According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

Chronic health conditions have been on the rise across the world. But few health care systems, have proved able to cope with managing this dramatic increase in chronic conditions. This report from the World Health Organization (WHO) provides a comprehensive framework for the prevention framework for the prevention and management of Chronic health conditions around the world. Chronic health conditions were defined in this report as “health problems that persist across time and require some degree of health care management”. This new report addresses how policy makers can take effective and innovative action to tackle these conditions. The report addresses the following issues: Exploring chronic conditions, including how and why they are increasing, what is their economic impact on patients, families, communities, and governments, and how to reduce their prevalence. The deficits in current systems of health to successfully manage chronic conditions because the acute care model dominates health care systems. The acute care model increased health care expenditures without improving populations health status. A new framework for health care systems to improve care for chronic conditions. This framework is comprised of fundamental components within the patient, health care organization and community, and policy levels. These components were described as “building blocks” that can be used to re-design a health care system to manage long-term health problems more effectively. The report describes eight essential elements for improving and creating innovations in the care of chronic conditions. These elements include: Supporting a shift in attitudes, so that decision­ makers, health workers and patients are aware that a shift in resources from the acute, episodic model of care is needed to meet the different of chronic conditions. Building political commitment to the process of preventing and managing chronic conditions. Avoiding fragmentation of services, to ensure that the care for chronic conditions is integrated. To align and analyze policies which affect chronic conditions, such as agricultural regulations, labor laws and health education. To use new, team care models and evidence-based skills for managing chronic conditions, worth more efficient use of health care personnel. To re-oriented Health care for chronic conditions around the patient and family. To support patients within their communities, because communities can fill a crucial gap in health services that are not provided by organized health care. To emphasize prevention, as many of the complications of chronic conditions can be prevented or reduced. This report provides a well-formulated framework for decision-makers and health service planners to implement strategies for comprehensively managing chronic conditions.

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Innovative care for chronic conditions: building blocks for action

Adults with better jobs enjoy better health: job title was, in fact, the social gradient metric first used to study the relationship between social class and chronic disease etiology, a core finding now replicated in most developed countries. What has been less well proved is whether this correlation is causal, and if so, through what mechanisms. Duringthepastdecade,muchresearchhasbeendirectedattheseissues.Bestevidencein2009suggeststhatoccupation does affect health. Most recent research on the relationship has been directed at disentangling the pathways through which lower-status work leads to adverse health outcomes. This review focuses on six areas of recent progress: (1) the role ofstatus in a hierarchical occupational system; (2) the roles of psychosocial job stressors ;( 3) effects of workplacephysicalandchemicalhazardexposures;(4)evidencethatworkorganizationmattersasacontextualfactor; (5) implications for the gradient of new forms of nonstandard or “precarious” employment such as contract and shift work; and (6) emerging evidence that women may be impacted differently by adverse working conditions, and possibly more strongly, than men.

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Work and its role in shaping the social gradient in health

Background Foodborne outbreaks continue to occur regardless of existing food safety measures indicating the shortcomings of these measures to assure food safety. This has led to the recognition of food safety culture as a key contributory factor to the food safety performance of food establishments. Scope and approach The aim of this paper is to identify determinants for conducting food safety culture research, using the systems approach as the underlying philosophy to guide the structured reconsideration of national, organisational and safety culture literature, in view of food safety. Key findings and conclusions Food safety culture is complex and many interlinking factors are at play. The analysis of ‘culture’ literature showed that food safety culture research should acknowledge the impact of national culture, specify hierarchical level(s) (strategic, tactical, and operational), establish underlying mechanisms, and consider the company's food risks and context characteristics. Major elements to be considered in food safety culture research include organisational and administrative characteristics (i.e. food safety vision, communication, commitment, leadership, training), technical facilities/resources (i.e. food hygiene/safety tools, equipment, & facilities), employee characteristics (i.e. attitudes, knowledge, perceptions and risk awareness), group characteristics, crucial FSMS characteristics, and actual food safety performance. Methodological requirements for food safety culture research include use of the systems approach, measurable indicators, classification systems for differentiated assessment, and use of multiple methods to enhance research validity. The identified food safety culture research determinants provide an underpinned and transparent starting point to the common understanding and research of food safety culture.

