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Economic policy discussions emphasise growth, the maximisation of output, efficiency and the pursuit of rational self‐interest. Many policymakers, bureaucrats and managers in health care have been influenced by economists who believe that competition and the marketplace will provide maximum output and efficiency. Thus, for some, health care involves treating more and more patients for the same money. They argue for strategies such as reducing waste, lowering costs, increasing inpatient throughput and introducing competition between providers, especially hospitals, in order to stimulate productivity to achieve their aim. Yet in health care more is not necessarily good. Embracing the culture of the marketplace in a predominantly publicly funded system runs the risk of failing to distribute health care services equitably, and leads to more inappropriate and unnecessary care. An approach that merely strives to treat more patients and lower costs should be rejected in favour of a health system that values effectiveness, health outcomes, quality and the public good, and is patient‐centred not delivery system‐centred.

Abstract: President Clinton's proposals to reform health‐care in the United States have stimulated unprecedented levels of discussion amongst stakeholders, commentators, policy analysts and the media. It seems obvious that there is a need to reform a system that consumes 14% of gross domestic product, yields only OECD‐average morbidity and mortality rates and fails to provide coverage to millions of people. Nevertheless, forces against change are marshalling considerable resources in opposition to Clinton's proposals, and now that the November 1994 mid‐term elections have routed the democrats in both the House of Representatives and the Senate, the belief is that his reforms will never be adopted in their original format. Some of the issues and ideas emanating from the American debate parallel trends in Australian health‐care. Elements in transition include the switch from an input‐to an outcomes‐orientation, improving the quality of care, focusing on the customer and securing greater value‐for‐money. Unlike America, Australia has a limit on national health‐care spending and this poses different challenges. However, the American debate is of vital interest to Australia. Australian and American hospitals are increasingly in competition to export services to South‐East Asia. Of particular importance to Australia are: the extremely public nature of the American debate, which should be emulated, the fact that explicit rationing is now clearly on the international health‐care agenda, the need to reconceptualise western culture's preoccupation with immortality, the need to alter economic incentives to health‐care providers and the shift to outcomes measurement and effectiveness. Despite the comparatively healthy state of the Australian system, complacency should not be allowed to set in. Lessons for Australia from America are numerous, and it behoves us to monitor closely developments, trends and options arising from the Clinton‐inspired debate.

Abstract: Several commentators have noted the accelerating turbulence occurring in health care at the present time. Indisputably, hospitals in Australia are going through a significant period of transition. It is argued in this paper that the magnitude of these changes will result in those organisations that we call hospitals in the future only barely resembling their counterparts in the recent past. A description of the movement to reform health care policy provides the backdrop to this discussion. This discussion of public policy initiatives broadly informs the debate and allows the major thesis of the paper to be explicated: that there is a health service management revolution occurring and it is taking place principally at the hospital level. Evidence for this view can be discerned from an analysis of four areas — organisational structure, the quality movement, changes in the management of hospitals and patients, and alterations in the way hospitals are financed. Thus, the very process of the transformation as it unfolds can be glimpsed. This paper discusses the evidence in an attempt to explain the crucial factors underpinning the revolution.

Part 1. Ideas -- Chapter 1. Introduction: Why this book? / Frances Rapport and Jeffrey Braithwaite -- Chapter 2. Qualitative Evidence Synthesis and Conceptual Development / Nicky Britten -- Chapter 3. The Life-Project of Personal Wellbeing: Modern healthcare and the individuality of health / Nigel Rapport -- Chapter 4. Socio-Narratology and the Clinical Encounter Between Human Beings / Arthur W Frank -- Chapter 5. Interrupted Body Projects and the Narrative Reconstruction of Self / Andrew C Sparkes -- Chapter 6. The Fourth Research Paradigm: Activating researchers for real world need / Frances Rapport and Jeffrey Braithwaite -- Part 2. Systems -- Chapter 7. Slack Resources in Healthcare Systems: Waste or resilience? / Tarcisio Abreu Saurin and Dayane MC Ferreira -- Chapter 8. Using Qualitative Methods to Understand Resilience in Complex Systems / Zeyad Mahmoud, Kate Churruca, Louise A Ellis, Robyn Clay-Williams and Jeffrey Braithwaite -- Chapter 9. Qualitative Assessment to Improve Everyday Activities: Work-as-imagined and work-as-done / Robyn Clay-Williams, Elizabeth Austin, Jeffrey Braithwaite and Erik Hollnagel -- Chapter 10. Narrativizing Cancer Patients' Longitudinal Experiences of Care: Qualitative inquiry into lived and online melanoma stories / Klay Lamprell, Frances Rapport and Jeffrey Braithwaite -- Chapter 11. Look the Other Way: Patient-centred care begins with care for our physicians / Klay Lamprell, Frances Rapport and Jeffrey Braithwaite -- Chapter 12. Resilient Healthcare in Refractory Epilepsy: Illuminating successful people-centred care / Patti Shih, Frances Rapport, Janet C Long, Emilie Francis-Auton, Mia Bierbaum, Mona Faris and Robyn Clay-Williams -- Part 3. Solutions -- Chapter 13. Sensemaking as a Strategy for Managing Uncertainty: Change and surprise in hospital settings / Holly J Lanham, Jacqueline A Pugh, David C Aron and Luci K Leykum -- Chapter 14. Simulation to Solve Health System Problems / Mary D Patterson and Ellen S Deutsch -- Chapter 15. Cross-Boundary Teaming to Establish Resilience Among Isolated 'Silos' / Kyota Nakamura, Shin Nakajima, Takeru Abe and Kazue Nakajima -- Chapter 16. "What on Earth Is Going on and What Should I Do Now?" Sensemaking as a qualitative process / Kate Churruca, Louise A Ellis, Janet C Long and Jeffrey Braithwaite -- Chapter 17. Deep Inside the Genomics Revolution: On the frontlines of care -- Stephanie Best, Janet C Long, Elise McPherson, Natalie Taylor and Jeffrey Braithwaite -- Information Classification: General -- Chapter 18. Much More Than Old Wine in New Bottles: Soft Systems Methodology (SSM) for healthcare improvement / Hanna Augustsson, Kate Churruca and Jeffrey Braithwaite -- Chapter 19. Conclusion: On progress, directions and signposts to a transformed healthcare system / Jeffrey Braithwaite and Frances Rapport.

