Factors that influence the clinical supervision implementation for nurses: A scoping review.

AIMS: The aim of this review is to identify and map the evidence available on the factors that influence the implementation of clinical supervision for nurses. DESIGN: The scoping review was conducted and reported following the JBI methodology for scoping reviews. DATA SOURCES: Searches were conducted on MEDLINE, PsycINFO, and CINAHL databases on 28 March 2023. REVIEW METHODS: A total of 1398 studies were imported into Covidence for screening. Researchers screened the papers according to the inclusion criteria. Empirical studies in English focusing on the implementation of clinical supervision for nurses were included, without year restrictions. Data from 16 studies were extracted and organized according to the constructs within the Consolidated Framework for Implementation Research (CFIR) domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. RESULTS: When compared with the CFIR constructs, it was found that the influence of the outer setting on implementation was less explored in the literature. Most of the reviewed data highlighted recurring factors, particularly logistical challenges of nursing work such as shift work and lack of control over work time. Organizational culture and managerial support were also identified as significant factors in the implementation. Another significant challenge in implementation was the variety in clinical supervision's design, purpose, and application, despite sharing the same label, leading to questions about whether studies are implementing the same practice. CONCLUSION: Policy documents should clearly define both the design and purpose of clinical supervision, beyond just its conceptual definition. Greater emphasis on equitable implementation of clinical supervision is necessary to prevent perpetuating existing inequalities. We conclude that implementation of such complex interventions is not linear, and the implementation strategies need to align with expected implementation challenges. IMPACT: The advantage of using the implementation framework lies not only in observing what exists as a form of evidence but also in identifying what is underdeveloped. Healthcare services and policy developers can utilize our review to recognize and address potential challenges in introducing, modifying, scaling up, or sustaining their clinical supervision implementation. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

It takes a community to save a life in cardiac arrest: Heart safe community pilots, Australia.

ISSUE ADDRESSED: In Australia only 1 in 12 people will survive an out of hospital cardiac arrest (OHCA). Heart Safe Community (HSC) is a public health initiative being implemented by the Heart Foundation, Victoria in partnership with Ambulance Victoria. It aims to improve survival from OHCA by improving public access to 24 hours Automated External Defibrillators (AEDs) and by building local community skills and confidence in basic resuscitation. Over the period 2017-20, the University of Melbourne was commissioned to evaluate the implementation, effectiveness, and sustainability of three HSC pilots in Victoria, Australia. METHODS: Mixed methods were used including eight focus group discussions with 64 local HSC community stakeholders and local HSC pilot site evaluation data. RESULTS: The local HSC pilot community presentation surveys revealed that the HSC pilots delivered hundreds of presentations on bystander resuscitation, with 2772 local community members being exposed to the call to action: 'Call, Push Shock' and 'anyone can save a life'. Focus group discussions revealed that the HSC pilots built local community capacity to respond to OHCA as demonstrated by increased knowledge, confidence and skills to call Emergency Medical Services, attempt chest compression, acquire and use an AED. Community leadership to advocate for improved access to AEDs and to propagate HSC initiatives amongst community settings and cohorts has occurred. HSC implementation enablers and challenges exist. Community capacity-building frameworks can explain what makes the HSC pilot work. CONCLUSION: HSC can build local community capacity to respond to OHCA. Eight principles are suggested to support the building, implementation and sustainability of future HSC efforts. SO WHAT?: The HSC experience reveals that community members across the lifespan and multiple settings embrace opportunities to improve the safety and response in their community to a cardiac arrest when the action is simplified and community ownership cultivated.

Transforming UNICEF's approach to health system strengthening: what place can a blended learning course play?

