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Maple JL, Whiteside M, Smallwood N, Putland M, Baldwin P, Bismark M, Harrex W, Johnson D, Karimi L, Willis K. Culture, conditions and care support mental health of healthcare workers during crises. Occup Med (Lond) 2024; 74:211-217. [PMID: 38319824 DOI: 10.1093/occmed/kqae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has presented immense challenges to health systems worldwide and significantly impacted the mental health of frontline healthcare workers. AIMS This study drew on the experiences of frontline healthcare workers to examine organizational strategies needed to support the mental health and well-being of healthcare workers during times of crisis. METHODS Semi-structured focus groups or individual interviews were conducted with healthcare workers to examine their perspectives on organizational strategies for enhancing staff mental health and well-being during crises. Data were analysed thematically. Following this, evidence for the identified strategies was reviewed to assess alignment with participant views and recommendations. RESULTS Thirty-two healthcare workers from diverse disciplines (10 allied health, 11 nursing, 11 medical) participated in the study. Data analysis identified three broad themes contributing to supporting mental health and well-being. These themes can be encapsulated as the 'Three Cs'-culture (building an organizational culture that prioritizes mental health); conditions (implementing proactive organizational strategies during crises) and care (ensuring fit-for-purpose strategies to support mental health and well-being). CONCLUSIONS Study findings underscore the necessity of an integrated and systemic organizational approach to address mental health and well-being in the healthcare workplace. This approach must be long term with the components of the 'Three Cs', particularly cultural change and conditions, viewed as a part of a suite of strategies to ensure crisis preparedness. It is imperative that organizations collaborate with their staff, providing support and fostering a safe and inclusive work environment that ultimately benefits patients, their care and staff well-being.
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Affiliation(s)
- J L Maple
- Institute for Health and Sport, Victoria University, Footscray, Victoria 3011, Australia
| | - M Whiteside
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3000, Australia
| | - N Smallwood
- Department of Respiratory Medicine, The Alfred Hospital, Prahran, Victoria 3004, Australia
- Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria 3004, Australia
| | - M Putland
- Department of Emergency Medicine, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
- Department of Critical Care, Faculty of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia
| | - P Baldwin
- Black Dog Institute, Randwick, New South Wales 2031, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - M Bismark
- Centre for Health Policy, University of Melbourne, Parkville, Victoria 3010, Australia
| | - W Harrex
- Australasian Faculty of Occupational and Medicine, Royal Australasian College of Physicians, Sydney, New South Wales 2000, Australia
| | - D Johnson
- Department of General Medicine, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - L Karimi
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria 3083, Australia
| | - K Willis
- Institute of Health and Sport, Victoria University, Footscray, Victoria 3011, Australia
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Birkeland S, Bismark M, Barry MJ, Möller S. Associations between knowledge of health issues and health care satisfaction and propensity to complain: a cross-sectional survey of adult men in Denmark. BMJ Open 2024; 14:e076257. [PMID: 38719305 PMCID: PMC11086498 DOI: 10.1136/bmjopen-2023-076257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES The objective of this study was to investigate associations between knowledge of health issues and healthcare satisfaction and propensity to complain including the association between knowledge and greater patient involvement. DESIGN The present study is a secondary analysis of a larger cross-sectional case vignette survey. SETTING Survey conducted in adult Danish men. PARTICIPANTS Participants included 6755 men aged 45-70 years. INTERVENTIONS Participants responded to a survey with scenarios illustrating prostate-specific antigen (PSA) testing and different information provision. PRIMARY AND SECONDARY OUTCOME MEASURES Using Likert scales (scored 1-5), participants rated their satisfaction with the care described and their inclination to complain and responded to a short quiz (scored 0-3) assessing their knowledge about the PSA test. RESULTS Satisfaction with healthcare increased with better quiz performance (Likert difference 0.13 (95% CI .07 to 0.20), p <0.001, totally correct vs totally incorrect responders) and correspondingly, the desire to complain significantly decreased (Likert difference -0.34 (95% CI 0.40 to -0.27), p <0.001). Respondents with higher education performed better (mean quiz score difference 0.59 (95% CI 0.50 to 0.67), p <0.001, most educated vs least educated). Responders who received information about the PSA test generally performed better (quiz score difference 0.41 (95% CI 0.35 to 0.47), p<0.001, neutral vs no information). Overestimation of PSA merits was more common than underestimation (7.9% vs 3.8%). CONCLUSIONS Mens' knowledge of the benefits of screening varies with education, predicts satisfaction with care and the desire to complain, and may be improved through greater involvement in decision-making.
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Affiliation(s)
- Søren Birkeland
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense University Hospital, Odense, Denmark
| | - Marie Bismark
- Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Sören Möller
- OPEN, Odense University Hospital, Odense, Denmark
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
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Birkeland S, Bismark M, Barry MJ, Möller S. Complaint behaviour among healthcare users: self-reported complaint experience and complaint proneness in adult men. BMJ Open Qual 2024; 13:e002581. [PMID: 38365433 PMCID: PMC10875482 DOI: 10.1136/bmjoq-2023-002581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
AIMS When patients are harmed by, or dissatisfied with, healthcare, only a minority will lodge a complaint or file a claim for compensation. This survey aimed to investigate complaint behaviour and inequalities in complaints using self-reports and hypothetical case vignettes. METHODS Cross-sectional, web-based survey among 6755 Danish men aged 45-70 years (response rate=30%). Participants reported their lifetime complaint experience and the likelihood that they would complain in response to hypothetical case vignettes. RESULTS Overall, 4.8% of participants had complained about healthcare. Predictors were younger age (OR 2.08, 95% CI 1.32 to 3.27, p=0.002 45-50 years compared with 65-70 years), chronic illness (OR 1.49, 95% CI 1.12 to 1.98, p=0.006), rural residence (OR 2.11, 95% CI 1.20 to 3.73, p=0.010 comparing least and most populated areas), high healthcare utilisation (OR 1.55, 95% CI 1.18 to 2.03, p=0.002 primary care, and OR 1.97, 95% CI 1.52 to 2.55, p=0.000 hospital care) and decreased agreeableness on the 10-item Big Five personality inventory (OR 0.91, 95% CI 0.83 to 0.99, p=0.034). Complaint experience was associated with increased wish to complain about the treatment in the hypothetical vignettes (p=0.006). CONCLUSIONS Roughly 1 in 20 men reported having complained about healthcare. Complaints were more common among men who were younger, living in rural areas, diagnosed with chronic illness and high users of healthcare services. Prior complaint experience may be associated with a higher proclivity for complaining about future healthcare. Findings suggest differences in the way healthcare users respond to care experiences, pointing to the importance of aligning expectations and providing clear information about treatment options.
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Affiliation(s)
- Søren Birkeland
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network, Odense University Hospital, Odense, Denmark
| | - Marie Bismark
- Public Health Law, University of Melbourne, Parkville, Victoria, Australia
| | | | - Sören Möller
- Open Patient data Exploratory Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Artus J, Davison L, Bismark M, Every-Palmer S. Australia's unethical deportation practice discriminates against New Zealanders with mental illness: 'Everybody needs good neighbours!'. Aust N Z J Psychiatry 2023; 57:1410-1416. [PMID: 37605518 PMCID: PMC10619172 DOI: 10.1177/00048674231193877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
In this article, we explore Australia's deportation of people with mental illness from an ethical and human rights perspective. We outline the legislative framework regulating migration policy in Australia, focussing on Section 501 (s.501) of the Migration Act 1958 (which makes provision for deportation of non-residents on character grounds) and on the recently issued Direction 99 (which provides guidance on visa refusal and cancellation under s.501). We find the definition of a failed character test embedded within the legislative framework to be discriminatory, in that it conflates mental illness with character attributes. We present recent data on s.501 deportees sourced from the New Zealand Police and Manatū Hauora (the New Zealand Ministry of Health). Drawing on our clinical experiences working in forensic psychiatry and rehabilitation services, we describe some of our patients' experiences and the detrimental effects of deportation on their health and well-being. We argue that deportation of people with mental illness contravenes principles of psychosocial rehabilitation and recovery, is discriminatory and constitutes a moral wrong. Furthermore, while we recognise that recent policy changes reflect a tempering of the previous hard-line policy stance, it remains to be seen what effects they will have in practice. We question whether the new guidance will be enough to improve the treatment of and outcomes for those with mental illness, or whether the changes represent a case of too little, too late.
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Affiliation(s)
- Julie Artus
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Lorraine Davison
- Wilfred Lopes Centre, Tasmanian Health Service, Statewide Mental Health Service South, Risdon Vale, TAS, Australia
| | - Marie Bismark
- Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Smallwood N, Bismark M, Willis K. Burn-out in the health workforce during the COVID-19 pandemic: opportunities for workplace and leadership approaches to improve well-being. BMJ Lead 2023; 7:178-181. [PMID: 37192091 DOI: 10.1136/leader-2022-000687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/25/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Burn-out is a long-standing problem among healthcare workers (HCWs) and leads to poorer quality and less safe patient care, lower patient satisfaction, absenteeism and reduced workforce retention. Crises such as the pandemic not only generate new challenges but also intensify existing workplace stresses and chronic workforce shortages. As the COVID-19 pandemic continues, the global health workforce is burnt-out and under immense pressure, with multiple individual, organisational and healthcare system drivers. METHOD In this article, we examine how key organisational and leadership approaches can facilitate mental health support for HCWs and identify strategies to support HCWs that are critical for supporting workforce well-being during the pandemic. RESULTS We identified 12 key approaches at the organisational and individual levels for healthcare leadership to support workforce well-being during the COVID-19 crisis. These approaches may inform leadership responses to future crises. CONCLUSION Governments, healthcare organisations and leaders must invest and deliver long-term measures to value, support and retain the health workforce to preserve high-quality healthcare.
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Affiliation(s)
- Natasha Smallwood
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Respiratory Research@Alfred, Central Clinical School, The Alfred Hospital, Monash University, Clayton, Victoria, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Karen Willis
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
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Birkeland S, Bismark M, Barry MJ, Möller S. 'My doctor should decide' - Predictors for healthcare users' stated preferences regarding medical decision-making. Patient Educ Couns 2023; 114:107825. [PMID: 37269622 DOI: 10.1016/j.pec.2023.107825] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To investigate predictors for healthcare users' declared decision control preferences and test their association with satisfaction in vignettes detailing various decision-making. METHODS Cross-sectional vignette survey within a representative general male population aged 45-70 years (response rate 30%). Survey vignettes illustrated different levels of patient involvement. Participants rated their satisfaction with healthcare illustrated and separately rated their 'control preferences'. Comparisons were conducted with linear regression. RESULTS Preferring the doctor to predominantly or exclusively decide (1588/6755 respondents) was associated with older age, being single, lower education, having chronic illness, and living in low-income and less populated areas, with fewer non-western immigrants. Following adjustment, lower education and chronic illness remained statistically significant. Personalities with less openness had preference for least control. When presented with specific clinical scenarios, respondents preferring active or passive roles were equally satisfied with scenarios demonstrating shared decision-making. DISCUSSION Some groups of healthcare users were more likely to say that they preferred their doctor to decide. However, findings suggest that control preference statements, prior to facing a decision, should be interpreted with caution. PRACTICAL VALUE Study findings highlight that patients vary regarding their expressed wish for control in medical decision-making but they seem equally satisfied with shared decision-making scenarios.