Determinants for conducting food safety culture research

Communication breakdown is a factor contributing to most cases of patient harm, and this harm continues to occur at unacceptable levels. Responding to this evidence, the Metro South District of Queensland Health (Australia) has developed a communication skills training programme titled 'Communication and Patient Safety'. The three modules, each lasting 3f h, cover both staff-to-patient and staff-to-staff communication issues, and an unusual feature is that clinical and non-clinical staff attend together. Following positive evaluation data from our initial pilot programme (involving 350 staff in a single hospital), the programme was expanded to all five hospitals in the district, and has now been completed by over 3000 staff. The results show that despite the significant time commitment, participants find the courses useful and relevant (Kirkpatrick level 1), they learn and retain new material (level 2), and they report changes in behaviour at individual, team and facility levels (level 3). Although it remains a challenge to obtain quantitative data showing that training such as this directly improves patient safety (level 4), our qualitative and informal feedback indicates that participants and their managers perceive clear improvements in the 'communication culture' after a workplace team has attended the courses. Improving 'communication for safety' in healthcare is a worldwide imperative, and other healthcare jurisdictions should be able to obtain similar results to ours if they develop and support interactive, non-didactic training in communication skills.

https://qualitysafety.bmj.com/content/qhc/21/1/84.full.pdf

A ‘Communication and Patient Safety’ training programme for all healthcare staff: can it make a difference?

Since the early 1990s, a body of evidence regarding the lack of quality in health care has emerged in many countries including Australia, the United Kingdom, New Zealand and the United States of America. It has brought the subject of health care safety to the top of the policy agenda and the forefront of the public debate worldwide. Studies show not only that failure of quality occurs, but also that it inflicts harm and wastes resources on a large scale. Experts in risk management, both within and outside the health care industry, emphasize system failures and system-driven errors over direct human error, and accentuate the crucial role that organisational culture plays in ensuring safety. Examination of the interrelationship between culture and safety in organisations demonstrates that organisational relationships influence both culture and safety and that effective two-way communication is pivotal to the success of the development of a corporate 'safety culture'.

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Organisational culture and safety: an interdependent relationship.

In line with the national health emergencies plan, the successes of human resource strategies during the cholera outbreak should be built upon through emergency exercises, especially in non-affected provinces. Population needs for all public health professionals involved in health emergency preparedness and response should be mapped, and planning should be implemented to increase the numbers in relevant areas. Human resource planning should be integrated with health emergency planning. It is essential to maintain and strengthen the human resource capacities and experiences gained during the cholera outbreak to ensure a more effective response to the next health emergency.

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Human resources for health: lessons from the cholera outbreak in Papua New Guinea.

The HIV epidemic in Papua New Guinea is now described as a generalized epidemic; that is, more than 1% of people aged 15 to 49 years are infected with HIV. The individual behavior of people is not the single most important factor that places them at risk of infection and drives the spread of the epidemic. Rather, a diverse range of factors—biological, sociocultural, and political—makes people vulnerable to infection and dictates their access to care and treatment services. This article examines these biological, sociocultural, and political influences on the HIV epidemic and on prevention and treatment strategies in Papua New Guinea.

Understanding the context of providing HIV prevention and treatment in Papua New Guinea.

This study reports findings from a survey of Papua New Guinean registered nurse who completed the Integrated Management of Adult and Adolescent Illness (IMAI) Chronic HIV Care training conducted between November 2005 and December 2006. The survey conducted is one component of a mixed method evaluation of the IMAI program in Papua New Guinea. Data from the questionnaires were entered into version 16 of the Statistical Package for the Social Sciences (SPSS) software program. The responses on the effect of the IMAI training program had on various aspects of how care is provided, learning needs and other program outcomes were analysed with a chi-square test being applied to detect any difference in the response given by the different demographic subgroups in terms of gender, age, care status, current employer and past educational attainment. The survey revealed that all thirty-five respondents have a positive impression of the IMAI program and expressed the view that the IMAI program had a positive effect on various aspects of patient care and their learning and experience. Overall, the survey identified that registered nurses who participated in the IMAI Chronic HIV Care training program perceive the program to be beneficial for improving the way HIV care is provided.

