Mary Westbrook | Macquarie University (original) (raw)

Papers by Mary Westbrook

The journal of occupational health and safety : Australia and New Zealand, 1992

Journal of applied rehabilitation counseling, Sep 1, 1993

A questionnaire survey of 665 members of the Arabic, Chinese, German, Greek, Italian and Anglo AU... more A questionnaire survey of 665 members of the Arabic, Chinese, German, Greek, Italian and Anglo AUstralian communities examined the typical reactions of men in their communities to the onset of physical disability. Reactions reported by the ethnic communities differed from those of the Anglo core society. In the latter there were greater expectations that men would express anger and cheerfulness, conceal their feelings, reject sympathy and help from others, be as independent as possible and quickly resume previous activities. In the Anglo and German communities men with disabilities were more likely to assume social roles such as employee, husband and father. The implications of the findings for the rehabilitation of members of ethnic minorities are discussed.

The journal of occupational health and safety : Australia and New Zealand, 1992

Restructuring is a prevalent managerial strategy, favoured by those who say they seek to create i... more Restructuring is a prevalent managerial strategy, favoured by those who say they seek to create improvements by merging organisations, streamlining organisational hierarchies or rationalising reporting arrangements (Brocklehurst 2001; Lathrop 1993; Relman 2005; Sen 2003). Proponents tend to argue that they will create through their restructuring efforts greater efficiency, i.e. more benefit for the same or less cost. Restructuring is typically sponsored by those in political or executive positions with capacities to enact such change and assume responsibility for leading efficient and effective services.

Culture and Climate in Health Care Organizations, 2010

Are culture and climate different aspects of organizations, or are they the same general construc... more Are culture and climate different aspects of organizations, or are they the same general construct? In one sense, there is an easy way to cut through the tangled thicket of this question. It depends on the definitions used to explain the concepts, and the perspectives taken in characterizing them. In this paper, we briefly trace the roots of the terms culture and climate, and discuss their manifestations and conceptualizations in contemporary theory and research. Although it is clear that much depends on how culture and climate are defined, we emphasize the commonalities and explore the links between them. We introduce some evidence drawn from an Australian study of 22 randomly sampled, stratified health care organizations. This was part of a large-scale national research project into health sector organizational behaviour. The findings provide a gate-way into understanding contrasting and converging views of culture and climate, particularly in terms of statistical relationships between the two concepts. The implications of this for research, practice, and teaching are discussed.

Journal of Applied Rehabilitation Counseling, 1995

A questionnaire survey of 665 members of the Chinese, Italian, German, Greek, Arabic aild Anglo A... more A questionnaire survey of 665 members of the Chinese, Italian, German, Greek, Arabic aild Anglo Australian communities investigated community expectations for women with physical disabilities. Germans' attitudes resembled those of the Anglo mainstream culture but other communities differed significantly in the following ways: women with disabilities were described as less likely to work, marry, have children, be socially active or live indepeildently. Most communities expected them to experience greater shame, be more withdrawn, less cheerful and less optimistic than did Anglo Australians. There was less expectation that such women would discuss their disabilities, act autonomously or strive for indepeildence.

Community Health Studies, 1982

Australian Journal of Social Issues, 1987

To examine whether recent social changes were associated with changes in women's self percept... more To examine whether recent social changes were associated with changes in women's self perceptions, the ambitions and self‐concepts of incoming female students in three health professions were surveyed in 1976 and 1986. In 1986 students were more ambitious to achieve professional recognition and leadership, more committed to their careers (even when their children were young), wanted fewer children, attached more importance to enjoying life and less to doing good in society, and had more egalitarian attitudes toward women's roles in society. In 1986, students described their self‐concepts in more masculine, androgynous and socially desirable terms. Greater career commitment was associated with higher levels of egalitarianism, masculinity and androgyny.

