Mark J. Avery, Allan W. Cripps and Gary D. Rogers
This study explores key governance, leadership and management activities that have impact on quality, risk and safety within Australian healthcare organisations.
Abstract
Purpose
This study explores key governance, leadership and management activities that have impact on quality, risk and safety within Australian healthcare organisations.
Design/methodology/approach
Current non-executive directors (n = 12) of public and private health boards were interviewed about contemporary approaches to fiduciary and corporate responsibilities for quality assurance and improvement outcomes in the context of risk and safety management for patient care. Verbatim transcripts were subjected to thematic analysis triangulated with Leximancer-based text mining.
Findings
Boards operate in a strong legislative, healthcare standards and normative environment of quality and risk management. Support and influence that create a positive quality and risk management culture within the organisation, actions that disseminate quality and risk broadly and at depth for all levels, and implementation and sustained development of quality and risk systems that report on and contain risk were critical tasks for boards and their directors.
Practical implications
Findings from this study may provide health directors with key quality and risk management agenda points to expand or deepen the impact of governance around health facilities' quality and risk management.
Originality/value
This study has identified key governance activities and responsibilities where boards demonstrate that they add value in terms of potential improvement to hospital and health service quality care outcomes. The demonstrable influence identified makes an important contribution to our understanding of healthcare governance.
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It is apparently becoming the fashion among certain types of self‐sufficient persons in this country to endeavour to bring discredit upon the scientific expert, and—whenever the…
Abstract
It is apparently becoming the fashion among certain types of self‐sufficient persons in this country to endeavour to bring discredit upon the scientific expert, and—whenever the practice can be indulged in with impunity—to snub and to insult him as far as possible. While this course of procedure is particularly to be observed when the expert is called upon to give evidence in a Court of Law, or to explain technical points before some highly inexpert body, it is not only in these circumstances that he is subjected to misrepresentation, discourtesy, and downright insult. Whenever a case occurs which appears to afford pabulum capable of being twisted into shape for the purpose, certain newspapers— generally, we are glad to say, of the lower class—are invariably ready to publish cheap sneers at science and scientific men, frequently accompanied by insulting suggestions. Other journals of a better class do not indulge in abuse and insulting suggestions, but confine themselves to lecturing the expert or experts with all that assurance which is characteristic of blatant ignorance. Accusations of incompetence and of culpable negligence are common in the gutter Press and in some so‐called Courts of Justice. Even suggestions of bad faith and of failure to honourably discharge duties undertaken are sometimes to be met with. It cannot be supposed that the reason for all this is to be found in the conduct of some very few persons who, in the eyes of all right‐thinking people, have brought discredit on themselves by appearing as “ advocate‐witnesses ” to defend the indefensible. At any rate, the conduct of such individuals affords no justification for tarring everybody with the same brush. The hostile, acidly‐cantankerous, and frequently grossly insolent attitude adopted by certain persons and in certain quarters towards those experts whose duties are of a public character and connected with legal or semi‐legal proceedings, is due to a reason which is not far to seek. It is due, in the first place, to the disgraceful ignorance in regard to scientific matters, even of the most elementary kind, which unhappily pervades all classes of the community;' and, secondly, to that form of jealousy peculiar to the small and mean mind which detests and kicks at anything and everything beyond its power of comprehension. When apparently contradictory evidence is given by scientific witnesses—appearing on opposite sides in a case—it is obviously far more easy and satisfactory to shriek about the “ differing of doctors ” than to admit that one's own miserable ignorance prevents one from seeing the points and from ascertaining whether there is any real contradiction or not. It is far more convenient to suggest that the public analyst, for instance, does not know what he is about, has made some absurd mistake, or has been guilty of scandalous negligence, than to admit that one does not understand his certificate owing to one's own defective education or inferior intellectual capacity.