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Affiliation(s)
- Søren Birkeland
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000 Odense, Denmark.
| | - Marie Bismark
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000 Odense, Denmark
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Bradfield O, Spittal M, Bismark M. Health impairment allegations against doctors: Qualitative analysis and insights for Australian general practitioners. Aust J Gen Pract 2023; 52:307-315. [PMID: 37149771 DOI: 10.31128/ajgp-08-22-6524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
METHOD A thematic analysis was conducted of semistructured interviews with 21 doctor-patients and four doctors' health experts. RESULTS Doctor-patient participants had experienced a past or family psychiatric history, personal loss or trauma, access to drugs at work, workplace stress or recent patient death or suicide. Many avoided seeking care and were significantly unwell when notified to medical regulators. Regulatory processes caused distress, symptom relapse, suicidality, financial pressures and work difficulties. Doctor-patient participants sought assistance from GPs, doctors' health services, medical defence organisations, recovery groups and benevolent associations. DISCUSSION When treating doctor-patients, GPs can consider targeted mental health screening, openly discussing mandatory reporting obligations and accessing advice from their medical defence organisation or local doctors' health service. Trust and clear communication benefits doctor-patients and the wider communities they serve.
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Affiliation(s)
- Owen Bradfield
- MBBS(Hons), BMedSc(Hons), LLB, MBA, FRACGP, Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic
| | - Matthew Spittal
- PhD, MBioStat, Professor, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic
| | - Marie Bismark
- MBChB (Otago), LLB, MBHL, MPH, MPsych, FAFPHM, Professor and Head of the Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic
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8
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Bradfield O, Jenkins K, Spittal M, Bismark M. Australian and New Zealand doctors' experiences of disciplinary notifications, investigations, proceedings and interventions relating to alleged mental health impairment: a qualitative analysis of interviews. Int J Law Psychiatry 2023; 86:101857. [PMID: 36571923 DOI: 10.1016/j.ijlp.2022.101857] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
When poor mental health impairs a doctor's ability to safely practise medicine, poor patient outcomes can result. Medical regulators play a critical role in protecting the public from impaired doctors, by requiring monitoring and treatment. However, regulatory processes may paradoxically harm doctors, with potential adverse implications for the community. There is little prior research examining the experiences of doctors with prior mental health or substance use challenges who are subject to regulatory notifications and processes relating to their health. Therefore, we explored this issue through the thematic analysis of semi-structured qualitative interviews. Participants reported that mandated treatment improved aspects of their health, but that fear of regulatory processes delayed them seeking treatment. Participants recognised being significantly unwell at the time of regulatory notification. Participants told us that regulatory processes triggered psychological distress, symptom relapse, and adverse financial and vocational implications. They also told us that these processes eroded their trust in regulators and regulatory processes. To improve health outcomes for unwell doctors and to create safer healthcare for the community, we propose: 1) greater awareness and education of the medical profession about the thresholds and requirements for mandatory reporting of health impairment; 2) better integrating specialised doctors' health services into existing regulatory pathways; and 3) adoption of a more therapeutic approach to regulation by medical regulators.
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Affiliation(s)
- Owen Bradfield
- Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, VIC 3010, Australia.
| | - Kym Jenkins
- Consultant Psychiatrist Cabrini Hospital Melbourne, Past President of the Royal Australian and New Zealand College of Psychiatrists, Past Medical Director Victorian Doctors' Health Program, Australia
| | - Matthew Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Marie Bismark
- Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia
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Abstract
OBJECTIVE To identify the prevalence and predictors of (a) thoughts of suicide or self-harm among healthcare workers during the COVID-19 pandemic and (b) help-seeking among those healthcare workers with thoughts of suicide or self-harm. METHOD Analysis of data from the Australian COVID-19 Frontline Healthcare Workers Study, an online survey of healthcare workers conducted during the second wave of the COVID-19 pandemic in Australia. Outcomes of interest were thoughts of suicide or self-harm as measured through the Patient Health Questionnaire for depression and help-seeking behaviours. RESULTS Overall, 819 (10.5%) of 7795 healthcare workers reported thoughts of suicide or self-harm over a 2-week period. Healthcare workers with these thoughts experienced higher rates of depression, anxiety, post-traumatic stress disorder and burnout than their peers. In multivariable models, the odds of suicide or self-harm thoughts were higher among workers who had friends or family infected with COVID-19 (odds ratio = 1.24, 95% confidence interval = [1.06, 1.47]), were living alone (odds ratio = 1.32, 95% confidence interval = [1.06, 1.64]), younger (⩽30 years cf. >50 years; odds ratio = 1.70, 95% confidence interval = 1.36-2.13), male (odds ratio = 1.81, 95% confidence interval = [1.49, 2.20]), had increased alcohol use (odds ratio = 1.58, 95% confidence interval = [1.35, 1.86]), poor physical health (odds ratio = 1.62, 95% confidence interval = [1.36, 1.92]), increased income worries (odds ratio = 1.81, 95% confidence interval = [1.54, 2.12]) or prior mental illness (odds ratio = 3.27, 95% confidence interval = [2.80, 3.82]). Having dependent children was protective (odds ratio = 0.75, 95% confidence interval = [0.61, 0.92]). Fewer than half (388/819) of the healthcare workers who reported thoughts of suicide or self-harm sought professional support. Healthcare workers with thoughts of suicide or self-harm were more likely to seek support if they were younger (⩽30 years cf. >50 years; odds ratio = 1.78, 95% confidence interval = [1.13, 2.82]) or had prior mental health concerns (odds ratio = 4.47, 95% confidence interval = [3.25, 6.14]). CONCLUSION One in 10 Australian healthcare workers reported thoughts of suicide or self-harm during the pandemic, with certain groups being more vulnerable. Most healthcare workers with thoughts of suicide or self-harm did not seek professional help. Strong and sustained action to protect the safety of healthcare workers, and provide meaningful support, is urgently needed.
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Affiliation(s)
- Marie Bismark
- Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia,Marie Bismark, Centre for Health Policy, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, Melbourne, VIC 3053, Australia.
| | - Katrina Scurrah
- 2 Centre for Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Amy Pascoe
- Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Karen Willis
- Institute for Health and Sport and College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Ria Jain
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Natasha Smallwood
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
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Birkeland S, Bismark M, Barry MJ, Möller S. Personality characteristics associated with satisfaction with healthcare and the wish to complain. BMC Health Serv Res 2022; 22:1305. [PMID: 36320078 PMCID: PMC9628068 DOI: 10.1186/s12913-022-08688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There is increasing evidence that satisfaction with healthcare and complaint rates vary with patients' socio-demographic characteristics. Likewise, patient personality might influence the perception of health care; however, empirical research has been scarce. The aim of this study was to investigate associations between health care user personality and satisfaction with care and urge to complain. METHODS This study is a randomized survey among Danish men aged 45 to 70 years (N = 6,756; 30% response rate) with hypothetical vignettes illustrating different courses of healthcare. Assuming they received the care described in vignettes, participants rated their satisfaction and wish to complain on a five-point Likert scale. Information on personality characteristics was obtained through self-reports using the standardized Big Five Inventory-10 (BFI-10). RESULTS In multivariate analyses, we found respondents with higher scores on the agreeableness dimension expressing greater satisfaction with care (Likert difference 0.06, 95% CI 0.04 to 0.07; p < 0.001) and decreased wish to complain (-0.07, 95% CI -0.08 to -0.05; p < 0.001) while high neuroticism scores were associated with less satisfaction (-0.02, 95% CI -0.03 to -0.00, p = 0.012) and an increased wish to complain about healthcare (0.04, 95% CI 0.03 to 0.06, p < 0.001). Interaction analyses could demonstrate no statistically significant interaction between the level of patient involvement in decision making in the scenarios and the effect of personality on respondents' satisfaction and wish to complain. Generally, however, when adjusting for personality, respondents' satisfaction increased (P < 0.001) with greater patient involvement illustrated in case scenarios while the wish to complain decreased (P < 0.001). CONCLUSION Our findings suggest low agreeableness and high neuroticism scores are associated with lower patient satisfaction with healthcare and increased wish to complain. Irrespective of personality, however, the wish to complain seems responsive to changes in patient involvement, underscoring the importance of inclusive healthcare communication.
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Affiliation(s)
- Søren Birkeland
- grid.7143.10000 0004 0512 5013Department of Clinical Research, University of Southern Denmark and Open Patient Data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. Floor, 5000 Odense C, Denmark
| | - Marie Bismark
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Michael J. Barry
- grid.38142.3c000000041936754XDivision of General Internal Medicine, Massachusetts, General Hospital & Harvard Medical School, Boston, USA
| | - Sören Möller
- grid.7143.10000 0004 0512 5013Department of Clinical Research, University of Southern Denmark and Open Patient Data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. Floor, 5000 Odense C, Denmark
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Birkeland S, Bismark M, Barry MJ, Möller S. Sociodemographic characteristics associated with a higher wish to complain about health care. Public Health 2022; 210:41-47. [PMID: 35870320 DOI: 10.1016/j.puhe.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/16/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Previous research has shown that patients who are older, less educated, or have lower income are less likely to lodge complaints about health care. This variation may reflect less wish to complain or inequitable access to complaint channels or remedies. We aimed to investigate associations between sociodemographic characteristics and health users' wish to complain. STUDY DESIGN This was a randomized case vignette survey among 6756 Danish men aged 45-70 years (30% response rate). METHODS Assuming they received the care in vignettes about prostate cancer (prostate-specific antigen) testing, participants rated their wish to complain on a 5-point Likert scale. Information on sociodemographic characteristics was obtained through self-reports and municipality-level information from national registries. RESULTS Lower education was associated with an increased wish to complain (mean Likert difference 0.44 [95% CI 0.36-0.51]; P < .001). The wish to complain was higher among unemployed men (difference 0.16 [95% CI 0.04-0.28]; P < .011) and those with a chronic illness (difference 0.06 [95% CI 0.02-0.10]; P < .004). Given the same healthcare scenarios, there was no difference in wish to complain among health users who were retired, living rurally, or from lower income groups. CONCLUSIONS Health users who are less educated, lower income, elderly, or from rural or minority communities appear to be as likely, or more likely, to wish to complain about health care as others. Yet, younger, well-educated, and higher income citizens are overrepresented in actual complaint statistics. The finding suggests persisting inequalities in the suitability or accessibility of complaint processes for some groups of patients.
