I am a Senior Lecturer in the Centre for Health Services Management at UTS. My research and teaching examines how to identify and share knowledge within clinical, organisational and policy environments in order to improve the quality and safety of health systems. My research strength is exemplified by my authorship of over 60 peer-reviewed academic outputs, and position on the Editorial Board of BMC Health Services Research.
I have applied my research expertise in diverse roles and organisations, including the Australian Institute of Health Innovation at Macquarie University, where I hold an Honorary Senior Research Fellow appointment. I have also been a senior policymaker and directed postgraduate health management programs at leading Australian universities.
I am particularly keen to supervise or contribute to research projects related to: a) health service accreditation programs and other standards-based organisational assessment processes; b) the implementation and impacts of large quality and safety policies or programs; and c) mechanisms that facilitate knowledge translation and exchange amongst healthcare professionals.
Hinchcliff, R., Senserrick, T., Travaglia, J., Greenfield, D. & Ivers, R. 2017, 'The enhanced knowledge translation and exchange framework for road safety: a brief report on its development and potential impacts.', BMJ Injury Prevention, vol. 23, no. 2, pp. 114-117.View/Download from: Publisher's site
Knowledge translation and exchange (KTE) can enable evidence-informed road safety policy and practice by reducing the gap between what is known to be effective and what actually occurs. A quality improvement project, undertaken within a government policy frame, was implemented in 2015 to produce an enhanced KTE framework for road safety (the framework). Information was collected from 35 road safety stakeholders in the UK, the Netherlands, Norway and Sweden. Thirteen KTE facilitators were identified that covered research funding and production, the expertise of knowledge users and dissemination practices. The framework was subsequently developed, which separated facilitators seen as essential for a KTE system, from others perceived as aspirational due to their lesser influence and the considerable time and resources required for their implementation. The framework provides a heuristic device to enable policy agencies to holistically assess and improve current KTE systems for road safety, to encourage evidence-informed policy and practice.
Debono, D., Travaglia, J.F., Dunn, A.G., Thoms, D., Hinchcliff, R., Plumb, J., Milne, J., Erez-Rein, N., Wiley, J. & Braithwaite, J. 2016, 'Strengthening the capacity of nursing leaders through multifaceted professional development initiatives: A mixed method evaluation of the 'Take The Lead' program.', Collegian (Royal College of Nursing, Australia), vol. 23, no. 1, pp. 19-28.View/Download from: UTS OPUS or Publisher's site
Effective nursing leadership is necessary for the delivery of safe, high quality healthcare. Yet experience and research tells us that nursing leaders are commonly unprepared for their roles. Take The Lead (TTL), a large-scale, multifaceted professional development program was initiated in New South Wales, Australia, to strengthen the capacity of Nursing/Midwifery Unit Managers (N/MUMs). The aim of this study was to examine the effects of TTL on job performance, nursing leadership and patient experience.Nursing/Midwifery Unit Managers (n = 30) and managers of N/MUMs (n = 30) who had completed the TTL program were interviewed between August and December 2010. The semi-structured interviews included a combination of open-ended questions and questions that required respondents to rate statements using a Likert scale. Data from the open-ended questions were thematically analysed to identify and categorise key concepts. The responses to the Likert items were analysed via descriptive statistics.Nursing/Midwifery Unit Managers' participation in TTL engendered improvements in job performance and leadership skills, as well as some improvement in patients' experiences of care. The program facilitated role clarification and helped foster peer-support and learning networks, which were perceived to provide ongoing professional and personal benefits to participants.Our study revealed a consensus about the beneficial outcomes of TTL among those involved with the program. It supports the significant and ongoing value of widely implemented, multifaceted nursing leadership development programs and demonstrates that participants value their informal interactions as highly as they do the formal content. These findings have implications for delivery mode of similar professional development programs.
Greenfield, D., Hinchcliff, R., Hogden, A., Mumford, V., Debono, D., Pawsey, M., Westbrook, J. & Braithwaite, J. 2016, 'A hybrid health service accreditation program model incorporating mandated standards and continuous improvement: interview study of multiple stakeholders in Australian health care.', The International journal of health planning and management, vol. 31, no. 3, pp. e116-e130.View/Download from: UTS OPUS or Publisher's site
The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi-structured interviews. Across 2011-12 there were 47 group and individual interviews involving 258 participants. Interviews lasted, on average, 1h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies; shifting of program content focus and details; different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance; continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from "malicious compliance" to "performance audits" to "quality improvement journeys". Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd.