BACKGROUND: The United Nations Children's Fund (UNICEF) published their Health Systems Strengthening (HSS) approach to meet its strategic goals of ending preventable maternal, newborn and child deaths and promoting the health and development of all children and reducing inequities in health in 2016. UNICEF commissioned the University of Melbourne's Nossal Institute for Global Health to develop and deliver a pilot blended HSS program, involving 60 hours of online learning and 2 weeks of face-to-face teaching over a 6-month period. To assess the extent to which the HSS program had built the first 83 UNICEF 2017 graduates' capabilities to apply HSS actions by 2017, UNICEF funded an independent evaluator from the University of Melbourne. METHODS: A mixed-methods assessment was conducted using: online surveys of graduates at: enrolment, completion, 6 months post-HSS program; nine focus groups with graduates at face-to-face workshops; and interviews with purposive samples of UNICEF graduates and graduate Senior Managers 12 months post-HSS program. RESULTS: The HSS program content, structure and mode of delivery was positively received. Graduates reported increased confidence taking HSS actions and multiple changes in work practices (e.g., increased systems thinking and using of health system-based approaches). Graduates' Senior Manager interviews revealed mixed impressions of graduates applying HSS actions, partly explained by the fit between the HSS program learnings and UNICEF's workplace environment. Key contextual factors influencing graduates applying HSS actions included: workload; limited opportunities to apply HSS actions; limited HSS examples; and variable support to apply HSS actions. Graduate and Senior Manager suggestions to optimise applying HSS actions included: linking HSS program content with UNICEF priorities; increasing opportunities for graduates to apply HSS actions; increasing access to HSS support. CONCLUSIONS: The paper concludes by presenting HSS program and assessment suggestions from the 2017 UNICEF Pilot HSS program assessment and actions taken for the 2018 UNICEF staff cohorts by HSS program developers, funders and beneficiaries.

Public libraries as health literate multi-purpose workspaces for improving health literacy.

Now more than ever, in this COVID-19 pandemic, our individual and collective ability to access, understand and apply information to inform our health care and broader lifestyle decisions ie, to be health literate - has life or death consequences. This paper reflects upon the proposition of public libraries as health literate multi-purpose workspaces for improving health literacy. We draw upon our combined experiences as evaluators of organizational health literacy initiatives, and library sector development, engagement and advocacy. Key ideas were presented as part of the 2020 State Library Victoria seminar series on 'Libraries: The Heart of a Healthy Community'. Key messages included: Public libraries are well positioned to contribute to the health literacy movement, as they provide the general public with: universal free access to information and services; extensive in-house and outreach educational collaborative learning opportunities; and health and wellbeing support by being welcoming, safe, and trusted community spaces. To date, limited discussion exists about conceptualizing public libraries as health literate multi-purpose workspaces for supporting and sustaining public library health literacy efforts. A health literate organizational framework is suggested to support libraries simply supporting health information literacy to being recognised as health literate organizations. Five workspace principles (empowerment, equitable, inclusive, collaborative and integrated) are suggested to provide directions for public libraries as health literate multi-purpose workspaces for improving the health literacy of individuals, communities, organizations and indeed systems. To inform the design, implementation and evaluation of public libraries as workspaces for improving health literacy, key principles-focused evaluation questions are suggested for consideration. SO WHAT?: Public Libraries as welcoming, safe, and trusted community organizations are well placed to be health literate multipurpose workspaces for improving health literacy.

A pilot study of adolescent health literacy research in Melbourne: Implementation and reflections.

ISSUES ADDRESSED: While adolescent health literacy research has gained momentum, there is little evidence regarding its implementation and data collection in school settings. This study explored the feasibility of collecting health literacy data from Australian secondary schools and piloted three health literacy instruments. METHODS: A cross-sectional study was designed to recruit four government secondary schools in Melbourne. Active, opt-in consent was obtained from parents and students in Years 7-9, and an online survey was conducted. Three health literacy instruments were used: the 8-item Health Literacy Assessment Tool (HLAT-8), the Newest Vital Sign (NVS), and the 47-item Health Literacy Survey (HLS-47). RESULTS: A total of 120 students (age 12-15 years) were finally recruited from one school, whereas the other three schools declined due to busy educational commitment or no interest in research. Learnings and reflections on data collection included: a shared perspective of health literacy evaluation between school and researchers; the feasibility of online data collection; and the possibility of obtaining passive, opt-out consent. About one-quarter (23.7%-32.2%) of students were likely to have poor health literacy. CONCLUSIONS: Although the recruitment was challenging, this pilot study indicates the feasibility of large-scale online health literacy survey in future school-based research. SO WHAT?: Measuring and monitoring adolescent health literacy is essential to achieve the aim of the Australian Curriculum of Health and Physical Education. More implementation research is needed with representative samples to validate health literacy instruments and examine the impact of health literacy on health promotion outcomes in Australian adolescents.