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Affiliation(s)
- S Birkeland
- Department of Clinical Research, University of Southern Denmark and Open Patient Data Explorative Network, Odense University Hospital. J. B. Winsløws Vej 9 a, 3. Floor, DK-5000 Odense C, Denmark.
| | - M Bismark
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - M J Barry
- Division of General Internal Medicine, Massachusetts General Hospital & Harvard Medical School, USA
| | - S Möller
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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Lee SM, Martino E, Bismark M, Bentley R. Evidence to guide ethical decision-making in the management of older people living in squalor: a narrative review. Intern Med J 2022; 52:1304-1312. [PMID: 35762169 PMCID: PMC9544969 DOI: 10.1111/imj.15862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
Older people living in squalor present healthcare providers with a set of complex issues because squalor occurs alongside a variety of medical and psychiatric conditions, and older people living in squalor frequently decline intervention. To synthesise empirical evidence on squalor to inform ethical decision‐making in the management of squalor using the bioethical framework of principlism. A systematic literature search was conducted using Medline, Embase, PsycINFO and CINAHL databases for empirical research on squalor in older people. Given the limited evidence base to date, an interpretive approach to synthesis was used. Sixty‐seven articles that met the inclusion criteria were included in the review. Our synthesis of the research evidence indicates that: (i) older people living in squalor have a high prevalence of frontal executive dysfunction, medical comorbidities and premature deaths; (ii) interventions are complex and require interagency involvement, with further evaluations needed to determine the effectiveness and potential harm of interventions; and (iii) older people living in squalor utilise more medical and social resources, and may negatively impact others around them. These results suggest that autonomous decision‐making capacity should be determined rather than assumed. The harm associated with squalid living for the older person, and for others around them, means a non‐interventional approach is likely to contravene the principles of non‐maleficence, beneficence and justice. Adequate assessment of decision‐making capacity is of particular importance. To be ethical, any intervention undertaken must balance benefits, harms, resource utilisation and impact on others.
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Affiliation(s)
- Sook Meng Lee
- Department of Geriatric Medicine, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Erika Martino
- Research Fellow and PhD candidate in the NHMRC Centre of Research Excellence in Healthy Housing, The Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Professor of the Law and Public Health Unit of the Centre for Health Policy, The Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Bentley
- Professor and Director of the NHMRC Centre of Research Excellence in Healthy Housing, The Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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13
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Bismark M, Smallwood N, Jain R, Willis K. Thoughts of suicide or self-harm among healthcare workers during the COVID-19 pandemic: qualitative analysis of open-ended survey responses. BJPsych Open 2022; 8:e113. [PMID: 35699151 PMCID: PMC9203357 DOI: 10.1192/bjo.2022.509] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Healthcare workers are at higher risk of suicide than other occupations, and suicidal thoughts appear to have increased during the COVID-19 pandemic. AIMS To understand the experiences of healthcare workers with frequent thoughts of suicide or self-harm during the pandemic, including factors that contributed to their distress, and the supports that they found helpful. METHOD We used content analysis to analyse free-text responses to the Australian COVID-19 Frontline Healthcare Workers Study, from healthcare workers who reported frequent thoughts that they would be better off dead or of hurting themselves, on the Patient Health Questionnaire-9. RESULTS A total of 262 out of 7795 healthcare workers (3.4%) reported frequent thoughts of suicide or self-harm in the preceding 2 weeks. They described how the pandemic exacerbated pre-existing challenges in their lives, such as living with a mental illness, working in an unsupportive environment and facing personal stressors like relationship violence or unwell family members. Further deterioration in their mental health was triggered by heavier obligations at home and work, amid painful feelings of loneliness. They reported that workplace demands rose without additional resources, social and emotional isolation increased and many healthful activities became inaccessible. Tokenistic offers of support fell flat in the face of multiple barriers to taking leave or accessing professional help. Validation of distress, improved access to healthcare and a stronger sense of belonging were identified as helpful supports. CONCLUSIONS These findings highlight the need for better recognition of predisposing, precipitating, perpetuating and protective factors for thoughts of suicide and self-harm among healthcare workers.
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Affiliation(s)
- Marie Bismark
- Centre for Health Policy, The University of Melbourne, Australia
| | - Natasha Smallwood
- Department of Respiratory Medicine, The Alfred Hospital, Australia; and Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, The Alfred Hospital and Monash University, Australia
| | - Ria Jain
- Faculty of Medicine, Nursing and Health Sciences, Monash University Clayton, Australia
| | - Karen Willis
- Institute for Health and Sport, Victoria University, Australia
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14
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Bradfield OM, Bismark M, Scott A, Spittal M. Vocational and psychosocial predictors of medical negligence claims among Australian doctors: a prospective cohort analysis of the MABEL survey. BMJ Open 2022; 12:e055432. [PMID: 35649606 PMCID: PMC9171255 DOI: 10.1136/bmjopen-2021-055432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To understand the association between medical negligence claims and doctors' sex, age, specialty, working hours, work location, personality, social supports, family circumstances, self-rated health, self-rated life satisfaction and presence of recent injury or illness. DESIGN AND SETTING Prospective cohort study of Australian doctors. PARTICIPANTS 12 134 doctors who completed the Medicine in Australia: Balancing Employment and Life survey between 2013 and 2019. PRIMARY OUTCOME MEASURE Doctors named as a defendant in a medical negligence claim in the preceding 12 months. RESULTS 649 (5.35%) doctors reported being named in a medical negligence claim during the study period. In addition to previously identified demographic factors (sex, age and specialty), we identified the following vocational and psychosocial risk factors for claims: working full time (OR=1.48, 95% CI 1.13 to 1.94) or overtime hours (OR 1.70, 95% CI 1.29 to 2.23), working in a regional centre (OR 1.69, 95% CI 1.37 to 2.08), increasing job demands (OR 1.16, 95% CI 1.04 to 1.30), low self-rated life satisfaction (OR 1.43, 95% CI 1.08 to 1.91) and recent serious personal injury or illness (OR 1.40, 95% CI 1.13 to 1.72). Having an agreeable personality was mildly protective (OR 0.91, 95% CI 0.83 to 1.00). When stratified according to sex, we found that working in a regional area, low self-rated life satisfaction and not achieving work-life balance predicted medical negligence claims in male, but not female, doctors. However, working more than part-time hours and having a recent personal injury or illness predicted medical negligence claims in female, but not male, doctors. Increasing age predicted claims more strongly in male doctors. Personality type predicted claims in both male and female doctors. CONCLUSIONS Modifiable risk factors contribute to an increased risk of medical negligence claims among doctors in Australia. Creating more supportive work environments and targeting interventions that improve doctors' health and well-being could reduce the risk of medical negligence claims and contribute to improved patient safety.
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Affiliation(s)
- Owen M Bradfield
- Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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15
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Bradfield OM, Bismark M, Scott A, Spittal M. Medical negligence claims and the health and life satisfaction of Australian doctors: a prospective cohort analysis of the MABEL survey. BMJ Open 2022; 12:e059447. [PMID: 35589347 PMCID: PMC9121477 DOI: 10.1136/bmjopen-2021-059447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the association between medical negligence claims and doctors' self-rated health and life satisfaction. DESIGN Prospective cohort study. PARTICIPANTS Registered doctors practising in Australia who participated in waves 4 to 11 of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey between 2011 and 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Self-rated health and self-rated life satisfaction. RESULTS Of the 15 105 doctors in the study, 885 reported being named in a medical negligence claim. Fixed-effects linear regression analysis showed that both self-rated health and self-rated life satisfaction declined for all doctors over the course of the MABEL survey, with no association between wave and being sued. However, being sued was not associated with any additional declines in self-rated health (coef.=-0.02, 95% CI -0.06 to 0.02, p=0.39) or self-rated life satisfaction (coef.=-0.01, 95% CI -0.08 to 0.07, p=0.91) after controlling for a range of job factors. Instead, we found that working conditions and job satisfaction were the strongest predictors of self-rated health and self-rated life satisfaction in sued doctors. In analyses restricted to doctors who were sued, we observed no changes in self-rated health (p=0.99) or self-rated life satisfaction (p=0.59) in the years immediately following a claim. CONCLUSIONS In contrast to prior overseas cross-sectional survey studies, we show that medical negligence claims do not adversely affect the well-being of doctors in Australia when adjusting for time trends and previously established covariates. This may be because: (1) prior studies failed to adequately address issues of causation and confounding; or (2) legal processes governing medical negligence claims in Australia cause less distress compared with those in other jurisdictions. Our findings suggest that the interaction between medical negligence claims and poor doctors' health is more complex than revealed through previous studies.
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Affiliation(s)
- Owen M Bradfield
- Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Bismark M, Tibble H, Moore JS, Morris JM, Paterson R, Fletcher M, Studdert D. Eyes and Ears on Patient Safety: Sources of Notifications About the Health, Performance, and Conduct of Health Practitioners. J Patient Saf 2021; 17:e800-e805. [PMID: 30480651 DOI: 10.1097/pts.0000000000000544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to describe the sources of notifications of concern ("notifications") regarding the health, performance, and conduct of health practitioners from 14 registered professions in Australia. METHODS This retrospective cohort study analyzed 43,256 notifications lodged with the Australian Health Practitioner Regulation Agency and the Health Professional Councils Authority between 2011 and 2016. We used descriptive statistical analysis to describe the characteristics of these notifications, including their source, issue and domain, and subject. RESULTS Patients and their relatives lodged more than three-quarters (78%) of notifications regarding clinical performance, including diagnosis, treatment, and communication. Fellow practitioners were a common source of notifications about advertising and titles. Self-reports commonly related to health impairments, such as mental illness or substance use. Other agencies played a role in reporting concerns about prescribing or supply of medicines. CONCLUSIONS Various actors in the healthcare system play different roles in sketching the picture of healthcare quality and safety that notifications present to regulators. Improved understanding of which sources are most likely to raise which concerns may enhance regulators' ability to identify and respond to patient safety risks.
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Affiliation(s)
- Marie Bismark
- From the Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Holly Tibble
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | | | - Jennifer Michelle Morris
- From the Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | | | - Martin Fletcher
- Australian Health Practitioner Regulation Agency, Melbourne, Victoria, Australia
| | - David Studdert
- Stanford University School of Medicine and Stanford Law School, Stanford, California
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17
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Smallwood N, Karimi L, Bismark M, Putland M, Johnson D, Dharmage SC, Barson E, Atkin N, Long C, Ng I, Holland A, Munro JE, Thevarajan I, Moore C, McGillion A, Sandford D, Willis K. High levels of psychosocial distress among Australian frontline healthcare workers during the COVID-19 pandemic: a cross-sectional survey. Gen Psychiatr 2021; 34:e100577. [PMID: 34514332 PMCID: PMC8423519 DOI: 10.1136/gpsych-2021-100577] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/03/2021] [Indexed: 12/17/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has had a profound and prolonged impact on healthcare services and healthcare workers. Aims The Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues, as well as the social, workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic. Methods A nationwide, voluntary, anonymous, single timepoint, online survey was conducted between 27 August and 23 October 2020. Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate. Participants were recruited through health organisations, professional associations or colleges, universities, government contacts and national media. Demographics, home and work situation, health and psychological well-being data were collected. Results A total of 9518 survey responses were received; of the 9518 participants, 7846 (82.4%) participants reported complete data. With regard to age, 4110 (52.4%) participants were younger than 40 years; 6344 (80.9%) participants were women. Participants were nurses (n=3088, 39.4%), doctors (n=2436, 31.1%), allied health staff (n=1314, 16.7%) or in other roles (n=523, 6.7%). In addition, 1250 (15.9%) participants worked in primary care. Objectively measured mental health symptoms were common: mild to severe anxiety (n=4694, 59.8%), moderate to severe burnout (n=5458, 70.9%) and mild to severe depression (n=4495, 57.3%). Participants were highly resilient (mean (SD)=3.2 (0.66)). Predictors for worse outcomes on all scales included female gender; younger age; pre-existing psychiatric condition; experiencing relationship problems; nursing, allied health or other roles; frontline area; being worried about being blamed by colleagues and working with patients with COVID-19. Conclusions The COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers. Crisis preparedness together with policies and practices addressing psychological well-being are needed.
