A systematic review of the evidence of how hospitals capture financial benefits of process improvement and the impact on hospital financial performance.

BACKGROUND: Governments, funders and hospital managers around the world are looking for ways to address the continual growth in expenditure by reducing the level of waste in the healthcare delivery system and improving the value of care provided to patients. Process improvement methods are applied to increase high value care, reduce low value care and remove waste from care processes. The purpose of this study is to review the literature to identify the methods used by hospitals to measure and capture financial benefits from PI initiatives to identify best practice. The review also pursues the way hospitals collate these benefits at the enterprise level to achieve improved financial performance. METHODS: A systematic review was undertaken in line with the PRISMA process and employed qualitative research methods. Databases searched were Medline, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINHAL), Web of Science and SCOPUS. The initial search was conducted in in July 2021 with a follow up search conducted in February 2023 using the same search terms and databases to identify additional studies published in the intervening period. The search terms were identified through the PICO (Participants, Interventions, Comparisons and Outcomes) method. RESULTS: Seven papers were identified that reported reduction in care process waste or improvement of the value of care using an evidence-based PI approach and included financial benefits analysis. Positive financial impact was measured for the PI initiatives but none of the studies reported how these financial benefits were captured or applied at the enterprise level. Three of the studies suggested that sophisticated cost accounting systems were required to enable this. CONCLUSION: The study demonstrates the paucity of literature in the field of PI and financial benefits measurement in healthcare. Where financial benefits are documented, they vary in terms of cost inclusions and the 'level' at which the costs were measured. Further research on best practice financial measurement methods is needed to enable other hospitals to measure and capture financial benefits arising from their PI programs.

The effects of emotional intelligence training on the job performance of Australian aged care workers.

BACKGROUND: Emotional intelligence (EI) training is popular among human resource practitioners, but there is limited evidence of the impact of such training on health care workers. PURPOSE: In the current article, we examine the effects of EI training on quality of resident care and worker well-being and psychological empowerment in an Australian aged care facility. We use Bar-On's (1997) conceptualization of EI. METHODOLOGY/APPROACH: We used a quasiexperimental design in 2014-2015 with experimental (training) and control (nontraining) groups of 60 participants in each group in two geographically separate facilities. Our final poststudy sample size was 27 participants for the training group and 17 participants for the control group. Over a 6-month period, we examined whether staff improved their well-being, psychological empowerment, and job performance measured as enhanced quality of care (self-rated and client-rated) by applying skills in EI. RESULTS: The results showed significant improvement among workers in the training group for EI scores, quality of care, general well-being, and psychological empowerment. There were no significant differences for the control group. PRACTICE IMPLICATIONS: Through examining the impact of EI training on staff and residents of an aged care facility, we demonstrate the benefits of EI training for higher quality of care delivery. This study demonstrates the practical process through which EI training can improve the work experiences of aged care workers, as well as the quality of care for residents.

Staff perspectives of a model of access and triage for reducing waiting time in ambulatory services: a qualitative study.

BACKGROUND: Specific Timely Appointments for Triage (STAT) is an intervention designed to reduce waiting time in community outpatient health services, shown to be effective in a large stepped wedge cluster randomised controlled trial. STAT combines initial strategies to reduce existing wait lists with creation of a specific number of protected appointments for new patients based on demand. It offers an alternative to the more traditional methods of demand management for these services using waiting lists with triage systems. This study aimed to explore perceptions of clinicians and administrative staff involved in implementing the model. METHOD: Semi-structured interviews with 20 staff members who experienced the change to STAT were conducted by an independent interviewer. All eight sites involved in the original trial and all professional disciplines were represented in the sample. Data were coded and analysed thematically. RESULTS: Participants agreed that shorter waiting time for patients was the main advantage of the STAT model, and that ongoing management of caseloads was challenging. However, there was variation in the overall weight placed on these factors, and therefore the participants' preference for the new or previous model of care. Perceptions of whether the advantages outweighed the disadvantages were influenced by five sub-themes: staff perception of how much waiting matters to the patient, prior exposure to the management of waiting list, caseload complexity, approach and attitude to the implementation of STAT and organisational factors. CONCLUSIONS: The STAT model has clear benefits but also presents challenges for staff members. The findings of this study suggest that careful preparation and management of change and active planning for known fluctuations in supply and demand are likely to help to mitigate sources of stress and improve the likelihood of successful implementation of the STAT model for improving waiting times for patients referred to community outpatient services.