"Sons of the West" leadership academy: Examining impact on community connectedness, leadership and self-efficacy.

ISSUE ADDRESSED: Australian men experience poorer health, have reduced help-seeking behaviours, engage in unhealthy coping mechanisms and suicide rates are disproportionately high, compared to Australian women. The "Sons of the West" (SOTW) Premiership Program is an Australian men's physical and mental health promotion program, which includes a Leadership Academy (LA), so that Premiership Program graduates can further develop skills and become leaders in improving male health. The aim of this research study was to determine if the SOTW Leadership Academy improved community connectedness, leadership attributes and self-efficacy amongst LA graduates. METHODS: Sixty-seven Australian males (M = 53.42, SD = 11.80, age range: 20-72), from two groups (Premiership Program graduates who completed the LA and those who only completed the Premiership Program) completed three self-rated questionnaires on community connectedness, self-efficacy and leadership qualities. RESULTS: There was a significant difference between the two groups, showing that LA graduates had increased levels of leadership skills, self-efficacy and community connectedness compared to those who did not complete the LA. CONCLUSION: This study indicates that a men's health program can not only engage and improve the health of men, but also help them develop skills and enhance their own strengths, so that they can improve the health and well-being of others. SO WHAT?: The development of leadership pathways and capacity building, embedded within health promotion programs, is an important aspect of improving health and well-being.

Evaluation of the Effectiveness of a Phone Based Care Coordination Pilot on Hospital Utilisation and Costs for Patients With Chest Pain.

BACKGROUND: A small percentage of the population represents a disproportionate number of attendances at emergency departments (ED). "Frequent presenters" to ED with chest pain do not always fit into established pathways for acute myocardial events. With accelerated "rule out" protocols, patients are often discharged from the ED after short lengths of stay. This research will evaluate the effectiveness of a phone based care-coordination pilot designed to meet the needs of patients attending ED with cardiac and non-cardiac chest pain. METHODS: A longitudinal, single-arm interventional study with retrospectively recruited control group. Ninety-five patients were enrolled as the intervention group; 97 patients were retrospectively identified as controls. These patients had re-presented with chest pain within 6 months of a cardiac event, or attended hospital within 12 months two or more times with chest pain and/or complex needs. Intervention group patients were holistically assessed then phone-coached to support self-management of chest pain over 6 months. Following descriptive and univariate analysis, multivariate analysis was conducted to adjust for noted differences between the intervention and control groups. RESULTS: Thirty-day representation to ED was significantly less for the intervention group (14.1%) compared to controls (27.7%). After adjusting for baseline differences, intervention patients were more than two-fold less likely to re-present compared to controls (OR=0.42, 95%CI: 0.19-0.96). After adjustment for baseline differences, the savings in subsequent inpatient costs was $1588 per person, as a result of intervention, patients were less likely to have inpatient readmissions (16.3%) compared to controls (20.2%), although this was not statistically significant (p=0.588). CONCLUSION: A phone based care-coordination pilot with targeted interventions has the potential to reduce ED presentations and hospital readmissions among patients representing with chest pain.

Key lessons for designing health literacy professional development courses.

