Research at the Centre
Health services research is a multidisciplinary field of scientific inquiry into questions about the appropriateness, equity, effectiveness and efficiency of different means of improving the health status of individuals and populations.
Both internationally and in Australia, there is a demand for high quality interventions delivered at the most reasonable cost, which leads to greater reliance on evidence from health services research. As with other key health care policy areas, research can contribute to resolving existing dilemmas and can provide innovatory ideas for the future and the CHSM is committed to providing sound evidence upon which health policy and planning decisions can be made.
Research Projects
The Centre is involved in a broad range of collaborative research and cross-disciplinary research activity with a strong emphasis on human resource and information management.
The main focus of the research program of the UTS Centre for Health Services Management for the past three years has been a $1.2m study for the New South Wales Department of Health: Nursing Workload, Skill Mix and Patient Outcomes Study.
Funding has also been obtained for a related study examining nursing work, scope of practice and workforce models in Queensland and ACT hospitals.
Other active research interests within the CHSM include:
- Research into the costing of specialist health services
- Organisation of health care, such as the systematisation of clinical care for specific, disease, treatment and case types
- Turnover costs for staff and patients
- Development of tools to evaluate the resiliency of clinical handover
- Use of electronic medication records and the impact on work
- Policy development in the area of aged care
- Policy analysis in end-of-life care
- Review and development of innovative models of nursing care
- Review and analysis of advanced practice roles
- Evaluation of initiatives in coordinated care
- Economic modelling of the nursing workforce
- Evaluation of clinical quality programs and training program in quality improvement
- Health policy development and implementation
Current research projects
The National Clinical Handover Program: Tools for ongoing observation, monitoring and evaluation of handover in order to ensure handover practices are resilient in the workplace.
Tender awarded by the Australian Commission for Safety and Quality in Health Care ($202,000, 2007). Investigators: Iedema R, Manias E, Duffield C, Homer C, White L, Crisp J, Scheeres H, Lee B, Kerridge R, Sorensen R, Gerdtz M, Carroll K, Thomas V, Mallock N.
This project focuses on designing a clinical handover monitoring tool using video-based simulation technologies. The products from this work will include: a governance document that will set out the parameters of use of video technologies for hospital quality improvement projects used by clinical staff themselves; a video-based monitoring tool that engages with informational as well as affective dimensions of clinical hand-over; a procedural model for using video technologies for hand-over monitoring, and (visual) examples and evaluations of video-reflexivity applications for the purpose of establishing a data bank that legitimises the tool and captures its successes.
Making nursing work - Development of an operational model for assigning advanced nursing roles
QNC Experienced Researcher Grant ($30,000 - 2007) - Chief Investigator Professor A Chang (QUT) with Gardner G and Duffield C.
Advances in health care practice and technology as well as changes in consumer demographics necessitate more innovative approaches to nursing workforce. Nursing roles have proliferated and there is a confusing array of titles. Clarity in definition and service application of the advanced practice nursing role (APN) role is paramount given the increasing demands for and diversification of nursing roles. Definition of the role of a nurse practitioner (NP) in Australia has left many managers in Queensland and throughout Australia unclear whether their service needs can and should be met by a NP or an Advanced Practice Nurse (APN). This study will provide a reference framework for service providers to understand the operational potential of advanced nursing roles; validate role domains on which to base educational master's programs for the APN; and operationally will distinguish between the APN and NP roles.
Economic Modelling of the Nurses' Labour Market in Australia.
ARC Linkage ($410,239 for 2007-2010) with Department of Human Services Victoria. Chief Investigator Professor A Scott (University of Melbourne) with Shields M, Creedy J, Kalb G, Duffield C and McCarty M.
Being able to devise policies that aid recruitment and retention is a key issue for government and other nurse employers. Given the moderate role played by wages shown in overseas literature, this research will focus on the non-wage aspects of nurses' jobs that influence nurse turnover. A survey of nurses will be conducted, and an already established economic model of factors influencing labour supply will be extended. The results will be used to influence pay and non-pay policies to reduce nurse shortages in Australia.
Patient and nurse outcomes and the cost of nurses' turnover in Australian hospitals.
ARC Linkage ($350,000 for 2007-2010) with Northern Sydney Central Coast Health, ACT Health and WA Health. Chief Investigator Professor C Duffield with Roche M, Homer C, O'Brien-Pallas L, Buchan J and Shamian J.
This research focuses on the costs and outcomes of nursing turnover for patients and staff. The overall aim of this study is to determine how the rate and intensity of nursing turnover (the loss of human capital as providers leave and the lost productivity as new hires are oriented) impact patient health and safety outcomes, nurse satisfaction, health and safety, and system outcomes (turnover costs). It is anticipated that the project will provide a turnover costing methodology for use with other health disciplines.
The impact of electronic medication administration records (e-MAR) on medication administration safety and nurses' work
NHMRC Project Grant ($641,125 2007-2009) Investigators: Westbrook JI, Dean-Franklin B, Day R, Duffield C, Coiera E, Williamson M.
The aims of this project are to determine how e-MARs impact upon medication safety by measuring changes in the types, rates & severity of medication administration errors (MAEs) following implementation of an e-MAR; assess changes in the time nurses spend in medication administration following implementation of an e-MAR, and identify by nurse classification if more or less time is spent on other work tasks as a consequence; provide recommendations to reduce MAEs and improve the design of e-MARs. This project will be the first of its kind in the world and the results will be of national and international significance in establishing the role e-MARs play in improving medication administration safety and their impact on nurses' work.
Nursing workload measurement and staffing
A grant of was awarded through ACT Health Research Open Tender ($226,000 for 2007 - 2008). Chief Investigator Professor C Duffield with Homer C, O'Brien-Pallas L, Diers D, Aisbett C, Roche M and King M).
This project will determine the components of nursing work and the impact of nursing workload on the ACT Health workforce and environment, patient/client outcomes and safety, and staff outcomes. The results should assist in making recommendations on the most appropriate way to understand the factors which generate work for nurses and contribute to their workload and how best to measure this and its impact.
NSW Health commissioned the Nursing Workload, Skill Mix and Patient Outcomes Study which came to an end in 2007.
Developing Evidence-Based Workforce Models for Nursing Services in Acute Care Hospitals
An ARC Linkage Project (2005-2007 $115,000) with additional funding from Affinity Foundation 2005-2007:$25,000 Queensland Nursing Council $40,000, Gold Coast Hospital $10,000, Princess Alexandra Hospital $10,000. Partner Organisation(s): Queensland Nursing Council; Princess Alexandra Hospital; Gold Coast Hospital
Investigators: Duffield, C.M., Chaboyer, W., Fox-Young, S., Winch, S., Kachel, P., Courtney, M., Burgess, D., Stockler, J.P. The aims of this study are to document the current activities undertaken by differing levels of nursing staff in hospitals and develop evidence-based guidelines for future service delivery.
The exercise of decision latitude by NSW Practice Nurses
Eamon Merrick MHSM RN (Doctoral Candidate): This research is supervised by Professor Christine Duffield PhD RN and Mr Richard John Baldwin MBA RN.
The exercise of decision latitude by NSW practice nurses is doctoral research being undertaken by Eamon Merrick. The results of this research will provide an evidence base which can be used to enhance the delivery of primary health care services to the Australian population.