Across healthcare systems, there is consensus about the need for independent and impartial assessment of performance. There is less agreement about how the measurement and reporting of performance actually improves healthcare. This webinar will discuss a recently published paper that introduces a conceptual framework that describes ways in which change can be leveraged by healthcare performance information (Levesque and Sutherland, 2017). The framework identifies eight levers for change enabled by performance information, spanning internal and external drivers, and emergent and planned processes: (1) cognitive levers provide awareness and understanding; (2) mimetic levers inform about the performance of others to encourage emulation; (3) supportive levers provide facilitation, implementation tools or models of care to actively support change; (4) formative levers develop capabilities and skills through teaching, mentoring and feedback; (5) normative levers set performance against guidelines, standards, certification and accreditation processes; (6) coercive levers use policies, regulations incentives and disincentives to force change; (7) structural levers modify the physical environment or professional cultures and routines; (8) competitive levers attract patients or funders.
Dr Levesque, Chief Executive of the NSW Agency for Clinical Innovation (ACI).
Dr Jean-Frédéric Levesque joined the NSW Agency for Clinical Innovation (ACI) as Chief Executive in June 2017. Prior to this he was the Chief Executive of the Bureau of Health Information (BHI) from 2013. Dr Levesque has previously held senior positions responsible for publicly reporting information about the Canadian health system. These included the role of Scientific Director, Analyses and Evaluation of Health Systems at the Institut National de Santé Publique du Québec and Deputy Commissioner, Performance Appraisal and Analysis, at the Commissaire a la santé et au bien-etre du Québec. He is currently a member of the Strategic Analytic Advisory Committee of the Canadian Institute of Health Information. Dr Levesque is a Conjoint Professor at the Centre for Primary Health Care and Equity of the University of New South Wales. His research focuses on healthcare performance, particularly in terms of how different models of care impact on patient outcomes and experiences of care, and on the analysis of healthcare reform. In 2011-12, he was a Visiting Academic at the University of Melbourne. He is a Fellow of the Royal College of Physicians of Canada in Preventive Medicine and Public Health and has a Doctorate in Public Health, a Masters in Community Health and a medical degree from the Université de Montréal, Canada.
Kim Sutherland – Acting Chief Executive, Bureau of Health Information
Kim Sutherland joined the Bureau of Health Information in 2010 and was appointed Acting Chief Executive in May 2017. Her substantive position is Senior Director, Performance Measurement and Reporting.
Kim is a health services researcher with experience in performance measurement and reporting, evaluation and assessment of quality, change management in healthcare organisations, and the diffusion of innovations. She has played a central role in the development of performance measurement frameworks in healthcare systems in the United Kingdom and in NSW. She was co-author on a series of reports evaluating the English National Health Service 10-year quality agenda and this work continues to act as the conceptual base for the joint Health Foundation - Nuffield Trust QualityWatch initiative, based in London. Kim currently sits on a healthcare quality indicator technical advisory group of the Organisation for Economic Cooperation and Development.
While at BHI, Kim has led project-based teams to produce over 40 peer reviewed reports that span a range of different patient groups, methodological approaches and organisational contexts to provide a comprehensive picture of performance in the NSW healthcare system.
Kim has a Bachelor of Science degree from the University of Technology, Sydney; a Master of Science from London Hospital Medical College; a Master of Business Administration from Imperial College, London; and a Doctorate from the University of Cambridge.
25 October 2017
"Futile” treatment and why doctors provide it to patients at the end of life: some empirical findings – 25 October
Presentation 1 (Lindy Willmott)
“Futile” treatment and why doctors provide it to patients at the end of life: some empirical findings
Abstract: Over-diagnosis results in treatment that is unnecessary and may be harmful. The “harms of too much medicine” are also contributed to by futile treatment at the end of life. While there is divergence about what the term “futility” means, there is general consensus that futile treatment (however it is defined) is sometimes provided in this setting. To date, there has been very little empirical research as to why doctors sometimes provide treatment knowing that treatment to be medically futile. This presentation reports on the results of 96 semi-structured interviews with doctors from a range of specialties in three Queensland public tertiary hospitals. It explores why doctors sometimes provide treatment they consider to be futile and strategies that they use to avoid providing it.
Title: What does “futility” mean? An empirical study of doctors’ perceptions
Abstract: Futile treatment has been identified as a pressing challenge for health professionals and health systems. But what does “futility” mean? While there has been an extensive debate over some decades about conceptual aspects of this term, very little empirical work has been done as to how doctors understand and operationalise the concept of futility. This presentation reports on the results of 96 semi-structured interviews with doctors from a range of specialties in three Queensland public tertiary hospitals. It explores how doctors understand the term “futility” and use it in the clinical setting at the end of life for adult patients. It also considers the processes reported for “diagnosing futility” and when providing treatment, which is otherwise regarded as futile, might still be seen as justifiable. Findings reveal that despite concerns about the term, the concept of “futility” is used in clinical decision-making. There was broad consensus that at the heart of the concept is benefit to the patient, but there was variability as to what constitutes “benefit” and how this was determined by different doctors in different settings. These findings have implications for how and by whom decisions are reached that treatment is no longer worth providing at the end of life.
Lindy Willmott is a Professor with the Faculty of Law at the Queensland University of Technology and a Director of the Australian Centre for Health Law Research at QUT. She researches and publishes extensively in the area of health law, particularly end-of-life issues. She has expertise in socio-legal research and has received funding from the Australian Research Council and the National Health and Medical Research Council to undertake empirical research into various aspects of decision-making at the end of life. Lindy is the author of many text books and is one of the editors of the text ‘Health Law in Australia’, now in its second edition. Lindy was a member of the Queensland Civil and Administrative Tribunal (previously the Guardianship and Administrative Tribunal) for seven years and is currently on the editorial board of the Journal of Medical Ethics.
Professor Ben White is a Director of the Australian Centre for Health Law Research in the Faculty of Law at the Queensland University of Technology (QUT). Ben graduated with first class Honours and a University Medal in Law from QUT and then completed a DPhil at Oxford University on a Rhodes Scholarship. Before joining the Law Faculty, he worked as an associate at the Supreme Court and at Legal Aid Queensland. Between 2005 and 2007, Ben was appointed as the full-time Commissioner of the Queensland Law Reform Commission where he had carriage of the Guardianship Review on behalf of the Commission. He also served as a part-time Commissioner between 2007 and 2010. Ben’s area of research focus is end of life decision-making and he is undertaking a number of Australian Research Council funded studies examining law at the end of life. He is currently a committee member of the Australasian Association of Bioethics and Health Law and an editor of ‘Health Law in Australia’ (2nd ed, 2014, Thomson).
18 July 2017
An introduction to the GRADE approach in systematic reviews and guideline development
A/Professor Zachary Munn Director Transfer Science, Joanna Briggs Institute and Director JBI Adelaide GRADE Center
The Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group began in the year 2000 as an informal collaboration of people with an interest in addressing the shortcomings of grading systems commonly used in health care. The working group has developed a common, sensible and transparent approach to grading quality (or certainty) of evidence and strength of recommendations. Many international organizations have provided input into the development of the GRADE approach which is now considered the standard in guideline development. This short webinar will provide an introduction to the GRADE approach in systematic reviews, health technology assessment and in developing trustworthy clinical guidelines.
A/Professor Zachary Munn is an advocate for evidence-based healthcare and for ensuring patients receive the best care possible based on the best available evidence. He is the director of the Transfer Science program of the Joanna Briggs Institute and is the Director of the JBI Adelaide GRADE Center, the first in Australia. In this role he leads the development and coordination of the Institute’s educational courses, the development of systematic review and implementation software tools, and the promotion and publication of the collaboration’s methodologies. A/Prof Munn is the current Chair of the international JBI Scientific Committee and has been involved in the conduct of dozens of systematic reviews, clinical guidelines, evidence implementation and health services research projects.
13 June 2017
Conclusions versus Decisions in Quantitative Research
Abstract: Drawing insights from the works of brilliant statisticians, such as Fisher, Neyman, Pearson, Lindley, Birnbaum, Pratt, Raiffa, Good and Tukey, this webinar presents the fundamental issues related to the debate regarding the distinction between conclusions and decisions in quantitative research. The webinar discusses ideas and implications relevant to health researchers, practitioners and policy-makers (no mathematical formulas are presented). ‘Decisions’ and ‘conclusions’ are defined, and their meanings and implications for quantitative research are discussed. Significance testing, hypotheses testing and confidence intervals are examined from the ‘conclusions versus decisions’ perspective. Examples are discussed and suggestions for best practice in quantitative research are proposed.
Dr Catalin Tufanaru: Dr Catalin Tufanaru MD, MPH, MClinSci, PhD, is a Research Associate at the Joanna Briggs Institute (JBI), Faculty of Health and Medical Sciences, University of Adelaide, Australia. Catalin is involved in teaching research methodology and statistics in a graduate program at University of Adelaide, the Master of Clinical Science in Evidence Based Health Care. He is an Associate Investigator at NHMRC Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), and a Research Affiliate at The Critical and Ethical Mental Health (CEMH) Research Group, the Robinson Research Institute, the University of Adelaide. Catalin is involved in the RIAT (Restoring Invisible and Abandoned Trials) initiative, and he is one of the co-authors of the RIAT re-analysis of Study 329. He is the author of five books on topics such as health promotion and health education, social marketing, health policy analysis, systematic reviews of economic evidence, and statistics for systematic reviews. Catalin is an accredited JBI Comprehensive Systematic Review trainer and a peer reviewer for the JBI Database of Systematic Reviews and Implementation Reports. Recent seminars presented by Catalin include ‘Statistical Misconceptions in Evidence-based Medicine’ (Aged and Extended Care Services Research Seminar, Basil Hetzel Institute, Adelaide, April 2017) and ‘Beyond hypothesis and significance testing in health research’ (Transdisciplinary Measurement and Evaluation Research Group, University of Adelaide, May 2017).