A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial.

BACKGROUND: Long waiting times are associated with public community outpatient health services. This trial aimed to determine if a new model of care based on evidence-based strategies that improved patient flow in two small pilot trials could be used to reduce waiting time across a variety of services. The key principle of the Specific Timely Appointments for Triage (STAT) model is that patients are booked directly into protected assessment appointments and triage is combined with initial management as an alternative to a waiting list and triage system. METHODS: A stepped wedge cluster randomised controlled trial was conducted between October 2015 and March 2017, involving 3116 patients at eight sites across a major Australian metropolitan health network. RESULTS: The intervention reduced waiting time to first appointment by 33.8% (IRR = 0.663, 95% CI 0.516 to 0.852, P = 0.001). Median waiting time decreased from a median of 42 days (IQR 19 to 86) in the control period to a median of 24 days (IQR 13 to 48) in the intervention period. A substantial reduction in variability was also noted. The model did not impact on most secondary outcomes, including time to second appointment, likelihood of discharge by 12 weeks and number of appointments provided, but was associated with a small increase in the rate of missed appointments. CONCLUSIONS: Broad-scale implementation of a model of access and triage that combined triage with initial management and actively managed the relationship between supply and demand achieved substantial reductions in waiting time without adversely impacting on other aspects of care. The reductions in waiting time are likely to have been driven, primarily, by substantial reductions for those patients previously considered low priority. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12615001016527 registration date: 29/09/2015.

An evidence-based approach to understanding the competency development needs of the health service management workforce in Australia.

BACKGROUND: Competent managers are essential to the productivity of organisations and the sustainability of health systems. Effective workforce development strategies sensitive to the current competency development needs of health service managers (HSMs) are required. PURPOSE: To conduct a 360° assessment of the competence of Australian HSMs to identify managerial competence levels, and training and development needs. METHODS: Assessment of 93 middle-level HSMs from two public hospitals (n = 25) and five community health services (CHS) (n = 68), using the Managerial Competency Assessment Partnership (MCAP) framework and tool, conducted between 2012 and 2014 in Victoria, Australia. RESULTS: Mean competency scores from both self- and combined colleagues' assessments indicated competence (scores greater than five but less than six) without guidance, but many HSMs have not had extensive experience. Around 12% of HSMs were unable to demonstrate the competency of 'evidence-informed decision-making' and 4% of HSMs were unable to demonstrate the competency of 'enabling and managing change'. CONCLUSION: The assessments confirmed managerial competence for the majority of middle-level HSMs from hospitals and CHS in Victoria, but found competency gaps. In addition, the assessment confirmed managerial strengths and weaknesses varied across management groups from different organisations. These findings suggest that the development of strategies to strengthen the health service management workforce should be multifaceted. PRACTICE IMPLICATIONS: A focus on competency in performance evaluation and development using the MCAP framework and tool not only provides insights into performance of HSMs, but also has the potential to provide an organisation strategic advantage through succession planning and advancing managers' competence via learning needs analysis and targeted professional development. Linking competencies of HSMs to organisational objectives and strategies provides optimal use of the human resource capacity, improving the organisation's productivity and sustainability.

Effective quality systems: implementation in Australian public hospitals.

PURPOSE: The purpose of this paper is to review the implementation of seven components of quality systems (QSs) linked with quality improvement in a sample of Australian hospitals. DESIGN/METHODOLOGY/APPROACH: The authors completed a systematic review to identify QS components associated with measureable quality improvement. Using mixed methods, the authors then reviewed the current state of these QS components in a sample of eight Australian hospitals. FINDINGS: The literature review identified seven essential QS components. Both the self-evaluation and focus group data suggested that none of the hospitals had all of these seven components in place, and that there were some implementation issues with those components that were in use. Although board and senior executives could point to a large number of quality and safety documents that they felt were supporting a vision and framework for safe, high-quality care, middle managers and clinical staff described the QSs as compliance driven and largely irrelevant to their daily pursuit of safe, high-quality care. The authors also found little specific training in quality improvement for staff, lack of useful data for clinicians on the quality of care they provide and confusion about how organisational QSs work. PRACTICAL IMPLICATIONS: This study provides a clearer picture of why QSs are not yet achieving the results that boards and executives want to achieve, and that patients require. ORIGINALITY/VALUE: This is the first study to explore the implementation of QSs in hospitals in-depth from the perspective of hospital staff, linking the findings to the implementation of QS component identified in the literature.

