This research was designed to see whether the clinical method espoused by Moira Stewart et al in the book "Patient-Centered: Transforming The Clinical Method" is appropriate for Pakeha general practitioners to use in clinical consultations with Maori patients. This thesis uses qualitative methodology. One of my supervisors and I selected from the kuia (old women) and kaumatua (old men) of Hauraki those whom I would approach to be involved. Nearly all responded in the affirmative. The kuia and kaumatua talked about their tikanga, about the basis of tikanga, about the spirituality of their Maori worldview. They talked about the need to maintain their tikanga, about qualities that they respect. They described different roles within Maoridom, especially those of the kuia, whaea (mothers) and Tohunga (experts). They refer to a GP as a Tohunga because of the GP�s special expertise. The GP is able to use his or her special expertise to heal Maori patients, but needs to be able to get through barriers to do so. They are also clear that Maori and Pakeha live in two different worlds which can merge in some circumstances. I came to two conclusions. The first is that the elements of Patient-Centered Medicine are relevant to the consultation of a Pakeha GP and Maori patient, and provides a framework that is productive. The second conclusion is that there is a better framework for working with Maori patients, within which Patient-Centered Medicine can be practiced more effectively. Maori already have a framework (tikanga) in which they function, and if in their settings, especially the marae, he or she is welcomed and has a place in their world; tikanga accommodates the GP as a Tohunga and Maori respond to him or her as such. In summary, a Pakeha GP who has some knowledge of tikanga or Maori culture and who has a basic knowledge of the Maori language of tikanga of Maori culture and who has a basic knowledge of the Maori language can work very well for his or her Maori patients by working within the framework of Tikanga Maori and by being patient-centered in consultation.

The decreasing Australian health dollar requires closer scrutiny on what outcome is purchased for it. Quality outcomes are produced by quality services, it is important to identify the constructs of quality care from individual stakeholders' perspectives. Empirical research on quality constructs is limited to medical and nursing literature. Within Physiotherapy and Chiropractics, little research has been undertaken to examine the constructs of quality care from individual stakeholder perspectives, or to develop monitoring systems that reflect the nature and philosophy of Physiotherapy and Chiropractic care / This research explored and expanded upon current knowledge on the constructs of quality and current quality monitoring standards within Physiotherapy and Chiropractic private sector services in Australia. This research explored individual primary stakeholder perspectives of quality (patients, providers and funders). The study identified factors that acted as barriers and incentives in the provision of quality care. This research generated a model of innovative quality monitoring strategies, which reflected stakeholders' perspectives, and could be utilised across private and public funding sectors / This research utilised a mixed method approach of qualitative and quantitative research paradigms. The main methods comprised of interviews with key stakeholders, surveys of patient's perspectives of quality care and an educational outreach program for providers / The findings highlight the multi-dimensional and multifactorial nature of health care quality and its constructs from the perspectives of different stakeholders. Patients and providers' expectations of quality were congruent and contained quality constructs ranging across structure, process and outcome dimensions. This research identified that patient expectations of quality are underpinned by patient-centred care and effective communication between patient and provider. In contrast, funders' perspectives of quality were unidimensional with predominant emphasis on cost of services. This study found funders' monitoring standards were inadequate in identifying poor practices or providing incentives to improve practice. This research provided ways in which funding agencies could continue to use traditional methods of monitoring (such as costs) as well as employing innovative strategies such as patient perspectives on the quality of care they would receive / This research provides the first known evaluation approach for patients to provide feedback on their expectations of quality of Physiotherapy and Chiropractic services. The unique evaluation instrument is profession-specific and it considers patients' expectations using an episode-of-care model rather than the traditional occasion-of-service model. The findings from the survey of Physiotherapy and Chiropractic patients identified the importance of meeting patient expectations prior to, during, and after, the first occasion-of-service with the provider in the episode, and then at three subsequent service points in the episode / This research identified providers' perspectives of an educational outreach program, which aimed to inform and educate them regarding the quality of care they provided. The findings indicated that providers were genuinely interested in uptake of patient feedback into clinical practice. Numerous dissemination strategies were possible within their practices and within their profession / This explanatory research is the first of its kind in providing foundational research evidence on the constructs of quality within private practice Physiotherapy and Chiropractics from different stakeholders' perspectives. It has also established that patients can be effectively engaged in monitoring quality of care. The findings highlight that patient expectations of quality vary throughout an episode-of-care and this needs to be recognised by other stakeholders in quality monitoring and quality improvement initiatives. The findings from this research can form the basis for future research in examining relationships of constructs of quality across other patient populations with other Allied Health disciplines, and in testing innovative quality improvement initiatives / Thesis (PhD)--University of South Australia, 2005

