Asia-Pacific Journal of Health Management <p>The&nbsp;<em>Asia Pacific Journal of Health Management</em>&nbsp;(<em>APJHM</em>) is a peer reviewed journal for managers of organisations offering health and aged care services. It was launched as the official journal of the Australasian College of Health Service Management in 2006. The target audience is professionals with an interest in health and aged care services, research, management and policy development.</p> <p>The mission of the&nbsp;<em>APJHM</em>&nbsp;is to advance understanding of the management of health and aged care service organisations within the Asia Pacific region through the publication of empirical research, theoretical and conceptual developments and analysis and discussion of current management practices.</p> en-US (Yaping Liu) (Yaing Liu) Mon, 15 Apr 2019 18:00:12 -0700 OJS 60 In this Issue <div> <p>This issue is a Special Issue in that it predominantly features a series of articles that have arisen from the CPCE Health Conference 2019. The special issue commences with an editorial where Professor Yuen emphasises the ongoing collaboration with this Journal, the ACHSM and the Hong College of health Services Executives and with the CPCE. His leadership and contribution are appreciated.</p> <p>The first article of the Special Issue is by Hasegawa, Matsumoto, and Hirata of Toho University Tokyo Japan who present an article entitled ‘Aging and Diversity of Medical Needs: Cost of Illness of Cerebrovascular Disease in Each Prefecture of Japan. This is followed by the contribution from Ng, Fong and Kwong of Hong Kong on the ‘Transition of hospital acute-centric to long term care in an ageing population in Hong Kong - is it an issue of service gap’. In the next article, Chu and Chong of Hong Kong address the ‘Oncology Pharmacist’s role and the impact on multidisciplinary patient-centred practice of oncology clinic in public hospitals in Hong Kong. Two interesting articles follow from Kwan, Yick and Wong of the Institute of Textiles and Clothing, Hong Kong Polytechnic University of Hong Kong who provide a research article on the ‘Impact of Co- creation Footwear Workshops on Older Women in Elderly Centres in Hong Kong’ and the following article from Yick, Yip and Ng, again from the Institute of Textiles and Clothing and from the Division of Science and Technology of the Hong Kong College of the same University. The latter article examines the importance of thermal comfort in foot wear design for the elderly and is entitled ‘Thermal equations for predicting foot skin temperature’. In conclusion, Kwong and Fong provide a review article on a contemporary issue of ‘promotion of appropriate use of electronic devices among Hong Kong adolescents.</p> <p>We thank Professor Yuen and his authors for this important contribution to our understanding of humane, wholistic and integrated care from diverse international health systems. &nbsp;</p> <p>In support of this effort of our colleagues above, we have added some more articles ready for publication. This includes an editorial on Health Reform that was prompted by my plenary session contribution at the CPCE Hong Kong Conference. We also continue the international emphasis of this issue with a contribution from Sharma of Maharishi Markandeshwar University, Northern India with a research article on the ‘Extrinsic Rewards, Occupational Commitment, Career Entrenchment and Career Satisfaction of Dentists’. Our next article is by Mak and colleagues in a research article entitled ‘What is the Professional Identity of Allied Health Managers?’ Isouard and Martin provide a further contribution about the Australian workforce in an article entitled ‘Managers of aged care residential services: 2006-2016.’ Way and colleagues conclude this issue with an analysis of management practice in one local health district in Australia entitled ‘The pursuit of purposeful partnerships-making a health matrix successful’.</p> </div> David Briggs ##submission.copyrightStatement## Mon, 15 Apr 2019 00:00:00 -0700 An Asian-Pacific Perspective on Solutions for a More Humanistic, Holistic and Integrated Model of Care <p>This Special Issue selects papers from the CPCE Health Conference 2019 held at the College of Professional &amp; Continuing Education (CPCE) of The Hong Kong Polytechnic University on 14 January 2019. CPCE is delighted to contribute to this Special Issue of APJHM. CPCE, together with the Hong Kong College of Health Services Executives, have been working together on many fronts with the Australian College of Health Services Management, and this Special Issue is an example of another fruitful collaboration......</p> Peter P Yuen ##submission.copyrightStatement## Sun, 14 Apr 2019 00:00:00 -0700 Aging and Diversity of Medical Needs: Cost of illness of cerebrovascular disease in each prefecture of Japan <p><em><strong>Background:&nbsp;</strong></em>Aging in Japan is advancing most rapidly in the world, and is expected to increase demand of medical services more in near future. Aging is uneven and progress of the aging varies from regions resulting in great differences in medical needs. In order to supply the needs for medical services, Japanese government developed “Regional Medical Vision”, which estimates the near future requirements for medical resources. However, this is a plan for redistribution of medical resources taking into only future changes of population composition based on current situation. In fact, each region has diversity of medical needs, and it is difficult to use average medical needs even if they are adjusted by population structures. In consideration of such situation, we tried to estimate the social burden of major diseases of each region in order to estimate the medical needs. We picked up cerebrovascular diseases (CVD, ICD10 code: I60 - I69) and dementia (ICD10code: F01, F03, G30), and calculated their social burden of all 47 prefectures in Japan that have great authority for health policy.