23 May 2017
Weekend allied health services in rehabilitation
Abstract: This webinar will present research on provision of additional weekend rehabilitation services. A series of preliminary studies including systematic reviews, a national survey of practice, and a pilot study were conducted prior to completion of a large randomised controlled trial of rehabilitation inpatients allocated to either a 6-day rehabilitation service (Monday to Saturday) or to standard care (5-day rehabilitation service Monday to Friday). The results demonstrated that compared to standard care inpatients allocated to receive the weekend service had a reduced length of hospital stay with greater likelihood of achieving clinically important improvements in functional independence and health-related quality of life during the admission. From the economic perspective this was likely to be a cost effective intervention. The body of research provides high quality evidence that providing additional allied health rehabilitation services can help patients get better quicker and is likely cost effective from a health service perspective. The next challenge in this research is to explore how best to facilitate transfer of this knowledge into practice.
Nicholas Taylor: Nick Taylor is Professor of Allied Health, a joint position between La Trobe University and Eastern Health. He leads the Allied Health Clinical Research office at Eastern Health. The focus of Nick’s research is on improving rehabilitation outcomes, both in the effectiveness of specific interventions and in the way services are delivered. He has more than 200 peer-reviewed journal publications.
Natasha Brusco: Tash Brusco is the Chief Physiotherapist at Cabrini Health. She completed a PhD in 2015 that involved a fully-powered randomised controlled trial in the inpatient rehabilitation setting examining weekend services with a cost effectiveness economic evaluation. Tash’s PhD thesis was recognised for its outstanding merit at La Trobe University by being awarded the Nancy Millis Medal for excellence. Tash has multiple additional roles at Cabrini Health including Research Fellow and the Manager of Education and Quality for Allied Health and Ambulatory Services. In addition, she is an Adjunct Senior Lecturer and Honorary Researcher at La Trobe University for the School of Allied Health.
18 May 2017
The Harkness Fellowships in Health Care Policy and Practice
Robin Osborn (Vice President and Director, The Commonwealth Fund) will discuss how the Fellowship works, the program throughout the year, and eligibility.
Jane Hall (Director of Strategy, Centre for Health Economics and Research Evaluation, University of Technology Sydney) will speak about the Fellowship and its relevance to Australian applicants.
Robyn Whittaker (2010-11 New Zealand Harkness Fellow) will discuss her Harkness Fellowship experience, her project, and how the Harkness Fellowship changed her life, personally and professionally.
The Harkness Fellowships in Health Care Policy and Practice provide a unique opportunity for mid-career professionals—academic researchers, government policymakers, clinical leaders, hospital and insurance managers, and journalists—from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, and the United Kingdom—to spend up to 12 months in the United States working with leading experts to study health care delivery reforms and critical issues on the health policy agenda in both the U.S. and their home countries. The Commonwealth Fund brings together the full class of Fellows through the year to participate in a series of high level policy briefings and leadership seminars with health care leaders.
The deadline for receipt of applications from Australia and New Zealand is September 5, 2017.
Please feel free to contact Robin Osborn (Director of the Harkness Fellowships in Health Care Policy and Practice) at firstname.lastname@example.org with any additional questions about eligibility, the project, or the application process.
27 April 2017
Bleeding hearts, profiteers or both? Understanding doctors' fees in an unregulated market.
Associate Professor Kees van Gool, Deputy Director of the Centre for Health Economics Research and Evaluation, University of Technology Sydney.
“[The Government] has no authority to control the amount doctors charge for their services as this would amount to civil conscription. Doctors are free to determine their own value of the health service they provide.” The Australian Department of Health and Ageing, 2009
This presentation focuses on the degree to which doctors use their freedom to set and differentiate their fees to different patients. In the context of the Australian health care system, fees have a direct bearing on the out-of-pocket costs faced by patients. The first part of this seminar shows that in an unregulated fee-setting environment, general practitioners (GPs) and specialists discriminate their fees on the basis of patients’ income status. The second part focuses on the impact of the 2004 Strengthening Medicare reforms. Whilst these reforms have been widely credited with increasing levels of bulk-billing among GPs, our findings suggest that there is considerable variation in GP responses to the reforms. As a result, the OOP costs incurred by different population groups have changed substantially, with direct implications on the barriers to access of GP care. Understanding the degree of fee variation among doctors is an important issue in terms of understanding the potential variable impact that a policy change may have.
Associate Professor Kees van Gool is a health economist and has extensive experience in international, national and regional health policy research. He is the Deputy Director of the Centre for Health Economics Research and Evaluation, based at the University of Technology Sydney. He leads a team of researchers working on the financing and economics of the Australian Health Care system, including a special focus on primary care. Kees was a lead investigator in two independent reviews of the Extended Medicare Safety Net conducted for the Department of Health and has been a chief investigator on a number of competitive grants. He has worked extensively on cancer care, screening, cystic fibrosis and policy evaluation. In 2011 he completed his PhD at the University of Technology Sydney, looking at the out-of-pocket costs faced by patients under Australia’s Medicare system. Kees has previously worked at the Department of Health, NSW Health and the OECD where he led a project on international policy analysis on cardiovascular disease care and outcomes.
29 March 2017
HSRAANZ Webinar Series – Needs must: Changing the focus of workforce planning models
Abstract: Health Care Planning has largely been based on applying anticipated population demographic change to existing levels of workforce supply (or service utilisation) with no attention given to changing patterns of health care need within populations. In this session a new approach to health workforce planning is presented that accommodates changes in population needs, changes in the services planned to address needs and changes in the way those services are to be delivered. The approach provides an important input to policies aimed at addressing the continuing rapid increases in the costs of publicly funded health care systems and answering claims that such systems are no longer sustainable.
Bio: Stephen Birch is a Professor in The Centre for Health Economics and Policy Analysis at McMaster University in Canada and in the Centre for Health Economics at the University of Manchester. He also is Adjunct Professor at the University of Technology Sydney, Australia and a former visiting professor at the University of Cape Town, South Africa. He is senior scientist at the WHO Collaborating Centre on Health Workforce Planning at Dalhousie University, Canada and a former member of the UK Department of Health’s Centre for Workforce Intelligence. He has served as a consultant with WHO and the World Bank as well as many national and provincial health departments on health workforce planning. His main research interests are in the economics of health care systems with particular emphasis on equity, resource allocation and planning and well as alternative delivery models. He has over 250 publications in peer reviewed journals and was ranked equal first in Canada in the 2012 World Bank publication on the quantity and impact of health economics research. He was Senior Editor for Social Science and Medicine from 1997-2012 and currently serves on editorial boards of several multidisciplinary scientific journals. He has served on various public boards including the Local Health Integration Network and the District Health Council in Hamilton Ontario, the Health Professions Regulatory Council in Ontario and the Community Health Council in York, UK.
22 February 2017
HSRAANZ Webinar Series – Understanding the potential of telehealth for people in remote locations
The use of telehealth to support patients living in remote areas is gaining much interest in the Australian health sector. In the right circumstances, telehealth can save people having to travel extensive distances to access specialist health services. This is especially important for people living in rural and remote areas of the country, and for people who have difficulty travelling away from home. This presentation will give an overview of a range of telehealth projects led by the University of Queensland’s Centre for Online Health (COH). Over time, most projects have been successfully translated from a research idea into routine service delivery in Queensland. Critical steps in establishing these projects will be discussed, as well as key research findings, challenges and lessons learnt.
Associate Professor Anthony Smith
Dr Anthony Smith is an Associate Professor and Director of the University of Queensland’s Centre for Online Health. He also has an Adjunct Professor appointment at the University of Southern Denmark's Centre of Innovative Medical Technology. Dr Smith has more than 16 years of research experience based on investigations of new telehealth applications for the benefit of clinicians and patients in regional and remote areas of Queensland. In 2013, Anthony began a role as chief investigator for the NHMRC Centre of Research Excellence (CRE) in Telehealth, where he leads two major themes of work involving telehealth applications in small remote communities and Indigenous communities. Anthony is the scientific committee chair for the International Conference on Successes and Failures in Telehealth (SFT); and past-President of the Australasian Telehealth Society (ATHS). His frequent work in rural and remote areas of Queensland provides him ample motivation for healthcare innovation and use of telehealth – with the ultimate aim of giving people living in underserved locations, convenient and fairer access to specialist healthcare.
Across nations, there appears to be consensus about the vital importance of strong and comprehensive primary care provision to enable effective prevention, treatment and management of long-term conditions, and a responsive and accessible service for people requiring episodic advice and care. The Commonwealth Fund, World Health Organisation, and European Commission have all underlined the policy importance of primary care in recent publications.