Thesis (PhD)--University of South Australia, 2002.

Thesis (PhD)--University of South Australia, 1998

Thesis (PhD)--University of South Australia, 2002.

The decreasing Australian health dollar requires closer scrutiny on what outcome is purchased for it. Quality outcomes are produced by quality services, it is important to identify the constructs of quality care from individual stakeholders' perspectives. Empirical research on quality constructs is limited to medical and nursing literature. Within Physiotherapy and Chiropractics, little research has been undertaken to examine the constructs of quality care from individual stakeholder perspectives, or to develop monitoring systems that reflect the nature and philosophy of Physiotherapy and Chiropractic care / This research explored and expanded upon current knowledge on the constructs of quality and current quality monitoring standards within Physiotherapy and Chiropractic private sector services in Australia. This research explored individual primary stakeholder perspectives of quality (patients, providers and funders). The study identified factors that acted as barriers and incentives in the provision of quality care. This research generated a model of innovative quality monitoring strategies, which reflected stakeholders' perspectives, and could be utilised across private and public funding sectors / This research utilised a mixed method approach of qualitative and quantitative research paradigms. The main methods comprised of interviews with key stakeholders, surveys of patient's perspectives of quality care and an educational outreach program for providers / The findings highlight the multi-dimensional and multifactorial nature of health care quality and its constructs from the perspectives of different stakeholders. Patients and providers' expectations of quality were congruent and contained quality constructs ranging across structure, process and outcome dimensions. This research identified that patient expectations of quality are underpinned by patient-centred care and effective communication between patient and provider. In contrast, funders' perspectives of quality were unidimensional with predominant emphasis on cost of services. This study found funders' monitoring standards were inadequate in identifying poor practices or providing incentives to improve practice. This research provided ways in which funding agencies could continue to use traditional methods of monitoring (such as costs) as well as employing innovative strategies such as patient perspectives on the quality of care they would receive / This research provides the first known evaluation approach for patients to provide feedback on their expectations of quality of Physiotherapy and Chiropractic services. The unique evaluation instrument is profession-specific and it considers patients' expectations using an episode-of-care model rather than the traditional occasion-of-service model. The findings from the survey of Physiotherapy and Chiropractic patients identified the importance of meeting patient expectations prior to, during, and after, the first occasion-of-service with the provider in the episode, and then at three subsequent service points in the episode / This research identified providers' perspectives of an educational outreach program, which aimed to inform and educate them regarding the quality of care they provided. The findings indicated that providers were genuinely interested in uptake of patient feedback into clinical practice. Numerous dissemination strategies were possible within their practices and within their profession / This explanatory research is the first of its kind in providing foundational research evidence on the constructs of quality within private practice Physiotherapy and Chiropractics from different stakeholders' perspectives. It has also established that patients can be effectively engaged in monitoring quality of care. The findings highlight that patient expectations of quality vary throughout an episode-of-care and this needs to be recognised by other stakeholders in quality monitoring and quality improvement initiatives. The findings from this research can form the basis for future research in examining relationships of constructs of quality across other patient populations with other Allied Health disciplines, and in testing innovative quality improvement initiatives / Thesis (PhD)--University of South Australia, 2005