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Affiliation(s)
- Natasha Smallwood
- Department of Respiratory Medicine, Alfred Hospital, Prahran, Victoria, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,School of Medicine and Healthcare Management, Caucasus University, Tbilisi, Georgia
| | - Marie Bismark
- Department of Psychiatry, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Public Health Law, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Mark Putland
- Department of Emergency Services, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Douglas Johnson
- Departments of General Medicine and Infectious Diseases, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Shyamali Chandrika Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Elizabeth Barson
- Department of Allied Health, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nicola Atkin
- Parkville Integrated Palliative Care Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Claire Long
- Department of Geriatric Medicine, Western Health, Footscray, Victoria, Australia
| | - Irene Ng
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Anne Holland
- Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Jane E Munro
- Rheumatology Unit, Royal Children's Hospital, Parkville, Victoria, Australia.,Arthritis and Rheumatology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Irani Thevarajan
- Department of Infectious Diseases, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Cara Moore
- Department of Intensive Care Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Anthony McGillion
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Debra Sandford
- Royal Adelaide Hospital, University of South Australia, Adelaide, South Australia, Australia
| | - Karen Willis
- College of Health and Biomedicine, Victoria University, Footscray, Victoria, Australia.,Division of Critical Care and Investigative Services, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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18
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Smallwood N, Pascoe A, Karimi L, Bismark M, Willis K. Occupational Disruptions during the COVID-19 Pandemic and Their Association with Healthcare Workers' Mental Health. Int J Environ Res Public Health 2021; 18:ijerph18179263. [PMID: 34501854 PMCID: PMC8431156 DOI: 10.3390/ijerph18179263] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Background: The COVID-19 crisis has caused prolonged and extreme demands on healthcare services. This study investigates the types and prevalence of occupational disruptions, and associated symptoms of mental illness, among Australian frontline healthcare workers during the COVID-19 pandemic. Methods: A national cross-sectional online survey was conducted between 27 August and 23 October 2020. Frontline healthcare workers were invited to participate via dissemination from major health organisations, professional associations or colleges, universities, government contacts, and national media. Data were collected on demographics, home and work situations, and validated scales of anxiety, depression, PTSD, and burnout. Results: Complete responses were received from 7846 healthcare workers (82.4%). Most respondents were female (80.9%) and resided in the Australian state of Victoria (85.2%). Changes to working conditions were common, with 48.5% reporting altered paid or unpaid hours, and many redeployed (16.8%) or changing work roles (27.3%). Nearly a third (30.8%) had experienced a reduction in household income during the pandemic. Symptoms of mental illness were common, being present in 62.1% of participants. Many respondents felt well supported by their workplaces (68.3%) and believed that workplace communication was timely and useful (74.4%). Participants who felt well supported by their organisation had approximately half the risk of experiencing moderate to severe anxiety, depression, burnout, and PTSD. Half (50.4%) of respondents indicated a need for additional training in using personal protective equipment and/or caring for patients with COVID-19. Conclusions: Occupational disruptions during the COVID-19 pandemic occurred commonly in health organisations and were associated with worse mental health outcomes in the Australian health workforce. Feeling well supported was associated with significantly fewer adverse mental health outcomes. Crisis preparedness focusing on the provision of timely and useful communication and support is essential in current and future crises.
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Affiliation(s)
- Natasha Smallwood
- Department of Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, Prahran, VIC 3004, Australia
- Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, VIC 3004, Australia;
- Correspondence: ; Tel.: +61-3-9903-8735
| | - Amy Pascoe
- Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, VIC 3004, Australia;
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3083, Australia;
- School of Medicine and Healthcare Management, Caucasus University, Tbilisi 0102, Georgia
| | - Marie Bismark
- Department of Psychiatry, Royal Melbourne Hospital, Grattan St, Parkville, VIC 3050, Australia;
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3050, Australia
| | - Karen Willis
- College of Health and Biomedicine, Victoria University, Footscray, Melbourne, VIC 3011, Australia;
- Division of Critical Care and Investigative Services, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia
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19
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Birkeland S, Bismark M, Barry MJ, Möller S. Does greater patient involvement in healthcare decision-making affect malpractice complaints? A large case vignette survey. PLoS One 2021; 16:e0254052. [PMID: 34214136 PMCID: PMC8253406 DOI: 10.1371/journal.pone.0254052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/19/2021] [Indexed: 12/14/2022] Open
Abstract
Background Although research findings consistently find poor communication about medical procedures to be a key predictor of patient complaints, compensation claims, and malpractice lawsuits (“complaints”), there is insufficient evidence to determine if greater patient involvement could actually affect the inclination to complain. Objectives We conducted an experimental case vignette survey that explores whether greater patient involvement in decision-making is likely to influence the intention to complain given different decisions and consequences. Methods Randomized, national case vignette survey with various levels of patient involvement, decisions, and outcomes in a representative Danish sample of men. We used prostate specific antigen (PSA) screening in men aged 45 to 70 years as the intervention illustrated in 30 different versions of a mock clinical encounter. Versions differed in the amount of patient involvement, the decision made (PSA test or no PSA test), and the clinical outcomes (no cancer detected, detection of treatable cancer, and detection of non-treatable cancer). We measured respondents’ inclination to complain about care in response to the scenarios on a 5-point Likert scale (from 1: very unlikely to 5: very likely). Results The response rate was 30% (6,756 of 22,288). Across all scenarios, the likelihood of complaint increased if the clinical outcome was poor (untreatable cancer). Compared with scenarios that involved shared decision-making (SDM), neutral information, or nudging in favor of screening, the urge to complain increased if the patient was excluded from decision-making or if the doctor had nudged the patient to decline screening (mean Likert differences .12 to .16, p < .001). With neutral involvement or nudging in favor of intervention, the desire to complain depended highly on the decision reached and on the patient’s course. This dependence was smaller with SDM. Conclusions Greater patient involvement in decision-making appears to be associated with less intention to complain about health care, with SDM resulting in the greatest reduction in complaint likelihood.
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Affiliation(s)
- Søren Birkeland
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marie Bismark
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Michael J. Barry
- Harvard Medical School, Boston, Massachusetts, United States of America
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Sören Möller
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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20
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Birkeland S, Bismark M, Barry MJ, Möller S. Is greater patient involvement associated with higher satisfaction? Experimental evidence from a vignette survey. BMJ Qual Saf 2021; 31:86-93. [PMID: 33888595 DOI: 10.1136/bmjqs-2020-012786] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patient-centredness is an essential quality parameter of modern healthcare. Accordingly, involving patients in decisions about care is required by international laws and an increasing number of medical codes and standards. These directives are based on ethical principles of autonomy. Still, there is limited empirical knowledge about the influence of patient involvement on satisfaction with care. OBJECTIVE In a large national vignette survey, we aimed to empirically test healthcare users' satisfaction with healthcare given different degrees of patient involvement, choices made and outcomes. METHODS A web-based cross-sectional survey distributed to a randomised sample of men in Denmark aged 45-70 years. Case vignettes used prostate-specific antigen (PSA) screening for early detection of prostate cancer as a clinical model. Using a 5-point Likert scale, we measured respondents' satisfaction with care in scenarios which differed in the amount of patient involvement (ranging from no involvement, through involvement with neutral or nudged information, to shared decision-making), the decision made (PSA test or no PSA test) and clinical outcomes (no cancer detected, detection of treatable cancer and detection of non-treatable cancer). RESULTS Participating healthcare users tended to be more satisfied with healthcare in scenarios illustrating greater levels of patient involvement. Participants were positive towards nudging in favour of the intervention but patient involvement through shared decision-making obtained the highest satisfaction ratings (Likert rating 3.81 without any involvement vs 4.07 for shared decision-making, p<0.001). Greater involvement also had an ameliorating effect on satisfaction if a non-treatable cancer was later diagnosed. CONCLUSION Our study provides empirical support for the hypothesis that greater patient involvement in healthcare decision-making improves satisfaction with care irrespective of decisions made and clinical outcomes. Overall satisfaction with the care illustrated was highest when decisions were reached through shared decision-making.
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Affiliation(s)
- Søren Birkeland
- Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark .,Open Patient data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark
| | - Marie Bismark
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael John Barry
- Informed Medical Decisions Program, Division of General Internal Medicine, Department of Medicine, and The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark.,Open Patient data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark
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21
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Schulz-Moore JS, Bismark M, Jenkinson C, Mello MM. Assessing Patients' Experiences with Medical Injury Reconciliation Processes: Item Generation for a Novel Survey Questionnaire. Jt Comm J Qual Patient Saf 2021; 47:376-384. [PMID: 33836941 DOI: 10.1016/j.jcjq.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many health care organizations want to improve their responses to patients who suffer medical injuries. Their ability to understand how well they meet patients' needs is limited by the lack of suitable instruments for assessing injured patients' experiences. METHODS This study aimed to generate items for a patient experience questionnaire that medical facilities can use to assess how well resolution met patients' needs. The Medical Injury Reconciliation Experiences Survey (MIRES) was based on findings from previous studies of New Zealand and American patients' experiences of non-litigation resolution of medical injuries. The researchers performed a content analysis of 24 transcripts from a stratified random sample of 92 interviews from the prior studies. Themes were extracted to develop a draft questionnaire, which was revised following feedback from experts. Cognitive debriefing interviews were conducted with 24 New Zealand and American injured patients. RESULTS There were 40 items in the following domains: perceptions of communications with health care providers after the injury (15 items), perceptions of remedial gestures (11 items), indicia of the patient's overall satisfaction with the reconciliation process (4 items), the nature and impacts of the injury (5 items), and patients' characteristics (5 items). Participants' feedback about the questionnaire was predominantly positive. Their suggestions led to 37 revisions. CONCLUSION The MIRES was comprehensible and acceptable to this group of post-injury patients. While further testing is desirable, the MIRES offers promise as a practicable approach that health care organizations can use to assess how well their reconciliation processes met patients' needs.
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Prang KH, Canaway R, Bismark M, Dunt D, Miller JA, Kelaher M. The impact of public performance reporting on cancer elective surgery waiting times: a data linkage study. BMC Health Serv Res 2021; 21:129. [PMID: 33557805 PMCID: PMC7871621 DOI: 10.1186/s12913-021-06132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/28/2021] [Indexed: 12/09/2022] Open
Abstract
Background Excessive waiting times for cancer elective surgery are a concern in publicly funded healthcare systems. Several countries including Australia have introduced healthcare reforms involving time-based targets and public performance reporting (PPR) of hospital data. However, there is mixed evidence of their benefits. We sought to examine the impact of targets and PPR of cancer elective surgery waiting times on access to breast, bowel and lung cancer elective surgery. Methods We analysed routinely-collected linked data on admissions and waiting times for patients aged 15 years or over (n = 199,885) who underwent cancer surgery in a public hospital in Victoria, Australia over a 10-year period. We conducted difference-in-differences analyses to compare waiting times before (2006–07 to 2011–12) and after (2012–13 to 2015–16) the introduction of PPR in meeting these targets. Results Across all cancer types, urgent patients were all treated within 30 days before and after PPR. Following PPR, there was a slight increase in the mean waiting times across all cancer types and urgency categories. Patients with lung cancer waited on average two and half days longer for treatment and patients with breast cancer waited on average half-a-day less. There was no effect of PPR on waiting times for patients with bowel cancer across urgency categories. Conclusions Our findings suggest that time-based targets and PPR had minimal impact on surgical waiting times. This may be due to reasonable waiting times prior to PPR, improved efficiency being masked by 20% growth in the population, lack of public knowledge that waiting times are publicly reported, or lack of real-time reporting to drive behavioural change. The use of generic elective surgery recommended waiting time measures for cancer is discussed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06132-w.