Health literacy courses for health professionals have emerged in response to health professionals' perceived lack of understanding of health literacy issues, and their failure to routinely adopt health literacy practices. Since 2013 in Victoria, Australia, the Centre for Culture, Ethnicity and Health has delivered an annual health literacy demonstration training course that it developed. Course development and delivery partners included HealthWest Partnership and cohealth. The courses are designed to develop the health literacy knowledge, skills and organisational capacity of the health and community services sector in the western metropolitan region of Melbourne. This study presents key learnings from evaluation data from three health literacy courses using Wenger's professional educational learning design framework. The framework has three educational learning architecture components (engagement, imagination and alignment) and four educational learning architecture dimensions (participation, emergent, local/global, identification). Participatory realist evaluation approaches and qualitative methods were used. The evaluations revealed that the health literacy courses are developing leadership in health literacy, building partnerships among course participants, developing health literacy workforce knowledge and skills, developing ways to use and apply health literacy resources and are serving as a catalyst for building organisational infrastructure. Although the courses were not explicitly developed or implemented using Wenger's educational learning design pedagogic features, the course structure (i.e. facilitation role of course coordinators, providing safe learning environments, encouraging small group work amongst participants, requiring participants to conduct mini-projects and sponsor organisation buy-in) provided opportunities for engagement, imagination and alignment. Wenger's educational learning design framework can inform the design of future key pedagogic features of health literacy courses.

Building health literacy responsiveness in Melbourne's west: a systems approach.

With high health inequities among some population groups, health professionals and organisations are increasingly taking action on health literacy. This case study demonstrates how a systems approach to health literacy responsiveness created change across a region. From 2013 to 2017 the Health Literacy Development Project incorporating a training course and community of practice (the Project) targeted the health and community services system in Melbourne's west. The Project created a ripple effect that built health literacy responsiveness at the individual and organisational level. This contributed to increased use of health literacy practices and led to systems change across the region. Creating change within the health and community services system is extremely challenging. This case study provides some evidence that a systems approach can support change in the health literacy responsiveness of a regional health and community services system over a 4-year timeframe.

Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations.

Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce. Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territories Results Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively. Participants reached consensus on five key roles for PHCOs in optimising nursing in general practice: (1) matching workforce size and skills to population needs; (2) facilitating leadership opportunities; (3) providing education and educational access; (4) facilitating integration of general practice with other primary care services to support interdisciplinary care; and (5) promoting advanced nursing roles. National concerns, such as limited opportunities for postgraduate education and career progression, were deemed best addressed by national nursing organisations, universities and peak bodies. Conclusions Advancement of nursing in general practice requires system-level support from a range of organisations. PHCOs play a significant role in education and leadership development for nurses and linking national nursing organisations with general practices. What is known about the topic? The role of nurses in Australian general practice has grown in the last decade, yet they face limited career pathways and opportunities for career advancement. Some nations have forged interprofessional primary care teams that use nurses' skills to the full extent of their scope of practice. PHCOs have played important roles in the development of general practice nursing in Australia and internationally. What does this paper add? This study delineates organisational support roles for PHCOs in strengthening nurses' roles and career development in Australian general practice. What are the implications for practitioners? Effective implementation of appropriate responsibilities by PHCOs can assist development of the primary care nursing workforce.

Is health workforce planning recognising the dynamic interplay between health literacy at an individual, organisation and system level?

The growing demands on the health system to adapt to constant change has led to investment in health workforce planning agencies and approaches. Health workforce planning approaches focusing on identifying, predicting and modelling workforce supply and demand are criticised as being simplistic and not contributing to system-level resiliency. Alternative evidence- and needs-based health workforce planning approaches are being suggested. However, to contribute to system-level resiliency, workforce planning approaches need to also adopt system-based approaches. The increased complexity and fragmentation of the healthcare system, especially for patients with complex and chronic conditions, has also led to a focus on health literacy not simply as an individual trait, but also as a dynamic product of the interaction between individual (patients, workforce)-, organisational- and system-level health literacy. Although it is absolutely essential that patients have a level of health literacy that enables them to navigate and make decisions, so too the health workforce, organisations and indeed the system also needs to be health literate. Herein we explore whether health workforce planning is recognising the dynamic interplay between health literacy at an individual, organisation and system level, and the potential for strengthening resiliency across all those levels.