Greenfield, D., Hogden, A., Hinchcliff, R., Mumford, V., Pawsey, M., Debono, D., Westbrook, J.I. & Braithwaite, J. 2016, 'The impact of national accreditation reform on survey reliability: a 2-year investigation of survey coordinators' perspectives.', Journal of evaluation in clinical practice, vol. 22, no. 5, pp. 662-667.View/Download from: Publisher's site
Accrediting health care organizations against standards is a recognized safety and quality intervention. The credibility of an accreditation programme relies on surveying reliability. We investigated accreditation survey coordinators' perceptions of reliability issues and their continued relevancy, during a period of national accreditation reform.In 2013 and 2014, questionnaire surveys were developed using survey coordinators' feedback of their experiences and concerns regarding the accreditation process. Each year, a purpose-designed questionnaire survey was administered during the accrediting agency survey coordinator training days.Participants reported that survey reliability was informed by five categories of issues: the management of the accreditation process, including standards and health care organizational issues; surveyor workforce management; survey coordinator role; survey team; and individual surveyors. A new accreditation system and programme did not alter the factors reported to shape survey reliability. However, across the reform period, there was a noted change within each category of the specific issues that were of concern. Furthermore, consensus between coordinators that existed in 2013 appears to have diminished in 2014. Across all categories, in 2014 there was greater diversity of opinion than in 2013.The known challenges to the reliability of an accreditation programme retained their potency and relevancy during a period of reform. The diversity of opinion identified across the coordinator workforce could potentially place the credibility and reliability of the new scheme at risk. The study highlights that reliability of an accreditation scheme is an ongoing achievement, not a one-off attainment.
Hinchcliff, R., Greenfield, D., Hogden, A., Sarrami-Foroushani, P., Travaglia, J. & Braithwaite, J. 2016, 'Levers for change: an investigation of how accreditation programmes can promote consumer engagement in healthcare.', International journal for quality in health care : journal of the International Society for Quality in Health Care, vol. 28, no. 5, pp. 561-565.View/Download from: UTS OPUS or Publisher's site
To examine how consumer engagement (CE) can be promoted through Australian accreditation programmes.A nation-wide qualitative study completed in 2012.All eight Australian States and Territories.Two-hundred and fifty-eight healthcare stakeholders from the acute, primary and aged care sectors.Forty-seven individual and group interviews were undertaken. Questions elicited views on the dimensions and utility of CE promotion by accreditation programmes.Healthcare stakeholders' views on the dimensions and utility of CE promotion by accreditation programmes.Four mechanisms of CE promotion were identified. Two involved requirements for health service organizations to meet CE-related standards related to consumer experience and satisfaction surveys, and consumer participation in organizational governance processes. Two mechanisms for promoting CE through accreditation processes were also identified, concerning consumer participation in the development and revision of standards, and the implementation of accreditation surveys. Accreditation programmes were viewed as important drivers of CE, yet concerns were raised regarding the organizational investments needed to meet programmes' requirements.Accreditation programmes use diverse mechanisms as levers for change to promote CE in healthcare. These mechanisms and their inter-relationships require careful consideration by accreditation agencies and health policymakers to maximize their potential benefits, while maintaining stakeholder engagement in programmes.
Greenfield, D., Debono, D., Hogden, A., Hinchcliff, R., Mumford, V., Pawsey, M., Westbrook, J. & Braithwaite, J. 2015, 'Examining challenges to reliability of health service accreditation during a period of healthcare reform in Australia.', Journal of health organization and management, vol. 29, no. 7, pp. 912-924.View/Download from: UTS OPUS or Publisher's site
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.
Greenfield, D., Hinchcliff, R., Banks, M., Mumford, V., Hogden, A., Debono, D., Pawsey, M., Westbrook, J. & Braithwaite, J. 2015, 'Analysing 'big picture' policy reform mechanisms: the Australian health service safety and quality accreditation scheme.', Health expectations : an international journal of public participation in health care and health policy, vol. 18, no. 6, pp. 3110-3122.View/Download from: UTS OPUS or Publisher's site
Agencies promoting national health-care accreditation reform to improve the quality of care and safety of patients are largely working without specific blueprints that can increase the likelihood of success.This study investigated the development and implementation of the Australian Health Service Safety and Quality Accreditation Scheme and National Safety and Quality Health Service Standards (the Scheme), their expected benefits, and challenges and facilitators to implementation.A multimethod study was conducted using document analysis, observation and interviews. Data sources were eight government reports, 25 h of observation and 34 interviews with 197 diverse stakeholders.Development of the Scheme was achieved through extensive consultation conducted over a prolonged period, that is, from 2000 onwards. Participants, prior to implementation, believed the Scheme would produce benefits at multiple levels of the health system. The Scheme offered a national framework to promote patient-centred care, allowing organizations to engage and coordinate professionals' quality improvement activities. Significant challenges are apparent, including developing and maintaining stakeholder understanding of the Scheme's requirements. Risks must also be addressed. The standardized application of, and reliable assessment against, the standards must be achieved to maintain credibility with the Scheme. Government employment of effective stakeholder engagement strategies, such as structured consultation processes, was viewed as necessary for successful, sustainable implementation.The Australian experience demonstrates that national accreditation reform can engender widespread stakeholder support, but implementation challenges must be overcome. In particular, the fundamental role of continued stakeholder engagement increases the likelihood that such reforms are taken up and spread across health systems.