BMC Research Notes, Oct 9, 2011

Background: Service accreditation is a structured process of recognising and promoting performanc... more 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 standards through research and expert views. They then apply standards, criteria and performance indicators, testing their effects, and monitoring compliance with them. The accreditation process has been widely adopted. The international investments in accreditation are considerable. However, reliable evidence of its efficiency or effectiveness in achieving organizational improvements is sparse and the value of accreditation in cost-benefit terms has yet to be demonstrated. Although some evidence suggests that accreditation promotes the improvement and standardization of care, there have been calls to strengthen its research base. In response, the ACCREDIT (Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork) project has been established to evaluate the effectiveness of Australian accreditation in achieving its goals. ACCREDIT is a partnership of key researchers, policymakers and agencies. Findings: We present the framework for our studies in accreditation. Four specific aims of the ACCREDIT project, which will direct our findings, are to: (i) evaluate current accreditation processes; (ii) analyse the costs and benefits of accreditation; (iii) improve future accreditation via evidence; and (iv) develop and apply new standards of consumer involvement in accreditation. These will be addressed through 12 interrelated studies designed to examine specific issues identified as a high priority. Novel techniques, a mix of qualitative and quantitative methods, and randomized designs relevant for health-care research have been developed. These methods allow us to circumvent the fragmented and incommensurate findings that can be generated in small-scale, project-based studies. The overall approach for our research is a multi-level, multi-study design. Discussion: The ACCREDIT project will examine the utility, reliability, relevance and cost effectiveness of differing forms of accreditation, focused on general practice, aged care and acute care settings in Australia. Empirically, there are potential research gains to be made by understanding accreditation and extending existing knowledge; theoretically, this design will facilitate a systems view of accreditation of benefit to the partnership, international research communities, and future accreditation designers. "Accreditation of health-care organisations is a multimillion dollar industry which shapes care in many countries. Recent reviews of research show little evidence that accreditation increases safety or improves quality. It's time we knew about

Sydney: Centre for Clinical Governance Research, University of New South Wales, 2005

Background: A four-year action research study was conducted across the Australian Capital Territo... more Background: A four-year action research study was conducted across the Australian Capital Territory health system to strengthen interprofessional collaboration (IPC) though multiple intervention activities. Methods: We developed 272 substantial IPC intervention activities involving 2,407 face-to-face encounters with health system personnel. Staff attitudes toward IPC were surveyed yearly using Heinemann et al’s Attitudes toward Health Care Teams and Parsell and Bligh’s Readiness for Interprofessional Learning scales (RIPLS). At study’s end staff assessed whether project goals were achieved. Results: Of the improvement projects, 76 exhibited progress, and 57 made considerable gains in IPC. Educational workshops and feedback sessions were well received and stimulated interprofessional activities. Over time staff scores on Heinemann’s Quality of Interprofessional Care subscale did not change significantly and scores on the Doctor Centrality subscale increased, contrary to predictions. ...

Clinical Governance: An International Journal, 2004

Aims to discover the work hospital clinician managers think they do and observe them in practice.... more Aims to discover the work hospital clinician managers think they do and observe them in practice. A total of 14 managerial interests and concerns were identified in focus group discussions. Clinician managers’ jobs are pressurised, and are more about negotiation and persuasion than command and control. Their work is of considerable complexity, pace and responsibility and it is predicated more on managing inputs (e.g. money and people) than care processes, systems, outputs and outcomes. Thus the capacity of clinicians in these roles to respond to reforms such as those envisaged in the Bristol Inquiry may be problematic. Qualitative studies are re‐affirmed as important in providing grounded insights into not only clinical activities, but also organisational behaviour and processes.

American Journal of Community Psychology, 1979

The socioeconomic status of 200 women, who were completing a childbearing year, was found to be s... more The socioeconomic status of 200 women, who were completing a childbearing year, was found to be significantly associated with their attitudes, affective arousal and coping strategies. Differences in attitude existed toward 11 of 18 aspects of childbearing, working-class women holding more positive attitudes with the exception of their negative attitudes concerning physical problems and labor. Affective arousal, as measured by the application of 12 content analysis scales to the women's recollections, was greatest among working-class women who experienced more mutation, guilt, and total anxiety. This was associated with their tendency to avoid confrontation and be fatalistic in dealing with problems. They were less likely to exhibit instrumental coping by attending prenatal classes, seeking information, or planning. Interactions of socioeconomic status, type of problem, and coping strategy chosen occurred, as did some variations in the reactions of middle- and upper middle-class women.