What is less clear however is how primary care should adapt and change to meet this challenge, and what health systems need to do to enable this. In many countries where primary care is based on general practice or family medicine as the core provision, there is considerable current focus on the ‘primary health care home’ model, as evidenced in New Zealand, Australia and the UK among others.
In this webinar, Professor Judith Smith will draw on her extensive research and policy experience of primary care in the UK, New Zealand and Australia to examine the opportunities and risks of developing new models of primary care that are fit for the future. She will draw out cross-country comparisons and learning, and identify the particular challenges that need to be addressed (and researched) if current policy ambitions for primary care are to be realised.
Professor Judith Smith BA MBA PhD
Director, Health Services Management Centre, University of Birmingham
Judith is a widely published health services researcher and policy analyst. She took up post as Director of the Health Services Management Centre (HSMC) and Professor of Health Policy and Management at the University of Birmingham on 1 June 2015. This followed six years spent as Director of Policy at the Nuffield Trust, an independent charitable research foundation in London. Judith’s main research interests are: health commissioning and purchasing; the organisation and management of primary care; long-term conditions and integrated care; the evaluation of health care organisation; and health care management and culture.
Earlier in her career, Judith spent 12 years at HSMC, holding the positions of Senior Lecturer, Director of Research, and Academic Director of the NHS Management Training Scheme. From 2007 to 2009, Judith was based in New Zealand as a Visiting Senior Research Fellow at the Victoria University of Wellington and working as an advisor to the New Zealand Ministry of Health.
Judith is a Non-Executive Director of the Birmingham Children’s Hospital NHS Foundation Trust, Honorary Professor at the London School of Hygiene and Tropical Medicine, and a member of the board of the UK Health Services Research Network. Judith’s other roles have included being an expert advisor on NHS organisation and commissioning, and policy assessor to the Mid Staffordshire NHS Foundation Trust Public Inquiry; chair of the Royal Pharmaceutical Society’s Commission on future models of care; and a member of the board of the European Health Management Association.
28 September 2016
Choosing Wisely – where we came from, where we are going and why we need you.
Please do not replicate or circulate any slides without the permission of the author
Choosing Wisely Australia aims to improve the quality of healthcare through bringing to light tests, treatments, and procedures where evidence shows they provide no benefit or, in some cases, lead to harm. Led by Australia’s medical and allied health colleges, societies and associations and facilitated by NPS MedicineWise, Choosing Wisely Australia challenges the way we think about healthcare, questioning the notion 'more is always better'. Unnecessary practices are a diversion away from effective care. They often lead to more frequent and invasive investigations that can expose the consumer to undue risk of harm, emotional stress, or financial cost. To date 19 colleges, societies and associations have come together to develop lists of recommendations: "Tests, treatments and procedures to question."
This webinar will be jointly presented by Dr Robyn Lindner from NPS MedicineWise and Professor Adam Elshaug who is a member of the Choosing Wisely Advisory Group. They will outline the road travelled thus far in facilitating the roll out Choosing Wisely Australia: the challenges, successes and lessons learned.
They will highlight case studies of where Choosing Wisely recommendations are being implemented at the clinical coalface; discuss where to from here; and how the campaign fits with the international Choosing Wisely movement (with over a dozen countries now participating). Lastly, they will draw attention to how members of the health services and policy research community can become engaged with the campaign through design, implementation and evaluation.
Dr Robyn Lindner
Dr Robyn Lindner is Client Relationships Manager at NPS MedicineWise - an independent not for profit organisation that develops programs for both health professionals and consumers to support quality use of medicines and health technologies including diagnostics. As part of this role, Robyn has recently led the implementation of a new healthcare initiative to Australia called Choosing Wisely. This initiative seeks to start a conversation about appropriate healthcare in Australia by challenging the notion that more is always better when it comes to healthcare.
Professor Adam Elshaug
Adam Elshaug is Professor of Health Policy, HCF Research Foundation Professorial Research Fellow, and Co-Director of the Menzies Centre for Health Policy (MCHP) at The University of Sydney. He also Heads the Value in Health Care Division within MCHP, is Senior Fellow with the Lown Institute in Boston, a ministerial appointee to the Medicare Benefits Schedule (MBS) Review Taskforce, a member of the Choosing Wisely Australia advisory group, the Choosing Wisely International Planning Committee, the ACSQHC's Atlas of Healthcare Variation Advisory Group, and an elected Member of the Executive Committee of the Health Services Research Association of Australia and New Zealand (HSRAANZ). He is a Chief Investigator within the Wiser Healthcare Collaborative: http://wiserhealthcare.org.au/ and his work in the area of low-value care has resulted in first-author publications in journals such as the NEJM, BMJ, JAMA, and MJA among others.
23 July 2016
HSRAANZ Webinar Series - Strategies to implement evidence: audit and feedback
Evidence-based healthcare relies on the use of the best available evidence in healthcare. This often requires a change in the way care is delivered, and change can be difficult. This presentation described methods for evidence implementation, with a focus on audit and feedback as a mechanism to change and improve practice. Specifically, this presentation will discussed:
An introduction to evidence-based healthcare
Current barriers to evidence-based healthcare
An introduction to evidence implementation and strategies for implementation
An introduction to audit and feedback projects including real world examples
Associate Professor Zachary Munn is the director of the Transfer Science program of the Joanna Briggs Institute: leading the development and coordination of the Institute’s educational courses, the development of systematic review and implementation software tools, and, the promotion and publication of the collaboration’s methodologies. He is the convener of two methodology committees focusing on grading evidence and systematic reviews of prevalence and incidence data. Dr. Munn is the current Chair of the international JBI Scientific Committee. Dr Munn has been involved in the conduct of dozens of systematic reviews and evidence implementation projects. Dr. Munn is a member of the GRADE working group, the Guidelines International Network tech working group, and a member of the Guidelines International Network Australia and New Zealand steering group.
The Joanna Briggs Institute (JBI) is the international not-for-profit, research and development centre within the Faculty of Health Sciences at the University of Adelaide, South Australia.
23 June 2016
HSRAANZ Webinar Series – panel on commissioning health care in Australia – reflecting on Primary Health Networks.
Health systems are challenged by pressures of increased demand and rising costs. The rise in complex chronic conditions means that the current system design that stems from an era when communicable disease was more prevalent than chronic is struggling to meet the changing health needs of the population. As governments look to ways to reform health systems we have seen an interest in the role of commissioning as a mechanism through which to reform many different aspects of public services. Primary Health Networks (PHN) have been charged with commissioning primary care services in Australia. The essence of commissioning is to take a stewardship role with a focus on providing vision and direction for the health system, collecting and using intelligence, and exerting influence - through regulation and other means.
As PHNs reach their first birthday it’s timely to take stock of how commissioning is developing both nationally and internationally. This webinar will incorporate research, policy and practice perspectives on the development and implementation of commissioning in Australia.
The panel session focused on broad areas relating to the following:
The current understanding of commissioning, and what it should achieve in PHN localities;
The challenges and opportunities of the commissioning process in Australia;
Concepts and elements of successful commissioning;
How are PHN commissioners working with wider stakeholder groups?
Helen Dickinson, Associate Professor of Public Governance at the School of Social and Political Sciences, University of Melbourne
Helen’s expertise is in public services, particularly in relation to topics such as governance, leadership, commissioning and priority setting and decision-making. Helen has published sixteen books and over fifty peer-reviewed journal articles on these topics and is also a frequent commentator within the mainstream media. She is co-editor of the Journal of Health, Organization and Management and Australian Journal of Public Administration. In 2015 Helen was made a Victorian Fellow of the Institute of Public Administration Australia and she has worked with a range of different levels of government, community organisations and private organisations in Australia, UK, New Zealand and Europe on research and consultancy programmes.
Learne Durrington Chief Executive WA Primary Health Alliance
With more than 25 years’ experience in the management of government and not-for-profit organisations, Learne Durrington has a reputation for driving innovation within and across the health and social care sectors. Learne is passionate about achieving a connected and accessible health system that is patient and outcome focused.
As the CEO of WA Primary Health Alliance, Learne is leading the establishment of strategic alliances and partnerships across WA to support systemic change within the primary healthcare system. Learne leads with the principle that good health outcomes can only be achieved through the combined effort of all levels of government, clinical and social care services together with private and public organisations.
Starting her career as a social worker, Learne has a MBA and is an Associate Professor of Health Sciences at Curtin University, a Fellow of the Australian College of Health Services Management and GAICD.
Suzanne Robinson, Associate Professor and Theme Leader for Health Systems and Health Economics, Curtin University
Suzanne is Theme Leader for the Health Systems and Health Economics group at Curtin University and an Honorary Senior Research Fellow at the University of Birmingham, UK. Suzanne has been involved in leading health systems and health economics projects that have had major impact on government reform initiatives. Suzanne also leads international research on decision making and priority setting in health, this work involves a number of aspects around population health planning and resource allocation. Suzanne has worked with a number of Australian and UK organisations around commissioning and procurement of health and social care services. This work involves both research and educational programmes, including the development and delivery of the first UK Masters programme in commissioning health services, this was delivered by the University of Birmingham. She was recently awarded the Australasian College of Health Services Management award for innovation and excellence for her work in health systems research and capacity building.
Jason Trethowan, Chief Executive Officer, Western Victoria Primary Health Network Ltd.
Jason Trethowan was appointed CEO of Western Victoria Primary Health Network in June 2015, with the organisation established on 1 July 2015.