Training a system-literate care coordination workforce.

People with chronic complex conditions continue to experience increasing health system fragmentation and poor coordination. To reverse these trends, one solution has been an investment in effective models of care coordination that use a care coordinator workforce. Care coordinators are not a homogenous workforce - but an applied professional role, providing direct and indirect care, and is often undertaken by nurses, allied health professionals, social workers or general practitioners. In Australia, there is no training curriculum nor courses, nor nationally recognised professional quality standards for the care coordinator workforce. With the growing complexity and fragmentation of the health care system, health system literacy - shared understanding of the roles and contributions of the different workforce professions, organisations and systems, among patients and indeed the health workforce is required. Efforts to improve health system literacy among the health workforce are increasing at a policy, practice and research level. However, insufficient evidence exists about what are the health system literacy needs of care coordinators, and what is required for them to be most effective. Key areas to build a health system literate care coordination workforce are presented. Care coordination is more than an optional extra, but one of the only ways we are going to be able to provide equitable health services for people with chronic complex conditions. People with low health literacy require more support with the coordination of their care, therefore we need to build a high performing care coordinator workforce that upholds professional quality standards, and is health literacy responsive.

Evaluation of population health short courses: implications for developing and evaluating population health professional development initiatives.

Population health as an approach to planning is key to improving the health and well-being of whole populations and to reduce inequities within and between population groups. The Victorian Department of Health North and West Metropolitan Region, in collaboration with The University of Melbourne (School of Population Health), have delivered four annual population health short courses. The short courses were designed to equip participants with knowledge and skills to implement population health approaches upon their return to their workplaces. For three consecutive years, online surveys (n=41) and semi-structured interviews (n=35), underpinned by participatory and realist evaluation approaches, were conducted to obtain the perceptions and experiences of the population health short course participants. Evaluation findings indicate that participants' understanding of population health concepts increased; however, there were mixed outcomes in assisting participants' implementation of population health approaches upon their return to their workplaces. A core list of perceived requirements, enablers and barriers emerged at an individual, organisational and system level as influencing the capability of participants to implement population health approaches. Evaluation recommendations and actions taken to revise short course iterations are presented, providing evidence that the evaluation approaches were appropriate and increased the use of evaluation learnings. Implications of evaluation findings for professional development practice (i.e. shift from a 'Course' as a one-off event to a Population Health 'Program' of inter-dependent components) and evaluation (i.e. participatory realist evaluation approaches) are presented.

Cancer care coordination: building a platform for the development of care coordinator roles and ongoing evaluation.

Continuity of care is integral to the quality and safety of care provided to people with cancer and their carers. Further evidence is required to examine the contribution Nurse Cancer Care Coordinator (NCCC) roles make in improving the continuity. The aim of the present study was to clarify the assumptions underpinning the NCCC roles and provide a basis for ongoing evaluation. The project comprised a literature review and a qualitative study to develop program logic. The participants who were purposively sampled included policy makers, practitioners, patient advocates, and researchers. Both the literature and participant reports found that NCCC roles are diverse and responsive to contextual influences to coordinate care at the individual (patient), organisational, and systems levels. The application of the program logic for the development of NCCC roles was explored. The conceptualisation of NCCC roles was also examined in relation to Boundary Spanning and Relational Coordination theory. Further research is required to examine how NCCCs contribute to improving equity, safety, quality and coordination of care. The project has implications for research, policy and practice, and makes explicit existing assumptions to provide a platform for further development and evaluation of these roles.

Generalism workforce planning. Definitional, pragmatic and transformational issues.

