolyzer systems. Inspired by the oxygen evolving complex of Photosystem II, the biological catalyst for this reaction, scientists around the globe have investigated the possibility to use manganese oxides (“MnOx”) for this task. This perspective article will look at selected examples from the last about 10 years of research in this field. At first, three aspects are addressed in detail which have emerged as crucial for the development of efficient electrocatalysts for the anodic oxygen evolution reaction (OER): (1) the structure and composition of the “MnOx” is of central importance for catalytic performance and it seems that amorphous, MnIII/IV oxides with layered or tunnelled structures are especially good choices; (2) the type of support material (e.g. conducting oxides or nanostructured carbon) as well as the methods used to immobilize the MnOx catalysts on them greatly influence OER overpotentials, current densities and long-term stabilities of the electrodes and (3) when operating MnOx-based water-oxidizing anodes in electrolyzers, it has often been observed that the electrocatalytic performance is also largely dependent on the electrolyte’s composition and pH and that a number of equilibria accompany the catalytic process, resulting in “adaptive changes” of the MnOx material over time. Overall, it thus has become clear over the last years that efficient and stable water-oxidation electrolysis by manganese oxides can only be achieved if at least four parameters are optimized in combination: the oxide catalyst itself, the immobilization method, the catalyst support and last but not least the composition of the electrolyte. Furthermore, these parameters are not only important for the electrode optimization process alone but must also be considered if different electrode types are to be compared with each other or with literature values from literature. Because, as without their consideration it is almost impossible to draw the right scientific conclusions. On the other hand, it currently seems unlikely that even carefully optimized MnOx anodes will ever reach the superb OER rates observed for iridium, ruthenium or nickel-iron oxide anodes in acidic or alkaline solutions, respectively. So at the end of the article, two fundamental questions will be addressed: (1) are there technical applications where MnOx materials could actually be the first choice as OER electrocatalysts? and (2) do the results from the last decade of intensive research in this field help to solve a puzzle already formulated in 2008: “Why did nature choose manganese to make oxygen?”