Greenfield, D., Civil, M., Donnison, A., Hogden, A., Hinchcliff, R., Westbrook, J. & Braithwaite, J. 2014, 'A mechanism for revising accreditation standards: a study of the process, resources required and evaluation outcomes.', BMC health services research, vol. 14, p. 571.View/Download from: UTS OPUS or Publisher's site
The study objective was to identify and describe the process, resources and expertise required for the revision of accreditation standards, and report outcomes arising from such activities.Secondary document analysis of materials from an accreditation standards development agency. The Royal Australian College of General Practitioners' (RACGP) documents, minutes and reports related to the revision of the accreditation standards were examined.The RACGP revision of the accreditation standards was conducted over a 12 month period and comprised six phases with multiple tasks, including: review methodology planning; review of the evidence base and each standard; new material development; constructing field trial methodology; drafting, trialling and refining new standards; and production of new standards. Over 100 individuals participated, with an additional 30 providing periodic input and feedback. Participants were drawn from healthcare professional associations, primary healthcare services, accreditation agencies, government agencies and public health organisations. Their expertise spanned: project management; standards development and writing; primary healthcare practice; quality and safety improvement methodologies; accreditation implementation and surveying; and research. The review and development process was shaped by five issues: project expectations; resource and time requirements; a collaborative approach; stakeholder engagement; and the product produced. The RACGP evaluation was that participants were positive about their experience, the standards produced and considered them relevant for the sector.The revision of accreditation standards requires considerable resources and expertise, drawn from a broad range of stakeholders. Collaborative, inclusive processes that engage key stakeholders helps promote greater industry acceptance of the standards.
Hinchcliff, R., Greenfield, D. & Braithwaite, J. 2014, 'Is it worth engaging in multi-stakeholder health services research collaborations? Reflections on key benefits, challenges and enabling mechanisms.', International journal for quality in health care : journal of the International Society for Quality in Health Care, vol. 26, no. 2, pp. 124-128.View/Download from: UTS OPUS or Publisher's site
Multi-Stakeholder Health Services Research Collaborations (M-SHSRCs) are increasingly pursued internationally to undertake complex implementation research that aims to directly improve the organisation and delivery of health care. Yet the empirical evidence supporting M-SHSRCs' capacity to achieve such goals is limited, and significant impediments to effective implementation are identified in the literature. This dichotomy raises the question, 'is it worth engaging in M-SHSRCs?' In this paper, we contribute to the narrative evidence-base by outlining key issues emerging from our substantial collaborative experience in Australia. Key benefits, challenges and mechanisms that may enable effective implementation of M-SHSRCs in other contexts are highlighted. We conclude that M-SHSRCs are worthwhile and succeed through significant financial, temporal and emotional investments.
Greenfield, D., Hinchcliff, R., Pawsey, M., Westbrook, J. & Braithwaite, J. 2013, 'The public disclosure of accreditation information in Australia: stakeholder perceptions of opportunities and challenges.', Health policy (Amsterdam, Netherlands), vol. 113, no. 1-2, pp. 151-159.View/Download from: UTS OPUS or Publisher's site
Public disclosure is increasingly a requirement of accrediting agencies and governments. There are few published empirical evaluations of disclosure interventions that inform evidence-based implementation or policy. This study investigated the practices associated with the public disclosure of healthcare accreditation information, in addition to multi-stakeholder perceptions of key challenges and opportunities for improvement. We conducted a mixed methods study comprising analysis of disclosure practices by accreditation agencies, and 47 semi-structured individual or group interviews involving 258 people. Participants were diverse stakeholders associated with Australian primary, acute and residential aged care accreditation programmes. Four interrelated issues were identified. First, there was broad agreement that accreditation information should be publicly disclosed, although the three accreditation agencies differed in the information they made public. Second, two implementation issues emerged: the need to educate the community about accreditation information, and the practical question of the detail to be provided. Third, the impact, both positive and negative, of disclosing accreditation information was raised. Fourth, the lack of knowledge about the impact on consumers was discussed. Public disclosure of accreditation information is an idea that has widespread support. However, translating the idea into practice, so as to produce appropriate, meaningful information, is a challenge.
Hinchcliff, R., Greenfield, D., Westbrook, J.I., Pawsey, M., Mumford, V. & Braithwaite, J. 2013, 'Stakeholder perspectives on implementing accreditation programs: a qualitative study of enabling factors.', BMC health services research, vol. 13, p. 437.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Accreditation programs are complex, system-wide quality and safety interventions. Despite their international popularity, evidence of their effectiveness is weak and contradictory. This may be due to variable implementation in different contexts. However, there is limited research that informs implementation strategies. We aimed to advance knowledge in this area by identifying factors that enable effective implementation of accreditation programs across different healthcare settings. METHODS: We conducted 39 focus groups and eight interviews between 2011 and 2012, involving 258 diverse healthcare stakeholders from every Australian State and Territory. Interviews were semi-structured and focused on the aims, implementation and consequences of three prominent accreditation programs in the aged, primary and acute care sectors. Data were thematically analysed to distil and categorise facilitators of effective implementation. RESULTS: Four factors were identified as critical enablers of effective implementation: the accreditation program is collaborative, valid and uses relevant standards; accreditation is favourably received by health professionals; healthcare organisations are capable of embracing accreditation; and accreditation is appropriately aligned with other regulatory initiatives and supported by relevant incentives. CONCLUSIONS: Strategic implementation of accreditation programs should target the four factors emerging from this study, which may increase the likelihood of accreditation being implemented successfully.