A path analysis study of factors influencing hospital staff perceptions of quality of care factors associated with patient satisfaction and patient experience.

BACKGROUND: Hospital staff are interested in information on patient satisfaction and patient experience that can help them improve quality of care. Staff perceptions of quality of care have been identified as useful proxies when patient data are not available. This study explores the organizational factors and staff attitudes that influence staff perceptions of the quality of the care they provide in relation to patient satisfaction and patient experience. METHODS: Cross sectional survey completed by 258 staff of a large multi-campus, integrated metropolitan hospital in Australia. Structured equation modelling was used to analyse the data. RESULTS: Our data suggest that different perceived organizational factors and staff attitudes contribute to different pathways for patient satisfaction and patient experience indicators. Hospital staff in our sample were more likely to indicate they provided the care that would result in higher patient satisfaction if they felt empowered within a psychologically safe environment. Conversely their views on patient experience were related to their commitment towards their hospital. There was no relationship between the staff perceptions of patient satisfaction and the staff response to the friends and family test. CONCLUSIONS: This study provides empirical evidence that staff perceptions of the quality of care they provide that is seen to be related to patient satisfaction and patient experience are enacted through different pathways that reflect differing perceptions of organizational factors and workplace psychological attitudes.

Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review.

BACKGROUND: To ensure quality of care delivery clinical supervision has been implemented in health services. While clinical supervision of health professionals has been shown to improve patient safety, its effect on other dimensions of quality of care is unknown. The purpose of this systematic review is to determine whether clinical supervision of health professionals improves effectiveness of care and patient experience. METHODS: Databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of each study was rated using the Medical Education Research Study Quality Instrument. Data were extracted on effectiveness of care (process of care and patient health outcomes) and patient experience. RESULTS: Seventeen studies across multiple health professions (medical (n = 4), nursing (n = 7), allied health (n = 2) and combination of nursing, medical and/or allied health (n = 4)) met the inclusion criteria. The clinical heterogeneity of the included studies precluded meta-analysis. Twelve of 14 studies investigating 38,483 episodes of care found that clinical supervision improved the process of care. This effect was most predominant in cardiopulmonary resuscitation and African health settings. Three of six studies investigating 1756 patients found that clinical supervision improved patient health outcomes, namely neurological recovery post cardiopulmonary resuscitation (n = 1) and psychological symptom severity (n = 2). None of three studies investigating 1856 patients found that clinical supervision had an effect on patient experience. CONCLUSIONS: Clinical supervision of health professionals is associated with effectiveness of care. The review found significant improvement in the process of care that may improve compliance with processes that are associated with enhanced patient health outcomes. While few studies found a direct effect on patient health outcomes, when provided to mental health professionals clinical supervision may be associated with a reduction in psychological symptoms of patients diagnosed with a mental illness. There was no association found between clinical supervision and the patient experience. REVIEW REGISTRATION: CRD42015029643 .

Are organisational factors affecting the emotional withdrawal of community nurses?

Objective The aim of the present study was to investigate the effects of work organisation on the emotional labour withdrawal behaviour of Australian community nurses. Methods Using a paper-based survey, a sample of 312 Australian community nurses reported on their emotional dissonance, withdrawal behaviours (i.e. job neglect, job dissatisfaction, stress-related presenteeism) and work organisation. A model to determine the partial mediation effect of work organisation was developed based on a literature review. The fit of the proposed model was assessed via structural equation modelling using Analysis of Moment Structures (AMOS; IMB). Results Community nurses with higher levels of emotional dissonance were less likely to be satisfied with their job and work organisation and had a higher tendency to exhibit withdrawal behaviours. Work organisational factors mediated this relationship. Conclusion Emotional dissonance can be a potential stressor for community nurses that can trigger withdrawal behaviours. Improving work organisational factors may help reduce emotional conflict and its effect on withdrawal behaviours. What is known about the topic? Although emotional labour has been broadly investigated in the literature, very few studies have addressed the effect of the quality of work organisation on nurses' withdrawal behaviours in a nursing setting. What does this paper add? This paper provides evidence that work organisation affects levels of emotional dissonance and has an effect on job neglect through stress-related presenteeism. What are the implications for practitioners? In order to minimise stress-related presenteeism and job neglect, healthcare organisations need to establish a positive working environment, designed to improve the quality of relationships with management, provide appropriate rewards, recognition and effective workload management and support high-quality relationships with colleagues.