International Journal for Health Care Quality Assurance, 2007

International Journal for Quality in Health Care, 2012

Objective. To compare four health professions' attitudes towards interprofessional collaboration ... more Objective. To compare four health professions' attitudes towards interprofessional collaboration (IPC) and their evaluations of a programme aimed at enhancing IPC across a health system. Design. Questionnaire survey. Setting. Australian Capital Territory health services. Participants. Sample of medical (38), nursing (198), allied health (152) and administrative (30) staff. Intervention(s). A 4-year action research project to improve IPC. Main Outcome Measure(s). Questionnaire evaluating the project and responses to the 'Attitudes toward Health Care Teams' and 'Readiness for Interprofessional Learning' scales. Results. Significant professional differences occurred in 90% of the evaluation items. Doctors were the least and administrative staff most likely to agree project aims had been met. Nurses made more favourable assessments than did allied health staff. Doctors made the most negative assessments and allied health staff the most neutral ratings. Improved interprofessional sharing of knowledge, teamwork and patient care were among the goals held to have been most achieved. Reduction in interprofessional rivalry and improved trust and communication were least achieved. Average assessment of individual goals being met was agree (31.9%), neutral (56.9%) and disagree (11.2%). On the two attitude scales, allied health professionals were most supportive of IPC, followed by nurses, administrators and doctors. Conclusions. Although overall attitudes towards IPC were favourable, only a third of participants reported that project goals had been achieved indicating the difficulties of implementing systems change. The response profiles of the professions differed. As in the previous research, doctors were least likely to hold favourable attitudes towards or endorse benefits from social or structural interventions in health care.

Centre for Clinical Governance Research, Sydney, 2006

Abstract: This report presents the findings of multiple studies conducted to evaluate the Inciden... more Abstract: This report presents the findings of multiple studies conducted to evaluate the Incident Information Management System (IIMS) for NSW Health. IIMS was introduced by NSW Health to act as a core mechanism for safety and quality improvement in Area Health ...

Centre for Clinical Governance Research, Sydney, 2006

Abstract: This report presents the findings of multiple studies conducted to evaluate the Inciden... more Abstract: This report presents the findings of multiple studies conducted to evaluate the Incident Information Management System (IIMS) for NSW Health. IIMS was introduced by NSW Health to act as a core mechanism for safety and quality improvement in Area Health ...

Social science & medicine (1982), 2006

In this paper, we discuss how a technique borrowed from defense and manufacturing is being deploy... more In this paper, we discuss how a technique borrowed from defense and manufacturing is being deployed in hospitals across the industrialized world to investigate clinical errors. We open with a discussion of the levers used by policy makers to mandate that clinicians not just report errors, but also gather to investigate those errors using root cause analysis (RCA). We focus on the tensions created for clinicians as they are expected to formulate 'systems solutions' that go beyond blame. In addressing these matters, we present a discourse analysis of data derived during an evaluation of the NSW Health Safety Improvement Program. Data include transcripts of RCA meetings which were recorded in a local metropolitan teaching hospital. From this analysis we move back to the argument that RCA involves clinicians in 'immaterial labour', or the production of communication and information, and that this new labour realizes two important developments. First, because RCA is ancho...

Strengthening organizational performance through accreditation research-a framework for twelve in... more Strengthening organizational performance through accreditation research-a framework for twelve interrelated studies: the ACCREDIT project study protocol

Journal of Applied Rehabilitation Counseling

The responses of 88 chronically ill patients to an open-ended question about their current experi... more The responses of 88 chronically ill patients to an open-ended question about their current experiences were content analysed to yield a set of measures assessing their psychological reactions to their illness. Uncertainty, anxiety, depression, anger expressed directly and indirectly, feelings of helplessness and competence, sociability and positive feelings were assessed by this means. Patients were interviewed during hospitalization and seven months later in the community. On both occasions they rated their handicaps in the areas of mobility, leisure activities, self-care and social relationships. These ratings were combined to provide four measures of rehabilitation. The findings indicate that psychological reactions to chronic illness predict rehabilitation. Improvement in mobility and relationships is perceived by patients who, during earlier hospitalization, experience anxiety and depression, express their anger directly rather than indirectly, and believe social supports to be...