Mumford, V., Forde, K., Greenfield, D., Hinchcliff, R. & Braithwaite, J. 2013, 'Health services accreditation: what is the evidence that the benefits justify the costs?', International journal for quality in health care : journal of the International Society for Quality in Health Care, vol. 25, no. 5, pp. 606-620.View/Download from: UTS OPUS or Publisher's site
To identify and analyse research on the use of economic evaluation in health services accreditation.Seven online health and economic databases, and key accreditation agency and health department websites were searched between June and December 2011.The selection criteria were English language and published empirical research studies on the topic of economic evaluation of health service accreditation. No formal economic evaluation of health services accreditation has been carried out to date. Empirical data on costs and benefits were analysed in 6 and 15 studies, respectively. Data extraction Meta-analysis was unsuitable due to output variability. Attributes relating toscalability and independence of outcome data were collected. For the benefit studies, we also assessed the strength of claim that accreditation improved patient safety and quality, and sources of potential bias.The incremental costs ranged from 0.2 to 1.7% of total costs averaged over the accreditation cycle. The benefit studies were inconclusive in terms of showing clear evidence that accreditation improves patient safety and quality of care.The lack of formal economic appraisal makes it difficult to evaluate accreditation in comparison to other methods to improve patient safety and quality of care. The lack of a clear relationship between accreditation and the outcomes measured in the benefit studies makes it difficult to design and conduct such appraisals without a more robust and explicit understanding of the costs and benefits involved.
Mumford, V., Greenfield, D., Hinchcliff, R., Moldovan, M., Forde, K., Westbrook, J.I. & Braithwaite, J. 2013, 'Economic evaluation of Australian acute care accreditation (ACCREDIT-CBA (Acute)): study protocol for a mixed-method research project.', BMJ open, vol. 3, no. 2.View/Download from: UTS OPUS or Publisher's site
The Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork-Cost-Benefit Analysis (ACCREDIT-CBA (Acute)) study is designed to determine and make explicit the costs and benefits of Australian acute care accreditation and to determine the effectiveness of acute care accreditation in improving patient safety and quality of care. The cost-benefit analysis framework will be provided in the form of an interactive model for industry partners, health regulators and policy makers, accreditation agencies and acute care service providers.The study will use a mixed-method approach to identify, quantify and monetise the costs and benefits of accreditation. Surveys, expert panels, focus groups, interviews and primary and secondary data analysis will be used in cross-sectional and case study designs.The University of New South Wales Human Research Ethics Committee has approved this project (approval number HREC 10274). The results of the study will be reported via peer-reviewed publications, conferences and seminar resentations and will form part of a doctoral thesis.
Braithwaite, J., Shaw, C.D., Moldovan, M., Greenfield, D., Hinchcliff, R., Mumford, V., Kristensen, M.B., Westbrook, J., Nicklin, W., Fortune, T. & Whittaker, S. 2012, 'Comparison of health service accreditation programs in low- and middle-income countries with those in higher income countries: a cross-sectional study.', International journal for quality in health care : journal of the International Society for Quality in Health Care, vol. 24, no. 6, pp. 568-577.View/Download from: UTS OPUS or Publisher's site
The study aim was twofold: to investigate and describe the organizational attributes of accreditation programmes in low- and middle-income countries (LMICs) to determine how or to what extent these differ from those in higher-income countries (HICs) and to identify contextual factors that sustain or are barriers to their survival.Web-based questionnaire survey.National healthcare accreditation providers and those offering international services. In total, 44 accreditation agencies completed the survey.Income distinctions, accreditation programme features, organizational attributes and cross-national divergence.Accreditation programmes of LMICs exhibit similar characteristics to those of HICs. The consistent model of accreditation worldwide, centres on promoting improvements, applying standards and providing feedback. Where they do differ, the divergence is over specialized features rather than the general logic. LMICs were less likely than HICs to include an evaluation component to programmes, more likely to have certification processes for trainee surveyors and more likely to make decisions on the accreditation status based on a formulaic, mathematically oriented approach. Accreditation programme sustainability, irrespective of country characteristics, is influenced by ongoing policy support from government, a sufficient large healthcare market size, stable programme funding, diverse incentives to encourage participation in accreditation by Health Care Organizations as well as the continual refinement and improvement in accreditation agency operations and programme delivery.Understanding the similarities, differences and factors that sustain accreditation programmes in LMICs, and HICs, can be applied to benefit programmes around the world. A flourishing accreditation programme is one element of the institutional basis for high-quality health care.