Previously, Jason was the CEO of Barwon Medicare Local and held this position from 2011. Jason led the organisation, collaborating closely with local community and health industry partners to strengthen the primary care system. Prior to Barwon Medical Local Jason was the CEO of Geelong Practitioner's Association from 2007 – 2011 where he led the establishment of Australia's leading headspace site (Barwon) from May 2007 and led the advocacy for and establishment of a $7M GP Super Clinic which opened in August 2010.
Jason's experience includes partnerships, business operations, health system innovation and corporate governance. He holds a Master's Degree in Business Administration (MBA), Graduate Certificate in Health Informatics and a Bachelor of Health Information Management. Jason is currently a Board Member of the G21 Geelong Region Alliance, a council member of the Australian Health and Hospital Association and also a Steering
26 May 2016
HSRAANZ Webinar - Obesity and General Practice
This webinar jointly presented by Prof Jon Karnon and Jodi Gray (University of Adelaide) and Mark Harris (University of New South Wales) addressed: the issues around the management of obesity in primary care; what referral options are needed and the role that local health authorities and PHNs can play in developing these; and an opportunity to express an interest in involvement in further research in this area.
Managing obesity is a major and increasing challenge for the Australian Health System. While GPs have an important role in the assessment and management of obesity and its complications, the intensity of support required for most obese patients to achieve and maintain weight loss is much higher than the amount of support it is possible to provide in routine practice.
Despite this GPs have limited referral options and relatively few patients are referred for more intensive behavioural or surgical interventions. There are a range of patient, practitioner and system factors that influence GPs decision to refer patients for weight management support, some of which can be addressed to improve referral.
One alternative to external referral is for patients to be offered more intensive, structured programs within general practice by practice nurses. This has a number of advantages but requires training, quality control and adequate funding to ensure that it is effective and sustainable.
Webinar participants will obtain:
An understanding of the issues around the management of obesity in primary care
A clearer view of what referral options are needed and the role that local health authorities and PHNs could play in developing these
An opportunity to express interest in involvement in further research in this area.
COMPaRE-PHC is a Centre for Research Excellence involving Universities and collaborating organisations across three states. The Centre is focused on conducting and translating research on weight management and obesity prevention into primary health care. This webinar will present some of the findings from the Centre’s research on the pathways for the management of obesity in primary care.
HSRAANZ Webinar "Improving health systems - the role of design thinking and operations research
Health systems and services are under stress. In Australia, the health budget continues to receive the attention of politicians and media on a regular basis. Politicians seem to want their cake and eat it too – to spend less, but have better outcomes delivered for patients and the community. In such an environment, the only thing that is certain is that change will occur. How can health care managers and clinicians seek to improve the services they run, while improving the bottom-line. The methods being employed in other industries have a lot to offer. We believe that design thinking – a way of achieving the goals of systems thinking – combined with appropriate methods from operations research has a lot to offer when change is required – it can help achieve both improved services and better outcomes.
This webinar provided attendees with an understanding of what operations research and design thinking are, and how they can be used in the health care setting. The need to properly understand the nature of the change and ways of facilitating this was also be discussed.
This webinar was be presented by Dr Mark Mackay (Flinders University); Mr Keith Stockman (Monash Health) and Professor Robert Adams (The Queen Elizabeth Hospital and University of Adelaide).
25 December 2016
HSRAANZ Webinar – “Priority setting and resource allocation in health care: lessons learned and future steps”
Craig Mitton, Professor and Senior Scientist, Centre for Clinical Epidemiology & Evaluation, School of Public Health, University of British Columbia.
Abstract - Health organizations the world-over must allocate resources within a limited funding envelope. Recently, decision makers have come under even greater pressure as year-over-year growth in budgets has decreased and organizations have entered into a period of serious fiscal constraint. The objective of this talk is to present a set of methods that have been used many times over across Canada and elsewhere to assist decision makers in addressing financial challenges while remaining true to their goals of population health and quality patient care. In addition to outlining latest methods and innovations, several case studies from Canada will be discussed including solutions to key challenges. Areas of potential future research will also be presented.
Bio - Craig Mitton is a Senior Scientist at the Centre for Clinical Epidemiology and Evaluation and a Professor in the School of Population and Public Health in the Faculty of Medicine at the University of British Columbia. Within the School Craig is Head of the Health Services and Policy Division and is the Director of the Master of Health Administration program. The focus of his research is in the application of health economics to impact real-world decision making in health organizations. He has published a book entitled the ‘Priority setting toolkit: a guide to the use of economics in health care decision-making’ and has authored over 120 peer reviewed publications. http://spph.ubc.ca/person/craig-mitton
Prof Craig Mitton - Slides
Mitton - Feb 25 2016
Prof Craig Mitton - Video of Presentation
16 November 2015
What Keeps You Strong? Contributing to a Research Program Aimed at Supporting the Wellbeing of Older Aboriginal and Torres Strait Islander Peoples
Dr Carol Davy, Senior Research Fellow, South Australian Health and Medical Research Institute
Despite poorer health status and higher levels of socio-economic disadvantage, statistics show that on average, older Aboriginal and Torres Strait Islander peoples are less likely to use aged care services, in comparison to their non-Indigenous counterparts. Improving understandings of Aboriginal and Torres Strait Islander peoples’ cultures and the factors that support concepts of wellbeing is likely to support greater engagement with such services. The aim of this research program is to develop a model of care which will assist primary healthcare and aged care services to support the wellbeing of older Aboriginal and Torres Strait Islander peoples. The program began with a large systematic literature review which identified interventions and strategies that have or could improve the wellbeing of older Indigenous peoples internationally. The results of this review suggested that Indigenous identity was central to wellbeing for many Indigenous peoples. Crucial to maintaining Indigenous identity was a sense of independence, whereby older Indigenous people are able to contribute to and remain active members of their community. As physical independence often diminishes with age, having the support of culturally safe primary healthcare and aged care services that understand the importance of maintaining an Indigenous identity and also cater for the particular needs of Indigenous peoples was also found to be important. Given the number of Indigenous peoples who have been impacted by assimilation policies, services that also support Indigenous peoples to reconnect with their culture, community and family may be particularly crucial.
Carol Davy has had over 12 years’ experience in using both qualitative and quantitative methods to better understand the health needs of particular populations. Carol’s PhD completed in 2009 utilised a social psychology methodology to better understand the role that belief systems such as the biomedical model, Indigenous knowledge and religion played in informing and guiding primary health care service provision and utilisation. Currently, Carol is working on a number of programs related to primary and aged care services at Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute. As Senior Research Fellow, Carol is helping to lead the work conducted by the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE) and “What Keeps You Strong” a program of work which aims to support the wellbeing of older Aboriginal and Torres Strait Islander peoples. She is also involved in a study which developed a Wellbeing Framework for use in primary healthcare services and has developed a suite of master classes which aim to strengthen the research capacity of staff working in the Aboriginal healthcare sector. Carol is a recipient of the 2015 Health Services Research and Policy Fellowship. Prior to completing her PhD, Carol worked closely with the Papua New Guinea Institute of Medical Research on a variety of projects, including developing and managing a study which aimed to measure both the patient and health systems costs of treating malaria, in addition to the potential savings which may be recognized if a preventative malaria program was implemented. Dr Carol Davy has also worked at the University of Adelaide where she was an investigator on the Middle East Area of Operations Health Studies, and senior researcher responsible for the Middle East Area of Operations Prospective Study.
13 October 2015
Academic-health service partnerships as a translational strategy: panacea or placebo?
Gill Harvey, Professorial Research Fellow, School of Nursing, The University of Adelaide
Abstract The challenges of translating research evidence into policy and practice are well recognised. One strategy that is increasingly pursued as a possible solution is the creation of formal collaborations between universities and health care organisations, premised on the belief that closer working between the producers and users of research evidence will help to overcome the barriers to translation.
In this seminar, I will explore the growing focus on these types of partnerships and examine emerging evidence about whether and how they actually work. This will include drawing on my experience of working within and evaluating the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) in the English National Health Service.
Biography Gill Harvey is based in the School of Nursing at the University of Adelaide. She came to the university in October 2013 whilst on a two year sabbatical from her post as Professor of Health Management at Manchester Business School (MBS) in the UK. In November 2014, she took up a 4 year contract as a High Cite Professorial Research Fellow in Adelaide. Gill has a professional background in nursing; previous posts in the UK include working as the Director of the Royal College of Nursing’s Quality Improvement Programme and Director of the National Institute for Health and Care Excellence (NICE) National Collaborating Centre for Nursing and Supportive Care, with a remit to develop clinical guidelines for the National Health Service (NHS). Her teaching and research interests are in the field of quality improvement, knowledge translation and mobilisation in health care.
Policy Based barriers and enablers to high quality health care provision in aged care settings
Dr Amee Morgans, Senior Research Fellow | RDNS Institute.
Abstract There are a range of federal and state government interface challenges which determine referral pathways and barriers between aged care and health care, which are summarised in Figure 1. There is an aged care/health care industry mutual misunderstanding about responsibilities for management of health care of aged care recipients, and current health service models are built on these assumptions, often to the disadvantage of the individual seeking services.
Critical to the success of the system delivering care to those who are most in need are the inter-sectoral relationships that can drive change and implementation from both health and aged care industry perspectives. The importance of peak bodies in driving inter-sector partnerships and communication is evident and the timing to commence these activities opportune.
