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Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to identify factors influencing quality of residential aged care, and the role and influence of an aged care accreditation programme.

Focus groups were held with 66 aged care staff from 11 Australian aged care facilities. Data from semi-structured interviews were analysed to capture categories representing participant views.

Participants reported two factors stimulating change: developments in the aged care regulatory and policy framework, and rising consumer expectations. Four corresponding effects on service quality were identified: increasing complexity of resident care, renewed built environments of aged care facilities, growing focus on resident-centred care and the influence of accreditation on resident quality of life. The accreditation programme was viewed as maintaining minimum standards of quality throughout regulatory and social change, yet was considered to lack capacity of itself to explicitly promote or improve resident quality of life.

For an increasingly complex aged care population, regulatory and societal change has led to a shift in service provision from institutional care models to one that is becoming more responsive to consumer expectations. The capacity of long-established and relatively static accreditation standards to better accommodate changing consumer needs comes into question.

This is the first study to examine the relationship between accreditation and residential aged care service quality from the perspectives of staff, and offers a nuanced view of “quality” in this setting.

Unlocking and transferring skills and capabilities in individuals to the teams they work within, and across, is the key to positive organisational development and improved patient care. Using the “deep smarts” model, the purpose of this paper is to examine these issues.

The “deep smarts” model is described, reviewed and proposed as a way of transferring knowledge and capabilities within healthcare organisations.

Effective healthcare delivery is achieved through, and continues to require, integrative care involving numerous, dispersed service providers. In the space of overlapping organisational boundaries, there is a need for “deep smarts” people who act as “boundary spanners”. These are critical integrative, networking roles employing clinical, organisational and people skills across multiple settings.

Studies evaluating the barriers and enablers to the application of the deep smarts model and 13 knowledge development strategies proposed are required. Such future research will empirically and contemporary ground our understanding of organisational development in modern complex healthcare settings.

An organisation with “deep smarts” people – in managerial, auxiliary and clinical positions – has a greater capacity for integration and achieving improved patient-centred care.

In total, 13 developmental strategies, to transfer individual capabilities into organisational capability, are proposed. These strategies are applicable to different contexts and challenges faced by individuals and teams in complex healthcare organisations.

This paper aims to explore if health professionals share understanding of teamwork that supports collaborative ward rounds.

A purpose-designed survey was conducted in two acute medical and two rehabilitation wards from a metropolitan teaching hospital. Medical officers, nurses and allied health professionals participated. To understand characteristics that support collaborative ward rounds, questions developed from literature and industry experience asked: what are the enablers and challenges to teamwork; and what are clinicians’ experiences of positive teamwork? Descriptive and thematic analyses were applied to the dimensions of effective teamwork as a framework for deductive coding.

Seventy-seven clinicians participated (93% response rate). Findings aligned with dimensions of teamwork framework. There was no meaningful difference between clinicians or specialty. Enablers to teamwork were: effective communication, shared understanding of patient goals, and colleague’s roles. Challenges were ineffective communication, individual personalities, lack of understanding about roles and responsibilities, and organisational structure. Additional challenges included: time; uncoordinated treatment planning; and leadership. Positive teamwork was influenced by leadership and team dynamics.

Ward rounds benefit from a foundation of collaborative teamwork. Different dimensions of teamwork present during ward rounds support clinicians’ shared understanding of roles, expectations and communication.

Rounds such as structured rounding, aim to improve teamwork. Inverting this concept to first develop effective collaboration will support team adaptability and resilience. This enables teams to transition between the multiple rounding processes undertaken in a single ward. The emphasis becomes high-quality teamwork rather than a single rounding process.

Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of “street-level bureaucracy” has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice.

This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics.

Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing “assimilist” from “externalist” positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients’ personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work.

A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.

The purpose of this paper is to develop understanding of the “HRM process” as defined by Bowen and Ostroff (2004). The authors clarify the construct of “HRM philosophy” and suggest it is communicated to employees through “HRM messages”. Interrelationships between these concepts and other elements of the HRM-performance relationship are explored. The study identifies commonalities in the HRM philosophy and messages underscoring high-performing HRM systems, and highlights the function of a “messenger” in delivering messages to staff.

Case study of eight Australian hospitals with top performing HRM systems. Combines primary interview data with independent healthcare accreditor reports.

All cases share an HRM philosophy of achieving high-performance outcomes through the HRM system and employees are provided with messages about continuous improvement, best practice and innovation. The philosophy was instilled primarily by executive-level managers, whereby distinctiveness, consensus and consistency of communications were important characteristics.

The research is limited by: omission of low or average performers; a single industry and country design; and exclusion of employee perspectives.

The findings reinforce the importance of identifying the HRM philosophy and its key communicators within the organisation, and ensuring it is aligned with strategy, climate and the HRM system, particularly during periods of organisational change.

The authors expand Bowen and Ostroff’s seminal work and develop the concepts of HRM philosophy and messages, offering the model to clarify key relationships. The findings underscore problems associated with a best practice approach that disregards HRM process elements essential for optimising performance.