Greenfield, D., Hinchcliff, R., Moldovan, M., Mumford, V., Pawsey, M., Irene Westbrook, J. & Braithwaite, J. 2012, 'A multimethod research investigation of consumer involvement in Australian health service accreditation programmes: the ACCREDIT-SCI study protocol.', BMJ open, vol. 2, no. 5.View/Download from: UTS OPUS or Publisher's site
Health service accreditation programmes are a regulatory mechanism adopted to drive improvements inpatient safety and quality. Research investigating the benefits or limitations, of consumer involvement in accreditation programmes is negligible. To develop our knowledge in this area the ACCREDIT collaboration (Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork) has developed a research plan, known as the ACCREDIT-SCI (Standards of Consumer Involvement) study protocol. Two complementary studies have been designed: one, to examine the effectiveness of a standard for consumer participation and two, to explore how patient experiences vary across a range of settings with differing accreditation results.The research setting is the Australian healthcare system, and the two studies focus on three accreditation programmes in the primary, acute and aged care domains. The studies will use multimethods: document analysis; interviews and surveys. Participants will be stakeholders across the three domains including: policy officers; frontline healthcare professionals; accreditation agency personnel, including surveyors and healthcare consumers. Drawing on previous experience, the research team has developed purpose-designed tools. Data will be analysed using thematic, narrative and statistical (descriptive and inferential) procedures.The University of New South Wales Human Research Ethics Committee has approved the two studies (HREC 10274). Findings will be disseminated through seminars, conference presentations, academic publications and research partner websites. The findings will be formulated to facilitate uptake by policy and accreditation agency professionals, researchers and academics, and consumers, nationally and internationally.
Greenfield, D., Hinchcliff, R., Westbrook, M., Jones, D., Low, L., Johnston, B., Banks, M., Pawsey, M., Moldovan, M., Westbrook, J. & Braithwaite, J. 2012, 'An empirical test of accreditation patient journey surveys: randomized trial.', International journal for quality in health care : journal of the International Society for Quality in Health Care, vol. 24, no. 5, pp. 495-500.View/Download from: UTS OPUS or Publisher's site
To evaluate the effectiveness of utilizing the patient journey survey (PJS) method in healthcare accreditation processes.Randomized trial of the PJS method in parallel with the current accreditation survey (CAS) method of the Australian Council on Healthcare Standards (ACHS).Acute healthcare organizations in Australia.Seventeen organizations, 28 organizational staff, nine surveyors and 38 patients.The results of each surveying method were compared. Participants provided feedback, via 18 interviews and 40 questionnaire surveys, about the benefits and disadvantages of a PJS compared to a CAS.The PJS method is not as comprehensive as the CAS method for accreditation assessment. In matched assessments the majority of items were rated lower by the PJS method than by the CAS. PJSs were shown to be appropriate for assessing mandatory clinical criteria, but were less effective for assessing corporate and support criteria. The two methods diverged in their final assessments of which organizations met the accreditation threshold. Participants endorsed the use of PJSs within accreditation processes.The PJS methodology complements but is not a substitute for existing accreditation methods. There is significant stakeholder support for the inclusion of the PJS method within the current accreditation programme.
Greenfield, D., Moldovan, M., Westbrook, M., Jones, D., Low, L., Johnston, B., Clark, S., Banks, M., Pawsey, M., Hinchcliff, R., Westbrook, J. & Braithwaite, J. 2012, 'An empirical test of short notice surveys in two accreditation programmes.', International journal for quality in health care : journal of the International Society for Quality in Health Care, vol. 24, no. 1, pp. 65-71.View/Download from: UTS OPUS or Publisher's site
To evaluate short notice surveys in accreditation programmes.Two trials using short notice surveys were conducted independently: a study of 20 healthcare organizations with the Australian Council on Healthcare Standards (ACHS) and a study of 7 general practices with the Australian General Practice Accreditation Limited (AGPAL). Participating organizations volunteered. ACHS and AGPAL selected 17 and 13 surveyors, respectively, and provided training for them on short notice surveys.Each agency's short notice surveys were an abbreviated version of their current advanced notification surveys. Short notice surveys assessed accreditation programme criteria or indicators that corresponded to the Australian Commission on Safety and Quality in Health Care's priority issues. Fifteen (out of 45) ACHS criteria and 48 (out of 174) AGPAL indicators that aligned to the Commission's criteria were evaluated. Participating organizations were given 2 days notice prior to the short notice surveys. Ratings from the short notice surveys were compared with those from the most recent advanced notification surveys, and statistical tests were performed to detect differences and potential confounding factors. Surveyors and organizational staff completed a post-survey feedback questionnaire which was analysed thematically and by inferential statistics.The short notice survey approach overall produced ratings congruent with the advanced notification survey for both accreditation programmes. However, for both programmes short notice surveys assessed that more organizations would not reach the accreditation threshold as compared with the previous survey. Organizations in both programmes were judged to have achieved less successful performance against clinical standards by the short notice survey than the advanced notification survey. There was support from surveyors and organizational staff for short notice survey to be adopted. However, there were mixed views about the impact of short notice ...