Biography Dr Morgans has extensive experience in management of teams responsible for strategic cross-divisional and multi-organisation project management, government policy analysis and research impact evaluation. Dr Morgans specialises in the design and delivery of projects which create real impact and innovative research that translates into operational, system and policy level change via evidence based industry level advocacy.
11 May 2015
"Why hospital standardised mortality ratios should be avoided"
Nick Black, Professor of Health Services Research, London School of Hygiene and Tropical Medicine
There is a pressing need to assess the quality of hospitals. Many countries have chosen to use hospital-wide mortality ratios, which have the attraction of simplicity and providing a single measure. But these measures are misleading for five key reasons, all of which will be discussed. Despite criticisms by leading health services researchers in the USA, Canada, UK and Australia over the past two decades, the use of this approach persists. And their use can have harmful consequences for patients, clinicians and managers. So if politicians and the public insist on deaths in hospital being used to improve the quality of hospitals, how might this be done better? An approach based on in-depth case record review being adopted in several countries will be explored together with rigorous methods for assessing the quality of hospital care.
Biography : Nick Black
After qualifying in medicine from Birmingham University in 1974, he worked in NHS hospitals before joining Save the Children Fund to run a child health programme in Nepal. He then underwent post-graduate training at Oxford, including a doctorate on reasons for the epidemic in surgery for glue ear, before spending three years as a lecturer at the Open University writing a distance-learning course 'Health and Disease' with a biologist, sociologist and economist.
In 1985 he moved to the LSHTM and was promoted to a Chair in Health Services Research in 1995. His main research interests are the use of clinical databases for evaluation and audit of health services (particularly in the field of surgery and critical care), patient-reported outcomes, non-randomised methods of evaluation and, recently, dementia care. He is a trustee of the Intensive Care National Audit & Research Centre.
In 1996, together with Nick Mays, he founded the Journal of Health Services Research & Policy, which they continue to edit and, in 2005, was elected Chair of the newly created UK HSR Network. In 2006 he published Walking London’s Medical History (new edition 2012) to raise public understanding of health services and health care policy through seven walks through London plus a tour of north and east Kent. Since 2007 he has chaired the National Advisory Group for Clinical Audit & Enquiries which advises NHS England. He is also a member of several advisory groups on quality assessment for the DH, NHSE, CQC and QualityWatch.
Social media for health services research: what works and what doesn’t? TWITTER.
Presenter: Melissa Sweet
Melissa Sweet is an independent journalist who specialises in covering public health, and is the author/co-author of several health-related books. She founded the public health blog Croakey, and is an active blogger and tweeter. She is currently undertaking a PhD at Canberra University, which will produce a long-form work of journalism about Aboriginal and Torres Strait Islander health and history, as well as a decolonising methodology for journalism practice. Twitter is a critical part of her PhD, and has also been useful in helping to transform her journalistic practice. She has an adjunct position as Senior Lecturer in the Sydney School of Public Health at the University of Sydney, and chairs the Public Interest Journalism Foundation based at the Centre for Advancing Journalism at the University of Melbourne.
The HSRAANZ Symposium and Annual General Meeting - 1 December 2016
This event was held at the National Press Club in Canberra on 1 December. Over 50 delegates from Universities, research centres and Health Departments were in attendance.
The theme for the day was Health Services Research – where to from here? A review of the state and potential of HSR in Australia and New Zealand Full Program
The day commenced with a presentation from Suzanne Robinson of Curtin University and member of the HSRAANZ Executive Committee on the preliminary results of the HSRAANZ commissioned study of the state and potential of Health Services Research in Australia and New Zealand. (Slides) (Please note that the slides contain preliminary data only which could change as the study progresses.)
Suzanne explained that as the the peak body for HSR in Australian and New Zealand the HSRAANZ has a major role in assisting health services researchers and policy makers to meet the challenges facing the health system in the 21st Century. In order to inform the Association's strategy over the next decade we have commissioned a study to provide a clearer picture of the current state of health services research in Australia and New Zealand.
Newcastle University Team
The evaluation team from University of Newcastle team is Dr Elizabeth Fradgley, A/Prof Christine Paul, Prof John Wiggers, Prof Deborah Loxton, Dr Catherine Chojenta, and Dr Melissa Harris. With support from Della Roach, Emma Byrnes, and Annika Ryan.
Prof Jon Karnon President of the HSRAANZ then spoke on the opportunities offered by the MRFF and Mark Booth and Erica Kneipp from the Department of Health responsed on the challenges facing health services and primary health care research and the opportunities offered by the MRFF; research translation centres and emphasis on evidence based policy and greater data availability. (Slides).
The morning concluded with examples of the best and most impactful health services research nominated for the HSRAANZ Impact Award (details attached)
The event concluded with breakout sessions addressing the potential role and approaches to HSR in different healthcare sectors:
A. Data infrastructure
What makes a useful clinical registry?
Need for transparency (quality, standards, integrity)
Clinical Registry – for data linkage; opt out system; other governance issues.
Long term as appropriate.
Regular reviews of minimum data sets.
What are the data linkage priorities?
Going national, linking of hospital collections, MBS and PBS data and national death index are most important
Also cancer, ED, administration, perinatal.
Rationalise governance and ethics.
Is patient reported outcomes data a priority? If so, how could it be supported?
Yes – quality of life
Fit for purpose – generic and disease specific
Clinical care vs research
Utility based measures
Link to clinical registries
What are other data infrastructure priorities?
Linkage of Federal data sets. Health plus
Trusted user model to other data sets and linked data sets.
C. Implementation and improvement in public hospitals
Need junior doctors in research positions. Research needs to be part of their rotation and well resourced.
Need to infiltrate clinical microsystems. Research related to clinical work. Snr Drs need to train juniors.
Need a critical mass of clinical researchers, with collaboration across smaller hospitals.
Need to include nursing and allied health
Need clinician led research and practice based research.
Undertake a survey of what clinicians need – time, funds, mentoring etc.
Simpson Centre clinician led NHMRC program grant.
Clinicians now more involved in health policy and provide a good opportunity to grow HSR.
NIR - put HSR on the agenda; leadership program; Fellowships
Horizons gap – need to predict gaps and have solutions ready.
Joint clinical and academic appointments. Harder in some areas. Senior doctors need training in mentoring. Junior doctors need training in research methods.
D. How to fund research in primary health care?
Should PHNs be allocated research budgets? For what scope and with what support?
They are already overworked so research budgets should be managed by others
But they are well placed to undertake research.
They have great billing data, but limited diagnostic data.
Opportunities – well positioned in rural and urban centres
If not, how else to fund and organise research in PHC?
Universities may have a role working with them.
Consider more joint appointment (academic and PHN-based) health services researchers
The changing face of the GP workforce: The results of the 2015 RNZCGP workforce survey
Date: 15 March 2016
The College of GPs conducts an annual electronic survey of its members. Nearly 2,500 responses to the 2015 survey were received, giving a response rate of 54% and providing valuable insights into the state of the GP workforce. Results revealed that among currently working respondents, 41% intended to retire in the next 10 years, 56% were aged 50 years or over and 53% were female. Information was also gathered on topics including practice ownership, vacancies, income, working hours, after hours commitments, and how likely members were to recommend a career in general practice. Female respondents earned less than their male colleagues and possible reasons for this difference will be discussed. In addition to the results of the 2015 RNZCGP survey, information from successive Medical Council Workforce Surveys will be presented to illustrate how the age profile of general practitioners became so skewed towards the older age groups and to illustrate the recent increase in the number of younger GPs.
Frances Townsend is a senior policy advisor with the Royal New Zealand College of General Practitioners. She graduated from Otago University with a medical degree in 1983, and went on to train as a general practitioner. She completed a Diploma in Public Health in 2003 and has worked for the Ministry of Health and for the past 10 years the College of General Practitioners on issues including the Health and General Practitioner workforce.
Reducing the Gap between Research, Policy and Practice Initiative
Summary Report of A Breakfast Conversation
Held on 24 November 2015
Attahced is a summary of feedback from our latest event which focused on including consumers’ voices in designing, undertaking and translating research. This interactive semi-structured conversational event encouraged exchange between researchers, clinicians, policy makers and consumers about their personal and practical challenges experienced in addressing research-policy-practice gaps.
Transforming Health: Shaping the Research Agenda Workshop Adelaide on 17 July
Transforming Health is intended to bring about a permanent change in systems and the culture of healthcare delivery. The vision is to deliver a quality healthcare system that provides best care, first time, every time. It has six quality principles to transform the system: patient centred, safe, effective, accessible, efficient and equitable.
While the focus is on improving metropolitan hospital services in South Australia, there will be flow-on effects, particularly in primary health care, aged care and country health services. Indeed, there is a commitment to work in partnership with General Practice, Primary Health Care, and the health industry.
As well as ensuring health care professionals are driving the initiative, engagement and consultation with community and consumers has been a significant component of the initiative to date and providing a time and place to contribute your Research Ideas
To support the research process, the Health Services Research Association of Australia and New Zealand (HSRAANZ), Primary Health Care Research & Information Service (PHCRIS), the South Australian Health & Medical Research Institute (SAHMRI) and Cancer Voices convened a Transforming Health Research Workshop. The aim was for researchers, health care professionals and managers, policy makers and consumers advocates to come together to share Research Ideas that could usefully inform the success of Transforming Health. We sought multidisciplinary approaches to cross–fertilise our thinking from the outset and shape how we work together. We asked for bold ideas. Ideas that do more than ‘improve’ but actually inform the implementation, monitor, evaluate and report the impact of ‘Transforming Health’. Research can identify what is working and why, what is not working and why, and any unintended consequences. It can examine what needs to be started, expanded or stopped.