The milk supply of our country, in one form or another, has been the subject of discussion year after year at Congress meetings. Its importance is an admitted fact, but…
Abstract
The milk supply of our country, in one form or another, has been the subject of discussion year after year at Congress meetings. Its importance is an admitted fact, but, notwithstanding, I again venture to call attention to the matter. On this occasion, however, I do not propose to touch much of the ground already covered by former papers, but to consider the results of experiments and observations made while dealing with milk supply under the Sale of Food and Drugs Acts. For many years dairy regulations have been in force throughout the country which deal with the construction of floors and walls, and with lighting and ventilation. The owners of dairy farms in many parts of Scotland have spent large sums of money in improving their farms. Indeed, some enthusiasts have gone the length of introducing a system of heating and mechanical means of ventilation. It is only reasonable to pause and consider the practical results of these improvements, and to discover who are reaping the benefits from a milk supply standpoint. Do the owners of dairy farms receive anything like a fair return for their capital outlay? No. It is a well‐known fact that rents are on the down grade. Is the farmer of to‐day in a better financial position than formerly? No. He will tell you that the working of a “modern dairy” is more expensive than in the old steading, and that there is less flow of milk from the cows in the large airy byre than in the small old “biggin.” The price of milk is considerably less than it was fifteen or twenty years ago. At that time it ranged from 10d. to 1s. per gallon, and it is well known to you that hundreds of gallons of milk are now sent into our large cities for at least a distance of 100 miles, carriage paid, at 7½d. per gallon. In some cases the price is 9d. per gallon during the winter and 7½d. in summer. A farmer I know has a contract with a dairyman to supply him with 20 gallons of sweet milk, 16 gallons of skim milk, and 4 gallons of cream every day at an average rate of 7½d. per gallon all the year round. I have proved, by having test samples taken of the sweet milk, that it contains an average fat of 4.89 per cent. in 16 gallons. Neither the owner nor occupier of the farm can be any better off so long as such small prices prevail. Does the profit then come to the consumer? It does not.
Kannika Damrongplasit and Cheng Hsiao
The authors use a reduced form state-dependent labor participation decision model to illustrate that parameter stability is achieved only if a model properly takes account the…
Abstract
The authors use a reduced form state-dependent labor participation decision model to illustrate that parameter stability is achieved only if a model properly takes account the observed sample heterogeneity and unobserved sample heterogeneity provided (external) conditions of a model stay constant. Our analysis of the dynamic response path to a health shock using Australian HILDA panel data from 2002 to 2009 shows that experiencing an event by itself can only have a temporary effects. The long-run equilibrium condition is independent of initial conditions or shocks that do not last. In other words, if experiencing an event does not lead to changes in the response parameters such as the real business cycle (Kydland & Prescott, 1977, 1982) or dynamic stochastic general equilibrium model (DSGE, e.g., Sbordone et al., 2010) assumed, policy change may only change the short-run response path. There is no long-term impact for a policy change. On the other hand, if a policy change leads to changes in the decision rules (e.g., the recent US–China trade friction) as the Lucas critique (1976) implies, then there is no other way to evaluate the impact of a policy except to explicitly model how agents respond to the policy change.
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We understand that at the Annual Meeting of the Iron and Steel Institute it was decided to expel all the alien‐enemy members of that body. In commenting upon this action The…
Abstract
We understand that at the Annual Meeting of the Iron and Steel Institute it was decided to expel all the alien‐enemy members of that body. In commenting upon this action The Engineer observes that it is some time since the name of the German Emperor was removed from the list of honorary members of the Institution of Civil Engineers, but that up to the present time ordinary alien‐enemy members of this Institution have not been expelled. The same observation applies to the Institution of Mechanical Engineers.
The Sanitary Committee of a certain County Council, strong with the strength of recent creation, have lately been animated by a desire to distinguish themselves in some way, and…
Abstract
The Sanitary Committee of a certain County Council, strong with the strength of recent creation, have lately been animated by a desire to distinguish themselves in some way, and, proceeding along the lines of least resistance, they appear to have selected the Public Analyst as the most suitable object for attack. The charge against this unfortunate official was not that he is incompetent, or that he had been in any way negligent of his duties as prescribed by Act of Parliament, but simply and solely that he has the temerity to reside in London, which city is distant by a certain number of miles from the much favoured district controlled by the County Council aforesaid. The committee were favoured in their deliberations by the assistance of no less an authority than the “Principal” of a local “Technical School”;—and who could be more capable than he to express an opinion upon so simple a matter? This eminent exponent of scientific truths, after due and proper consideration, is reported to have delivered himself of the opinion that “scientifically it would be desirable that the analyst should reside in the district, as the delay occasioned by the sending of samples of water to London is liable to produce a misleading effect upon an analysis.” Apparently appalled by the contemplation of such possibilities, and strengthened by another expression of opinion to the effect that there were as “good men” in the district as in London, the committee resolved to recommend the County Council to determine the existing arrangement with the Public Analyst, and to appoint a “local analyst for all purposes.” Thus, the only objection which could be urged to the employment of a Public Analyst resident in London was the ridiculous one that the composition of a sample of water was likely to seriously alter during the period of its transit to London, and this contention becomes still more absurd when it is remembered that the examination of water samples is no part of the official duty of a Public Analyst. The employment of local scientific talent may be very proper when the object to be attained is simply the more or less imperfect instruction of the rising generation in the rudiments of what passes in this country for “technical education”; but the work of the Public Analyst is serious and responsible, and cannot be lightly undertaken by every person who may be acquainted with some of the uses of a test‐tube. The worthy members of this committee may find to their cost, as other committees have found before them, that persons possessing the requisite knowledge and experience are not necessarily indigenous to their district. Supposing that the County Council adopts the recommendation, the aspirations of the committee may even then be strangled in their infancy, as the Local Government Board will want to know all about the matter, and the committee will have to give serious and valid reasons in support of their case.
