Keith Stockman - Academia.edu (original) (raw)

Papers by Keith Stockman

Hospital readmissions are the consequence of an individual unstable health journeys in the contex... more Hospital readmissions are the consequence of an individual unstable health journeys in the context of their local health services and community configurations. The Patient Journey Record System (PaJR) has developed a conversational approach with care guides and clinician coaches who support such health journeys irrespective of condition and location.

Journal of Clinical Microbiology, 1992

The antimicrobial susceptibilities of 100 clinical isolates of Pseudomonas aeruginosa to gentamic... more The antimicrobial susceptibilities of 100 clinical isolates of Pseudomonas aeruginosa to gentamicin, amikacin, tobramycin, ticarcillin, piperacillin, and ceftazidime were determined by using the Sceptor system (BBL Microbiology Systems, Cockeysville, Md.), and the results were compared with those obtained using the National Committee for Clinical Laboratory Standards reference agar dilution method. Excellent correlation was observed for the aminoglycosides, with greater than 95% agreement within 1 doubling dilution of the reference agar dilution MIC, while ticarcillin and piperacillin showed lower percent agreement values of 91 and 88%, respectively.

Design Science and Innovation, 2020

Modern healthcare has delivered achievements that no one could have anticipated prior to World Wa... more Modern healthcare has delivered achievements that no one could have anticipated prior to World War II, largely driven by science in both discovery and application mode. Why then do so many now feel that modern healthcare is failing to deliver on the unwritten promise that as each year unfolds greater gains will be delivered than in the year before? Design and systems thinking offers an opportunity for healthcare workers to co-design new ways of organising and delivering services. First, however, healthcare workers will need to learn new technical skills and gain a greater appreciation of the sociotechnical construction of heath service delivery as well as receive instruction in new methods so that these new ways of being and organising service delivery can be brought into effect. This will have profound implications for existing service delivery models and organisations. This chapter outlines and illustrates some approaches that can and are being taken to train and educate the healthcare workforce to design and bring into being the healthcare organisations and systems for the future. It is not clear which clinicians and students are best suited to learn and apply the methods and mindsets of design and systems thinking, nor which settings and contexts are best suited to the application of these methods. Research on the teaching and learning experience will guide further developments in the teaching of design and systems thinking for healthcare professionals.

International Journal of Integrated Care, 2021

Post-hospital syndrome (PHS) is a state of increased vulnerability to ill-health in the 10 days p... more Post-hospital syndrome (PHS) is a state of increased vulnerability to ill-health in the 10 days post discharge, but what health states lead to admission? This study investigates health profiles/symptoms 10 days before and after acute medical admissions in Monash Watch (MW)-a hospital telehealth pilot to optimize avoidable hospitalizations in those with predicted risk of 3+ hospitalizations using hospital algorithms. Methods: Telecare guides conduct regular patient outbound phone calls. More alerts per call indicate greater risk. Total alerts represent general health, psychosocial and care issues. Red alerts represent medical symptoms and illness. Design: A cohort study of MW subgroup of 103 admitted patients (total sample 233). Data: Self-reported health profiles and alerts in 764 MW phone call records and acute (nonsurgical) admissions data over a 6 month period Analytics: Descriptive time series using homogeneity metrics with XLSTAT. Results: Fair to poor self-rated health was reported 10 days before until 5 days after admission. Moderate to severe pain and feeling depressed was reported from 10 days before to 10 days after admissions. Total alerts statistically increased 3 days before an acute admission and persisted for 10 days afterwards. Red alerts increased 1 day before admission and remained until 10 days after admission. Conclusion: A pre-hospital phase of Post-Hospital Syndrome may exist, with high levels of significant symptoms, poor health, low mood and pain before medical admission, as well as afterwards. This pre-hospital phase needs further investigation and may allow better admission planning or the use of alternative approaches.