The symposium held at CHERE’s offices in Ultimo was a huge success with a high calibre researchers and policy makers looking at the latest developments in Australia, New Zealand and internationally in health policy and providing another opportunity for HSRAANZ members to get together and to finish another successful year.Kees Van Gool, Associate Professor, Centre for Health Economics Research and Evaluation kicked of the Symposium with the presentation of a paper looking at the impact of economic crisis on health and health care.
Abstract: “Health, austerity and economic crises: assessing the short-term impact in OECD countries”
The economic crisis that started in 2008 has had a profound impact on the lives of citizens. Millions of people lost their job, saw their life-savings disappear and experienced prolonged financial hardship. The economic crisis has also led a number of OECD governments to introduce austerity measures to reduce public deficits. The health sector, like many other social welfare programmes, has witnessed extensive spending cuts and has also been the subject of substantial reforms. The combined effects of economic crisis, austerity and reforms have led many OECD health systems into unchartered territory. This paper looks at the impact of economic crisis on health and health care. It summarises findings from the published literature on the effects of economic crisis that took place over the past few decades and also describes recent health policy reforms, focusing on those countries where the economic crisis has hit hardest. Finally, this paper analyses the empirical relationship between unemployment and health care use, quality and health outcomes, using data from OECD Health Statistics. In doing so, it investigates whether the effects of unemployment on health outcomes have been extenuated by austerity measures.
While many of the health reforms undertaken since the start of the economic crisis can make a positive long-term contribution to the health system’s productivity and efficiency, there may also be negative impacts. The short-term effects examined in this paper suggest that austerity measures have had mixed success in protecting patients from reduced health care access, but there remains an important need to actively monitor the wider long-term health impact of the economic crisis.
In her presentation Jackie Cumming, HSRAANZ President and Professor, School of Government, Victoria University of Wellington reviewed developments in the New Zealand health system and reflected on those reforms and the lessons for Australia.
Abstract: “Health System Reforms in New Zealand”
The New Zealand health system went through a series of health reforms during the 1990s and early 2000s, with the overarching organisational arrangements settling by the mid-2000s. Twenty geographically based District Health Boards (DHBs) plan services for their populations, and deliver a wide range of hospital and community services themselves. They work with privately owned primary health care providers to deliver primary health care services organised through Primary Health Organisations (PHOs). During the late 2000s, 80+ PHOs were amalgamated into the 36 that exist today. DHBs also work with not-for-profit providers to deliver some primary health care and community care services (e.g., iwi-based, Māori and Pacific-led primary health care providers, health promotion groups etc.). The most recent changes have involved the establishment of Alliance Leadership Teams (ALTs) where DHBs, PHOs and providers are to work together to plan and deliver services. The main focus is on strengthening primary health care, delivering care closer to home and better integrating services, particularly across primary and secondary health care services. In this talk, Jackie will reflect on these reforms and their effects and discuss key lessons for Australia.
After lunch the 2014 HSRAANZ Best PhD Student Prize was presented to Paul Harris. Paul is a final year PhD student in the Population and Social Health Research Program at Griffith University. Paul won the prize for his paper “The public’s preferences for emergency care alternatives and the influence of the presenting context.” Paul presented his research to the Symposium.
Tony Sherbon, Chief Executive Officer, Independent Hospital Pricing Authority led the afternoon session with a talk on “National Funding Reform: Achieving success with Activity Based Funding.”
Abstract: “National Funding Reform: Achieving success with Activity Based Funding.”
Activity based funding is a funding method in which hospitals are funded on outputs which are categorised, weighted, costed and priced by purchasing organisations. There are a range of categorisation systems available for use by purchasers. Australia uses Australian Revised Diagnosis Related Groups for inpatient service classification and is developing improved systems for categorisation of emergency department services, subacute services, and outpatient services.
In December 2011, Australia established an independent agency to price each service provided by state government hospitals. This in turn determines the amount of federal government funding provided to each state government run local hospital network.
Hospitals can gain a greater understanding of their cost base with activity based funding and can plan their investment in services to fund their services based on the expected price and funding received for those services.
The day closed with Diane Watson, inaugural Chief Executive Officer of the National Health Performance Authority will provide an update on impact of national performance reporting in Australia and abroad.
Abstract “National performance reporting: Progress and impact in Australia and abroad”
Most developed countries have implemented nation-wide, public reporting schemes to monitor and improve health care. In December 2014 it will be two years since the National Health Performance Authority released its first report on the performance of 400 of Australia's largest emergency departments. This presentation will focus on how the Authority uses the "tools of research and knowledge translation" to publish new information in ways that stimulate or accelerate action in local communities to improve health and care. Each of the Authority's reports result in media with audiences of 2,000,000 to 20,000,000 and one of its web based interactive tools has been used by 65,000 people. The presentation will highlight the impact of performance reporting in Australia and abroad. Please visit our new MyHospitals and MyHealthyCommunities websites!
On 29 July 2014 the Association ran an Emerging Research Workshop in Melbourne - hosted by the one of our Corporate Members - the Centre for Health Policy, Melbourne School of Population and Global Health. In the morning four emerging researcher presented their work and received constructive feedback from expert discussants. In the afternoon there was a round table discussion on developing a career in health services research. You can read here a report from Belinda O'Sullivan one of the delegates at the workshop.
Reducing the Gap between Research, Policy and Practice Initiative
A Knowledge Exchange Event
While there have been spectacular advances in primary health care research, policy and practice over the past 20 years: from tobacco control, to mental health initiatives and improved cultural understandings of health care, translating evidence-based research to policy and practice can be a long, arduous and uncertain task.
The Reducing the Gap Between Research, Policy and Practice Initiative aims to address the challenge of translating research into policy and practice by providing a supportive collegial environment that encourages discussion, the sharing of ideas, information and knowledge, to improve primary health care outcomes.
A joint initiative co-founded by the South Australian Health and Medical Research Institute (SAHMRI), the Health Services Research Association of Australia and New Zealand (HSRAANZ) and the Primary Health Care Research & Information Service (PHCRIS), the first three sessions have been met with enthusiastic responses from researchers, policy makers and research users, and will continue throughout 2014.
The reality of this work is that it’s political; there is no way of getting around that. As a researcher who wants to make a difference to policy or practice, you must surround yourself with a good team of people – not just researchers, but policy makers,” said Professor Justin Beilby, Executive Dean of the University of Adelaide’s Faculty of Health Sciences.
The second panel discussion included the perspectives of policy makers including: Dr David Panter, Chief Executive Officer of Central Adelaide Local Health Network Department of Health South Australia; Christine Morris, a prominent South Australian health promotion consultant and Churchill Fellow; and Jeff Fiebig from the ACH Group. Facilitated by PHCRIS’ Knowledge Exchange Manager, Dr Christina Hagger, Senior Research Fellow, they too spoke of the complexity of working in this space.
“In the case of tobacco the changes to policy didn’t just come from the researchers and the evidence they supplied, the real changes came from the willingness of advocacy groups, politicians and government to support change against all odds,” said Christine Morris.
The third session in the series, facilitated by Dr Carol Davy, Senior Post Doctoral Fellow, Wardliparingga Aboriginal Research Unit focused on community perspectives. The panel of community advocates included: Ms Stephanie Miller, Executive Director, Health Consumer Alliance of SA Inc; Ms Julie Marker, Acting Chair, Cancer Voices South Australia; and Mr Tim Agius, Director Strategic Development, Maari Ma Health Aboriginal Corporation. Offering insight into the research user's perspective, all panelists called for more integration between consumers, researchers, and policy makers, and respectful research which engages whole communities, not just consumers
"Aboriginal people have been researched to death, but at no time have we been asked what research we would like to be done," said Tim Agius. "Researchers and policy makers need to engage not only with consumers but with communities, from the beginning of a project, not at the end. If you get the process right you’ll get the outcome you’re looking for."
HSRAANZ/University of Auckland School of Population Health - Early Career HSR Workshop "How to successfully publish you research"
Developing a successful publication track record is an essential part of a successful research career. This workshop held in Auckland on 26 October 2012 gave advice to early career health services researchers on strategies and approaches to get their research published in leading journals. Thanks to the University of Auckland School of Population Health for hosting the event.presentation 1- Chris Carswell, editor of PharmaconoEconomics, Co-Editor of The Patient: Patient-Centered Outcomes Research, Consulting Editor, Applied Health Economics and Health Policy
presentation 2- Tim Tenbensel former Assistant Editor (Health Policy) at Social Science and Medicine
Who is setting the research agenda in health services research?
Held - Monday 16th July, 9.00-11.45 am
Royal Adelaide Hospital
This was a half day forum around horizon scanning for health services research and policy. It looked at how the future research needs of policy makers and clinicians can be predicted and addressed? From their personal perspectives an expert panel of health stakeholders was asked to think about and forecast the areas of evidence (general and specific) that people in their position will need to make decisions in 2017. Audience participation was encouraged and audience views on particular issues was sought during and after the presentations.