Empirical exploration of brilliance in health care: perceptions of health professionals.

Objective The aim of the present study was to develop a positive organisational scholarship in health care approach to health management, informed by health managers and health professionals' experiences of brilliance in health care delivery. Methods A sample of postgraduate students with professional and/or management experience within a health service was invited to share their experiences of brilliant health services via online discussions and a survey running on the SurveyMonkey platform. A lexical analysis of student contributions was conducted using the individual as the unit of analysis. Results Using lexical analysis, the examination of themes in the concept map, the relationships between themes and the relationships between concepts identified 'care' as the most important concept in recognising brilliance in health care, followed by the concepts of 'staff' and 'patient'. Conclusions The research presents empirical material to support the emergence of an evidence-based health professional perspective of brilliance in health management. The findings support other studies that have drawn on both quantitative and qualitative materials to explore brilliance in health care. Pockets of brilliance have been previously identified as catalysts for changing health care systems. Both quality, seen as driven from the outside, and excellence, driven from within individuals, are necessary to produce brilliance. What is known about the topic? The quest for brilliance in health care is not easy but essential to reinvigorating and energising health professionals to pursue the highest possible standards of health care delivery. What does this paper add? Using an innovative methodology, the present study identified the key drivers that health care professionals believe are vital to moving in the direction of identifying brilliant performance. What are the implications for practitioners? This work presents evidence on the perceptions of leadership and management practices associated with brilliant health management. Lessons learned from exceptionally well-delivered services contain different templates for change than those dealing with failures, errors, misconduct and the resulting negativity.

Improving access for community health and sub-acute outpatient services: protocol for a stepped wedge cluster randomised controlled trial.

BACKGROUND: Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional "waitlist and triage" model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care. This trial aims to test whether the model is cost effective in reducing waiting time across multiple services, and to measure the impact on service provision, health-related quality of life and patient satisfaction. METHODS/DESIGN: A stepped wedge cluster randomised controlled trial has been designed to evaluate the impact of the STAT model in 8 community health and outpatient services. The primary outcome will be waiting time from referral to first appointment. Secondary outcomes will be nature and quantity of service received (collected from all patients attending the service during the study period and health-related quality of life (AQOL-8D), patient satisfaction, health care utilisation and cost data (collected from a subgroup of patients at initial assessment and after 12 weeks). Data will be analysed with a multiple multi-level random-effects regression model that allows for cluster effects. An economic evaluation will be undertaken alongside the clinical trial. DISCUSSION: This paper outlines the study protocol for a fully powered prospective stepped wedge cluster randomised controlled trial (SWCRCT) to establish whether the STAT model of access and triage can reduce waiting times applied across multiple settings, without increasing health service costs or adversely impacting on other aspects of patient care. If successful, it will provide evidence for the effectiveness of a practical model of access that can substantially reduce waiting time for outpatient and community services with subsequent benefits for both efficiency of health systems and patient care. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12615001016527 . Approved 15/9/2015.

Does clinical supervision of health professionals improve patient safety? A systematic review and meta-analysis.