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Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie A Miller
- Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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23
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Canaway R, Prang KH, Bismark M, Dunt D, Kelaher M. Public disclosure of hospital clinicians' performance data: insights from medical directors. AUST HEALTH REV 2021; 44:228-233. [PMID: 31296279 DOI: 10.1071/ah18128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 01/30/2019] [Indexed: 11/23/2022]
Abstract
Objective This study gathered information from public hospital chief medical officers to better understand underlying mechanisms through which public reporting affects institutional behavioural change and decision making towards quality improvement. Methods This qualitative study used thematic analysis of 17 semistructured, in-depth interviews among a peak group of medical directors representing 26 health services in Victoria, Australia. Results The medical directors indicated a high level of in-principle support for public reporting of identifiable, individual clinician-level data. However, they also described varying conceptual understanding of what public reporting of performance data is. Overall, they considered public reporting of individual clinicians' performance data a means to improve health care quality, increase transparency and inform consumer healthcare decision making. Most identified caveats that would need to be met before such data should be publicly released, in particular the need to resolve issues around data quality and timeliness, context and interpretation and ethics. Acknowledgement of the public's right to access individual clinician-level data was at odds with some medical directors' belief that such reporting may diminish trust between clinicians and their employers, thus eroding rather than motivating quality improvement. Conclusions Public reporting of identifiable individual healthcare clinicians' performance data is an issue that merits robust research and debate given the effects such reporting may have on doctors and on hospital quality and safety. What is known about the topic? The public reporting of individual clinician-level data is a mechanism used in some countries, but not in Australia, for increasing health care transparency and quality. Clinician-level public reporting of doctors' performance attracts contention and debate in Australia. What does this paper add? This paper informs debate around the public reporting of individual clinician-level performance data. Among a discrete cohort of senior hospital administrators in Victoria, Australia, there was strong in-principle support for such public reporting as a means to improve hospital quality and safety. What are the implications for practitioners? Before public reporting of individual clinician performance data could occur in Australia, resolution of issues would be required relating to legality and ethics, data context and interpretation, data quality and timeliness.
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Affiliation(s)
- Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia. ; ; ; and Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic. 3010, Australia.
| | - Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia. ; ;
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia. ; ;
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia. ; ;
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia. ; ; ; and Corresponding author.
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24
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Smallwood N, Karimi L, Pascoe A, Bismark M, Putland M, Johnson D, Dharmage SC, Barson E, Atkin N, Long C, Ng I, Holland A, Munro J, Thevarajan I, Moore C, McGillion A, Willis K. Coping strategies adopted by Australian frontline health workers to address psychological distress during the COVID-19 pandemic. Gen Hosp Psychiatry 2021; 72:124-130. [PMID: 34454341 PMCID: PMC8437691 DOI: 10.1016/j.genhosppsych.2021.08.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The Australian COVID-19 Frontline Healthcare Workers Study investigated coping strategies and help-seeking behaviours, and their relationship to mental health symptoms experienced by Australian healthcare workers (HCWs) during the COVID-19 pandemic. METHODS Australian HCWs were invited to participate a nationwide, voluntary, anonymous, single time-point, online survey between 27th August and 23rd October 2020. Complete responses on demographics, home and work situation, and measures of health and psychological wellbeing were received from 7846 participants. RESULTS The most commonly reported adaptive coping strategies were maintaining exercise (44.9%) and social connections (31.7%). Over a quarter of HCWs (26.3%) reported increased alcohol use which was associated with a history of poor mental health and worse personal relationships. Few used psychological wellbeing apps or sought professional help; those who did were more likely to be suffering from moderate to severe symptoms of mental illness. People living in Victoria, in regional areas, and those with children at home were significantly less likely to report adaptive coping strategies. CONCLUSIONS Personal, social, and workplace predictors of coping strategies and help-seeking behaviour during the pandemic were identified. Use of maladaptive coping strategies and low rates of professional help-seeking indicate an urgent need to understand the effectiveness of, and the barriers and enablers of accessing, different coping strategies.
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Affiliation(s)
- Natasha Smallwood
- Department of Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, Prahran, Victoria 3004, Australia; Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria 3004, Australia.
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, VIC 3083, Australia,School of Medicine and Healthcare Management, Caucasus University, Tbilisi, Georgia
| | - Amy Pascoe
- Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria 3004, Australia
| | - Marie Bismark
- Department of Psychiatry, Royal Melbourne Hospital, Grattan St Parkville, Vic 3050, Australia,Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3050, Australia
| | - Mark Putland
- Department of Emergency Services, Royal Melbourne Hospital, Grattan St Parkville, Vic 3050, Australia,Department of Critical Care, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Australia
| | - Douglas Johnson
- Departments of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050, Australia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3050, Australia
| | - Elizabeth Barson
- Department of Allied Health, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia
| | - Nicola Atkin
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria 3050, Australia
| | - Clare Long
- Department of Geriatric Medicine, Western Health, 160 Gordon St, Footscray, VIC 3011, Australia
| | - Irene Ng
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia,Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Grattan Street, Parkville, Victoria 3050, Australia
| | - Anne Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Australia,Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Melbourne, Australia,Institute for Breathing and Sleep, Melbourne, Australia
| | - Jane Munro
- Rheumatology Unit, Royal Children's Hospital, Parkville, Victoria 3050, Australia,Arthritis and Rheumatology, Murdoch Children's Research Institute, Parkville, Victoria 3050, Australia,Department of Paediatrics, University of Melbourne, Parkville, Victoria 3050, Australia
| | - Irani Thevarajan
- Department of Infectious Diseases, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia
| | - Cara Moore
- Department of Intensive Care Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia
| | - Anthony McGillion
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Australia,Royal Adelaide Hospital, University of South Australia, Australia
| | - Karen Willis
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, Vic 3083, Australia,Division of Critical Care and Investigative Services, Royal Melbourne Hospital, Grattan Street, Parkville, Vic 3050, Australia
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25
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Faulkner N, Wright B, Lennox A, Bismark M, Boag J, Boffa S, Waxman B, Watson-Kruse J, Paine G, Bragge P. Simulation-based training for increasing health service board members' effectiveness: a cluster randomised controlled trial. BMJ Open 2020; 10:e034994. [PMID: 33318104 PMCID: PMC7737029 DOI: 10.1136/bmjopen-2019-034994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES There is a paucity of research on how to improve the functioning of health service boards, despite their importance in influencing patient care. We examined the impact of simulation-based training on health service board members' perceptions of their skills in communicating during board meetings and of board meeting processes. DESIGN Prospective, cluster randomised controlled trial. SETTING Health service boards in Victoria, Australia. PARTICIPANTS Twelve boards were randomised, and pre- and post-intervention data were collected and analysed from 57 members of these boards. INTERVENTIONS Boards were randomly allocated to either a treatment condition in which they received a 2-hour simulation-based training session or to a wait list control condition. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome variables were board members' perceptions regarding: (1) their skill and confidence in communicating during board meetings and (2) processes at their board meetings. Measures were collected in the intervention group before and 3 months post-training and compared with a wait list control group. RESULTS Skills and confidence in communicating during board meetings was higher after training (control marginal mean=5.11, intervention marginal mean=5.42, mean difference=0.31, 90% CI (-0.03 to 0.66), one-sided p=0.068, d=0.40). Board meeting processes were also improved after training (control marginal mean=4.97, intervention marginal mean=5.37, mean difference=0.40, 90% CI (0.14 to 0.65), one-sided p=0.005, d=0.54). CONCLUSIONS Simulation-based training appeared to improve board members' skills and confidence, and perceptions of board meeting processes. A larger scale trial is needed to examine possible impacts on patient outcomes. TRIAL REGISTRATION Open Science Framework: http://osf.io/jaxt6/; Pre-results.
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Affiliation(s)
- Nicholas Faulkner
- BehaviourWorks Australia, Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Breanna Wright
- BehaviourWorks Australia, Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Alyse Lennox
- BehaviourWorks Australia, Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Marie Bismark
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Boag
- Victorian Managed Insurance Authority, Melbourne, Victoria, Australia
| | - Sophie Boffa
- Safer Care Victoria, Victoria Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Bruce Waxman
- Wonthaggi Hospital, Bass Coast Health, Wonthaggi, Victoria, Australia
| | | | - Geoff Paine
- BehaviourWorks Australia, Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
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26
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Taouk Y, Bismark M, Hattingh HL. Pharmacists subject to complaints: a national study of pharmacists reported to health regulators in Australia. J Pharm Pract Res 2020. [DOI: 10.1002/jppr.1633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yamna Taouk
- Centre for Health Policy Melbourne School of Population and Global Health The University of Melbourne Melbourne Australia
| | - Marie Bismark
- Centre for Health Policy Melbourne School of Population and Global Health The University of Melbourne Melbourne Australia
| | - Hendrika Laetitia Hattingh
- Gold Caost Health Queensland Health Gold Coast Australia
- School of Pharmacy and Pharmacology Quality Use of Medicines Network Clinical Sciences 2 Griffith University Australia
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27
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Schulz Moore J, Mello MM, Bismark M. 'Poking the skunk': Ethical and medico-legal concerns in research about patients' experiences of medical injury. Bioethics 2019; 33:948-957. [PMID: 31222898 DOI: 10.1111/bioe.12599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 12/19/2018] [Accepted: 01/13/2019] [Indexed: 06/09/2023]
Abstract
Improving how health care providers respond to medical injury requires an understanding of patients' experiences. Although many injured patients strongly desire to be heard, research rarely involves them. Institutional review boards worry about harming participants by asking them to revisit traumatic events, and hospital staff worry about provoking lawsuits. Institutions' reluctance to approve this type of research has slowed progress toward responses to injuries that are better able to meet patients' needs. In 2015-2016, we were able to surmount these challenges and interview 92 injured patients and families in the USA and New Zealand. This article explores whether the ethical and medico-legal concerns are, in fact, well-founded. Consistent with research about trauma-research-related distress, our participants' accounts indicate that the pervasive fears about retraumatization are unfounded. Our experience also suggests that because being heard is an important (but often unmet) need for injured patients, talking provides psychological benefits and may decrease rather than increase the impetus to sue. Our article makes recommendations to institutional review boards and researchers. The benefits to responsibly conducted research with injured patients outweigh the risks to participants and institutions.