Link to presentation
A/Prof Jackie Cumming President, HSRAANZ
Panel Member 1 Clinician – Tertiary Setting
Assoc Prof Craig Whitehead Repatriation General Hospital, Adelaide
Grant Review Panel Experts – Helen Christensen (Professor and Director of the Centre for Mental Health Research, College of Medicine at The Australian National University Canberra), Paul Dugdale (Director of Chronic Disease Management, Aged Care and Rehabilitation Services, ACT Health (Senior Staff Specialist) and is Associate Professor of Public Health in the ANU Medical School), Davina French (Ageing Research Unit at the ANU)
Successful Applicant –Emily Banks (Scientific Director of the 45 and Up Study, Head of Chronic Disease Epidemiology at the National Centre for Epidemiology and Population Health)
Q and A Session
HSRAANZ Seminar - Mental Health Services Research - Achieving Outcomes in Mental Health Reform - Melbourne 15 August 2011
The government’s recent budget announcement of $1.5 billion in new initiatives to deliver better mental health care is an important initial step towards transformational mental health reform. How can we be sure of the effectiveness of that investment in the prevention, diagnosis and treatment of individuals with or at risk of mental disorders? And what role is there for health services research in informing and influencing how governments and the private sector design, implement and measure programs in mental health?
This seminar, presented by the HSRAANZ and the Centre for Health Policy, Programs and Economics, University of Melbourne showcased how health services research methods are being used to inform mental health policy.
HSRAANZ Workshop - What are the secrets to a successful health services research grant application? 21 October 2010.
The slides from this successful workshop on the secrets to a successful health services research grant application are now available.
This workshop which was attended by over 30 delegates focused on NHMRC project grants and featured a panel of experts including a senior NHMRC representative, successful applicants, and grant review panel experts, who reflected on common pitfalls and the secrets of success, the key elements of a strong grant application, tips and techniques for successful grant writing, and ways to improve writing discipline.
Some of the question tackled in the Q and A session included:
• What makes different types of research (behavioral group, secondary data analysis/trial groups) fundable?
• Do projects proposing a trial of an intervention need to have an economic evaluation component and how should it be included?
• Should you bother to submit an application if you have only just completed your PhD and only have one publication?
• What should you do when you have a researcher who is essential to your research project but does not have a good track record?
• How do you decide who should be a CI and an AI and who should be the CIA?
Introduction Chair – Rosalie Viney (Rosalie Viney) NHMRC Expert – Elim Papadakis (no slides) Grant Review Panel Experts – Louisa Jorm , Marion Haas (Slides) and Sally Redman Successful Applicants – Annie McCluskey and Sallie Pearson
Mid year Seminar - Consumer Responsive Healthcare - What does it mean?
The Association ran a Seminar at Melbourne University on the 4th September 2009. This seminar discussed the different methodologies used to elicit citizen’s preference for treatment and services and their place in health services research.
The Implementation of New Zealand's Health Targets: Generating Traction or Driving to Distractions?
Held on 21 May 2015 - Victoria University, Wellington
Performance targets have been a cornerstone of New Zealand’s health policy since 2009. They are set to become more deeply entrenched in our publicly-funded health system through the formulation and implementation of IPIF (Integrated Performance and Incentive Framework). For advocates of this approach, health targets provide a way to prioritise attention, enhance accountability and stimulate health service improvement. Critics of targets and performance management focus on potential downsides including target-induced myopia, the prospect that health services will ‘hit the target but miss the point’, and unnecessarily distort the work of those providing health services.
In this environment, it is crucial to understand how regimes of targets and performance management are actually implemented, given the potential for substantial benefits and the substantial risks. Our presentation is based on extensive research into the implementation of two health targets that were in place between 2009 and 2012: shorter stays in emergency departments, and immunisation coverage of two-year-olds. We will address:
•What type of activities and initiatives had the most impact on target implementation?
•What was the balance of positive and negative consequences for each of these targets?
In answering these questions, we can begin to identify the key features of health targets that generate positive consequences, and those that are likely to lead to problems. In doing so, we aim to highlight the key factors that need to be considered by those designing regimes of performance management.
Tim Tenbensel is the Head of the Health Systems Section in the School of Population Health, University of Auckland, where he lectures in health policy and public management. His research has focused on the implementation of health policy initiatives, including health targets, Better Sooner More Convenient primary care initiatives, and the introduction of the DHB system in the early 2000s.
Esther Willing (Ngati Toarangatira) is a lecturer in Māri Health and Policy, based at Te Kupenga Hauora Māri, University of Auckland. She recently completed her PhD on the implementation on the immunisation target for two year olds. She also has extensive experience in health services evaluation over a ten year period. She has a particular interest in the potential of health targets to address health inequalities.
Positioning primary health care at the centre of health systems – how far have we come through health reform?
10 December 2012
Presenter: Mark Booth. First Assistant Secretary, Primary and Ambulatory Care Division, Department of Health and Ageing.
Abstract: Over the past 20 years, Mark has been involved in primary health care reform in the United Kingdom, New Zealand and Australia. This presentation provides an over view of health reform from working as a researcher, a health policy maker and senior health advisor in the UK and New Zealand, a Commonwealth Fund Harkness Fellow in the US, and more recently as part of the Senior Executive of the Commonwealth Department of Health and Ageing.
Biography: Mark has a background as a health economist, working in health policy areas in the UK and New Zealand. He joined the Department of Health and Ageing in 2010, undertaking several Branch Head roles including responsibility for the development and implementation of the Medicare Locals initiative. Mark is First Assistant Secretary of the Primary and Ambulatory Care Division which aims to provide Australians with access to high quality, cost-effective, evidence-based primary care which coordinates with other types of care such as aged care services and hospital specialists.
Mark was a 2006–07 Commonwealth Fund Harkness Fellow in Health Care Policy.
HSRAANZ Lecture - The Long and Winding Road to Long-Term Care Reform in the United States
On 28 November Joshua M Wiener, Ph.D., Distinguished Fellow and Program Director for Aging, Disability and Long-Term Care at RTI International gave a lecture examining the major changes and the options for future reform in delivery, quality assurance and financing of long-term care.
Joshua M. Wiener, Ph.D, is a Distinguished Fellow and Program Director for Aging, Disability and Long-Term Care at RTI International. He is the author or editor of eight books and over 200 journal articles, reports and monographs on health care for older people, people with disabilities, quality assurance, residential care facilities, long-term services and supports, international health care systems, Medicaid, health reform, health care rationing, and maternal and child health.
CHERE/HSRAANZ Lecture - Dr Tony Sherbon - IHPA and Activity Based Funding
The slides from this lecture presented by Dr Sherbon on 16 October 2012 are now available - SLIDES
The Independent Hospital Pricing Authority (IHPA) commenced operations in December 2011 and is charged with the responsibility of introducing some key elements of activity based funding for public hospitals in Australia. The Commonwealth legislation that created the IHPA was based on the National Health Reform Agreement signed by all first ministers in August 2011.
In June 2012, IHPA published its Pricing Framework and the National Efficient Price for the 2012/13 financial year which will provide a firm basis for hospital managers to plan for the uncapped introduction of activity based Commonwealth funding from 1 July 2014. Commonwealth payments to Local Hospital Networks will be based on this National Efficient Price from 1 July 2012 although a guarantee of funding will apply at jurisdictional level for the 2012/13 and 2013/14 financial years which are transitionary years under the Agreement.
IHPA has also drafted criteria that will be used to determine which public hospitals are activity base funded and which will be block funded. This has important implications for all small hospitals in Australia.
IHPA is also responsible for designing and implementing new activity based funding systems for mental health, subacute care and teaching, training and research in all Australian public hospitals and has commenced work on these issues.
Before taking up the position of Acting Chief Executive Officer in the Independent Hospital Pricing Authority in September 2011, Dr Tony Sherbon had 21 years experience in clinical and administrative management within the NSW, ACT and South Australian health systems.
Dr Sherbon is currently working on the establishment of the Independent Hospital Pricing Authority agreed at the Council of Australian Governments meetings held in April 2010 and February 2011.
Dr Sherbon previously oversaw the design and implementation of the SA Government’s Health Care Plan in his previous role as Chief Executive of SA Health.
Dr Sherbon has previously chaired the Australian Health Ministers Advisory Council, and has previously been a Board member of the South Australian Health and Medical Research Institute, National E-Health Transition Authority and Health Workforce Australia.
26 July 2012 - Public Lecture - Health services research on complementary and integrative medicine: Some advances from the field Professor Jon Adams, Professor of Public Health, University of Technology Sydney
ABSTRACT: The popularity, use and practice of complementary and integrative medicine (CAM) raises a number of core public health/health services research issues with reference to effectiveness, patient-practitioner communication, professional role and inter-professional relations amongst others. Unfortunately such topics remain largely under-researched. In order to improve health, well-being and health care for all and to help expand the broad evidence-base around CAM it is essential that a critical and rigorous program of public health and health services research be promoted and undertaken in this area. In response, the Network of Researchers in the Public Health of Complementary and Alternative Medicine (NORPHCAM) [an international network with headquarters based at the University of Technology Sydney] conducts and promotes rigorous, critical public health and health services research examining traditional, complementary and integrative health care.