Surveying health professionals' satisfaction with the integrated management of adult and adolescent illness chronic HIV care training programme: the Papua New Guinea experience

In May, 2005, the Papua New Guinea (PNG) National Department of Health (NDoH) determined that the Integrated Management of Adult and Adolescent Illness (IMAI) Chronic HIV Care training program, modified for the PNG context, would serve as the basis for the development of teams for the Rapid Scale-Up of HIV/AIDS Care and Treatment. The IMAI Chronic HIV Care training program was developed as a joint effort carried out in a working partnership involving WHO, Geneva, the WHO Regional Office for Africa (AFRO), as well as many international collaborating institutions. Trials and implementation of the program have occurred predominantly on the African continent and to date there has been no research undertaken to examine the effectiveness of the IMAI program as a learning modality for preparing registered nurses to provide comprehensive HIV care.

The purpose of this hermeneutic informed interpretive research study is to explore and describe how registered nurses in Papua New Guinea make sense of their learning and implementation of the IMAI training program in providing Comprehensive Care and treatment to people living with HIV/AIDS. The study is a mixed methods study. The rationale for this approach was to better understand the research problem by converging both broad numerical trends from quantitative research and the detail of qualitative research with the intent of producing a richer and more complete picture of the investigated phenomenon. Data collection included a quantitative survey, semi-structured interviews and a focus group. These data informed the development of descriptive accounts that allowed for the subsequent identification of common and divergent themes reflective of factors that influenced nurses learning and implementation of IMAI training.

The findings from the quantitative survey revealed that all respondents had a positive impression of the IMAI program and expressed the view that the IMAI program had a positive effect on various aspects of patient care and their learning and experience. Overall, the survey identified that registered nurses who participated in the IMAI Chronic HIV Care training program perceived the program to be beneficial for improving the way HIV care is provided.

Three major themes were identified from the qualitative analysis, and under these major themes data was arranged as sub-themes. The three major themes identified were Overcoming Personal Anxiety, Actioning Learning and Identifying Challenges.

The qualitative analysis revealed that overwhelmingly, the fear of anxiety of HIV was significant for all participants of the semi-structured interviews. Nurses in the focus group felt that the overt expression of fear given by the interview participants more accurately reflected the reality for the majority of nurses in Papua New Guinea. Most nurses also identified that their participation in the IMAI program contributed to their personal change process and helped them to identify and understand their fear of HIV. Expert patient trainers (EPTs) were a highly valued component of the flexible IMAI training methodology and were seen by nurses as being important both for learning and for assisting them to overcome their personal anxiety created by the fear of HIV.

The findings also identified that the key challenge faced by nurses in attempting to implement their learning was that of system issues including a lack of medical supplies, including antiretroviral drugs (ART), lack of staff and an absence of continuing professional education. These issues require enhanced commitment from the NDoH if nurses are to be effective in implementing their learning to provide HIV care and treatment. It is also important that NDoH give support to enable the establishment and implementation of continuing education for nurses providing HIV care and treatment and that the development of processes to ensure the ongoing maintenance of quality in HIV care and treatment training be implemented as a matter of priority.

Finally this study has provided an in-depth understanding of the experiences of how registered nurses in Papua New Guinea make sense of their learning and implementation of the IMAI training program in providing comprehensive HIV care and treatment to people living with HIV/AIDS. The current multitude of factors fueling the HIV/AIDS epidemic in Papua New Guinea are explored as is the current status of HIV/AIDS in New Guinea, and the multitude of cultural patterns, social, and political factors influencing the spread of HIV within the country. This exploration also undertakes a comprehensive discussion of cultural issues related to gender inequality including a rich description of changing cultural patterns and values in Papua New Guinea.

Geoffrey Clark

Papers

Organisational culture and safety: an interdependent relationship.

Human resources for health: lessons from the cholera outbreak in Papua New Guinea.

Understanding the context of providing HIV prevention and treatment in Papua New Guinea.

Surveying health professionals' satisfaction with the integrated management of adult and adolescent illness chronic HIV care training programme: the Papua New Guinea experience

Kisim help bilong olgeta manmeri long PNG long sikAIDS : a mixed methods study