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Affiliation(s)
| | - Michelle M Mello
- Stanford Law School and Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Marie Bismark
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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28
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Canaway R, Bismark M, Dunt D, Kelaher M. Public reporting of hospital performance data: views of senior medical directors in Victoria, Australia. AUST HEALTH REV 2019; 42:591-599. [PMID: 28988569 DOI: 10.1071/ah17120] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to better understand senior medical directors' perceptions of public reporting of hospital performance data, how public reporting affects institutional behavioural change towards quality improvement and how it could be improved. Methods Interviews were undertaken with 17 medical directors representing 26 metropolitan and regional public hospitals in Victoria, Australia, between June and August 2016. Data were analysed thematically. Results Medical directors are well placed to comment on clinical and administrative aspects of quality, safety and performance monitoring in public hospitals. Their responses largely suggested that public reporting of hospital performance data in Australia is immature and not fulfilling its potential. There was little consensus among informants around what public reporting is, who it is for or its purpose. Although public reporting was considered to have important functions for hospitals and consumers, it was generally considered to lack robustness and have underutilised potential to inform consumers, build trust and drive quality and performance improvements within hospitals. Conclusions The next steps needed to advance public reporting of hospital performance data in Australia include engaging clinicians and patients in selection and development of metrics, improving timeliness of reporting, and improving communication of information so that it is accessible and meaningful for different audiences. What is known about the topic? Public reporting of hospital performance data is a mechanism increasingly used in the Australian health system, but it has attracted little research. What does this paper add? This paper reveals a lack of shared understanding among medical directors in Victoria, Australia, on what public reporting of hospital performance data is, who it is for and its purpose. The paper highlights the potential importance of public reporting of hospital performance data for rural and regional healthcare consumers and how it may be strengthened. What are the implications for practitioners? Stronger systems of public reporting of hospital performance data have the potential to increase consumer engagement and improve hospital performance, quality and safety. Awareness of the discourse around public reporting of hospital performance data can increase practitioners' engagement in debate and development of reporting systems.
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Affiliation(s)
- Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
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29
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Prang KH, Canaway R, Bismark M, Dunt D, Kelaher M. Associations between patient experiences and clinical outcomes: a cross-sectional data linkage study of the Australian private healthcare sector. BMJ Open Qual 2019; 8:e000637. [PMID: 31523739 PMCID: PMC6711428 DOI: 10.1136/bmjoq-2019-000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/29/2019] [Accepted: 07/31/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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30
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Sherwood R, Bismark M. The ageing surgeon: a qualitative study of expert opinions on assuring performance and supporting safe career transitions among older surgeons. BMJ Qual Saf 2019; 29:113-121. [PMID: 31363015 PMCID: PMC7045790 DOI: 10.1136/bmjqs-2019-009596] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/15/2019] [Accepted: 06/19/2019] [Indexed: 12/01/2022]
Abstract
Background Unlike some other safety critical professions, there is no mandatory age of retirement for doctors, including surgeons. Medical regulators in Australia are implementing additional checks on doctors from the age of 70. We describe expert opinions on assuring performance and supporting career transitions among older surgeons. Methods In this qualitative study, experts in four countries were purposively selected for their expertise in surgical governance. Experts responded to interviews (Australia, New Zealand and UK) or a survey (Canada). A tiered framework of interventions was developed by integrating findings with previous literature and responsive regulation theory. Results 52 experts participated. Participants valued the contribution of senior surgeons, while acknowledging that age-related changes can affect performance. Participants perceived that identity, relationships and finances influence retirement decisions. Experts were divided on the need for age-specific testing, with some favouring whole-of-career approaches to assuring safe care. A lack of validated tools for assessing performance of older surgeons was highlighted. Participants identified three options for addressing performance concerns—remediate, restrict or retire—and emphasised the need for co-ordinated and timely responses. Conclusion Experts perceive the need for a staged approach to assessing the performance of older surgeons and tailoring interventions. Most older surgeons are seen to make decisions around career transitions with self-awareness and concern for patient safety. Some older surgeons may benefit from additional guidance and support from employers and professional colleges. A few poorly performing older surgeons, who are recalcitrant or lack insight, require regulatory action to protect patient safety. Developing robust processes to assess performance, remediate deficits and adjust scopes of practice could help to support safe career transitions at any age.
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Affiliation(s)
- Rupert Sherwood
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia .,Division of Women's and Children's, Western Health, St Albans, Victoria, Australia
| | - Marie Bismark
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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31
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Faulkner N, Wright B, Bragge P, Lennox A, Bismark M, Boag J, Boffa S, Waxman B. Simulation-based training for increasing health service board members' effectiveness: protocol for a cluster-randomised controlled trial. BMJ Open 2019; 9:e025170. [PMID: 31005915 PMCID: PMC6500314 DOI: 10.1136/bmjopen-2018-025170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Research indicates that health service boards can influence quality of care. However, government reviews have indicated that board members may not be as effective as possible in attaining this goal. Simulation-based training may help to increase board members' ability to effectively communicate and hold hospital staff to account during board meetings. METHODS AND ANALYSIS To test effectiveness and feasibility, a prospective, cluster-randomised controlled trial will be used to compare simulation-based training with no training. Primary outcome variables will include board members' perceived skill and confidence in communicating effectively during board meetings, and board members' perceptions of board meeting processes. These measures will be collected both immediately before training, and 3 months post-training, with boards randomly assigned to intervention or control arms. Primary analyses will comprise generalised estimating equations examining training effects on each of the primary outcomes. Secondary analyses will examine participants' feedback on the training. ETHICS AND DISSEMINATION Research ethics approval has been granted by Monash University (reference number: 2018-12076). We aim to disseminate results through peer-reviewed journal publication, conference presentation and social media. TRIAL REGISTRATION NUMBER Open Science Framework: http://osf.io/jaxt6/; Pre-results.
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Affiliation(s)
- Nicholas Faulkner
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Breanna Wright
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Alyse Lennox
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Marie Bismark
- Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Jane Boag
- Victorian Managed Insurance Authority, Melbourne, Victoria, Australia
| | - Sophie Boffa
- Department of Health & Human Services, Safer Care Victoria, Melbourne, Victoria, Australia
| | - Bruce Waxman
- Bass Coast Health, Wonthaggi, Victoria, Australia
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32
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Keogh LA, Gillam L, Bismark M, McNamee K, Webster A, Bayly C, Newton D. Conscientious objection to abortion, the law and its implementation in Victoria, Australia: perspectives of abortion service providers. BMC Med Ethics 2019; 20:11. [PMID: 30700292 PMCID: PMC6354355 DOI: 10.1186/s12910-019-0346-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/14/2019] [Indexed: 11/11/2022] Open
Abstract
Background In Victoria, Australia, the law regulating abortion was reformed in 2008, and a clause (‘Section 8’) was introduced requiring doctors with a conscientious objection to abortion to refer women to another provider. This study reports the views of abortion experts on the operation of Section 8 of the Abortion Law Reform Act in Victoria. Methods Nineteen semi-structured qualitative interviews were conducted with purposively selected Victorian abortion experts in 2015. Interviews explored the impact of abortion law reform on service provision, including the understanding and implementation of Section 8. Interviews were transcribed verbatim and analysed thematically. Results The majority of participants described Section 8 as a mechanism to protect women’s right to abortion, rather than a mechanism to protect doctors’ rights. All agreed that most doctors would not let moral or religious beliefs impact on their patients, and yet all could detail negative experiences related to Section 8. The negative experiences arose because doctors had: directly contravened the law by not referring; attempted to make women feel guilty; attempted to delay women’s access; or claimed an objection for reasons other than conscience. Use or misuse of conscientious objection by Government telephone staff, pharmacists, institutions, and political groups was also reported. Conclusion Some doctors are not complying with Section 8, with adverse effects on access to care for some women. Further research is needed to inform strategies for improving compliance with the law in order to facilitate timely access to abortion services.
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Affiliation(s)
- Louise Anne Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, 3010, Australia.
| | - Lynn Gillam
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, 3010, Australia.,Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Kathleen McNamee
- Family Planning Victoria, Melbourne, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Amy Webster
- Women's Health Victoria, Melbourne, Australia
| | | | - Danielle Newton
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, 3010, Australia
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Prang KH, Canaway R, Bismark M, Dunt D, Kelaher M. The impact of Australian healthcare reforms on emergency department time-based process outcomes: An interrupted time series study. PLoS One 2018; 13:e0209043. [PMID: 30540856 PMCID: PMC6291126 DOI: 10.1371/journal.pone.0209043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/27/2018] [Indexed: 12/01/2022] Open
Abstract
Background In 2011, the Australian government introduced national healthcare reforms aimed at increasing the timeliness and quality of hospital care. The healthcare reforms included, but were not limited to, emergency department (ED) time-based targets, financial incentives, and public performance reporting of hospital data. We sought to evaluate the impact of the national healthcare reforms on ED time-based process outcomes. Methods A quasi-experimental study of ED presentations from 2006 to 2016 in the state of Victoria, Australia. Uncontrolled, interrupted time-series analyses were used to evaluate, by hospital peer groups, the effect of national healthcare reforms on: patient wait times for treatment; treatment within recommended time; and patient departure within four hours of arrival in ED. Results There were small improvements in ED time-based process outcomes following the introduction of the national healthcare reforms. These occurred in most hospital peer groups immediately and over the longer term, across the various triage categories. The largest improvements occurred in small hospitals and smallest improvements in medium sized hospitals. ED time-based targets, now abolished by the Australian government, were not achieved in any hospital peer groups. Conclusions Our findings suggest that national healthcare reforms had the potential to prompt fundamental changes in ED processes leading to significant improvements in ED performances across most hospital peer groups but were generally unable to reach the ED targets imposed nationally. ED performances also varied by hospital peer groups. Attention to ED time-based process outcomes within hospital peer groups may provide insights into hospital practices that could improve the quality and efficiency of ED care.
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Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
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Prang KH, Canaway R, Bismark M, Dunt D, Miller JA, Kelaher M. Public performance reporting and hospital choice: a cross-sectional study of patients undergoing cancer surgery in the Australian private healthcare sector. BMJ Open 2018; 8:e020644. [PMID: 29703855 PMCID: PMC5922515 DOI: 10.1136/bmjopen-2017-020644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES National mandatory public performance reporting (PPR) for Australian public hospitals, including measures of cancer surgery waiting times, was introduced in 2011. PPR is voluntary for private hospitals. The aims of this study were to assess whether PPR of hospital data is used by patients with breast, bowel or lung cancer when selecting a hospital for elective surgery and how PPR could be improved to meet their information needs. DESIGN A national cross-sectional postal questionnaire. SETTING Australian private healthcare sector. PARTICIPANTS Private patients with breast, bowel or lung cancer who attended a public or private hospital for elective surgery (n=243) in 2016. OUTCOME MEASURES Patients' choice of hospital, use of PPR information and preferred areas of PPR information. Descriptive and conventional qualitative content analyses were conducted. RESULTS Two hundred and twenty-eight respondents (94%) attended a private hospital. Almost half could choose a hospital. Choice of hospital was not influenced by PPR data (92% unaware) but by their specialist (90%). Respondents considered PPR to be important (71%) but they did not want to see the information, preferring their general practitioners (GPs) to tell them about it (40%). Respondents considered surgery costs (59%), complications (58%) and recovery success rates (57%) to be important areas of information that should be publicly reported. Almost half suggested that quality indicators should be reported at the individual clinician level. Analysis of the open-ended questions identified four themes: (1) decision-making factors; (2) data credibility; (3) unmet information needs and (4) unintended consequences. CONCLUSIONS PPR of hospital data had no substantial impact on patients' choice of hospital. Nonetheless, many respondents expressed interest in using it in future. To increase PPR awareness and usability, personalised and integrated information on cost and quality of hospitals is required. Dissemination of PPR information via specialists and GPs could assist patients to interpret the data and support decision-making.