International Journal of Integrated Care, 2021

International Journal of Integrated Care, 2021

Internal Medicine Journal, 2011

Modern healthcare has delivered achievements that no one could have anticipated prior to World Wa... more Modern healthcare has delivered achievements that no one could have anticipated prior to World War II, largely driven by science in both discovery and application mode. Why then do so many now feel that modern healthcare is failing to deliver on the unwritten promise that as each year unfolds greater gains will be delivered than in the year before? Design and systems thinking offers an opportunity for healthcare workers to co-design new ways of organising and delivering services. First, however, healthcare workers will need to learn new technical skills and gain a greater appreciation of the sociotechnical construction of heath service delivery as well as receive instruction in new methods so that these new ways of being and organising service delivery can be brought into effect. This will have profound implications for existing service delivery models and organisations. This chapter outlines and illustrates some approaches that can and are being taken to train and educate the healt...

Big data provide the hope of major health innovation and improvement. However, there is a risk of... more Big data provide the hope of major health innovation and improvement. However, there is a risk of precision medicine based on predictive biometrics and service metrics overwhelming anticipatory human centered sense-making, in the fuzzy emergence of personalized (big data) medicine. This is a pressing issue, given the paucity of individual sense-making data approaches. A human-centric model is described to address the gap in personal particulars and experiences in individual health journeys. The Patient Journey Record System (PaJR) was developed to improve human-centric healthcare by harnessing the power of person-centred data analytics using complexity theory, iterative health services and information systems applications over a 10 year period. PaJR is a web-based service supporting usually bi-weekly telephone calls by care guides to individuals at risk of readmissions.

Medical Journal of Australia

Journal of clinical …, 1992

Rationale, Aims, and Objectives HealthLinks: Chronic Care is a state‐wide public hospital initiat... more Rationale, Aims, and Objectives HealthLinks: Chronic Care is a state‐wide public hospital initiative designed to improve care for cohorts at‐risk of potentially preventable hospitalizations at no extra cost. MonashWatch (MW) is an hospital outreach service designed to optimize admissions in an at‐risk cohort. Telehealth operators make regular phone calls (≥weekly) using the Patient Journey Record System (PaJR). PaJR generates flags based on patient self‐report, alerting to a risk of admission or emergency department attendance. ‘Total flags’ of global health represent concerns about self‐reported general health, medication, and wellness. ‘Red flags’ represent significant disease/symptoms concerns, likely to lead to hospitalization. Methods A time series analysis of PaJR phone calls to MW patients with ≥1 acute non‐surgical admissions in a 20‐day time window (10 days pre‐admission and 10 days post‐discharge) between 23 December 2016 and 11 October 2017. Pettitt's hypothesis‐testi...

Applying complexity science to unstable health journeys.

Frontiers in Public Health, 2018

Purpose: Potentially preventable hospitalizations (PPH) are minimized when adults (usually with m... more Purpose: Potentially preventable hospitalizations (PPH) are minimized when adults (usually with multiple morbidities ± frailty) benefit from alternatives to emergency hospital use. A complex systems and anticipatory approach to PPH, the Patient Journey Record System (PaJR) is proposed. Application: PaJR is a web-based service supporting weekly telephone calls by trained Care Guides (CG) to individuals at risk of PPH. The Victorian HealthLinks Chronic Care algorithm provides case finding from hospital big data. Prediction algorithms on call data helps optimize emergency hospital use through adaptive and anticipatory care. Monash Watch deployment incorporating PaJR is conducted by Monash Health in its Dandenong urban catchment area, Victoria, Australia. Theory: A Complex Adaptive Systems (CAS) framework underpins PaJR, and recognizes unique individual journeys, their historical and current influences, and difficult-to-predict tipping points. Rosen’s modelling relationship and anticip...