Much that is written on product costing is prescriptive. Such literature suggests normative ways to accomplish the tasks of identifying, classifying, determining and using product costs. Some critics might argue that this is managerialist, top — down thinking which should be rejected. Others might suggest that normative, prescriptive approaches ignore complex social factors such as the exercise of power and influence, or that the outputs of health, welfare and education are not products at all and are not therefore amenable to a product costing process. We explore some aspects of this debate through the analysis of a case study of the Tasmanian health sector in which a product costing process was conducted in three hospitals. We conclude that a number of benefits to identified stakeholders — in this case bureaucrats, hospital managers and clinical staff — can emerge from a product costing process. We briefly locate the discussion in the context of some characteristics of organisational learning.

Health Policy: Development, Implementation and Evaluation in Australia. By Heather GARDNER (ed.) The Price of Health: Australian Governments and Medical Politics 1910–1960. By James A Gillespie Federalism and Health Policy: The Development of Health Systems in Canada and Australia. By Gwendolyn Gray The President's Health Security Plan. By White House Domestic Council Hospitals in Transition: The Resource Management Experiment. By Tim Packwood, Justin Keen and Martin Buxton

"This book promotes an understanding and a greater level of resilient health care. The book provides an awareness to health care workers of the purposeful muddling that so evocatively describes their work, so that they are more informed, and become better able to function and operate in the multitude of complex ecosystems we call "healthcare". This book argues the case for the importance of recognising and understanding muddling behaviours, practices and activities in order to create resilient care. The book demonstrates how resilient health care principles can enable those on the frontlines to work more effectively towards interdisciplinary care by gaining a deeper understanding of real-world practices that manifest in everyday clinical settings. This is done by presenting a set of case studies, theoretical chapters, and applications that relate experiences, bring forth ideas, and illustrate practical solutions. Primarily aimed at people who are directly involved in the running and improvement of health care systems, providing them with practical guidance. It is also direct interest to health care professionals in clinical and managerial positions as well as researchers"--

Part I: Openings. Introduction: The Journey to Here and What Happens Next. Bon Voyage: Navigating the Boundaries of Resilient Health Care. Part II: Negotiating Across Boundaries. Working Across Boundaries: Creating Value and Producing Safety in Health Care Using Empathetic Negotiation Skills. Untangling Conflict in Health Care. Part III: Theorising About Boundaries. 'Practical' Resilience: Misapplication of Theory?. Creating Resilience in Health Care Organisations through Various Forms of Shared Leadership. Simulation: A Tool to Detect and Traverse Boundaries. Part IV: Empiricising Boundaries. Looking Back Over the Boundaries of our Systems and Knowledge. Understanding Medication Dispensing as Done in Real World Settings -- Combining Conceptual Models and an Empirical Approach. Resilient Frontline Management of the Operating Room Floor: The Role of Boundaries and Coordination. Patient Flow Management: Codified and Opportunistic Escalation Actions. Trust and Psychological Safety as Facilitators of Resilient Health Care. Collaborative Use of Slack Resources as a Support to Resilience: Study of a Maternity Ward. Resilient Performance in Acute Health Care: Implementation of an Intervention Across Care Boundaries. Part V: Closure. Discussion, Integration and Concluding Remarks

Coming of age -- The need of a guide to deliver resilient health care -- Procuring evidence for resilient health care -- Resilience engineering for quality improvement : case study in a unit for the care of older people -- Using workarounds to examine characteristics of resilience in action -- Simulation as a tool to study systems and enhance resilience -- Exploring resilience strategies in anaesthetists' work : a case study using interviews and the resilience markers framework (RMF) -- Promoting resilience in the maternity services -- Team resilience : implementing resilient healthcare at Middlemore ICU -- Understanding normal work to improve quality of care and patient safety in a spine center -- Engineering resilience in an urban emergency department -- Patterns of adaptive behaviour and adjustments in performance in response to authoritative safety pressure regarding the handling of KCl concentrate solutions -- A case study of resilience in inpatient diabetes care -- Where process improvement meets resilience : a study of the preparation and administration of drugs in a surgical inpatient unit -- The safety-II case : reconciling the gap between WAI and WAD through structured dialogue and reasoning about safety -- When disaster strikes : sustained resilience performance in an acute clinical setting -- Making it happen : from research to practice