HSRAANZ Distinguished Investigator Awards
The HSRAANZ Distinguished Investigator Awards recognize researchers who have made a significant contribution to the field of health services and health policy research in Australia and New Zealand through scholarship and teaching, advancement of science and methods, and leadership (relative to level of award).
Life Time Achievement - Professor Libby Roughead
Professor Libby Roughead, Research Professor School of Pharmacy and Medical Sciences, University of South Australia has developed a strong research agenda through her leadership of the Quality Use of Medicines and Pharmacy Research Centre (QUMPRC). Appointed Director in 2011, she currently leads a multidisciplinary team of 26 research and support staff and eight PhD students. With more than 200 research papers assessing harms associated with medicine used and over $50m in research funding, Libby has established an exceptional record of research translation into both policy and practice. Her translation successes are due largely to working directly with policy makers and government.
Libby’s impact on policy and practice is extensive. Her research on medication safety has underpinned Australia’s health goals and targets and the current work plan in medication safety for the Australian Commission on Safety and Quality in Health Care (ACSQHC). Her 2015 report on medication safety in mental health is being used by ACSQHC to develop a work program in this area. Her research quantifying the extent of treatment conflicts in people with multimorbidity led Therapeutic Guidelines Ltd to develop a work plan for inclusion of multimorbidity in Australia’s national guidelines. Her research on interventions for improving use of medicines supported funding of home medicine reviews in Australia and provided the model for the sustained implementation of the Veterans’ Medicines Advice and Therapeutics Education Services (MATES) project, provided by the Australian Government Department of Veterans’ Affairs. The Veterans’ MATES program, which was re-funded in 2016, has implemented over 40 interventions, targeted every general practitioner, pharmacy, aged-care facility and veteran in Australia and resulted in measureable improvements in veteran health and net cost savings.
Libby has made a significant contribution to the profession of health services research through her active engagement on national committees, such as Australia’s Drug Utilisation Subcommittee (member since 2001) and her board membership of Therapeutic Guidelines Ltd, a national body providing guidelines for Australian health professionals.
Libby has supervised 7 PhD students to completion, has 4 current PhD students and has hosted extended visits by 8 international researchers during the last five years. Libby has a successful track record in identifying, recruiting, training and mentoring early career post-doctoral fellows who have been identified by her as having capacity for independent research and future leadership roles.
Libby leads The Medicine and Device Surveillance CRE a collaboration multi-national collaboration between UniSA, University of Adelaide, Flinders University, University of Western Australia, Royal Adelaide Hospital and the National Prescribing Service, Harvard Medical School USA, University of Tokyo Japan, Seoul National University Korea, and the National Cheng Kung University Taiwan which has resulted in 47 publications and the development of the Asian Pharmacoepidemiology Network (AsPEN).
Unfortunately Libby was unable to attend the HSRAANZ Conference to accept her award but our President Jon Karnon caught up with Libby in Adelaide to discuss her research career and present her award.
Mid-Career Award - Professor Amanda Wheeler
Professor Amanda Wheeler is the Professor of Mental Health, Griffith University, University of Auckland (Clinical A/Professor) https://experts.griffith.edu.au/academic/a.wheeler
Professor Wheeler has worked as a health practitioner, educator and researcher in mental health and pharmacy practice for almost 20 years. After establishing a highly successful research centre in a public health service in NZ that she directed for over 10 years, Amanda was awarded her PhD in 2009. Despite a late start to a publishing career, Amanda has made a significant contribution to health services & health policy research, with a key focus on reducing the burden of disease and treatment burden for people experiencing mental illness, and the delivery of person-centred care in the community pharmacy setting. She is nationally and internationally recognised for her expertise in these areas.
Since 2004, Amanda has obtained four competitive national research grants totalling almost $4.5 million, published over 115 peer-reviewed papers (31 as first author, 5 solo-authored), 30 published abstracts/letters and delivered oral presentations at more than 35 conferences and meetings. Thirty-three publications to date have emanated from two Federal Department of Health grants, of which she was lead investigator. Amanda’s publications are well cited (900 citations) with an h-index of 20. Significant outcomes from her research work leading to practice changes include: development and validation of a consumer outcome tool that has been incorporated by the NZ Ministry of Health as part of the national suite of outcome measures in mental health services; development and implementation of best-practice guidelines for the use of the antipsychotic clozapine which were recommended by NZ Coronial Services in 2010 to be made available nationally; developed and implemented an audit and feedback cycle for antipsychotic use in schizophrenia that led to sustained, evidence-based changes in prescribing practice; developed and evaluated an on-line mental health continuing education programme for more than 600 Australian community pharmacy staff. In 2013 she was awarded a Griffith Health Excellence Award for outstanding research success
and work in the area of mental health and addictions.