</p> <p><em><strong>Method:&nbsp;</strong></em>Modifying the COI method developed by Rice D, we newly defined and estimated C-COI of CVD (ICD10 code: I60 - I69) and dementia (ICD10code: F01, F03, G30). C-COI consists of five parts; direct cost (medical), morbidity cost, mortality cost, direct cost (long term care (LTC)) and informal care cost (family’s burden). Direct cost (medical) is medical cost of each disease. Morbidity cost is opportunity cost for inpatient care and outpatient care. Mortality cost is measured as the loss of human capital (human capital method). These three costs are known as components of original cost of illness by Rice D. Direct cost (LTC) is long term care insurance benefits. Family’s burden is “unpaid care cost” by family, relatives and friends in-home and in-community (opportunity cost). We calculated such costs at 2013/2014 using Japanese official statistics.</p> <p><em><strong>Results:&nbsp;</strong></em>The total C-COI of CVD in Japan was about 6,177 billion JPY, the maximum was 621 billion JPY in Tokyo and the minimum was 33 billion JPY in Tottori (Tokyo/Tottori=18.8), whereas the total C-COI of dementia was 3,778 billion JPY, the maximum was 341 billion JPY in Tokyo and the minimum was 22 billion JPY in Tottori (Tokyo/Tottori=15.5). The C-COI per capita of CVD in Japan was about 48 thousand JPY, the maximum was 66 thousand JPY in Kagoshima and the minimum was 38 billion JPY in Saitama (Kagoshima/Saitama=1.7), whereas the total C-COI of dementia was 3,778 billion JPY, the maximum was 46 thousand JPY in Shimane and the minimum was 22 thousand JPY in Chiba (Shimane/Chiba=2.1).</p> <p><em><strong>Conclusion:&nbsp;</strong></em>We substantiated a method to calculate the social burden of medical care and LTC care for each prefecture using C-COI methods. In both diseases, a large difference was found in total costs per capita and components ratio between prefectures. The situations of social burden of diseases has diversity among prefectures. When estimating the future medical needs of each region, it is necessary to take each regional condition into account.</p> Tomonori Hasegawa, Kunichika Matsumoto, Koki Hirata ##submission.copyrightStatement## Mon, 01 Apr 2019 00:00:00 -0700 Transition of Hospital Acute-Centric to Long Term Care in An Ageing Population in Hong Kong - Is it an issue of service gap? <p>Health expenditure at around 5.7% GDP is low for a developed society like Hong Kong, which is unique in having a dual track of public and private services in its health care system. Such phenomenon has been steady over the last three decades, apparently not affected at all by a major change in the Government in 1997. The public and private sections have equal share of the total health dollars consistently over the years, despite the increase of Government’s annual spending from 11% to 17% since 1990, implying a similar trend in the private sector, which is funded predominantly by out of the pocket expenses with some insurance contribution. However, Hong Kong has the longest life expectancy in the world. This has resulted in the increase in the demand for health and long-term care, casting doubt on whether the traditional model of financing and delivery of care will be sustainable. The Government has pledged that that no one is denied adequate medical treatment due to lack of means, a stance in existence for decades and being reflected by the steady state of public and private share of health expenditure. Apart from two major re-structuring of the governance system, there has been little change in the service provision organisations. The system is often criticized for being heavily hospital based and acute-centric, particularly in the public services. Primary care is taken up predominantly by the private sector, mostly in clinical services, not focusing on prevention. It is apparent that there is a significant service gap, that needs to be examined and addressed systematically before a practical solution can be formulated. A more holistic, humanistic and better integrated system of care, with innovative care patterns, shall be the way forward.