NORPHCAM currently leads a number of mixed-method, national projects both completed and in progress exploring health economics, rural health, women's health and the CAM/conventional care interface (funded by NHMRC, ARC and PHCRED in excess of $6M). Drawing upon recent and ongoing fieldwork this presentation will illuminate how a public health and health service research program is essential to understanding and exploring the role of CAM in contemporary health care and in addressing the research capacity building challenges facing the field.
BIOGRAPHY: Jon is an NHMRC Career Development Fellow and Professor of Public Health in the Faculty of Nursing, Midwifery and Health at UTS. Jon also holds a number of international positions including Visiting Professor of Health Services Research (Complementary and Integrative Health Care) at the London South Bank University, UK. He is also Executive Director of the Network of Researchers in the Public Health of Complementary and Alternative Medicine, NORPHCAM– an international network with over 200 members promoting and conducting rigorous public health and health services research examining the practice and use of complementary and alternative medicine (CAM), traditional medicine and integrative health care. Jon has been leading a national team of researchers examining CAM use and provision for women’s health in Australia. Drawing upon data from the Australian Longitudinal Study on Women’s Health, this ground-breaking work constitutes the largest longitudinal analysis of CAM use in the world to date, n=>40,000 women.
Jon has extensive training in qualitative health research methods, health social science and mixed-method design. He currently leads (CIA) 6 national & international CAM projects (ARC and NHMRC-funded) and has been researching numerous aspects of CAM and conventional primary health care for over 10 years attracting in excess of AUD$5.5M in external funding since 2007.
21 May 2012 5:00pm - Evidence into practice: the contribution of behavioural science - Professor Susan Michie, Professor of Health Psychology, University College, London
ABSTRACT: Due to the considerable investment in trials of healthcare interventions and in evidence syntheses, we have increasingly good evidence about best practice. However, much is wasted because research evidence and guideline recommendations are not implemented effectively. The result is that good quality health care and best health outcomes may not be achieved.
Interventions to improve delivery of evidence-based health care have achieved modest and variable success. Improving implementation depends on changing the behaviour of health professionals and others, but behavioural science is seldom used to inform interventions to improve practice.Three problems in taking healthcare interventions from trial to practice will be addressed, illustrated by research from behavioural science:
Key intervention characteristics are rarely described in sufficient detail in trial protocols and published reports to be replicated.
Fidelity, the extent to which interventions are delivered as stated in trial or clinical protocols, is seldom reported and is often poor.
Theories of behaviour change are rarely used to inform interventions to change practice.
BIOGRAPHY: Professor Michie undertook her undergraduate and postgraduate training in experimental and developmental psychology at the University of Oxford and her clinical psychology training at the Institute of Psychiatry, University of London. Professor Michie is a chartered clinical and health psychologist, Fellow of the Academy of Social Sciences, the European Health Psychology Society and the British Psychological Society.
Professor Michie leads UCL’s Health Psychology Research Group, studying behaviour change in relation to health: how to understand it theoretically and how to design more effective interventions. Her work develops methods to advance the study of behaviour change e.g. developing taxonomies of behaviour change techniques to specify the content of interventions, applying theory to synthesising evidence in systematic reviews. This is conducted in the domains of professional practice and implementation (e.g. behavioural support for smoking cessation, hand hygiene), and preventive behaviours amongst patients and the general population (e.g. physical activity and healthy eating, vaccination uptake). She is co-author of a comprehensive model of behaviour change (the Behaviour Change Wheel) and contributed to the 2011 House of Lords Science and Technology Enquiry into Behaviour Change.
Professor Michie is co-director of the UK’s National Health Service’s Centre for Smoking Cessation and Training and Chair of the Behaviour and Communication group of the UK Government’s Scientific Pandemic Influenza Advisory Group on which she serves. She was a consultant to the Department of Health advising on public health policy and practice, 2004-2010 and is currently a member of the Public Health Interventions Advisory Committee of NICE (National Institute of Clinical and Health Excellence), and of its Implementation Strategy Group. Professor Michie is on several international advisory boards, including Knowledge Translation Canada and the Implementation Research Institute, USA.
The Pursuit of Happiness and Wellbeing: A Forlorn Hope? - Professor Sir Mansel Aylward,
Held on Wednesday, 18 April 2012, 1.00 – 2.30 pm, Victoria University of Wellington, Professor Sir Mansel Aylward, Inaugural International Visiting Chair, Ko Awatea Centre for Health System Innovation and Improvement, Counties Manukau District Health Board, gave a talk about “The Pursuit of Happiness and Wellbeing: A Forlorn Hope?” and the work he has been doing at Ko Awatea – a centre designed to bring together thinking, innovation and action.
Sir Mansel is recognised internationally for his considerable contribution and ongoing involvement in health systems improvement, advice on policy and implementation, especially on work and health. He is the first-ever Chair of the Bevan Commission in Wales, which brings together a group of international experts to give expert advice to the Minster for Health and Social Services to help ensure that increasingly Wales can draw on best practice from across the world while remaining true to the principles of the NHS as established by Anuerin Bevan. He is current Chair of Public Health Wales, a new unified NHS Trust responsible for the delivery of public health services at national, local and community level in Wales. He is also Director of the Centre for Psychosocial and Disability Research at Cardiff University which offers a unique opportunity to extend knowledge and understanding of the psychosocial, economic and cultural factors that influence health, illness, recovery, rehabilitation and reintegration. Sir Mansel was Chair of the Wales Centre for Health, an Assembly Government Sponsored Body established to be the ‘hub of connected organisations’ and to communicate better health messages to the people of Wales. He was also former Chief Medical Advisor and Chief Scientist to the UK Department for Work and Pensions.
He is a physician and specialist in rheumatology and rehabilitation, therapeutics and clinical pharmacology; a visiting Professor at several universities in Europe and North America and a consultant to the United States Social Security Administration and Department of Labour. He led the Corporate Medical Group on the UK Government's Welfare Reform initiatives and made a major contribution in establishing the new postgraduate diploma for doctors in Disability Assessment Medicine. He was closely involved in developing the UK’s successful “Pathways to Work” initiatives and a framework for Vocational Rehabilitation. He is keenly interested in addressing the health, work and social issues relevant to morbidity, mortality, work, economic inactivity and social exclusion in the South Wales Valleys where he was born and brought up. His interests are in rheumatology and rehabilitation, health and productivity, psychosocial illnesses, health inequalities, chronic fatigue syndromes and back pain disability. He has published widely in these various areas.
Guided car: A Model of Care for People withMulit-Morbidity- Seminar with Chad Boult,Prof of Health Policy and Management,John Hopkins Bloomberg School of Public Health
Dr Boult gave a public lecture at the Health Services Research Centre, School of Government, Victoria University, Wellington in 3 April 2012.
Dr Boult described and led a discussion of the creation and evaluation of the “Guided Care” model of health care for people with multiple chronic conditions. Guided Care is a, team-based model of primary care in which a registered nurse, co-located in a primary care practice, partners with 2-5 physicians to provide comprehensive, coordinated, patient-centered care to 50-60 patients. These services include comprehensive assessment, care planning, transitional care, proactive patient monitoring, care coordination, self-management support, caregiver support, and facilitation of access to community-based services.
A 3-year, multi-site, cluster-randomized controlled trial showed that Guided Care significantly improved:
The quality of chronic care
Physicians’ satisfaction with chronic care
Guided Care also produced modest reductions in re-admissions to hospitals, skilled nursing facilities and home health care, especially in well-integrated systems of care. Practices can adopt Guided Care fairly easily because technical assistance is available: a practical implementation manual; on-line courses for physicians, practice administrators and nurses; and a patient orientation booklet.
The seminar included a conversation between the speaker and the audience about the application of lessons from the Guided Care project to health care in New Zealand.
Dr Boult holds joint appointments on the faculties of the Johns Hopkins University Schools of Medicine and Nursing. He is a teacher, a researcher and a board-certified physician in Family Medicine and Geriatrics. He has extensive experience in developing, testing, evaluating, and diffusing new models of health care for older persons with chronic conditions.
Increasing Patient Activation to Improve Health and Reduce Costs
Professor Judith Hibbard Senior Researcher and Professor ,University of Oregon, 23 March 2011
Abstract: In this presentation I will review the evidence about what patient and consumer activation entails, how it is measured, and what we have learned about patients at different levels of activation. I will elaborate on the research that indicates that activation levels are predictive of health behaviors, health status, health care utilization and costs. Further, I will review the strategies that have been shown to be effective in increasing activation in patients. Finally, I will discuss how the research results are informing approaches for improving care.
Judith Hibbard is a Senior Researcher and Professor at the University of Oregon. Over the last 28 years she has focused her research on consumer choices and behavior in health care. She has a particular interest in testing approaches that give patients more knowledge and control over their health and health care. Her studies examine such topics as: how consumers understand and use health care information, how health literacy affects choices, enrollee behavior within consumer driven health plans, and assessments of patient and consumer activation She is the lead author of the Patient Activation Measure (PAM). Prof. Hibbard advises many health care organizations, foundations, and initiatives. She has served on several advisory panels and commissions, including the National Advisory Counsel for AHRQ, the National Health Care Quality Forum, United Health Group Physician Advisory Panel, and a National Advisory Council for the Robert Wood Johnson Foundation. Prof. Hibbard holds a masters degree in Public Health from UCLA and her doctoral degree is from the School of Public Health at the University of California at Berkeley.