Amanda provides a significant amount of time and effort to mentor students through the research journey. She has supervised 2 PhD and 2 MPhil graduates and is currently the convenor of the Higher Degree Research Program at the School of Human Services and Social Work at Griffith University. Amanda’s leadership skills have been recognised by fellowships with the UK College of Mental Health Pharmacy and the European Society for Person Centred Healthcare, appointments to the Advisory Committee on Medicines Scheduling for the Australian TGA, as Chair of the Clinical Pharmacy Group of the European Society for Person Centred Healthcare, and journal Editorial Board membership (The Patient and Journal of Pharmaceutical Policy and Practice). Her dedication to all facets of health services research makes Amanda a worthy recipient of such a prestigious award.
HSRAANZ Best Health Services and Policy Research Papers
Best overall Paper - Jing Jing He
He, J., et al. Improving patient flow and satisfaction: An evidence-based pre-admission clinic and
transfer of care pathway for elective surgery patients. Collegian (2017), http://dx.doi.org/10.1016/j.colegn.2017.04.006
Bio: Jing Jing He is a research nurse at Macquarie University Hospital and a PhD candidate at the University of Sydney. Jing graduated with First Class Honours in Nursing from the University of Sydney. As a nurse, Jing has worked in various specialties include day surgery, cardiology, community nursing and clinical trials. In 2014, she was appointed by Macquarie University Hospital as the research coordinator for the Pre-Admission Clinic Project (funded by the HCF Research Foundation). She has successfully led the project and implemented a triage system and discharge pathway for elective surgery patients. Jing has a particular interest in clinical health innovations and using advanced technologies to improve patient outcome and practice efficiency. Her PhD study focuses on the impact of chemotherapy-induced alopecia and a scalp cooling device on adult oncology patients.
Aims: To redesign, implement and evaluate a Pre-Admission Clinic incorporated with a Transfer of Care Pathway for elective surgery patients.
Methods: An evidence-based approach was used to redesign the Pre-Admission Clinic and the Transfer of Care Pathway. The impact of the pre-admission clinic and the care pathway was evaluated. De-identified data containing patient outcomes was collected from the hospital electronic medical record system from May 2014 to March 2015. Outcome measures included surgical cancellations, last-minute can-cellations, average length of stay, discharge delays, and adverse events that were compared pre and post-implementation. Patient satisfaction was measured pre and post-implementation by using a mod-ified version of Best Practice hospital survey.
Results: A total of 10,854 eligible cases were included (5716 in the pre-implementation period and 5138 in the post-implementation period). The overall cancellation rate remained relatively stable (p = 0.95), however, the last-minute cancellation rate was reduced post-implementation (p = 0.02). Although no difference was observed in average length of stay (p = 0.39), the percentage of discharge delays was reduced (p = 0.027). The incidence of adverse events was too low to draw statistical conclusion. A sample of 102 patients completed the patient satisfaction survey. The overall satisfaction improved post-implementation (p = 0.03).
Conclusions: The evidence-based Pre-Admission Clinic and the Transfer of Care Pathway had a positive impact on last-minute surgical cancellations, discharge delays and patient satisfaction.
Best ECR Paper - Dr Erin Penno
Penno E, Gauld R. The role, costs and value for money of external
consultancies in the health sector: A study of New Zealand’s District Health Boards. Health Policy (2017),
Bio: Following a background working in the health sector in both the United Kingdom and New Zealand, Erin recently completed a PhD in public health at the University of Otago. She is currently a Research Fellow in the Dean’s Office in the Otago Business School where her research focuses on health funding, policy and systems.