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Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie A. Miller
- Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Canaway R, Bismark M, Dunt D, Prang KH, Kelaher M. "What is meant by public?": Stakeholder views on strengthening impacts of public reporting of hospital performance data. Soc Sci Med 2018. [PMID: 29524870 DOI: 10.1016/j.socscimed.2018.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Public reporting of hospital performance data is a developing area that is gaining increased attention. This is the first study to explore a range of stakeholder opinions on how such public reporting could be strengthened in Australia. Thirty-four semi-structured interviews were conducted with a purposive sample of expert healthcare consumer, provider and purchaser informants who worked in a variety of senior roles and had knowledge of or involvement in public reporting of hospital data within the public or private healthcare sectors. Informants from all Australian states, territory and national jurisdictions participated. Thematic analysis was used to gain an overview of experts' opinions to inform policy and systems-development for strengthening foundational frameworks for public reporting of health services performance. Themes arising were synthesised to generate explanatory figures to highlight key areas for strengthening public reporting. Our findings suggest that in Australia there is a lack of agreement on what the objectives and who the audience are for public reporting of hospital performance data. Without this shared understanding it is difficult to strengthen frameworks and impacts of public reporting. When developing frameworks for public reporting of hospital data in Australia, more explicit definition of what or who are the 'public' is needed along with identification of barriers, desired impacts, data needs, and data collection/reporting/feedback mechanisms. All relevant stakeholders should be involved in design of public reporting frameworks. Offering multiple systems of public reporting, each tailored to particular audiences, might enable greater impact of reporting towards improved hospital quality and safety, and consumer knowledge to inform treatment decisions. This study provides an overview of perspectives, but further research is warranted to develop PR frameworks that can generate greatest impacts for the needs of various audiences.
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Affiliation(s)
- Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, The University of Melbourne, 3010, Victoria, Australia.
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, The University of Melbourne, 3010, Victoria, Australia.
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, The University of Melbourne, 3010, Victoria, Australia.
| | - Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, The University of Melbourne, 3010, Victoria, Australia.
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, The University of Melbourne, 3010, Victoria, Australia.
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Prang KH, Canaway R, Bismark M, Dunt D, Kelaher M. The use of public performance reporting by general practitioners: a study of perceptions and referral behaviours. BMC Fam Pract 2018; 19:29. [PMID: 29433449 PMCID: PMC5810107 DOI: 10.1186/s12875-018-0719-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 01/29/2018] [Indexed: 11/14/2022]
Abstract
Background Public performance reporting (PPR) of hospital data aims to improve quality of care in hospitals and to inform consumer choice. In Australia, general practitioners (GPs) are gatekeepers to secondary care with patients requiring their referral for non-emergency access. Despite their intermediary role, GPs have been generally overlooked as potential users of PPR of hospital data, with the majority of the PPR research focussing on consumers, surgeons and hospitals. Methods We examined the use of PPR of hospital data by GPs when referring patients to hospitals. Semi-structured interviews were conducted with 40 GPs, recruited via the Victorian Primary Care Practice-Based Research Network and GP teaching practices in Victoria, Australia. The interviews were recorded, transcribed and analysed thematically. Results We found that the majority of GPs did not use PPR when referring patients to hospitals. Instead, they relied mostly on informal sources of information such as their own or patients’ previous experiences. Barriers that prevented GPs’ use of PPR in their decision making included: lack of awareness and accessibility; perceived lack of data credibility; restrictive geographical catchments for certain hospitals; limited choices of public hospitals in regional and rural areas; and no mandatory PPR for private hospitals. Conclusions Our findings suggest that lack of PPR awareness prevented GPs from using it in their referral practice. As gatekeepers to secondary care, GPs are in a position to guide patients in their treatment decisions and referrals using available PPR data. We suggest that there needs to be greater involvement by GPs in the development of hospital performance and quality indicators in Australia if GPs are to make greater use of them. The indicators require further development before GPs perceive them as valid, credible, and of use for informing their referral practices. Electronic supplementary material The online version of this article (10.1186/s12875-018-0719-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia.
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Abstract
Although it has long been recognised that doctors play a crucial role in the effectiveness and efficiency of health organisations, patient experience and clinical outcomes, over the past 20 years the topic of medical engagement has started to garner significant international attention. Australia currently lags behind other countries in its heedfulness to, and evidence base for, medical engagement. This Perspective piece explores the link between medical engagement and health system performance and identifies some key questions that need to be addressed in Australia if we are to drive more effective engagement.
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Affiliation(s)
- Helen Dickinson
- Melbourne School of Government, The University of Melbourne, Vic. 3052, Australia
| | - Marie Bismark
- School of Population and Global Health, The University of Melbourne, Rm 442, Level 4, 207 Bouverie Street, Carlton, Vic. 3010, Australia. Email
| | - Grant Phelps
- Department of Health Victoria, 50 Lonsdale Street, Melbourne, Vic. 3350, Australia. Email
| | - Erwin Loh
- School of Public Health and Preventive Medicine/School of Clinical Sciences at Monash Health, Monash University, 246 Clayton Road, Clayton, Vic. 3168, Australia. Email
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Abstract
IMPORTANCE Dissatisfaction with medical malpractice litigation has stimulated interest by health care organizations in developing alternatives to meet patients' needs after medical injury. In communication-and-resolution programs (CRPs), hospitals and liability insurers communicate with patients about adverse events, use investigation findings to improve patient safety, and offer compensation when substandard care caused harm. Despite increasing interest in this approach, little is known about patients' and family members' experiences with CRPs. OBJECTIVE To explore the experiences of patients and family members with medical injuries and CRPs to understand different aspects of institutional responses to injury that promoted and impeded reconciliation. DESIGN, SETTING, AND PARTICIPANTS From January 6 through June 30, 2016, semistructured interviews were conducted with patients (n = 27), family members (n = 3), and staff (n = 10) at 3 US hospitals that operate CRPs. Patients and families were eligible for participation if they experienced a CRP, spoke English, and could no longer file a malpractice claim because they had accepted a settlement or the statute of limitations had expired. The CRP administrators identified hospital and insurer staff who had been involved in a CRP event and had a close relationship with the injured patient and/or family. They identified patients and families by applying the inclusion criteria to their CRP databases. Of 66 possible participants, 40 interviews (61%) were completed, including 30 of 50 invited patients and families (60%) and 10 of 16 invited staff (63%). MAIN OUTCOMES AND MEASURES Patients' reported satisfaction with disclosure and reconciliation efforts made by hospitals. RESULTS A total of 40 participants completed interviews (15 men and 25 women; mean [range] age, 46 [18-67] years). Among the 30 patients and family members interviewed, 27 patients experienced injuries attributed to error and received compensation. The CRP experience was positive overall for 18 of the 30 patients and family members, and 18 patients continued to receive care at the hospital. Satisfaction was highest when communications were empathetic and nonadversarial, including compensation negotiations. Patients and families expressed a strong need to be heard and expected the attending physician to listen without interrupting during conversations about the event. Thirty-five of the 40 respondents believed that including plaintiffs' attorneys in these discussions was helpful. Sixteen of the 30 patients and family members deemed their compensation to be adequate but 17 reported that the offer was not sufficiently proactive. Patients and families strongly desired to know what the hospital did to prevent recurrences of the event, but 24 of 30 reported receiving no information about safety improvement efforts. CONCLUSIONS AND RELEVANCE As hospitals strive to provide more patient-centered care, opportunities exist to improve institutional responses to injuries and promote reconciliation.
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Affiliation(s)
- Jennifer Moore
- Faculty of Law, University of New South Wales, Sydney, Australia
| | - Marie Bismark
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Michelle M Mello
- Stanford Law School, Stanford University, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
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Affiliation(s)
- G Phelps
- Deakin University School of Medicine, Geelong, Victoria, Australia
| | - E Loh
- Medical Administration, Monash Health, Melbourne, Victoria, Australia
| | - H Dickinson
- Melbourne University School of Government, Melbourne, Victoria, Australia
| | - M Bismark
- The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
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Milner A, Witt K, Spittal MJ, Bismark M, Graham M, LaMontagne AD. The relationship between working conditions and self-rated health among medical doctors: evidence from seven waves of the Medicine In Australia Balancing Employment and Life (Mabel) survey. BMC Health Serv Res 2017; 17:609. [PMID: 28851354 PMCID: PMC5576303 DOI: 10.1186/s12913-017-2554-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background Psychosocial job stressors, such as low control and high demands, have been found to influence the health and wellbeing of doctors. However, past research in this area has relied on cross-sectional data, which limits causal inferences about the influence of psychosocial job stressors on health. In this study, we examine this relationship longitudinally while also assessing whether the relationship between psychosocial job stressors and health is modified by gender. Methods The data source was seven annual waves of the Medicine in Australia: Balancing Employment and Life (MABEL) survey. The outcome was self-rated health (measured using the SF-12), and key exposures reflected job control, job demands, work-life balance variables, employment arrangements, and aggression experienced at work. We used longitudinal fixed and random effects regression models to assess within and between-person changes in health. Results Excessive job demands, low job control, feelings of not being rewarded at work, and work-life imbalance were associated with higher within-person odds of poorer self-rated health. Gender differences were apparent. For female doctors, work arrangements and work-life imbalance were associated with poorer self-rated health whilst task-based job stressors were associated with poorer self-rated health in male doctors. Conclusions These results suggest the importance of addressing adverse working environments among doctors. Trial registration Not applicable. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2554-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allison Milner
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, 3010, Australia. .,Work, Health and Wellbeing Unit, Population Health Research Centre, School of Health & Social Development, Deakin University, Melbourne, Australia.
| | - Katrina Witt
- Turning Point, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Melissa Graham
- Centre for Health through Action on Social Exclusion, School of Health and Social development, Deakin University, Melbourne, Australia
| | - Anthony D LaMontagne
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, 3010, Australia.,Work, Health and Wellbeing Unit, Population Health Research Centre, School of Health & Social Development, Deakin University, Melbourne, Australia
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Dickinson H, Phelps G, Loh E, Bismark M. Medical management and leadership: a time of transition? Intern Med J 2017; 47:818-820. [DOI: 10.1111/imj.13479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 11/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Helen Dickinson
- Public Service Research Group; The University of New South Wales; Sydney New South Wales Australia
| | - Grant Phelps
- Department of Internal Medicine; Ballarat Health Services; Ballarat Victoria Australia
| | - Erwin Loh
- Department of Medical Administration; Monash Health; Victoria Australia
| | - Marie Bismark
- School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
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Canaway R, Bismark M, Dunt D, Kelaher M. Perceived barriers to effective implementation of public reporting of hospital performance data in Australia: a qualitative study. BMC Health Serv Res 2017; 17:391. [PMID: 28592277 PMCID: PMC5463349 DOI: 10.1186/s12913-017-2336-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/25/2017] [Indexed: 05/29/2023] Open
Abstract
Background Public reporting of government funded (public) hospital performance data was mandated in Australia in 2011. Studies suggest some benefit associated with such public reporting, but also considerable scope to improve reporting systems. Methods In 2015, a purposive sample of 41 expert informants were interviewed, representing consumer, provider and purchasers perspectives across Australia’s public and private health sectors, to ascertain expert opinion on the utility and impact of public reporting of health service performance. Qualitative data was thematically analysed with a focus on reporting perceived strengths and barriers to public reporting of hospital performance data (PR). Results Many more weaknesses and barriers to PR were identified than strengths. Barriers were: conceptual (unclear objective, audience and reporting framework); systems-level (including lack of consumer choice, lack of consumer and clinician involvement, jurisdictional barriers, lack of mandate for private sector reporting); technical and resource related (including data complexity, lack of data relevance consistency, rigour); and socio-cultural (including provider resistance to public reporting, poor consumer health literacy, lack of consumer empowerment). Conclusions Perceptions of the Australian experience of PR highlight important issues in its implementation that can provide lessons for Australia and elsewhere. A considerable weakness of PR in Australia is that the public are often not considered its major audience, resulting in information ineffectually framed to meet the objective of PR informing consumer decision-making about treatment options. Greater alignment is needed between the primary objective of PR, its audience and audience needs; more than one system of PR might be necessary to meet different audience needs and objectives. Further research is required to assess objectively the potency of the barriers to PR suggested by our panel of informants. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2336-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, VIC, 3010, Australia.