The journal of occupational health and safety : Australia and New Zealand, 1992

Journal of applied rehabilitation counseling, Sep 1, 1993

A questionnaire survey of 665 members of the Arabic, Chinese, German, Greek, Italian and Anglo AU... more A questionnaire survey of 665 members of the Arabic, Chinese, German, Greek, Italian and Anglo AUstralian communities examined the typical reactions of men in their communities to the onset of physical disability. Reactions reported by the ethnic communities differed from those of the Anglo core society. In the latter there were greater expectations that men would express anger and cheerfulness, conceal their feelings, reject sympathy and help from others, be as independent as possible and quickly resume previous activities. In the Anglo and German communities men with disabilities were more likely to assume social roles such as employee, husband and father. The implications of the findings for the rehabilitation of members of ethnic minorities are discussed.

The journal of occupational health and safety : Australia and New Zealand, 1992

Restructuring is a prevalent managerial strategy, favoured by those who say they seek to create i... more Restructuring is a prevalent managerial strategy, favoured by those who say they seek to create improvements by merging organisations, streamlining organisational hierarchies or rationalising reporting arrangements (Brocklehurst 2001; Lathrop 1993; Relman 2005; Sen 2003). Proponents tend to argue that they will create through their restructuring efforts greater efficiency, i.e. more benefit for the same or less cost. Restructuring is typically sponsored by those in political or executive positions with capacities to enact such change and assume responsibility for leading efficient and effective services.

Culture and Climate in Health Care Organizations, 2010

Are culture and climate different aspects of organizations, or are they the same general construc... more Are culture and climate different aspects of organizations, or are they the same general construct? In one sense, there is an easy way to cut through the tangled thicket of this question. It depends on the definitions used to explain the concepts, and the perspectives taken in characterizing them. In this paper, we briefly trace the roots of the terms culture and climate, and discuss their manifestations and conceptualizations in contemporary theory and research. Although it is clear that much depends on how culture and climate are defined, we emphasize the commonalities and explore the links between them. We introduce some evidence drawn from an Australian study of 22 randomly sampled, stratified health care organizations. This was part of a large-scale national research project into health sector organizational behaviour. The findings provide a gate-way into understanding contrasting and converging views of culture and climate, particularly in terms of statistical relationships between the two concepts. The implications of this for research, practice, and teaching are discussed.

Journal of Applied Rehabilitation Counseling, 1995

A questionnaire survey of 665 members of the Chinese, Italian, German, Greek, Arabic aild Anglo A... more A questionnaire survey of 665 members of the Chinese, Italian, German, Greek, Arabic aild Anglo Australian communities investigated community expectations for women with physical disabilities. Germans' attitudes resembled those of the Anglo mainstream culture but other communities differed significantly in the following ways: women with disabilities were described as less likely to work, marry, have children, be socially active or live indepeildently. Most communities expected them to experience greater shame, be more withdrawn, less cheerful and less optimistic than did Anglo Australians. There was less expectation that such women would discuss their disabilities, act autonomously or strive for indepeildence.

Community Health Studies, 1982

Australian Journal of Social Issues, 1987

To examine whether recent social changes were associated with changes in women's self percept... more To examine whether recent social changes were associated with changes in women's self perceptions, the ambitions and self‐concepts of incoming female students in three health professions were surveyed in 1976 and 1986. In 1986 students were more ambitious to achieve professional recognition and leadership, more committed to their careers (even when their children were young), wanted fewer children, attached more importance to enjoying life and less to doing good in society, and had more egalitarian attitudes toward women's roles in society. In 1986, students described their self‐concepts in more masculine, androgynous and socially desirable terms. Greater career commitment was associated with higher levels of egalitarianism, masculinity and androgyny.