Purpose: Potentially preventable hospitalizations (PPH) are minimized when adults (usually with m... more Purpose: Potentially preventable hospitalizations (PPH) are minimized when adults (usually with multiple morbidities ± frailty) benefit from alternatives to emergency hospital use. A complex systems and anticipatory journey approach to PPH, the Patient Journey Record System (PaJR) is proposed. Application: PaJR is a web-based service supporting ≥weekly telephone calls by trained lay Care Guides (CG) to individuals at risk of PPH. The Victorian HealthLinks Chronic Care algorithm provides case finding from hospital big data. Prediction algorithms on call data helps optimize emergency hospital use through adaptive and anticipatory care. MonashWatch deployment incorporating PaJR is conducted by Monash Health in its Dandenong urban catchment area, Victoria, Australia. Theory: A Complex Adaptive Systems (CAS) framework underpins PaJR, and recognizes unique individual journeys, their dependence on historical and biopsychosocial influences, and difficult to predict tipping points. Rosen's modeling relationship and anticipation theory additionally informed the CAS framework with data sense-making and care delivery. PaJR uses perceptions of current and future health (interoception) through ongoing conversations to anticipate possible tipping points. This allows for possible timely intervention in trajectories in the biopsychosocial dimensions of patients as "particulars" in their unique trajectories. Evaluation: Monash Watch is actively monitoring 272 of 376 intervention patients, with 195 controls over 22 months (ongoing). Trajectories of poor health (SRH) and anticipation of worse/uncertain health (AH), and CG concerns statistically shifted at a tipping point, 3 days before admission in the subset who experienced ≥1 acute admission. The −3 day point was generally consistent across age and gender. Three randomly selected case studies demonstrate the processes of anticipatory and reactive care. PaJR-supported services achieved higher than pre-set targets-consistent reduction in acute bed days (20-25%) vs. target 10% and high levels of patient satisfaction. Discussion: Anticipatory care is an emerging trajectory data analytic approach that uses human sense-making as its core metric demonstrates improvements in processes and outcomes. Multiple sources can provide big data to inform trajectory care, however Martin et al. Anticipation in Hospital Avoidance simple tailored data collections may prove effective if they embrace human interoception and anticipation. Admission risk may be addressed with a simple data collections including SRH, AH, and CG perceptions, where practical. Conclusion: Anticipatory care, as operationalized through PaJR approaches applied in MonashWatch, demonstrates processes and outcomes that successfully ameliorate PPH.

Hospital readmissions are the consequence of an individual unstable health journeys in the contex... more Hospital readmissions are the consequence of an individual unstable health journeys in the context of their local health services and community configurations. The Patient Journey Record System (PaJR) has developed a conversational approach with care guides and clinician coaches who support such health journeys irrespective of condition and location.

Journal of Clinical Microbiology, 1992

The antimicrobial susceptibilities of 100 clinical isolates of Pseudomonas aeruginosa to gentamic... more The antimicrobial susceptibilities of 100 clinical isolates of Pseudomonas aeruginosa to gentamicin, amikacin, tobramycin, ticarcillin, piperacillin, and ceftazidime were determined by using the Sceptor system (BBL Microbiology Systems, Cockeysville, Md.), and the results were compared with those obtained using the National Committee for Clinical Laboratory Standards reference agar dilution method. Excellent correlation was observed for the aminoglycosides, with greater than 95% agreement within 1 doubling dilution of the reference agar dilution MIC, while ticarcillin and piperacillin showed lower percent agreement values of 91 and 88%, respectively.

Design Science and Innovation, 2020

Modern healthcare has delivered achievements that no one could have anticipated prior to World Wa... more Modern healthcare has delivered achievements that no one could have anticipated prior to World War II, largely driven by science in both discovery and application mode. Why then do so many now feel that modern healthcare is failing to deliver on the unwritten promise that as each year unfolds greater gains will be delivered than in the year before? Design and systems thinking offers an opportunity for healthcare workers to co-design new ways of organising and delivering services. First, however, healthcare workers will need to learn new technical skills and gain a greater appreciation of the sociotechnical construction of heath service delivery as well as receive instruction in new methods so that these new ways of being and organising service delivery can be brought into effect. This will have profound implications for existing service delivery models and organisations. This chapter outlines and illustrates some approaches that can and are being taken to train and educate the healthcare workforce to design and bring into being the healthcare organisations and systems for the future. It is not clear which clinicians and students are best suited to learn and apply the methods and mindsets of design and systems thinking, nor which settings and contexts are best suited to the application of these methods. Research on the teaching and learning experience will guide further developments in the teaching of design and systems thinking for healthcare professionals.