BACKGROUND: Generalist primary care medical practitioners have been the cornerstone of healthcare systems through general practice. Internationally and within Australia, calls to strengthen generalist primary care medical practice have increased with the ever growing burden on the health system from the demand and workforce sides. Professional bodies have called for further work to quantify and predict generalist workforce requirements and distribution as a matter of urgency. Despite recent Australian health workforce planning analysis and modelling predicting workforce number requirements, definitional, pragmatic and transformational issues confront generalism workforce planning. OBJECTIVE: This article describes the challenges involved in generalist workforce planning and suggests potential solutions. DISCUSSION: We argue for a generalist workforce capability-based model that seeks to identify how to prepare, support and sustain core capabilities required for generalists to ensure team-based primary care is safe and effective within and across sectors and settings.

An evaluation of the quality of evidence underpinning diabetes management models: a review of the literature.

OBJECTIVE: There is a paucity of research on the quality of evidence relating to primary care workforce models. Thus, the aim of the present study was to evaluate the quality of evidence on diabetes primary care workforce models in Australia. METHODS: The National Health and Medical Research Council of Australia's (National Health and Medical Reseach Council; 2000, 2001) frameworks for evaluating scientific evidence and economic evaluations were used to assess the quality of studies involving primary care workforce models for diabetes care involving Australian adults. A search of medical databases (MEDLINE, AMED, RURAL, Australian Indigenous HealthInfoNet and The Cochrane Institute), journals for diabetes care (Diabetes Research and Clinical Practice, Diabetes Care, Diabetic Medicine, Population Health Management, Rural and Remote Health, Australian Journal of Primary Health, PLoS Medicine, Medical Journal of Australia, BMC Health Services Research, BMC Public Health, BMC Family Practice) and Commonwealth and state government health websites was undertaken to acquire Australian studies of diabetes workforce models published 2005-13. Various diabetes workforce models were examined, including 'one-stop shops', pharmacy care, Aboriginal services and telephone-delivered interventions. The quality of evidence was evaluated against several criteria, including relevance and replication, strength of evidence, effect size, transferability and representativeness, and value for money. RESULTS: Of the 14 studies found, four were randomised controlled trials and one was a systematic review (i.e. Level II and I (best) evidence). Only three provided a replicable protocol or detailed intervention delivery. Eleven lacked a theoretical framework. Twelve reported significant improvements in clinical (patient) outcomes, commonly HbA1c, cholesterol and blood pressure; only four reported changes in short- and long-term outcomes (e.g. quality of life). Most studies used a small or targeted population. Only two studies assessed both benefits and costs of their intervention compared with usual care and cost effectiveness. CONCLUSIONS: More rigorous studies of diabetes workforce models are needed to determine whether these interventions improve patient outcomes and, if they do, represent value for money. WHAT IS KNOWN ABOUT THE TOPIC?: Although health systems with strong primary care orientations have been associated with enhanced access, equity and population health, the primary care workforce is facing several challenges. These include a mal-distribution of resources (supply side) and health outcomes (demand side), inconsistent support for teamwork care models, and a lack of enhanced clinical inter-professional education and/or training opportunities. These challenges are exacerbated by an ageing health workforce and general population, as well as a population that has increased prevalence of chronic conditions and multi-morbidity. Although several policy directions have been advocated to address these challenges, there is a lack of high-quality evidence about which primary care workforce models are best (and which models represent better value for money than current practice) and what the health effects are for patients. WHAT DOES THIS PAPER ADD?: This study demonstrated several strengths and weaknesses of Australian diabetes models of care studies. In particular, only five of the 14 studies assessed were designed in a way that enabled them to achieve a Level II or I rating (and hence the 'best' level of evidence), based on the NHMRC's (2000, 2001) frameworks for assessing scientific evidence. The majority of studies risked the introduction of bias and thus may have incorrect conclusions. Only a few studies described clearly what the intervention and the comparator were and thus could be easily replicated. Only two studies included cost-effectiveness studies of their interventions compared with usual care. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Although there has been an increase in the number of primary care workforce models implemented in Australia, there is a need for more rigorous research to assess whether these interventions are effective in producing improved health outcomes and represent better value for money than current practice. Researchers and policymakers need to make decisions based on high-quality evidence; it is not obvious what effect the evidence is having on primary care workforce reform.