This paper examines spending on external consultancies in each of New Zealand’s 20 District Health Boards (DHB). Using evidence obtained from DHBs, it provides an insight into the cost and activities of consultants within the New Zealand health sector, the policies behind their engagement and the processes in place to ensure value for money. It finds that DHB spending on external consultants is substantial, at $NZ10–60 million annually. However, few DHBs had policies governing when consultants should be engaged and many were unable to easily identify the extent or purpose of consultancies within their organisation, making it difficult to derive an accurate picture of consultant activity throughout the DHB sector. Policies surrounding value for money were uncommon and, where present, were rarely applied. Given the large sums being spent by New Zealand’s DHBs, and assuming expenditure is similar in othe r health systems, the findings point to the need for greater accountability for expenditure and better evidence of value for money of consultancies within publicly funded health systems.
Best Paper by a PhD Student - Ms Priya Martin
Martin, P., Kumar, S., Lizarondo, L. and Tyack, Z. (2016), Factors influencing the perceived quality of clinical supervision of occupational therapists in a large Australian state. Aust Occup Ther J, 63: 338–346. doi:10.1111/1440-1630.12314 Link
Bio: Priya is an occupational therapist who has worked in a number of clinical, teaching, training and research roles in Australia and overseas. She currently works as a research officer with the Queensland Rural Generalist Pathway in Toowoomba, Queensland. She is also a PhD candidate with the University of South Australia. Her PhD research investigates the factors that contribute to high quality clinical supervision in allied health. She has expertise in interprofessional education, health professional education and training, curriculum development, mixed methods research designs and rural and remote workforce issues. She is increasingly being recognised as an international leader in the research and practice of clinical supervision.
Background/aim: Clinical supervision is important for effective health service delivery, professional development and practice. Despite its importance there is a lack of evidence regarding the factors that improve its quality. This study aimed to investigate the factors that inﬂuence the quality of linical supervision of occupational therapists employed in a large public sector health service covering mental health, paediatrics, adult physical and other practice areas.
Methods: A mixed method, sequential explanatory study design was used consisting of two phases. This article reports the quantitative phase (Phase One) which involved administration of the Manchester Clinical Supervision Scale (MCSS-26) to 207 occupational therapists.
Results: Frequency of supervision sessions, choice of super- visor and the type of supervision were found to be the predictor variables with a positive and signiﬁcant inﬂuence on the quality of clinical supervision. Factors such as age, length of supervision and the area of practice were found to be the predictor variables with a negative and signiﬁcant inﬂuence on the quality of clinical supervision.
Conclusion: Factors that inﬂuence the perceived quality of clinical supervision among occupational therapists have been identiﬁed. High quality clinical supervision is an important component of clinical governance and has been shown to be beneﬁcial to practitioners, patients and the organisation. Information on factors that make clinical supervision effective identiﬁed in this study can be added to existing supervision training and practices to improve the quality of clinical supervision.
We will be featuring more on our winning papers and authors over the next few weeks.
Best Abstracts a HSR17
As part of the peer review process for the Conference the scientific committee identified the highest ranked abstract overall and from an emerging researcher.
Best Abstract Overall - Thomas Elliott Senior Research Assistant, QIMR Berghofer Medical Research Institute
Using a hybrid discrete-event /agent-based model to examine improved triaging of GPreferred patients to colonoscopies
Thomas Elliott1, Anton Lord1, Lisa Simms1, Graham Radford-Smith2, L.Gordon1
1QIMR Berghofer Medical Research Institute; 2Royal Brisbane and Women’s Hospital
Background: Demand for colonoscopy services is placing significant pressure on health resources in Australia with over 700,000 procedures annually and costing over $1.1 billion. Current triaging processes do not effectively discriminate patients who will or will not show significant bowl disease (SBD). A new risk assessment tool may improve system efficiency and enhance patient care.
Methods: We constructed a hybrid discrete event/agent-based model in AnyLogic software to simulate the GP-referral patterns, triaging, appointment booking, waiting times and costs for colonoscopies at the Royal Brisbane and Womens’ Hospital (RBWH). Using data from a cohort study of 466 GP-referred patients with lower abdominal symptoms, we utilised a newly designed clinical risk assessment tool (RAT) to model the current inefficiency in treatment urgency categorisation. The RAT had a specificity of 98%, showing its appropriateness for use as a rule-in test. We examined the RAT’s effect on waiting times and costs through simulation modelling at the hospital system
Results: Approximately 2,200 patients referred to the colonoscopy clinic at the RBWH are treated each year. The RAT improved triaging for 9% of moderate urgent and 4% of least urgent patients. Over a year approximately 89 patients with SBD could receive more timely care. Moderately urgent patients with SBD received care 121 days earlier, while least urgent patients received care 114 days earlier.