BMC Research Notes, Oct 9, 2011

Background: Service accreditation is a structured process of recognising and promoting performanc... more 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 standards through research and expert views. They then apply standards, criteria and performance indicators, testing their effects, and monitoring compliance with them. The accreditation process has been widely adopted. The international investments in accreditation are considerable. However, reliable evidence of its efficiency or effectiveness in achieving organizational improvements is sparse and the value of accreditation in cost-benefit terms has yet to be demonstrated. Although some evidence suggests that accreditation promotes the improvement and standardization of care, there have been calls to strengthen its research base. In response, the ACCREDIT (Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork) project has been established to evaluate the effectiveness of Australian accreditation in achieving its goals. ACCREDIT is a partnership of key researchers, policymakers and agencies. Findings: We present the framework for our studies in accreditation. Four specific aims of the ACCREDIT project, which will direct our findings, are to: (i) evaluate current accreditation processes; (ii) analyse the costs and benefits of accreditation; (iii) improve future accreditation via evidence; and (iv) develop and apply new standards of consumer involvement in accreditation. These will be addressed through 12 interrelated studies designed to examine specific issues identified as a high priority. Novel techniques, a mix of qualitative and quantitative methods, and randomized designs relevant for health-care research have been developed. These methods allow us to circumvent the fragmented and incommensurate findings that can be generated in small-scale, project-based studies. The overall approach for our research is a multi-level, multi-study design. Discussion: The ACCREDIT project will examine the utility, reliability, relevance and cost effectiveness of differing forms of accreditation, focused on general practice, aged care and acute care settings in Australia. Empirically, there are potential research gains to be made by understanding accreditation and extending existing knowledge; theoretically, this design will facilitate a systems view of accreditation of benefit to the partnership, international research communities, and future accreditation designers. "Accreditation of health-care organisations is a multimillion dollar industry which shapes care in many countries. Recent reviews of research show little evidence that accreditation increases safety or improves quality. It's time we knew about

Sydney: Centre for Clinical Governance Research, University of New South Wales, 2005

Background: A four-year action research study was conducted across the Australian Capital Territo... more Background: A four-year action research study was conducted across the Australian Capital Territory health system to strengthen interprofessional collaboration (IPC) though multiple intervention activities. Methods: We developed 272 substantial IPC intervention activities involving 2,407 face-to-face encounters with health system personnel. Staff attitudes toward IPC were surveyed yearly using Heinemann et al’s Attitudes toward Health Care Teams and Parsell and Bligh’s Readiness for Interprofessional Learning scales (RIPLS). At study’s end staff assessed whether project goals were achieved. Results: Of the improvement projects, 76 exhibited progress, and 57 made considerable gains in IPC. Educational workshops and feedback sessions were well received and stimulated interprofessional activities. Over time staff scores on Heinemann’s Quality of Interprofessional Care subscale did not change significantly and scores on the Doctor Centrality subscale increased, contrary to predictions. ...

Clinical Governance: An International Journal, 2004

Aims to discover the work hospital clinician managers think they do and observe them in practice.... more Aims to discover the work hospital clinician managers think they do and observe them in practice. A total of 14 managerial interests and concerns were identified in focus group discussions. Clinician managers’ jobs are pressurised, and are more about negotiation and persuasion than command and control. Their work is of considerable complexity, pace and responsibility and it is predicated more on managing inputs (e.g. money and people) than care processes, systems, outputs and outcomes. Thus the capacity of clinicians in these roles to respond to reforms such as those envisaged in the Bristol Inquiry may be problematic. Qualitative studies are re‐affirmed as important in providing grounded insights into not only clinical activities, but also organisational behaviour and processes.

American Journal of Community Psychology, 1979

The socioeconomic status of 200 women, who were completing a childbearing year, was found to be s... more The socioeconomic status of 200 women, who were completing a childbearing year, was found to be significantly associated with their attitudes, affective arousal and coping strategies. Differences in attitude existed toward 11 of 18 aspects of childbearing, working-class women holding more positive attitudes with the exception of their negative attitudes concerning physical problems and labor. Affective arousal, as measured by the application of 12 content analysis scales to the women's recollections, was greatest among working-class women who experienced more mutation, guilt, and total anxiety. This was associated with their tendency to avoid confrontation and be fatalistic in dealing with problems. They were less likely to exhibit instrumental coping by attending prenatal classes, seeking information, or planning. Interactions of socioeconomic status, type of problem, and coping strategy chosen occurred, as did some variations in the reactions of middle- and upper middle-class women.