Greenfield, D., Pawsey, M., Hinchcliff, R., Moldovan, M. & Braithwaite, J. 2012, 'The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact.', BMC health services research, vol. 12, p. 329.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Healthcare accreditation standards are advocated as an important means of improving clinical practice and organisational performance. Standard development agencies have documented methodologies to promote open, transparent, inclusive development processes where standards are developed by members. They assert that their methodologies are effective and efficient at producing standards appropriate for the health industry. However, the evidence to support these claims requires scrutiny. The study's purpose was to examine the empirical research that grounds the development methods and application of healthcare accreditation standards. METHODS: A multi-method strategy was employed over the period March 2010 to August 2011. Five academic health research databases (Medline, Psych INFO, Embase, Social work abstracts, and CINAHL) were interrogated, the websites of 36 agencies associated with the study topic were investigated, and a snowball search was undertaken. Search criteria included accreditation research studies, in English, addressing standards and their impact. Searching in stage 1 initially selected 9386 abstracts. In stage 2, this selection was refined against the inclusion criteria; empirical studies (n = 2111) were identified and refined to a selection of 140 papers with the exclusion of clinical or biomedical and commentary pieces. These were independently reviewed by two researchers and reduced to 13 articles that met the study criteria. RESULTS: The 13 articles were analysed according to four categories: overall findings; standards development; implementation issues; and impact of standards. Studies have only occurred in the acute care setting, predominately in 2003 (n = 5) and 2009 (n = 4), and in the United States (n = 8). A multidisciplinary focus (n = 9) and mixed method approach (n = 11) are common characteristics. Three interventional studies were identified, with the remaining 10 studies having research designs to investigate clinical or o...
Hinchcliff, R., Greenfield, D., Moldovan, M., Pawsey, M., Mumford, V., Westbrook, J.I. & Braithwaite, J. 2012, 'Evaluation of current Australian health service accreditation processes (ACCREDIT-CAP): protocol for a mixed-method research project.', BMJ open, vol. 2, no. 4.View/Download from: UTS OPUS or Publisher's site
Accreditation programmes aim to improve the quality and safety of health services, and have been widely implemented. However, there is conflicting evidence regarding the outcomes of existing programmes. The Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork-Current Accreditation Processes (ACCREDIT-CAP) project is designed to address key gaps in the literature by evaluating the current processes of three accreditation programmes used across Australian acute, primary and aged care services.The project comprises three mixed-method studies involving documentary analyses, surveys, focus groups and individual interviews. Study samples will comprise stakeholders from across the Australian healthcare system: accreditation agencies; federal and state government departments; consumer advocates; professional colleges and associations; and staff of acute, primary and aged care services. Sample sizes have been determined to ensure results allow robust conclusions. Qualitative information will be thematically analysed, supported by the use of textual grouping software. Quantitative data will be subjected to a variety of analytical procedures, including descriptive and comparative statistics. The results are designed to inform health system policy and planning decisions in Australia and internationally.The project has been approved by the University of New South Wales Human Research Ethics Committee (approval number HREC 10274). Results will be reported to partner organisations, healthcare consumers and other stakeholders via peer-reviewed publications, conference and seminar presentations, and a publicly accessible website.
Hinchcliff, R., Greenfield, D., Moldovan, M., Westbrook, J.I., Pawsey, M., Mumford, V. & Braithwaite, J. 2012, 'Narrative synthesis of health service accreditation literature.', BMJ quality & safety, vol. 21, no. 12, pp. 979-991.View/Download from: UTS OPUS or Publisher's site
AIMS: To systematically identify and synthesise health service accreditation literature. METHODS: A systematic identification and narrative synthesis of health service accreditation literature published prior to 2012 were conducted. The search identified 122 empirical studies that examined either the processes or impacts of accreditation programmes. Study components were recorded, including: dates of publication; research settings; levels of study evidence and quality using established rating frameworks; and key results. A content analysis was conducted to determine the frequency of key themes and subthemes examined in the literature and identify knowledge-gaps requiring research attention. RESULTS: The majority of studies (n=67) were published since 2006, occurred in the USA (n=60) and focused on acute care (n=79). Two thematic categories, that is, 'organisational impacts' and 'relationship to quality measures', were addressed 60 or more times in the literature. 'Financial impacts', 'consumer or patient satisfaction' and 'survey and surveyor issues' were each examined fewer than 15 times. The literature is limited in terms of the level of evidence and quality of studies, but highlights potential relationships among accreditation programmes, high quality organisational processes and safe clinical care. CONCLUSIONS: Due to the limitations of the literature, it is not prudent to make strong claims about the effectiveness of health service accreditation. Nonetheless, several critical issues and knowledge-gaps were identified that may help stimulate and inform discussion among healthcare stakeholders. Ongoing effort is required to build upon the accreditation evidence-base by using high quality experimental study designs to examine the processes, effectiveness and financial value of accreditation programmes and their critical components in different healthcare domains.