PURPOSE: To determine whether clinical supervision (CS) of health professionals improves patient safety. DATA SOURCES: Databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking. STUDY SELECTION: Two reviewers independently applied inclusion and exclusion criteria. Thirty-two studies across three health professions [medicine (n = 29), nursing (n = 2) and paramedicine (n = 1)] were selected. DATA EXTRACTION: The quality of each study was rated using the Medical Education Research Study Quality Instrument. Risk ratios (RR) were calculated for patient safety outcomes of mortality, complications, adverse events, reoperation following initial surgery, conversion to more invasive surgery and readmission to hospital. RESULTS OF DATA SYNTHESIS: Results of meta-analyses provided low-quality evidence that supervision of medical professionals reduced the risk of mortality (RR 0.76, 95% CI 0.60-0.95, I(2) = 76%) and supervision of medical professionals and paramedics reduced the risk of complications (RR 0.69, 95% CI 0.53-0.89, I(2) = 76%). Due to a high level of statistical heterogeneity, sub-group analyses were performed. Sub-group analyses provided moderate-quality evidence that direct supervision of surgery significantly reduced the risk of mortality (RR 0.68, 95% CI 0.50-0.93, I(2) = 33%) and direct supervision of medical professionals conducting non-surgical invasive procedures significantly reduced the risk of complications (RR 0.33, 95% CI 0.24-0.46, I(2) = 0%). CONCLUSIONS: CS was associated with safer surgery and other invasive procedures for medical practitioners. There was a lack of evidence about the relationship between CS and safer patient care for non-medical health professionals.

Understanding the perspectives of health service staff on the Friends and Family Test.

Objectives The present study was designed to determine what staff consider when asked to respond to the Friends and Family Test question. Methods Over 300 health service staff responded to an online questionnaire exploring whether they would recommend treatment at their organisation to friends and family (Friends and Family Test). Results Staff identified staff attitudes and behaviours, the busyness of the health service and quality of care as themes that affected their recommendation. A considerable number of staff also identified factors largely outside the control of the health service as influencing their response. Conclusions Majority of respondents based their perceptions on personal expectations, with smaller numbers citing personal experience and hearsay. Staff would need to see changes both in the quality of care and management practice to amend their recommendation on the Friends and Family Test. What is known about the topic? The Friends and Family Test is seen as a useful tool to gather the opinions of patients and staff on the patient experience, yet there has been little validation of this question. What does this paper add? The present study suggests that, as currently worded, the question does not reliably report staff perceptions regarding patient experience. The study illustrates that the relationship with the organisation and perceptions of effective management are linked to staff responses. What are the implications for practitioners? The Family and Friends Test question may need to be more clearly focused to gather the desired information. Improvement on this indicator is only likely to be seen when management teams are meeting the expectations of staff for good management practice.

Clinical supervision for allied health staff: necessary but not sufficient.

Objectives The aim of the present study was to explore the perspectives of allied health professionals on appropriate content for effective clinical supervision of staff. Methods A set of statements regarding clinical supervision was identified from the literature and confirmed through a Q-sort process. The final set was administered as an online survey to 437 allied health professionals working in two Australian health services. Results Of the 120 respondents, 82 had experienced six or more clinical supervision sessions and were included in the analysis. Respondents suggested that clinical supervision was beneficial to both staff and patients, and was distinct from line management performance monitoring and development. Curiously, some of the respondents did not agree that observation of the supervisee's clinical practice was an aspect of clinical supervision. Conclusions Although clinical supervision is included as a pillar of clinical governance, current practice may not be effective in addressing clinical risk. Australian health services need clear organisational policies that outline the relationship between supervisor and supervisee, the role and responsibilities of managers, the involvement of patients and the types of situations to be communicated to the line managers. What is known about the topic? Clinical supervision for allied health professionals is an essential component of clinical governance and is aimed at ensuring safe and high-quality care. However, there is varied understanding of the relationship between clinical supervision and performance management. What does this paper add? This paper provides the perspectives of allied health professionals who are experienced as supervisors or who have experienced supervision. The findings suggest a clear role for clinical supervision that needs to be better recognised within organisational policy and procedure. What are the implications for practitioners? Supervisors and supervisees must remember their duty of care and ensure compliance with organisational policies in their clinical supervisory practices.

Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses.