International Journal for Health Care Quality Assurance, 2007

International Journal for Quality in Health Care, 2012

Objective. To compare four health professions' attitudes towards interprofessional collaboration ... more Objective. To compare four health professions' attitudes towards interprofessional collaboration (IPC) and their evaluations of a programme aimed at enhancing IPC across a health system. Design. Questionnaire survey. Setting. Australian Capital Territory health services. Participants. Sample of medical (38), nursing (198), allied health (152) and administrative (30) staff. Intervention(s). A 4-year action research project to improve IPC. Main Outcome Measure(s). Questionnaire evaluating the project and responses to the 'Attitudes toward Health Care Teams' and 'Readiness for Interprofessional Learning' scales. Results. Significant professional differences occurred in 90% of the evaluation items. Doctors were the least and administrative staff most likely to agree project aims had been met. Nurses made more favourable assessments than did allied health staff. Doctors made the most negative assessments and allied health staff the most neutral ratings. Improved interprofessional sharing of knowledge, teamwork and patient care were among the goals held to have been most achieved. Reduction in interprofessional rivalry and improved trust and communication were least achieved. Average assessment of individual goals being met was agree (31.9%), neutral (56.9%) and disagree (11.2%). On the two attitude scales, allied health professionals were most supportive of IPC, followed by nurses, administrators and doctors. Conclusions. Although overall attitudes towards IPC were favourable, only a third of participants reported that project goals had been achieved indicating the difficulties of implementing systems change. The response profiles of the professions differed. As in the previous research, doctors were least likely to hold favourable attitudes towards or endorse benefits from social or structural interventions in health care.

Centre for Clinical Governance Research, Sydney, 2006

Abstract: This report presents the findings of multiple studies conducted to evaluate the Inciden... more Abstract: This report presents the findings of multiple studies conducted to evaluate the Incident Information Management System (IIMS) for NSW Health. IIMS was introduced by NSW Health to act as a core mechanism for safety and quality improvement in Area Health ...

Centre for Clinical Governance Research, Sydney, 2006

Abstract: This report presents the findings of multiple studies conducted to evaluate the Inciden... more Abstract: This report presents the findings of multiple studies conducted to evaluate the Incident Information Management System (IIMS) for NSW Health. IIMS was introduced by NSW Health to act as a core mechanism for safety and quality improvement in Area Health ...

Social science & medicine (1982), 2006

In this paper, we discuss how a technique borrowed from defense and manufacturing is being deploy... more In this paper, we discuss how a technique borrowed from defense and manufacturing is being deployed in hospitals across the industrialized world to investigate clinical errors. We open with a discussion of the levers used by policy makers to mandate that clinicians not just report errors, but also gather to investigate those errors using root cause analysis (RCA). We focus on the tensions created for clinicians as they are expected to formulate 'systems solutions' that go beyond blame. In addressing these matters, we present a discourse analysis of data derived during an evaluation of the NSW Health Safety Improvement Program. Data include transcripts of RCA meetings which were recorded in a local metropolitan teaching hospital. From this analysis we move back to the argument that RCA involves clinicians in 'immaterial labour', or the production of communication and information, and that this new labour realizes two important developments. First, because RCA is ancho...

Strengthening organizational performance through accreditation research-a framework for twelve in... more Strengthening organizational performance through accreditation research-a framework for twelve interrelated studies: the ACCREDIT project study protocol

Journal of Applied Rehabilitation Counseling

The responses of 88 chronically ill patients to an open-ended question about their current experi... more The responses of 88 chronically ill patients to an open-ended question about their current experiences were content analysed to yield a set of measures assessing their psychological reactions to their illness. Uncertainty, anxiety, depression, anger expressed directly and indirectly, feelings of helplessness and competence, sociability and positive feelings were assessed by this means. Patients were interviewed during hospitalization and seven months later in the community. On both occasions they rated their handicaps in the areas of mobility, leisure activities, self-care and social relationships. These ratings were combined to provide four measures of rehabilitation. The findings indicate that psychological reactions to chronic illness predict rehabilitation. Improvement in mobility and relationships is perceived by patients who, during earlier hospitalization, experience anxiety and depression, express their anger directly rather than indirectly, and believe social supports to be...