Commissioning health and community services is a complex task involving planning, purchasing and monitoring services for a population. It is particularly difficult when attempting system-level reform, and many barriers to effective commissioning have been documented. In Victoria, the state government has operated as a commissioner of many services, including mental health community support and alcohol and other drug treatment services. This study investigated the perceived consequences of a reform process in these two sectors after recommissioning was used as a mechanism to achieve sector-wide redesign. Semi-structured interviews were conducted with 23 senior staff from community health, mental health and drug and alcohol services 6 months after implementation. The process was affected by restructuring in the commissioning department resulting in truncation of preparatory planning and technical work required for system design. Consequently, reform implementation was reportedly chaotic, costly to agencies and staff, and resulted in disillusionment of enthusiastic reform supporters. Negative service system impacts were produced, such as disruption of collaborative and/or comprehensive models of care and strategies for reaching marginalised groups. Without careful planning and development commissioning processes can become over-reliant on competitive tendering to produce results, create significant costs to service providers and engender system-level issues with the potential to disrupt innovative models focused on meeting client needs.
Aim This study is a narrative inquiry that aims to better understand the experience of nurses implementing a Person-Centred Care (PCC) bundle onto an acute care ward in a large hospital in Melbourne, Australia. Background The PCC includes five key focus areas aimed at streamlining nursing practice 1) Nursing assessment and care planning, 2) bedside handover, 3) patient safety rounding, 4) patient whiteboards, and 5) safety huddles. The PCC bundle outlines a nursing care process that is interactional with the patient, focused on information sharing, safety and respect. Method A narrative inquiry was used to explore the nurse's experiences implementing the PCC. Surveys and focus groups were used to collect data and thematic analysis was used to identify any key themes. Results The three themes were; Passing the baton ; Keeping the cogs moving when time poor ; and Deep interpersonal relating-The sum of us .
Objectives: This paper reports on a comparative evaluation of indicators that are in use, or proposed for use, by leading international organizations to assess their adequacy for the purpose of monitoring key issues related to gender, equity and health.Methods: A comprehensive health information framework was developed on a generic framework by the ISO (2001) to use for the analysis of gender equity within mainstream health systems. A sample of 1 095 indicators used by key international organizations were mapped to this framework and assessed for technical quality and gender sensitivity. Results:The evaluation found defi ciencies in the indicators currently in use, from the viewpoint of both technical quality and underlying conceptual bases, as well as in their coverage of the framework, and especially in relation to health system performance.Conclusions: Routine administrative reporting offered large numbers of indicators but these did not allow for monitoring of gender equity and health. The paper concludes that there is merit in developing a core set of leading indicators that can be used for comparisons across peer countries and communities.Performance measurement has become a common feature of health organizations at national and international levels, and the importance of developing and using appropriate indicators has been of concern to the series of international meetings organized by the WHO Kobe Centre (WKC) on women and health and welfare systems. The fi rst of these meetings resulted in the Awaji Declaration (WKC 2000) which outlined principles for reforming the health and welfare system by shifting focus from health care policy to healthy public policy; from access to services to access to health; from institutions to integrated services delivery; from provider-driven care to client and community-centred care; and from narrow indicators of morbidity and effi ciency to broader indicators of equity and well-being. The Canberra Communiqué (WKC 2001) outlined a range of strategies to effect reform, including building women's leadership and capacity in data collection and analysis for action. It called for public health and health services data to be disaggregated by sex, and for collection design and analysis to 'identify gender differences in experiences, impacts, causes and responses to health needs' (WKC 2001). The Kobe Action Plan, (WKC 2002) operationalised the Communiqué and identifi ed the comparative evaluation of indicators of gender equity, gender equality and health used by international agencies as an immediate priority. The work described here is part of this project. Box 1 Defi nitionsGender -the cultural, social, temporal and political constructions of men and women, girls and boys.Gender indicators -measure the status of women against some 'normative' standard or reference group (e. g. men) and should be able to measure changes in women's status and roles over time.Equity -the equally fair treatment of women and men, including recognition that women and men have different needs, prefere...
This article briefly describes recent initiatives to improve consumer participation in health services that have led to the establishment of the National Resource Centre for Consumer Participation in Health. The results of a component of the needs assessment undertaken by the newly established Centre are presented. They provide a 'snapshot' of the types of feedback and participation processes mainly being utilised by Australian health services at the different levels of seeking information, information sharing and consultation, partnership, delegated power and consumer control. They also allow identification of the organisational commitment made by Australian health services to support a more coordinated approach to community and consumer feedback and participation at different levels of health services such as particular emphasis on determining the presence of community and consumer participation in key organisational statements, specific consumer policies and plans, identifiable leadership, inclusion into job descriptions, allocation of resources, and staff development and consumer training. Discussion centres around four key observations and some of the key perceived external barriers.
Objectives: Indicators are important for measuring progress, raising awareness of issues, improving the evidence base for decision-making and helping to identify which issues need priority-attention. As such, they can contribute to improved accountability and enhanced health system performance and responsiveness. Gender-sensitive health indicators, in particular, can provide a rigorous information base for policy actions that can improve health outcomes and reduce unjust health inequities resulting from the social construction of gender.Methods: Several case studies are described in the paper to illustrate the effective use of gender-sensitive indicators in making infl uential contributions to health system development and reform, and improving accountability, performance and responsiveness. Results/Conclusions: It is necessary for frameworks for health indicators to include the broad determinants of health, plus incorporate gender as a central component for analysis, so to be sensitive enough to detect gender differences in health experiences and enable consideration of equity in the analysis of health system performance. Some additional principles and strategies for the development and use of gender-sensitive health indicators include the building of effective monitoring and reporting systems which have linkages with governance, health system development and health sector reform processes, and adequate infrastructure and capacity building.Since the latter decades of the 20 th century, performance indicators have become part of the routine of public policy development and program management. While the use of data (including health indicators) has always been important for public health action, the health policy discourse, internationally, has shifted to evidence-based decision-making in more recent times. Within this broader context, women's health advocates have argued for improving data collections and making sexdisaggregated data available. Such data could then be transformed into appropriate health indicators, which in turn can lead to improvements in decision-makers' understanding of the gendered dimensions of health policy, research, programs and legislation. The working premise then is that indicators are important for measuring progress, raising awareness of issues, improving the evidence base for decision-making and helping to identify which issues need to receive immediate and future priority-attention. Indicators are, therefore, conducive to better accountability and may contribute to improving health system performance and responsiveness. Starting with such a premise, this paper aims to provide an explanation of what gender-sensitive health indicators are and how they might be used. A key issue is that while indicators have been developed to measure 'women's progress' and 'health', those which measure gender-sensitivity in health are limited. The paper is organised into the following sections: defi nitions of gender-sensitive health indicators; using gender-sensitive health indicators; successful app...
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