International Journal of Integrated Care, 2021

Post-hospital syndrome (PHS) is a state of increased vulnerability to ill-health in the 10 days p... more Post-hospital syndrome (PHS) is a state of increased vulnerability to ill-health in the 10 days post discharge, but what health states lead to admission? This study investigates health profiles/symptoms 10 days before and after acute medical admissions in Monash Watch (MW)-a hospital telehealth pilot to optimize avoidable hospitalizations in those with predicted risk of 3+ hospitalizations using hospital algorithms. Methods: Telecare guides conduct regular patient outbound phone calls. More alerts per call indicate greater risk. Total alerts represent general health, psychosocial and care issues. Red alerts represent medical symptoms and illness. Design: A cohort study of MW subgroup of 103 admitted patients (total sample 233). Data: Self-reported health profiles and alerts in 764 MW phone call records and acute (nonsurgical) admissions data over a 6 month period Analytics: Descriptive time series using homogeneity metrics with XLSTAT. Results: Fair to poor self-rated health was reported 10 days before until 5 days after admission. Moderate to severe pain and feeling depressed was reported from 10 days before to 10 days after admissions. Total alerts statistically increased 3 days before an acute admission and persisted for 10 days afterwards. Red alerts increased 1 day before admission and remained until 10 days after admission. Conclusion: A pre-hospital phase of Post-Hospital Syndrome may exist, with high levels of significant symptoms, poor health, low mood and pain before medical admission, as well as afterwards. This pre-hospital phase needs further investigation and may allow better admission planning or the use of alternative approaches.

International Journal of Integrated Care, 2021

International Journal of Integrated Care, 2021

Internal Medicine Journal, 2011

Modern healthcare has delivered achievements that no one could have anticipated prior to World Wa... more Modern healthcare has delivered achievements that no one could have anticipated prior to World War II, largely driven by science in both discovery and application mode. Why then do so many now feel that modern healthcare is failing to deliver on the unwritten promise that as each year unfolds greater gains will be delivered than in the year before? Design and systems thinking offers an opportunity for healthcare workers to co-design new ways of organising and delivering services. First, however, healthcare workers will need to learn new technical skills and gain a greater appreciation of the sociotechnical construction of heath service delivery as well as receive instruction in new methods so that these new ways of being and organising service delivery can be brought into effect. This will have profound implications for existing service delivery models and organisations. This chapter outlines and illustrates some approaches that can and are being taken to train and educate the healt...

Big data provide the hope of major health innovation and improvement. However, there is a risk of... more Big data provide the hope of major health innovation and improvement. However, there is a risk of precision medicine based on predictive biometrics and service metrics overwhelming anticipatory human centered sense-making, in the fuzzy emergence of personalized (big data) medicine. This is a pressing issue, given the paucity of individual sense-making data approaches. A human-centric model is described to address the gap in personal particulars and experiences in individual health journeys. The Patient Journey Record System (PaJR) was developed to improve human-centric healthcare by harnessing the power of person-centred data analytics using complexity theory, iterative health services and information systems applications over a 10 year period. PaJR is a web-based service supporting usually bi-weekly telephone calls by care guides to individuals at risk of readmissions.

Medical Journal of Australia

Journal of clinical …, 1992

Rationale, Aims, and Objectives HealthLinks: Chronic Care is a state‐wide public hospital initiat... more Rationale, Aims, and Objectives HealthLinks: Chronic Care is a state‐wide public hospital initiative designed to improve care for cohorts at‐risk of potentially preventable hospitalizations at no extra cost. MonashWatch (MW) is an hospital outreach service designed to optimize admissions in an at‐risk cohort. Telehealth operators make regular phone calls (≥weekly) using the Patient Journey Record System (PaJR). PaJR generates flags based on patient self‐report, alerting to a risk of admission or emergency department attendance. ‘Total flags’ of global health represent concerns about self‐reported general health, medication, and wellness. ‘Red flags’ represent significant disease/symptoms concerns, likely to lead to hospitalization. Methods A time series analysis of PaJR phone calls to MW patients with ≥1 acute non‐surgical admissions in a 20‐day time window (10 days pre‐admission and 10 days post‐discharge) between 23 December 2016 and 11 October 2017. Pettitt's hypothesis‐testi...