In discussing the merits and demerits of infants' foods, it is impossible to avoid reference to the physiological problems connected with infantile digestion, because, of course…
Abstract
In discussing the merits and demerits of infants' foods, it is impossible to avoid reference to the physiological problems connected with infantile digestion, because, of course, the whole question of suitability or otherwise turns upon the degree of digestibility of the preparations. Appearance and flavour, although of great importance in the case of adults generally, and invalids in particular, here play only a minor part.
Shirley Day, Edwin Fleming and Allan Bunch
Ninety per cent of information handled within libraries, information units and offices is printed on paper. This comes in the form of books, journals, newsprint and miscellaneous…
Abstract
Ninety per cent of information handled within libraries, information units and offices is printed on paper. This comes in the form of books, journals, newsprint and miscellaneous documents including letters. At the same time information originating within organisations is increasingly generated on computers and is displayed and read via electronic screens. Libraries, information units and offices are becoming a mix of the automated and the unautomated. In the past, integrating printed material with computer stored material was impractical. The electronic storage of documents as images rather than computer coded text required storage capacity beyond the scope of many computer systems.
MIDSUMMER sees the general settling down of thoughtful librarians to a contemplation of their Winter programmes. This seems a cruel suggestion since (if we are fortunate) the…
Abstract
MIDSUMMER sees the general settling down of thoughtful librarians to a contemplation of their Winter programmes. This seems a cruel suggestion since (if we are fortunate) the skies are still blue above us, the trees green, and—well, holidays are just ahead. One duty, however, belongs to midsummer and that is the annual election of the Library Association Council. There is growing evidence that in this matter we are no longer prepared to leave our representation in the most important council that exists for us to chance. By the time these words appear the question, so far as 1928 is concerned, will have been settled. We hope a well‐balanced Council will be the result, and that, after an interval of several years, Ireland will be represented.
The endeavour that is being made at the present time to rouse public interest in the extremely important question of the purity of the national milk supply is one that deserves…
Abstract
The endeavour that is being made at the present time to rouse public interest in the extremely important question of the purity of the national milk supply is one that deserves unqualified praise. It is in no spirit of carping criticism that it is here pointed out that the partial and unofficial remedy by which it is proposed to diminish the risk to the consumer may in itself be indirectly a means of continuing what has become a grave public danger. No reasonable doubt can exist that pasteurization as a method of dealing with large quantities of milk in bulk and from all sources will be of considerable use. It will certainly tend, if carried into effect to the extent and in the way suggested, to greatly lessen the risk that consumers run at the present time. It will prevent a large amount of disease that arises from the consumption of impure milk. But such a method, however admirable and philanthropic in conception and sound in theory, is one that by no means answers all, or even a part of, the large number of important questions connected with the subject. The general public and honest milk dealers will, it is to be hoped, benefit by the new milk legislation that is proposed by the Local Government Board and by the London County Council. The public, however, is very apt to be caught by a phrase, and may, therefore, think that “milk pasteurization” is the beginning and the end of all that need or can be said on the subject. It is likely that the foundation of depots for the preparation and supply of pasteurized milk will blind its eyes to the fact that the evils which have rendered the establishment of such places necessary remain untouched. Indeed, the very fact that milk depots of this kind are at work may be used by interested persons as evidence that all hygienic requirements have been complied with, that for this reason veterinary considerations may be ruled “out of court,” and that the necessity for further legislation of a more fundamental and drastic kind no longer exists. The agitation that is taking place at the present moment is no new thing. For many years past the matter has engaged the most serious attention of those experts whose business it is to investigate and, as far as they are permitted, to control the quality of the milk supplies of both our town and country districts. For example, a perusal of the annual reports of the Local Government Board that have been issued since that Board was instituted in the early seventies, will satisfy any one, who takes the time and trouble to read them, that Public Analysts have from time to time animadverted in terms more or less strong on the poor quality of the milk supplied, and that even if the field of inquiry be limited to what may be called