</p> Tommy K. C. Ng, Ben Y.F Fong, Catherine K. Y Kwong ##submission.copyrightStatement## Mon, 15 Apr 2019 00:00:00 -0700 Oncology Pharmacist’s Role and Impact on the Multidisciplinary Patient-Centre Practice of Oncology Clinic in Public Hospitals <p>Oncology pharmacy service was developed and integrated into the multidisciplinary team of oncology clinic in 2013 at the United Christian Hospital aiming to enhance the holistic patient-centre practice of the clinic through the optimization of the safety and efficacy of anti-cancer treatment. This review aims to describe the role and impact of oncology pharmacists (OPs) in clinical setting to optimize anti-cancer treatment for cancer patients in a multidisciplinary care approach. From selection, prescribing, procurement to monitoring and patient education, OPs significantly contribute to the safety and effective use of anti-neoplastics in any circumstances. OPs provide professional advices to oncologists in choosing the appropriate anti-cancer agents for specific cancer and designing personalized anti-cancer treatment according to patients’ fitness and appropriateness for chemotherapy. Parenteral and oral chemotherapeutic agents carry heightened risk of causing significant patient harm when they are used in errors. Thus, OPs also develop standardized chemotherapy orders and ensure the final dose is appropriate in terms of both hematological and non-hematological responses and tolerability. Moreover, OPs play an important role in procuring anti-cancer drugs and sourcing alternative drug choices that will deliver similar clinical outcomes. In addition, OPs also assure the clinical integrity of anti-cancer drugs for full anti-neoplastic activity and safe administration of these drugs by nursing staff to minimize potential occupational risk. Most importantly, OPs play a vital role in providing direct patient care functions such as drug therapy monitoring and management (e.g. ensure that patients receive sufficient pre-medications for administration of anti-cancer drugs), and medication counseling for patients and their carers to better understand their anti-cancer treatment. The positive impact of integrating OPs into the multidisciplinary patient-center practice of oncology clinic includes (1) reduction in potentially life-threatening medication incidents and cancer drug administration errors in public hospitals; (2) collaboration with oncologists to select the most suitable cancer drug regimens for patients; (3) prevention of potential occupational risk to the healthcare professionals who handle cancer drugs; and (4) provision of optimal therapy treatment, monitoring and counseling to patients to reduce side effects and hospital readmission. The professional drug knowledge of OPs adds value to the multidisciplinary team in oncology clinics and the growth of OPs into effective direct patient care in oncology clinics should be encouraged to optimize medication-related outcomes.</p> Chu Man Hin, Chong Chung Hong ##submission.copyrightStatement## Mon, 15 Apr 2019 00:00:00 -0700 Impact of Co-creation Footwear Workshops on Older Women in Elderly Centers in Hong Kong <p><em><strong>Background:</strong></em> The use of appropriate footwear could reduce the risk of falls among the geriatric population. However, the elderly are generally reluctant to accept new footwear designs particularly with the incorporation of fabrication materials and functional design features that are perceived to be less comfortable. Co-creation activities that encourage user involvement during the product design process and development can therefore address this issue and provide unique benefits and better value for users, increase acceptance, and even lead to positive perception as well as positive psychological impacts, thereby increasing the practical use of newly designed footwear.</p> <p><em><strong>Objective:</strong> </em>This study aims to investigate the impact of hands-on footwear workshops on perceived functionality of geriatric footwear for older women.</p> <p><strong><em>Method:</em></strong> Footwear co-design workshops for older women were carried out in two elderly centers in Hong Kong. Twenty-one healthy females between 64 and 80 years old (mean: 71; SD: 4.2), were recruited. Subjects were invited to decorate the prescribed geriatric footwear prototype and discuss their ideas on footwear design in a group of three. They were surveyed after completing the footwear decoration.</p> <p><em><strong>Main outcome measures:</strong> </em>The perceptions of the subjects on the geriatric footwear and related design features were analysed.</p> <p><em><strong>Results:</strong> </em>The questionnaire survey shows positive results in the psychological value of the workshops for older women. The participants express high levels of satisfaction with the co-design process and a strong sense of achievement with the newly designed geriatric footwear. The acceptance and awareness of the functions of the footwear are greatly enhanced.</p> <p><em><strong>Conclusions:</strong></em> The co-design approach has positive psychological impacts on the elderly and their acceptance of the final product. This approach also better meets the aesthetic needs of the users.</p> Mei-ying Kwan, Kit-lun Yick, Yan-yan Wong ##submission.copyrightStatement## Mon, 15 Apr 2019 00:00:00 -0700 Thermal Equations for Predicting Foot Skin Temperatur <p><em><strong>Purpose:</strong></em> Studying the foot skin temperature of both the young and elderly is important for preventing foot diseases and improving thermal comfort and variability during gait. However, few studies have predicted the thermal conditions in footwear under different variables. The aim of this study is to therefore formulate thermal equations for both the young and elderly to predict their foot skin temperature under the variables of age, gender, activity level and various properties of different types of footwear.