Applying complexity science to unstable health journeys.

Frontiers in Public Health, 2018

Purpose: Potentially preventable hospitalizations (PPH) are minimized when adults (usually with m... more Purpose: Potentially preventable hospitalizations (PPH) are minimized when adults (usually with multiple morbidities ± frailty) benefit from alternatives to emergency hospital use. A complex systems and anticipatory approach to PPH, the Patient Journey Record System (PaJR) is proposed. Application: PaJR is a web-based service supporting weekly telephone calls by trained Care Guides (CG) to individuals at risk of PPH. The Victorian HealthLinks Chronic Care algorithm provides case finding from hospital big data. Prediction algorithms on call data helps optimize emergency hospital use through adaptive and anticipatory care. Monash Watch deployment incorporating PaJR is conducted by Monash Health in its Dandenong urban catchment area, Victoria, Australia. Theory: A Complex Adaptive Systems (CAS) framework underpins PaJR, and recognizes unique individual journeys, their historical and current influences, and difficult-to-predict tipping points. Rosen’s modelling relationship and anticip...

Purpose: Potentially preventable hospitalizations (PPH) are minimized when adults (usually with m... more Purpose: Potentially preventable hospitalizations (PPH) are minimized when adults (usually with multiple morbidities ± frailty) benefit from alternatives to emergency hospital use. A complex systems and anticipatory journey approach to PPH, the Patient Journey Record System (PaJR) is proposed. Application: PaJR is a web-based service supporting ≥weekly telephone calls by trained lay Care Guides (CG) to individuals at risk of PPH. The Victorian HealthLinks Chronic Care algorithm provides case finding from hospital big data. Prediction algorithms on call data helps optimize emergency hospital use through adaptive and anticipatory care. MonashWatch deployment incorporating PaJR is conducted by Monash Health in its Dandenong urban catchment area, Victoria, Australia. Theory: A Complex Adaptive Systems (CAS) framework underpins PaJR, and recognizes unique individual journeys, their dependence on historical and biopsychosocial influences, and difficult to predict tipping points. Rosen's modeling relationship and anticipation theory additionally informed the CAS framework with data sense-making and care delivery. PaJR uses perceptions of current and future health (interoception) through ongoing conversations to anticipate possible tipping points. This allows for possible timely intervention in trajectories in the biopsychosocial dimensions of patients as "particulars" in their unique trajectories. Evaluation: Monash Watch is actively monitoring 272 of 376 intervention patients, with 195 controls over 22 months (ongoing). Trajectories of poor health (SRH) and anticipation of worse/uncertain health (AH), and CG concerns statistically shifted at a tipping point, 3 days before admission in the subset who experienced ≥1 acute admission. The −3 day point was generally consistent across age and gender. Three randomly selected case studies demonstrate the processes of anticipatory and reactive care. PaJR-supported services achieved higher than pre-set targets-consistent reduction in acute bed days (20-25%) vs. target 10% and high levels of patient satisfaction. Discussion: Anticipatory care is an emerging trajectory data analytic approach that uses human sense-making as its core metric demonstrates improvements in processes and outcomes. Multiple sources can provide big data to inform trajectory care, however Martin et al. Anticipation in Hospital Avoidance simple tailored data collections may prove effective if they embrace human interoception and anticipation. Admission risk may be addressed with a simple data collections including SRH, AH, and CG perceptions, where practical. Conclusion: Anticipatory care, as operationalized through PaJR approaches applied in MonashWatch, demonstrates processes and outcomes that successfully ameliorate PPH.