purely analytical standards the difficulties of the case are enormous, even if they be looked at from the best and the most hopeful point of view. At the present moment we are more concerned with the equally important hygienic aspect of the question. Local self‐government, while conferring a large amount of autonomy on administrative units, has naturally resulted in an almost entire absence of any definite national system that can deal with the important subject of food supply generally and milk supply in particular. At the present time it is left to the local authority to decide whether it will or will not apply for powers from the central authority—the Local Government Board—to put into force regulations under the Dairies, Cowsheds, and Milkshops Order, though in cases where this has been done the benefit to all concerned has been marked, and the necessity for such action demonstrated. The subject of the milk supply divides itself, roughly speaking, into three branches, which may be referred to under the headings of Production, Carriage, and Sale, though it is evident that no sharp line of demarcation can be drawn. With regard to all of these the law is either defective or nonexistent. Under the present “system” prosecutions are mostly instituted against persons of whom it is alleged that they have knowingly sold milk from which fat has been abstracted or to which water has been added, but even here “the difficulties connected with the administration of the Sale of Food and Drugs Acts in the case of milk have been a constant subject of discussion between the officers of local authorities and the Board's Inspectors.” What these difficulties are are well known to all who are brought into contact with the administration of the Food and Drugs Acts, but any one can satisfy himself as to them by reference to, say, the last annual report of the Board of Agriculture in this respect, keeping in mind, at the same time, the fact that only one aspect of the case is there dealt with. Under the heading of Production brief reference may be made to the subject of the cow and her surroundings. Much evidence exists which shows the urgent need for expert and unbiassed hygienic and veterinary inspection of all dairy farms, cowsheds, and cows. In much that has been recently written on the subject of pure milk in the daily press, it is somewhat remarkable to note that while the dangers that arise from drinking raw milk derived from tuberculous cows has been rightly insisted on, comparatively little reference has been made to the importance of cow and cowshed inspection. It is unfortunately the case in too many instances that the owners of cows are content to house the animals in sheds under conditions that are usually, though wrongly, thought to be fit only for pigs. This, of course, leaves entirely out of the question the fact that the animals themselves may be tuberculous or otherwise diseased, and therefore a source of most serious danger to the public health. With regard to carriage of milk it may be pointed out that the modern city draws its supply of milk from all over the country, and that this means a rail journey of frequently some hours' duration. Our modes of transporting and handling milk have not, however, kept pace with modern requirements. The frequently Arcadian simplicity of the methods in vogue would appeal the more strongly to lovers of the picturesque if they did not lead so often to the introduction of filth of all kinds into the milk cans. Lastly, regarding the sale of milk from retailer to consumer, the public itself is largely to blame for the objectionable practice of adding colouring matter to the milk. A general impression is abroad among the poorer, and therefore it may be presumed the more ignorant, consumers, that milk is not genuine unless it be what is called “cream coloured.” Hence the introduction of annatto or some less innocent substance. For the frequent presence of such substances as formaldehyde, boracic acid, and other “preservatives” no excuse of any kind exists. Such practices are simply means but too often resorted to of masking incipient putrefaction induced by tardy and uncleanly methods. At the same time, these dangerous chemical preservatives make the “food” more difficult of digestion, with results to young children and persons in weak health that are too obvious to need comment. In addition to all this the milk may be subjected, of course, to adulteration of the usual kind. Hence the present position is that against defective methods of production and sale, out‐of‐date methods of transport, absence of any national and compulsory system of inspection and control, and a law that is either deficient or hopelessly tangled, a semi‐philanthropic method is proposed which, though probably sound and admirable in itself, is almost certain to be used by the unserupulous as a means of preventing the important problem of our milk supply being attacked in the only way in which there is reasonable hope of success—that is, by an appeal to the cow and its surroundings. Unless the method of pasteurization be recognised as a useful but still a subordinate means of dealing with an already contaminated substance, it is more than likely that tinkering and generally unsatisfactory legislation will be resorted to, and that as a result of this the state of the milk supply will remain very much as it is at present.