The decreasing Australian health dollar requires closer scrutiny on what outcome is purchased for it. Quality outcomes are produced by quality services, it is important to identify the constructs of quality care from individual stakeholders' perspectives. Empirical research on quality constructs is limited to medical and nursing literature. Within Physiotherapy and Chiropractics, little research has been undertaken to examine the constructs of quality care from individual stakeholder perspectives, or to develop monitoring systems that reflect the nature and philosophy of Physiotherapy and Chiropractic care / This research explored and expanded upon current knowledge on the constructs of quality and current quality monitoring standards within Physiotherapy and Chiropractic private sector services in Australia. This research explored individual primary stakeholder perspectives of quality (patients, providers and funders). The study identified factors that acted as barriers and incentives in the provision of quality care. This research generated a model of innovative quality monitoring strategies, which reflected stakeholders' perspectives, and could be utilised across private and public funding sectors / This research utilised a mixed method approach of qualitative and quantitative research paradigms. The main methods comprised of interviews with key stakeholders, surveys of patient's perspectives of quality care and an educational outreach program for providers / The findings highlight the multi-dimensional and multifactorial nature of health care quality and its constructs from the perspectives of different stakeholders. Patients and providers' expectations of quality were congruent and contained quality constructs ranging across structure, process and outcome dimensions. This research identified that patient expectations of quality are underpinned by patient-centred care and effective communication between patient and provider. In contrast, funders' perspectives of quality were unidimensional with predominant emphasis on cost of services. This study found funders' monitoring standards were inadequate in identifying poor practices or providing incentives to improve practice. This research provided ways in which funding agencies could continue to use traditional methods of monitoring (such as costs) as well as employing innovative strategies such as patient perspectives on the quality of care they would receive / This research provides the first known evaluation approach for patients to provide feedback on their expectations of quality of Physiotherapy and Chiropractic services. The unique evaluation instrument is profession-specific and it considers patients' expectations using an episode-of-care model rather than the traditional occasion-of-service model. The findings from the survey of Physiotherapy and Chiropractic patients identified the importance of meeting patient expectations prior to, during, and after, the first occasion-of-service with the provider in the episode, and then at three subsequent service points in the episode / This research identified providers' perspectives of an educational outreach program, which aimed to inform and educate them regarding the quality of care they provided. The findings indicated that providers were genuinely interested in uptake of patient feedback into clinical practice. Numerous dissemination strategies were possible within their practices and within their profession / This explanatory research is the first of its kind in providing foundational research evidence on the constructs of quality within private practice Physiotherapy and Chiropractics from different stakeholders' perspectives. It has also established that patients can be effectively engaged in monitoring quality of care. The findings highlight that patient expectations of quality vary throughout an episode-of-care and this needs to be recognised by other stakeholders in quality monitoring and quality improvement initiatives. The findings from this research can form the basis for future research in examining relationships of constructs of quality across other patient populations with other Allied Health disciplines, and in testing innovative quality improvement initiatives / Thesis (PhD)--University of South Australia, 2005

Advance directives (ADs) convey consumers' wishes about accepting or refusing future treatment if they become incompetent. The issue of making a particular AD, more commonly referred to as a living will, is the focus of this thesis. The typical direction of the living will is that life-sustaining activities such as the provision of mechanical ventilation should be withheld so that a person may die what is hoped to be a 'peaceful death'. Clearly the whole basis of the thinking behind the recognition of ADs is that patients' wishes should prevail. ADs have been championed by some as a means of preserving both dignity and autonomy at the end of life in the face of increasing medical advances in technology to preserve life indefinitely. ADs are seen as a means of promoting peace of mind in will-makers, of allowing carers and family to honour the person's wishes and of stimulating communication between all involved parties.While at present there is no statutory right for people in New Zealand to make ADs, it is considered they have rights to do so in common law as consumers of health and disability services in this country. Little is known about the views of New Zealanders making ADs or their justification for doing so. This small qualitative study, using a discourse analysis approach after Potter and Wetherell (1987), aimed to investigate how the participants justified making ADs. Six people were interviewed and the transcriptions were analysed identifying three dominant interpretative repertoires and three corresponding subject positions.The findings indicated that the participants positioned themselves: as independent self-determining individuals who knew when they were ready to make ADs after witnessing undesirable deaths of close family members; as judges of knowing when inappropriate treatments lead to undignified deaths; and as concerned parents who want to relieve their families of uncertainty in the future when making surrogate end-of-life decisions for them. Witnessing a prolonged family member's death in the past was a contributing factor to the participants making ADs. The participants' recall of these events led them to make their wishes known in advance so that their families, in turn, would not have to go through a similar experience at the terminal stages of their lives. The overarching motivations for formalising ADs was to avoid having life artificially prolonged by receiving life-sustaining treatments as well as the desire to die a dignified death.This study highlights the need for healthcare professionals to value the importance of advance planning with well adults before they lose the capacity to give informed choices at the end of life. The taking of a values history as part of this advance planning may inform family and healthcare professionals about peoples' general values and at the same time confirm and record end-of-life choices for future reference.