Conclusion: Our preliminary analyses indicate the RAT has significant potential to improve the coordination of patient care, improve patient outcomes, spare some patients from colonoscopies, while also saving substantial hospital expenditure.
Best Abstract from an Early Career Researcher - Grace Kyoon-Achan University of Manitoba
Journeys to healthcare transformation: Partnering for change through Community based Participatory Research with Manitoba First Nations
Grace Kyoon-Achan1, Josée G. Lavoie1, Kathi Avery Kinew2, Stephanie Sinclair2
1University of Manitoba; 2First Nations Health and Social Secretariat of Manitoba
Background: Community-based participatory research can help support communities’ efforts in the formulation and implementation of innovative and transformative change. We share a collaborative journey in our work with eight (8) First Nations in Manitoba Canada who were seeking to improve the health of their communities. Participating communities wanted to produce evidence to move toward good health as they define it and to inform changes in healthcare based on community input on how to improve the health of their respective communities.
Methods: Indigenous knowledges and processes guided data gathering and analysis. Community based participatory methods were used for the conceptualization of the study, data collection, analyses and knowledge translation. A variety of methods were used including: qualitative interviews, administrative health data analyses, surveys and case studies depending on the needs of the studies and the interests of different First Nation stakeholders, health directors and researchers.
Results: Research relationships built upon strong ethics and locally recognized protocols enhance mutual commitment to support community-driven transformation. Collaborative and respectful relationships are platforms for defining and strengthening First Nations health and healthcare priorities. This is an important step in building long term changes that will be sustained long after research projects come to an end.
Conclusion: This study yielded a blueprint for respectful community-based participatory research
involving First Nations peoples, communities, University-based researchers and First Nations
community-based researchers. The result is a locally owned yet widely recognized process that is
effective and sustainable while also having fulfilled researchers and funding obligations.
Highly Commended - Tim Tenbensel University of Auckland
Gaming the New Zealand Emergency Department target. How did it vary between hospitals, and why?
Tim Tenbensel1, Peter Jones2, Linda Chalmers2, Sarah Appleton-Dyer1, Lisa Walton1
1University of Auckland’ 2Auckland District Health Board
Background: New Zealand’s Shorter Stays in Emergency Departments target was implemented from 2009 to address ED crowding. The target required 95% of patients to be seen, treated or discharged within six hours. ‘Gaming’ is commonly regarded as an undesirable side-effect of using targets to drive health service improvement.
Aims: Our research sought to identify the presence and extent of gaming after the target’s implementation, and explain variation in gaming across four case-study sites.
Methods: We adopted a mixed-methods approach. To track the extent of gaming, ED utilisation data was collected from four case study hospitals from 2007 (two years pre-target) to 2012. Rates of pretarget ‘spikes’ and ‘digit preference bias’ were derived from this data. We conducted 68 semistructured interviews about target implementation with ED and hospital clinicians and managers in 2011 and 2012.
Results: Significant ‘spikes’ of the proportion of ED discharges for the time interval immediately prior to the six hour target appeared in all sites after the target’s introduction. At all sites, patients were taken off the target stream (eg moved to short-stay units) to avoid target breaches. However, lower levels of gaming were associated with sites that adopted a ‘whole-of-hospital’ approach to target implementation. Gaming was more prevalent where implementation focused solely on ED staff and processes, without additional resources.
Conclusion: While gaming occurred in all sites, our research demonstrates that a myopic focus on avoiding target breaches within ED accentuates gaming, whereas more holistic approaches to target implementation and additional resources help to reduce it.
Three Minute Thesis Competition
The Three Minute Thesis Competition was one of the highlights of the 10th Health Services and Policy Research Conference. Entrants had 3 minutes to present their work with the assistance of a single power point slide.
Competition prizes were sponsored by:
JUDGES' CHOICE - Tara Officer, Health Services Research Centre, Victoria University of Wellington
"Nurse practitioners and pharmacist prescribers in primary health care: A realist evaluation of the New Zealand experience"
PEOPLE'S CHOICE - Kristin Edwards, James Cook University
"A data linkage and patient outcome study of aeromedical retrieval services in Central Queensland"