Australian health review : a publication of the Australian Hospital Association
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Nurse practitioners will become a vital component of the health workforce because of the growing need to manage chronic illness, to deliver effective primary health services, and to manage workforce challenges effectively. In addition, the role of nurse practitioner is an excellent example of increased workforce flexibility and changes to occupational boundaries. ⋯ We argue that any tendency to write specific protocols to define the limits of nurse practitioner practice will reduce the efficacy of their contribution. The distinction we wish to make in this paper is between guidelines aiming to support practice, and protocols which aim to control practice.
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Lean thinking is a method for organising complex production processes so as to encourage flow and reduce waste. While the principles of lean thinking were developed in the manufacturing sector, there is increasing interest in its application in health care. This case history documents the introduction and development of Redesigning Care, a lean thinking-based program to redesign care processes across a teaching general hospital. ⋯ Rather, it has been concerned with improving the flow of patients through clinical and other systems. Concepts that emerged in the manufacturing sector have been readily translatable into health care. Lean thinking may play an important role in the reform of health care in Australia and elsewhere.
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There is increasing attention to nursing workforce issues such as recruitment, retention, turnover, workplace health and safety issues and their impact on quality patient care. A number of these problems have been linked to poor morale. While there has been a lack of consensus on the determinants of morale, it is clear that the outcomes of poor morale not only add considerable cost to the organisation but also impact negatively on patient care. This article provides a systematic overview of the literature surrounding nursing morale and the variables identified in the literature that impact upon morale, and discusses the implications for future research.
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Fast track systems to stream emergency department (ED) patients with low acuity conditions have been introduced widely, resulting in reduced waiting times and lengths of stay for these patients. We aimed to prospectively assess the impact on patient flows of a fast track system implemented in the emergency department of an Australian tertiary adult teaching hospital which deals with relatively few low acuity patients. ⋯ Streaming fast track patients in the emergency department of an Australian tertiary adult teaching hospital can reduce waiting times and length of stay for discharged patients without increasing waiting times for admitted patients, even in an ED with few low acuity patients.
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Currently, primary health care (PHC) is under-represented in health statistics due to the lack of a comprehensive PHC data collection. This research explores the utility of population health surveys to address questions relating to access to and use of PHC, using diabetes as an example. ⋯ This approach could inform the development of questions and extension of population health surveys to provide a better understanding of access to and use of quality PHC in Australia. The additional information would complement other data collections with a community-based perspective and contribute to the development of PHC policy.