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Keogh LA, Newton D, Bayly C, McNamee K, Hardiman A, Webster A, Bismark M. Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia. ACTA ACUST UNITED AC 2016; 43:18-24. [PMID: 27913574 DOI: 10.1136/jfprhc-2016-101541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/07/2016] [Accepted: 11/07/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In Victoria, Australia, abortion was decriminalised in October 2008, bringing the law in line with clinical practice and community attitudes. We describe how experts in abortion service provision perceived the intent and subsequent impact of the 2008 Victorian abortion law reform. METHODS Experts in abortion provision in Victoria were recruited for a qualitative semi-structured interview about the 2008 law reform and its perceived impact, until saturation was reached. Nineteen experts from a range of health care settings and geographic locations were interviewed in 2014/2015. Thematic analysis was conducted to summarise participants' views. RESULTS Abortion law reform, while a positive event, was perceived to have changed little about the provision of abortion. The views of participants can be categorised into: (1) goals that law reform was intended to address and that have been achieved; (2) intent or hopes of law reform that have not been achieved; (3) unintended consequences; (4) coincidences; and (5) unfinished business. All agreed that law reform had repositioned abortion as a health rather than legal issue, had shifted the power in decision making from doctors to women, and had increased clarity and safety for doctors. However, all described outstanding concerns; limited public provision of surgical abortion; reduced access to abortion after 20 weeks; ongoing stigma; lack of a state-wide strategy for equitable abortion provision; and an unsustainable workforce. CONCLUSION Law reform, while positive, has failed to address a number of significant issues in abortion service provision, and may have even resulted in a 'lull' in action.
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Affiliation(s)
- L A Keogh
- Associate Professor, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - D Newton
- Research Fellow, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Bayly
- Senior Clinical Adviser, Women's Health, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - K McNamee
- Medical Director, Family Planning Victoria, Melbourne, Victoria, Australia
| | - A Hardiman
- Manager, Pregnancy Advisory Service, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - A Webster
- Senior Policy and Health Promotion Officer, Women's Health Victoria, Melbourne, Victoria, Australia
| | - M Bismark
- Associate Professor of Law and Public Health, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Newton D, Bayly C, McNamee K, Hardiman A, Bismark M, Webster A, Keogh L. How do women seeking abortion choose between surgical and medical abortion? Perspectives from abortion service providers. Aust N Z J Obstet Gynaecol 2016; 56:523-529. [DOI: 10.1111/ajo.12506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/17/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Danielle Newton
- Gender and Women's Health; Centre for Health Equity; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Chris Bayly
- The Royal Women's Hospital; Parkville Victoria Australia
| | - Kathleen McNamee
- Family Planning Victoria & Department of Obstetrics and Gynaecology; Monash University; Melbourne Victoria Australia
| | - Annarella Hardiman
- Pregnancy Advisory Service; The Royal Women's Hospital; Parkville Victoria Australia
| | - Marie Bismark
- Centre for Health Policy; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Amy Webster
- Women's Health Victoria; Melbourne Victoria Australia
| | - Louise Keogh
- Gender and Women's Health; Centre for Health Equity; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
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Newton D, Bayly C, McNamee K, Bismark M, Hardiman A, Webster A, Keogh L. '…a one stop shop in their own community': Medical abortion and the role of general practice. Aust N Z J Obstet Gynaecol 2016; 56:648-654. [PMID: 27440477 DOI: 10.1111/ajo.12507] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The introduction to Australia of modern medical abortion methods, which require less specialist expertise and equipment than the more traditional surgical methods, have brought an as yet unrealised potential to improve access to abortion services. AIMS To investigate the potential for expanding the role of general practice in the provision of medical abortion in Victoria. MATERIALS AND METHODS In 2015, in-depth interviews were conducted with 19 experts in abortion service provision in Victoria. A semi-structured interview schedule was used to guide the interviews. Interviews were transcribed verbatim and transcripts analysed thematically. RESULTS Participants were largely very supportive of the provision of early medical abortion in general practice as a way of increasing abortion access for women, particularly in rural and regional communities. Access to abortion was seen as an essential component of women's comprehensive health care and therefore general practitioners (GPs) were perceived as ideally placed to provide this service. However, this would require development and implementation of new service models, careful consideration of GP and nurse roles, strengthening of partnerships with other health professionals and services in the community, and enhanced training, support and mentoring for clinicians. CONCLUSION The application of these findings by relevant health services and agencies has the potential to increase provision of medical abortion services in general practice settings, better meeting the health-care needs of women seeking this service.
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Affiliation(s)
- Danielle Newton
- Gender and Women's Health, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Chris Bayly
- The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Kathleen McNamee
- Family Planning Victoria & Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Annarella Hardiman
- Pregnancy Advisory Service, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Amy Webster
- Women's Health Victoria, Melbourne, Victoria, Australia
| | - Louise Keogh
- Gender and Women's Health, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Spittal MJ, Bismark M. Reducing suicide through improved quality of care. Lancet Psychiatry 2016; 3:491-2. [PMID: 27107806 DOI: 10.1016/s2215-0366(16)30023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/17/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Matthew J Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3010, Australia.
| | - Marie Bismark
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3010, Australia
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Brashler R, Finestone HM, Nevison C, Marshall SC, Deng G, Bismark M, Mukherjee D. Time to Make a Call? The Ethics of Mandatory Reporting. PM R 2016; 8:69-74. [PMID: 26773862 DOI: 10.1016/j.pmrj.2015.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Rebecca Brashler
- Rehabilitation Institute of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL(∗)
| | - Hillel M Finestone
- University of Ottawa and Élisabeth Bruyère Hospital, Bruyère Continuing Care, Ottawa, Ontario, Canada(†)
| | - Colleen Nevison
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada(‡)
| | - Shawn C Marshall
- University of Ottawa, and The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada(§)
| | - George Deng
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada(¶)
| | - Marie Bismark
- Melbourne School of Population and Global Health, University of Melbourne, Australia(#)
| | - Debjani Mukherjee
- Rehabilitation Institute of Chicago and Northwestern University Feinberg School, Donnelley Ethics Program, Physical Medicine & Rehabilitation, Medical Humanities, Rehabilitation Institute of Chicago, 345 Superior St Room 164, Chicago, IL 60611(‖).
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Burns JM, Birrell E, Bismark M, Pirkis J, Davenport TA, Hickie IB, Weinberg MK, Ellis LA. The role of technology in Australian youth mental health reform. AUST HEALTH REV 2016; 40:584-590. [DOI: 10.1071/ah15115] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/31/2015] [Indexed: 11/23/2022]
Abstract
This paper describes the extent and nature of Internet use by young people, with specific reference to psychological distress and help-seeking behaviour. It draws on data from an Australian cross-sectional study of 1400 young people aged 16 to 25 years. Nearly all of these young people used the Internet, both as a source of trusted information and as a means of connecting with their peers and discussing problems. A new model of e-mental health care is introduced that is directly informed by these findings. The model creates a system of mental health service delivery spanning the spectrum from general health and wellbeing (including mental health) promotion and prevention to recovery. It is designed to promote health and wellbeing and to complement face-to-face services to enhance clinical care. The model has the potential to improve reach and access to quality mental health care for young people, so that they can receive the right care, at the right time, in the right way. What is known about the topic? One in four young Australians experience mental health disorders, and these often emerge in adolescence and young adulthood. Young people are also prominent users of technology and the Internet. Effective mental health reform must recognise the opportunities that technology affords and leverage this medium to provide services to improve outcomes for young people. What does this paper add? Information regarding the nature of young people’s Internet use is deficient. This paper presents the findings of a national survey of 1400 young Australians to support the case for the role of technology in Australian mental health reform. What are the implications for practitioners? The Internet provides a way to engage young people and provide access to mental health services and resources to reduce traditional barriers to help-seeking and care. eMental health reform can be improved by greater attention toward the role of technology and its benefits for mental health outcomes.
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Abstract
OBJECTIVE To elicit medical leaders' views on reasons and remedies for the under-representation of women in medical leadership roles. DESIGN Qualitative study using semistructured interviews with medical practitioners who work in medical leadership roles. Interviews were transcribed verbatim and transcripts were analysed using thematic analysis. SETTING Public hospitals, private healthcare providers, professional colleges and associations and government organisations in Australia. PARTICIPANTS 30 medical practitioners who hold formal medical leadership roles. RESULTS Despite dramatic increases in the entry of women into medicine in Australia, there remains a gross under-representation of women in formal, high-level medical leadership positions. The male-dominated nature of medical leadership in Australia was widely recognised by interviewees. A small number of interviewees viewed gender disparities in leadership roles as a 'natural' result of women's childrearing responsibilities. However, most interviewees believed that preventable gender-related barriers were impeding women's ability to achieve and thrive in medical leadership roles. Interviewees identified a range of potential barriers across three broad domains-perceptions of capability, capacity and credibility. As a counter to these, interviewees pointed to a range of benefits of women adopting these roles, and proposed a range of interventions that would support more women entering formal medical leadership roles. CONCLUSIONS While women make up more than half of medical graduates in Australia today, significant barriers restrict their entry into formal medical leadership roles. These constraints have internalised, interpersonal and structural elements that can be addressed through a range of strategies for advancing the role of women in medical leadership. These findings have implications for individual medical practitioners and health services, as well as professional colleges and associations.
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Affiliation(s)
- Marie Bismark
- University of Melbourne, Carlton, Victoria, Australia
| | | | - Laura Thomas
- University of Melbourne, Carlton, Victoria, Australia
| | - Erwin Loh
- Monash Health, Clayton, Victoria, Australia
| | - Grant Phelps
- Deakin University, Waurn Ponds, Victoria, Australia
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Abstract
The 1987 Cartwright Report into events at New Zealand's National Women's Hospital catalysed sweeping changes to promote and protect patients' rights. A generation on, it is comfortable to believe that such sustained and deliberate violations of patient rights "couldn't happen here" and "couldn't happen now." And yet, contemporary examples beg a different truth. Three of Cartwright's messages hold an enduring relevance for health practitioners and patients: the need for patients to be respected as people; to be supported to make informed choices; and to have their voices heard, even when they whisper. These challenges cannot be met in isolation from broader determinants of patients' rights and will require social, technological, and cultural change in order to prevent another "unfortunate experiment."
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Affiliation(s)
- Marie Bismark
- Centre for Health Policy, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia,
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