AIMS AND OBJECTIVES: To determine whether a formal mentoring programme assists nurse practitioner candidates to develop competence in the clinical leadership competencies required in their advanced practice roles. BACKGROUND: Nurse practitioner candidates are required to show evidence of defined clinical leadership competencies when they apply for endorsement within the Australian health care system. Aiming to assist the candidates with the development or enhancement of these leadership skills, 18 nurse practitioner candidates participated in a mentoring programme that matched them with senior nurse mentors. DESIGN: A pre-postlongitudinal intervention study. METHOD: Eighteen nurse practitioner candidates and 17 senior nurses participated in a voluntary mentoring programme that incorporated coaching and action learning over 18 months in 2012 and 2013. Participants completed a pen and paper questionnaire to document baseline measures of self-reported leadership practices prior to commencement of the programme and again at the end of the programme. RESULTS: The mentors and the nurse practitioner candidates qualitatively evaluated the programme as successful and quantitative data illustrated significant improvement in self-reported leadership practices among the nurse practitioner candidates. In particular, the nurse practitioner candidates reported greater competence in the transformational aspects of leadership, which is directly related to the nurse practitioner candidate clinical leadership standard. CONCLUSIONS: A formal, structured mentoring programme based on principles of action learning was successful in assisting Australian advanced practice nurses enhance their clinical leadership skills in preparation for formal endorsement as a nurse practitioner and for success in their advanced practice role. RELEVANCE TO CLINICAL PRACTICE: Mentoring can assist nurses to transition to new roles and develop knowledge and skills in clinical leadership essential for advanced practice roles. Nurse managers should make greater use of mentoring programmes to support nurses in their transition to new roles.

Organisational development in a rural hospital in Australia.

OBJECTIVE: This paper analyses an organisational development project that aimed to change the organisational culture and improve people management systems and processes. The questions addressed were: was the change process a success; how was success defined; and what were the barriers to its progress? METHODS: We examined the process of change over a 3-year period. The organisational development intervention is described and analysed. Qualitative methods, including document review, in-depth interviews and focus groups, participant observation, newsletters and diary entries were used to gather the data. A variant of competing values was used to analyse the data. RESULTS: We sought to build trust with all managers and encouraged reflection by conducting feedback sessions, presentations, workshops and one-on-one and group discussions. A cross-site action group was established to encourage organisation-wide participation in the project. However, it was clear that stakeholders had different understandings and perceptions of the problems facing the organisation. The project faltered when a leadership development intervention was organised. CONCLUSIONS: The existence of at least four different organisational 'worlds' and identities, according to different professional groupings with different goals, languages and values, was evident. The relationship between the researcher and subjects was key in terms of whether the researcher is seen as an 'expert' or as a 'facilitator'. In bringing about change, we need to work with the Chief Executive Officer in empowering others. Hence, the researchers need to engage in continual dialogue across boundaries and within groups as well as at individual levels to provide support for organisational change.

Emotional rescue: the role of emotional intelligence and emotional labour on well-being and job-stress among community nurses.

AIMS: To investigate the extent to which emotional labour and emotional intelligence are associated with well-being and job-stress among a group of Australian community nurses. The moderating role of emotional intelligence was evaluated as a key factor in the rescue of healthcare workers from job-stress, thus increasing job retention. BACKGROUND: Although emotional labour has been broadly investigated in the literature, the contribution of emotional labour and emotional intelligence to the well-being and experience of job-stress in a community nursing setting requires further exploration. DESIGN: This study used a cross-sectional quantitative research design with data collected from Australian community nurses. METHODS: Australian community nurses (n = 312) reported on their perceived emotional labour, emotional intelligence and their levels of well-being and job-stress using a paper and pencil survey in 2010. RESULTS/FINDINGS: Results from structural equation modelling support the hypothesis that both emotional labour and emotional intelligence have significant effects on nurses' well-being and perceived job-stress. Emotional intelligence plays a moderating role in the experience of job-stress. CONCLUSION: These findings provide additional evidence for the important effects that emotional labour and emotional intelligence can have on well-being and job-stress among community nurses. The potential benefits of emotional intelligence in the nurses' emotional work have been explored.

What is the nature, extent and impact of bullying in surgical settings? Insights of surgeons in Australia and Aotearoa New Zealand.