</p> <p><em><strong>Methodology:</strong></em> A total of 80 participants between 20 and 85 years old are recruited in this study, including 40 younger subjects (mean: 23.0; SD: 4.05) and 40 elderly subjects (mean: 69.8; SD: 4.59). They are tasked to sit, walk and run in a conditioning chamber.</p> <p><em><strong>Findings:</strong> </em>Regression equations for predicting the foot skin temperature of the young and elderly people are formulated, with R squares of 0.513 and 0.350 respectively. The level of activity is the most important factor when predicting the foot skin temperature. The material properties of the footwear also show a significant impact on the foot skin temperature of the elderly.</p> <p><em><strong>Value:</strong> </em>The findings of this study provide the basis for better thermal comfort and help to facilitate the footwear design process.</p> Pui-Ling Li, Kit-lun Yick, Joanne Yip, Sun-pui Ng ##submission.copyrightStatement## Mon, 15 Apr 2019 00:00:00 -0700 Promotion of Appropriate Use of Electronic Devices Among Hong Kong Adolescents <p>The advancement of technology is changing the world so rapidly with implication to people’s daily activities and health. The excessive utilisation of electronic devices, particularly among adolescents, are affecting the physical, psychological and social wellbeing of these young people. Physical inactivity, obesity, musculoskeletal conditions, vision, cognitive development, sleep pattern, family relationship, addiction and gaming are issues of importance and attention arising from the inappropriate use of electronic devices. Stakeholders, including the parents, teachers, government, community organisations and the adolescents themselves, have different but complementary roles in the prevention of internet addiction and in the promotion of appropriate use of electronic devices among adolescents.</p> Catherine K. Y Kwong, Ben Y.F Fong ##submission.copyrightStatement## Mon, 15 Apr 2019 00:00:00 -0700 Healthy Governance and Healthy Public Policy: Towards realistic health reform and empowered communities <p>The lead Editorial in this issue – a special issue, as it contains six articles presented at the College of Professional and Continuing Education (CPCE) of the Hong Kong Polytechnic University Health Conference of 2019 is provided by Professor Peter Yuen, Dean of that College and Professor, Department of Management and Marketing of the Hong Kong Polytechnic University......</p> David Briggs ##submission.copyrightStatement## Sun, 14 Apr 2019 00:00:00 -0700 Extrinsic Rewards, Occupational Commitment, Career Entrenchment and Career Satisfaction of Dentists <p>Information concerning occupational commitment and career satisfaction of dentists in India is incomplete. Satisfaction of dentists with their profession and commitment towards the profession are important determinants of the future of the dental profession. Therefore, the present study examined the relationship between extrinsic rewards and career entrenchment and occupational commitment of dentists. The study also measured the effect of career entrenchment and occupational commitment on career satisfaction of dentists. Data were collected from 85 dentists of two private dental hospitals of Udaipur city, India. Of the total respondents percent (n=48) 56 per cent were male and 44 per cent (n=37) were female. The age of the respondents ranged from 23 to 56 years. 54 per cent of the respondents were employed in their current jobs for less than 10 years and 46 were in the same job for more than 10 years. The data thus collected was analyzed with the help of SPSS 21 using descriptive (mean, standard deviation, percentiles) and inferential statistics (one way ANOVA, post hoc analysis, correlation and multiple regression). The study revealed significant relationship between extrinsic rewards and career entrenchment and affective commitment of dentists. Furthermore, career entrenchment and occupational commitment were found to be significant predictors of career satisfaction. The study puts forward some suggestion for future research in this area.</p> Sakshi Sharma ##submission.copyrightStatement## Mon, 15 Apr 2019 00:00:00 -0700 What Is the Professional Identity of Allied Health Managers? <p><em><strong>Objective</strong></em>: This paper explores the professional identity (PI) of Allied Health Managers (AHMs) and how their identity is typically constructed.</p> <p><em><strong>Methods:</strong></em> A qualitative research methodology utilising semi-structured interviews was employed for this research. Thematic analysis was used to extract relevant data from the transcripts.</p> <p><em><strong>Settings:</strong></em> The study was undertaken in five acute hospitals within one of the largest metropolitan Local Health Districts in New South Wales, Australia. A total of sixteen AHMs and deputy AHMs were interviewed.</p> <p><strong><em>Results:</em> </strong>Three key themes identified were: PI of AHM, motivation of becoming a manager, and construction of their identity. Factors motivating AHMs to follow a management pathway were identified as being a natural progression and having interest in high-level decision-making. Despite AHMs sharing similar role conflict as the medical managers, they adapted to hybrid manager roles with minimal resentment. They also adopted to the hybrid manager role with a positive, realistic and flexible perspective.