Doctor of Philosophy(PhD) / This thesis consists of a series of studies of new models of multidisciplinary community health care in four compartments. These compartments are acute, subacute, outpatient and maintenance care. The purpose of the individual studies is to demonstrate the benifits of munltidisciplinary community health care in delivering alternatives to current practice by replacing hospital care or improving traditional community care.

The decreasing Australian health dollar requires closer scrutiny on what outcome is purchased for it. Quality outcomes are produced by quality services, it is important to identify the constructs of quality care from individual stakeholders' perspectives. Empirical research on quality constructs is limited to medical and nursing literature. Within Physiotherapy and Chiropractics, little research has been undertaken to examine the constructs of quality care from individual stakeholder perspectives, or to develop monitoring systems that reflect the nature and philosophy of Physiotherapy and Chiropractic care / This research explored and expanded upon current knowledge on the constructs of quality and current quality monitoring standards within Physiotherapy and Chiropractic private sector services in Australia. This research explored individual primary stakeholder perspectives of quality (patients, providers and funders). The study identified factors that acted as barriers and incentives in the provision of quality care. This research generated a model of innovative quality monitoring strategies, which reflected stakeholders' perspectives, and could be utilised across private and public funding sectors / This research utilised a mixed method approach of qualitative and quantitative research paradigms. The main methods comprised of interviews with key stakeholders, surveys of patient's perspectives of quality care and an educational outreach program for providers / The findings highlight the multi-dimensional and multifactorial nature of health care quality and its constructs from the perspectives of different stakeholders. Patients and providers' expectations of quality were congruent and contained quality constructs ranging across structure, process and outcome dimensions. This research identified that patient expectations of quality are underpinned by patient-centred care and effective communication between patient and provider. In contrast, funders' perspectives of quality were unidimensional with predominant emphasis on cost of services. This study found funders' monitoring standards were inadequate in identifying poor practices or providing incentives to improve practice. This research provided ways in which funding agencies could continue to use traditional methods of monitoring (such as costs) as well as employing innovative strategies such as patient perspectives on the quality of care they would receive / This research provides the first known evaluation approach for patients to provide feedback on their expectations of quality of Physiotherapy and Chiropractic services. The unique evaluation instrument is profession-specific and it considers patients' expectations using an episode-of-care model rather than the traditional occasion-of-service model. The findings from the survey of Physiotherapy and Chiropractic patients identified the importance of meeting patient expectations prior to, during, and after, the first occasion-of-service with the provider in the episode, and then at three subsequent service points in the episode / This research identified providers' perspectives of an educational outreach program, which aimed to inform and educate them regarding the quality of care they provided. The findings indicated that providers were genuinely interested in uptake of patient feedback into clinical practice. Numerous dissemination strategies were possible within their practices and within their profession / This explanatory research is the first of its kind in providing foundational research evidence on the constructs of quality within private practice Physiotherapy and Chiropractics from different stakeholders' perspectives. It has also established that patients can be effectively engaged in monitoring quality of care. The findings highlight that patient expectations of quality vary throughout an episode-of-care and this needs to be recognised by other stakeholders in quality monitoring and quality improvement initiatives. The findings from this research can form the basis for future research in examining relationships of constructs of quality across other patient populations with other Allied Health disciplines, and in testing innovative quality improvement initiatives / Thesis (PhD)--University of South Australia, 2005