BACKGROUND: A significant body of literature has examined the impact of verbal and non-verbal bullying in surgical settings, where a central focus has been on the experiences of trainee and junior members of the surgical team, women in surgery and other health professionals, such as nurses. Research on how surgeons' perceive or experience bullying is more limited. Therefore, this study aims to investigate the views of surgeons on negative and disrespectful verbal and non-verbal behaviour and bullying in surgical settings, including its impact on surgeons themselves and the surgical staff they oversee. METHODS: Semi-structured interviews were undertaken with surgeons between February and November 2019. Questions explored surgeons' perceptions of interpersonal communication and behaviour in their surgical workplaces in the preceding 6-months. A narrative analysis approach was used to code, interpret, and report the interview data. RESULTS: Thirty-one interviews were conducted with surgeons (19 male and 12 female), from Australia (26) and Aotearoa New Zealand (5) from 10 surgical specialties. Three themes were identified with associated subthemes: bullying (five subthemes), non-verbal bullying (seven subthemes), and impact and outcomes of bullying (six subthemes). CONCLUSION: This study revealed a notable shift in the reported verbal and non-verbal bullying behaviour among surgeons, demonstrating a decrease in intensity, physicality and violence for the 6-months prior to interviews conducted in 2019, when compared with surgeons' historic experiences. Despite reported behaviour being more subtle and indirect, it nonetheless continues to have a marked impact on many surgeons as well as the staff they oversee.

The knowledge and reuse practices of researchers utilising government health information assets, Victoria, Australia, 2008-2020.

BACKGROUND: Using government health datasets for secondary purposes is widespread; however, little is known on researchers' knowledge and reuse practices within Australia. OBJECTIVES: To explore researchers' knowledge and experience of governance processes, and their data reuse practices, when using Victorian government health datasets for research between 2008-2020. METHOD: A cross-sectional quantitative survey was conducted with authors who utilised selected Victorian, Australia, government health datasets for peer-reviewed research published between 2008-2020. Information was collected on researchers': data reuse practices; knowledge of government health information assets; perceptions of data trustworthiness for reuse; and demographic characteristics. RESULTS: When researchers used government health datasets, 45% linked their data, 45% found the data access process easy and 27% found it difficult. Government-curated datasets were significantly more difficult to access compared to other-agency curated datasets (p = 0.009). Many respondents received their data in less than six months (58%), in aggregated or de-identified form (76%). Most reported performing their own data validation checks (70%). To assist in data reuse, almost 71% of researchers utilised (or created) contextual documentation, 69% a data dictionary, and 62% limitations documentation. Almost 20% of respondents were not aware if data quality information existed for the dataset they had accessed. Researchers reported data was managed by custodians with rigorous confidentiality/privacy processes (94%) and good data quality processes (76%), yet half lacked knowledge of what these processes entailed. Many respondents (78%) were unaware if dataset owners had obtained consent from the dataset subjects for research applications of the data. CONCLUSION: Confidentiality/privacy processes and quality control activities undertaken by data custodians were well-regarded. Many respondents included data linkage to additional government datasets in their research. Ease of data access was variable. Some documentation types were well provided and used, but improvement is required for the provision of data quality statements and limitations documentation. Provision of information on participants' informed consent in a dataset is required.

Reducing waiting time for community rehabilitation services: a controlled before-and-after trial.

OBJECTIVE: To investigate whether a simple alternative (specific timely appointments for triage [STAT]) to the more common approach of managing demand using a waitlist with a triage system could reduce waiting time for a community rehabilitation program (CRP) without adverse impacts on patient care. DESIGN: A prospective, controlled before-and-after trial. Preintervention and postintervention data were collected for 6 months in 2 consecutive years. STAT was introduced at an intervention site and compared with a control site using a triaged waitlist. SETTING: Two musculoskeletal CRP teams within a large metropolitan health service. PARTICIPANTS: All patients referred to both sites during periods preintervention (n=483) and postintervention (n=488). INTERVENTION: Under STAT, clinicians created a specified number of assessment times each week based on average referral numbers, and patients were immediately allocated an appointment on referral. MAIN OUTCOME MEASURES: The primary outcome was the time from referral to first appointment; secondary outcomes included program duration, quality-of-life scores (using the EuroQol EQ-5D), and unplanned hospital admissions. RESULTS: Waiting time decreased from a mean of 17.5 days to 10.0 days (P<.01) at the intervention site, with no significant change at the control site. Intervention site patients were over 3 times more likely to be seen within 7 days than control site patients (odds ratio, 3.3; 95% confidence interval, 2.2-4.9). Secondary outcomes did not differ significantly between groups. CONCLUSIONS: A simple alternative to using a triaged waitlist to manage CRP referrals reduced waiting time without adversely affecting care. Results were sustained over 6 months with no additional resources.