Hinchcliff, R., Westbrook, J., Greenfield, D., Baysari, M., Moldovan, M. & Braithwaite, J. 2012, 'Analysis of Australian newspaper coverage of medication errors.', International journal for quality in health care : journal of the International Society for Quality in Health Care, vol. 24, no. 1, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
To investigate the frequency, style and reliability of newspaper reporting of medication errors.Content analysis of articles discussing medication errors that were published in the 10 most widely read Australian daily newspapers between January 2005 and January 2010. Main outcome measure(s) Newspaper source, article type, article topic, leading news actors, identified causes and solutions of medication errors and cited references.Ninety-two articles included discussion of medication errors, with the one national newspaper, The Australian, the main source of articles (n = 24). News items were the most frequent type of articles (n = 73), with the majority (n = 55) primarily focused on broader hospital problems. Government representatives, advocacy groups, researchers, health service staff and private industry groups were prominent news actors. A shortage of hospital resources was identified as the central cause of medication errors (n = 38), with efficient error reporting systems most frequently identified as a solution (n = 25). Government reports were cited on 39 occasions, with peer-reviewed publications infrequently cited (n = 4).Australian newspaper reporting of medication errors was relatively limited. Given the high prevalence of errors and the potential role consumers can play in identifying and preventing errors, there is a clear argument for increasing public awareness and understanding of issues relating to medication safety. Existing coverage of this issue is unrelated to research evidence. This suggests the need for patient safety researchers and advocacy groups to engage more strongly with the media as a strategy to increase the productive public discourse concerning medication errors and gain support for evidence-based interventions.
Braithwaite, J., Westbrook, J., Johnston, B., Clark, S., Brandon, M., Banks, M.G., Hughes, C., Greenfield, D., Pawsey, M., Corbett, A., Georgiou, A., Callen, J., Vretveit, J., Pope, C., Suol, R., Shaw, C., Debono, D., Westbrook, M., Hinchcliff, R. & Moldovan, M. 2011, 'Strengthening Organizational Performance Through Accreditation Research-a Framework For Twelve Interrelated Studies: The Accredit Project Study Protocol', BMC Research Notes, vol. 4, no. 390, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
Background: Service accreditation is a structured process of recognising and promoting performance and adherence to standards. Typically, accreditation agencies either receive standards from an authorized body or develop new and upgrade existing standard
Fitzgerald-Husek, A., Martiniuk, A.L.C., Hinchcliff, R., Aochamus, C.E. & Lee, R.B. 2011, '"I do what I have to do to survive": an investigation into the perceptions, experiences and economic considerations of women engaged in sex work in Northern Namibia.', BMC women's health, vol. 11, p. 35.View/Download from: UTS OPUS or Publisher's site
There is little published research investigating sex work in Namibia, particularly in rural areas. Therefore, the aim of this paper was to determine the views of women engaged in sex work in the Oshakati area of Namibia concerning the main factors influencing their use, or non-use, of male condoms during transactional sexual exchanges.Qualitative interviews were used to better understand the perceptions, experiences and economic considerations of female sex workers in Namibia who were involved in a Behavior Change Communication Program encouraging safer sex practices among high-risk populations in 2006 and 2007.While the Behavior Change Communication Program has made significant strides in educating and empowering young women to negotiate more consistent condom use with sexual partners, the gendered economic inequalities and power imbalances within rural and semi-urban Namibian society that favor men hinder further advancement towards positive behavioral change for HIV prevention and also hinder the development of the loving relationships sought by some sex workers.This study found that sex workers and transactional sex encounters are heterogeneous entities dependent upon the characteristics of the man (known, stranger, wealthy, attractive to the woman) and the woman (in financial need, desiring love). These features all influence condom use. The 3 E's 'education, empowerment and economic independence' are critical factors needed to encourage and facilitate consistent condom use to prevent HIV transmission. Without financial independence and occupational alternatives building on their health education and empowerment, women who engage in sex work-and transactional sex more generally-will remain largely marginalized from Namibian society, and will continue engaging in risky sexual practices that facilitate HIV acquisition and transmission throughout the community.
Hinchcliff, R., Poulos, R., Ivers, R.Q. & Senserrick, T. 2011, 'Understanding novice driver policy agenda setting.', Public Health, vol. 125, no. 4, pp. 217-221.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Despite the acute impact of road trauma involving novice drivers, there have been few efforts to identify the main factors influencing the novice driver policy agenda. Increasing the transparency of such policy dynamics may help inform future novice driver policy agenda-setting processes, as well as those in other public health settings. METHODS: Forty interviews were conducted between 2007 and 2009 with individuals involved in novice driver policy debates and processes in four Australian states. RESULTS: An increasing body of positive evaluations from other jurisdictions was seen to provide an initial stimulus for Australian novice driver policy activities. The dissemination of evidence by researchers, lobbying and advocacy by other influential stakeholders, and media reporting of multiple-fatality novice driver crashes were seen as other factors central to policy agenda setting. CONCLUSIONS: Australian graduated driver licensing (GDL) policy initiatives may only be acted upon once adequate political support is identified in terms of community demand for action and public acceptance of GDL policy in neighboring states. As such, researcher encouragement of community support for unpopular evidence-based policies during windows of opportunity for policy reform may act as an influential agenda-setting force.