</p> <p><em><strong>Conclusion:</strong></em> Despite facing role conflict as a hybrid-professional-manager, AHMs manage the transition from clinicians to managers with a positive approach. This indicates that AHMs may require certain skills or characteristics to successfully construct their PI.</p> Ka-Hi May Mak, Louise Kippist, Terry Sloan, Kathy Eljiz ##submission.copyrightStatement## Sun, 14 Apr 2019 00:00:00 -0700 Managers of Aged Care Residential Services: 2006-2016 <p><strong><em>Purpose</em> :</strong> Aged care Australia is going through a transformation reform to respond to the growing number of aged people in need of support in daily living. In this context, this article provides analyses of the number and characteristics of managers of aged care residential services in relation to number of aged people, residents of aged care facilities and people employed in them.&nbsp;</p> <p><strong><em>Methodology/Design:&nbsp;</em></strong>Design of the analyses follows specifications provided by the authors for tabulations prepared by the Australian Bureau of Statistics (ABS) from the censuses of population conducted by ABS in 2006 and 2016.&nbsp;</p> <p><em><strong>Analysis :</strong></em> Analysis of changes of the number of managers of aged care residential facilities against the number of aged people, residents of aged care facilities, and people employed in them. Further, the analyses examine changes in the age and sex of managers, their category, field and level of education, weekly income, hours worked, marital status, country of birth and indigenous status.&nbsp;</p> <p><strong><em>Findings:&nbsp;&nbsp;</em></strong>There was a large increase in the number of employees and managers per resident, and a stable ratio of managers per employees. While the proportion of female managers declined, the average age of managers increased slightly. Both the fields and level of education remained similar in the decade. The average income of managers was similar as that in all industries in 2016, with a larger increase during the decade than in all industries. Average hours worked remained about the same. The same applied to marital status. The proportion of Australia-born managers declined while that of managers born in Asia rose substantially. The proportion of indigenous managers about doubled during the decade.&nbsp;</p> <p><strong><em>Implications:&nbsp;</em></strong>Relevance to those concerned with the evolving transformation of aged care in Australia and those interested with management training of the growing number of managers of aged care residential services.&nbsp;</p> Jo M Martins, Godfrey Isouard ##submission.copyrightStatement## Mon, 15 Apr 2019 00:00:00 -0700 The Pursuit of Purposeful Partnerships-Making A Health Matrix Successful <p><em><strong>Objective:</strong></em> To analyse a matrix model of management to optimize the partnerships, collaboration and interaction between vertical management structures (services and geographical clusters) and horizontal clinical structures (Clinical Networks and Streams) in a large Local Health District [LHD] in New South Wales, Australia.</p> <p><em><strong>Approach:&nbsp;</strong></em>An ‘Action Research’ approach utilising a maturity tool, the Collaboration Rubric®, an evidence-based model for Network analysis. The rubric describes four types of collaboration and defines the three essential drivers that allow successful collaborations.</p> <p><em><strong>Outcomes</strong>:</em> Benchmarking comparisons indicate that this LHD is operating at a level well above base level for the three drivers that enable collaboration [capacity, authority and shared value]. The professional relationship between Clinical Networks/ Streams and Operational Managers, is the main barrier to improving collaboration. The Operational Managers have clear positional authority related to the organisational structure and are accountable to their Executive for good governance and financial management. Clinical leaders hold substantial influential power derived from their professional authority.</p> <p>The following actions have been identified to improve collaboration.</p> <ul> <li>Ensure all leaders actively “manage for collaboration“</li> <li>Executive fosters joint innovation projects characterised by collaborative practice between the Clinical Networks/Streams and Operational Managers.</li> <li>Ensure leadership accountabilities are held as close as possible to any projects (locally) involving reform or innovation</li> <li>Clinical Network/Streams’ operational plans are jointly agreed with local management and signed off by Executive</li> <li>LHD recruit leadership with skills in managing for collaboration</li> </ul> <p><strong><em>Conclusions:</em>&nbsp;</strong>This evaluation supports the use an Action Research approach using the Collaboration Rubric® as a useful tool to define not only the type of collaboration required but the key drivers that must be addressed to facilitate improved [horizontal and vertical] partnerships leading to better outcomes. This local health district will build improved collaboration utilising the insights gained from this analysis.</p> Phillip Lewis Way, Patricia M Davidson, Gail Winkworth, Michael White ##submission.copyrightStatement## Sun, 31 Mar 2019 00:00:00 -0700