As a sector, higher education is at the low end of innovation rankings. The challenges we face – demographic, technological, political, and pedagogical – will require sustained innovation at a strategic level. Recent research with mature companies has identified exemplars in strategic innovation (e.g., O’Connor, Corbett, & Peters, 2018). This work explores whether – and how – higher education institutions might adapt insights from the corporate sector for strategic innovation in teaching and learning.

The introductory section provides an overview of the nature of strategic innovation (and why it is hard to sustain), strategic issues facing higher education, and the status and challenges of sustaining strategic innovation for teaching. The next two sections describe insights from research with corporate exemplars of sustaining strategic innovation. Each section uses a scenario from higher education as a proof-of-concept test to explore the application of the corporate sector insights for strategic innovation in higher education teaching and learning.

The final section of the chapter discusses the planned next steps to prototype and test adaptation of these corporate sector insights with institutional innovation leaders in higher education, as well as additional potential sources of insights (from other research in the corporate sector and from strategic innovation in the public sector).

Health systems are changing at variable rates. Periods of significant change can create new challenges or amplify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability.

Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards.

Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy; accrediting agency management of the accreditation process, including the program’s framework; survey coordinators; survey team dynamics; individual surveyors; and healthcare organizations’ approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain.

Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.

Inquiries into healthcare organisations have highlighted organisational or system failure, attributed to poor responses to early warning signs. One response, and challenge, is for professionals and academics to build capacity for quality and safety research to provide evidence for improved systems. However, such collaborations and capacity building do not occur easily as there are many stakeholders. Leadership is necessary to unite differences into a common goal. The lessons learned and principles arising from the experience of providing distributed leadership to mobilise capacity for quality and safety research when researching health care accreditation in Australia are presented.

A case study structured by temporal bracketing that presents a narrative account of multi‐stakeholder perspectives. Data are collected using in‐depth informal interviews with key informants and ethno‐document analysis.

Distributed leadership enabled a collaborative research partnership to be realised. The leadership harnessed the relative strengths of partners and accounted for, and balanced, the interests of stakeholder participants involved. Across three phases, leadership and the research partnership was enacted: identifying partnerships, bottom‐up engagement and enacting the research collaboration.

Two principles to maximise opportunities to mobilise capacity for quality and safety research have been identified. First, successful collaborations, particularly multi‐faceted inter‐related partnerships, require distributed leadership. Second, the leadership‐stakeholder enactment can promote reciprocity so that the collaboration becomes mutually reinforcing and beneficial to partners.

The paper addresses the need to understand the practice and challenges of distributed leadership and how to replicate positive practices to implement patient safety research.

This paper aims to examine an organisation's enactment of clinical governance through applying and advancing a theoretical model.

The research site was a large organisation within an autonomous jurisdiction. The study focused on one organisational division. There were nine interviews and 15 focus groups (118 participants). Ethnographic observations totalled 60.5 hours. Document analysis was conducted with organisational reports and website. Data were examined against the model's four attributes and 24 elements, and used to conduct an organisational culture analysis.

Analysis showed that a majority of elements, 17 of 24, were strongly identifiable. The remainder were identifiable but not strongly so. Analysis suggested two additions to the model: the inclusion of two elements to an existing attribute and a new attribute and defining elements. This showed that the organisation was working towards, but not yet having achieved, a positive quality and safety culture. In particular, a schism in understanding between managers and frontline staff was noted.

The study empirically applied and refined a health service theory. The new model, the “clinical governance practice model”, can be broadly applied, and can continue to be developed to expand the evidence base for the field.

Substantively, the study accounts for differences in managerial and frontline staff actions in applying clinical governance. Investigations to understand and identify strategies to bridge the differences are required.

The study is an original application and refinement of a health service theory. The study identifies that the interpretation of clinical governance, whilst different in different places, gives rise to similar disagreements.

The purpose of this article is to test whether healthcare accreditation survey processes are reliable.

The study uses multiple methods to document stakeholder experiences and views on accreditation survey reliability. There were 29 research activities, comprising 25 focus groups, three interviews and a survey questionnaire. In total, 193 stakeholders participated; 134 in face‐to‐face activities and 56 via questionnaire. All were voluntary participants. Using open‐ended questioning, stakeholders were asked to reflect upon accreditation survey reliability.

Stakeholders perceived healthcare accreditation surveys to be a reliable activity. They identified six interrelated factors that simultaneously promoted and challenged reliability: the accreditation program, including organisational documentation and surveyor accreditation reports; members' relationship to the accrediting agency and survey team; accreditation agency personnel; surveyor workforce renewal; surveyor workforce management; and survey team conduct including coordinator role. The six factors realised shared expectations and conduct by accreditation stakeholders; that is, they enabled accreditation stakeholder self‐governance.

Knowledge gained can be used to improve accreditation program reliability, credibility and ongoing self‐governance.

The paper is a unique examination of healthcare accreditation surveys the reliability. The findings have potential application to reliability in other healthcare areas.