Hinchcliff, R., Chapman, S., Ivers, R.Q., Senserrick, T. & Du, W. 2010, 'Media framing of graduated licensing policy debates.', Accident; analysis and prevention, vol. 42, no. 4, pp. 1283-1287.View/Download from: Publisher's site
BACKGROUND: The overrepresentation of young drivers in road trauma statistics produces significant media interest. Graduated licensing restrictions involving night-time curfews and restrictions on passenger numbers are prominent topics within media coverage. This was particularly apparent in Australia between January 2004 and July 2008, when various models of either restriction were introduced in four states. METHODS: Australian newspaper and Sydney free-to-air television coverage during the peak period were analysed to identify the framing strategies used by news actors supporting or opposing these policies. RESULTS: Fifteen frames were identified. These predominantly assessed the proposed restrictions in terms of their need, evidence base, practicality and the degree to which they were consonant with 'commonsense' perceptions and had community support. While expert road injury reduction news actors primarily emphasised their moral imperative and likely effectiveness, opponents stressed their impracticality and proposed alternative solutions. CONCLUSIONS: Research evidence is only one component of information presented as policy-relevant in policy discourse conducted in news media. Policy reform advocates using the media to advocate for evidence-based policies in road injury prevention need to appreciate that evidence is not the only currency exchanged in such debates and should study opponents' rhetoric in order to anticipate and counteract the framing strategies being used.
Hinchcliff, R., Ivers, R.Q., Poulos, R. & Senserrick, T. 2010, 'Utilization of research in policymaking for graduated driver licensing.', American journal of public health, vol. 100, no. 11, pp. 2052-2058.View/Download from: Publisher's site
Young drivers are overrepresented in road trauma and vehicle-related deaths, and there is substantial evidence for the effectiveness of graduated driver licensing (GDL) policies that minimize young drivers' exposure to high-risk driving situations. However, it is unclear what role research plays in the process of making GDL policies. To understand how research is utilized in this context, we interviewed influential GDL policy actors in Australia and the United States. We found that GDL policy actors generally believed that research evidence informed GDL policy development, but they also believed that research was used to justify politically determined policy positions that were not based on evidence. Further efforts, including more effective research dissemination strategies, are required to increase research utilization in policy.
Walker, E., Howard, E., Harris, A., Barnes, B., Parnell, H. & Hinchcliff, R. 2015, 'Development of the Australian Graduated Licensing Scheme Policy Framework: a demonstration of jurisdictions taking action together to reduce road trauma.', Australasian College of Road Safety Conference 2015, Australasian College of Road Safety Conference, Gold Coast, Australia.View/Download from: UTS OPUS
One of the most effective measures to reduce crashes amongst young drivers is the implementation
of a comprehensive Graduated Licensing Scheme (GLS). Yet while all Australian jurisdictions have
some form of GLS in place, young drivers remain over-represented in crashes on Australian roads.
This indicates that improvements to GLS models in each jurisdiction would be beneficial.
The Centre for Road Safety in Transport for New South Wales, on behalf of the Austroads Road
Safety Taskforce, commissioned road safety consultants Eric Howard and Anne Harris to develop
an evidence-informed GLS policy framework that can be applied across all Australian jurisdictions.
The project involved a review of current Australian GLS arrangements, a discussion paper outlining
key research findings and extensive consultation with road safety and licensing representatives from
The framework identifies fundamental GLS components to guide, rather than prescribe, the
implementation of increasingly effective GLS models across Australia. The GLS components relate
to key areas of focus that contribute to young driver crashes including age, experience, risk taking
and licensing access and support. The framework outlines the features of progressively more
comprehensive GLS models that address these issues (i.e. standard, enhanced and exemplar models)
to account for the varied starting points across Australia and enable jurisdictions to make
The Australian GLS Policy Framework was approved by the Transport Ministers of every
jurisdiction. The success of this project demonstrates how policy agencies can take action together
to reduce Australian road trauma, even when jurisdictions' current policies differ considerably.
Hinchcliff, R., Wilkinson, R., Thompson, J., Higgins-Whitton, L., Ma, A., Holloway, L., Kurti, L., Rendel, P., Grant, J. & Walker, E. 2014, 'Barriers to obtaining a driving licence in regional and remote areas of Western NSW', http://acrs.org.au/publications/conference-papers/database/, Australasian Road Safety Research, Policing and Education Conference, ACRS, Melbourne, Australia.View/Download from: UTS OPUS
Hinchcliff, R., Ivers, R., Poulos, R., Chapman, S. & Senserrick, T. 2008, 'What is the role of researcher media advocacy within the Australian road safety policy process?', http://acrs.org.au/publications/conference-papers/database/, Australasian Road Safety Research, Policing and Education Conference 2008, Adelaide.
This report presents the findings of a systematic literature review on short-notice and unannounced survey methodologies in healthcare accreditation.
Hinchcliff, R., Harrison, R., Elizabeth, M., Mears, S., Heslop, D. & Hay, L. 2017, Addressing unwarranted clinical variation: A rapid review of current evidence, NSW Agency for Clinical Innovation website.