A framework to support team-based models of primary care within the Australian health care system.

Health systems with strong primary care orientations are known to be associated with improved equity, better access for patients to appropriate services at lower costs, and improved population health. Team-based models of primary care have emerged in response to health system challenges due to complex patient profiles, patient expectations and health system demands. Successful team-based models of primary care require a combination of interprofessional education and learning; organisational and management policies and systems; and practice support systems. To ensure evidence is put into practice, we propose a framework comprising five domains (theory, implementation, infrastructure, sustainability and evaluation) to assist policymakers, educators, researchers, managers and health professionals in supporting team-based models of primary care within the Australian health care system.

Communication at the interface between hospitals and primary care - a general practice audit of hospital discharge summaries.

BACKGROUND: Timeliness and quality of hospital discharge summaries are crucial for patient safety and efficient health service provision after discharge. METHODS: We audited receipt rates, timeliness and the quality of discharge summaries for 49 admissions among 38 patients in an urban general practice. For missing discharge summaries, a hospital medical record search was performed. RESULTS: Discharge summaries were received for 92% of identified admissions; 73% were received within three days and 55% before the first post-discharge visit to the general practitioner (GP). Administrative information and clinical content, including diagnosis, treatment and follow-up plans, were well reported. However, information regarding tests, referrals and discharge medication was often missing; 57% of summaries were entirely typed and 13% had legibility issues. DISCUSSION: Completion rates were good but utility was compromised by delays, content omissions and formatting. Digital searching enables extraction of information from rich existing datasets contained in GP records for accurate measurement of discharge summary receipt rate and timing.

An evaluation of New Zealand's iterative Workforce Service Reviews: a new way of thinking about health workforce planning.

OBJECTIVE: To ensure New Zealand's health workforce was fit for purpose, Health Workforce New Zealand (HWNZ) funded Workforce Service Reviews (WSRs) to develop visions for service reconfiguration and workforce for 2020. This paper describes what makes the WSR processes work, for whom, and in what circumstances. METHOD: Semi-structured interviews informed by a realist evaluation approach were conducted to obtain perceptions and experiences of WSR participants from four WSRs: eye health, palliative care, anaesthesia and aged care. RESULTS: The WSR process was a successful means of bringing together professionals from across the health disciplines and building sector capacity to develop new ways of thinking about service and workforce planning. WSRs were constrained by: mixed signals about process and outcomes; being challenged not milestone focussed; lacking clarity about ownership of visions; and variable clarity about next steps. WSRs were optimised by having: a lead clinician with policy know-how, ability to inspire, bring people together, distil ideas into coherent frameworks; and a project manager with project enablement skill sets and expertise in complex systems, implementation, change management. CONCLUSIONS: Evidence now exists at a point in time about what makes the WSR processes work. Implications for HWNZ are presented using a capacity-building framework to inform future decision making regarding WSRs. WHAT IS KNOWN ABOUT THE TOPIC? More appropriate workforce planning is required to meet the challenges facing the health workforce, from both the demand and the workforce side. To ensure New Zealand's healthcare workforce was fit for purpose, HWNZ initiated an iterative WSR process in topic specific areas. The WSRs process was designed to develop a vision of the relevant health service and workforce for 2020, and models of care that were patient-centred and team-based. WHAT DOES THIS PAPER ADD? The paper provides evidence that the WSR process was a successful means for bringing together professionals from across the health disciplines and building sector capacity to develop new ways of thinking about service and workforce planning. The paper presents key enablers of, and barriers to, the WSR iterative process. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? The evaluation revealed that a multitude of factors can influence the capacity of the WSR process at the individual (workforce skills and abilities), organisational (leadership and interactions) and systems (infrastructure) levels. Implications for HWNZ on ways to build the capacity of the WSRs according to three capacity-building dimensions are presented to inform future decision making.

Promoting Child Health Equity through Health Literacy.

Every child has the right to a fulfilling and thriving life [...].