Doctor of Philosophy (PhD) / Understanding factors that enhance or diminish performance levels of individuals is instrumental for achieving individual (low level) and organisational (high level) goals. In this study, the effect of social network structure, position, ties and information and communication technologies (ICT) use on performance attitudes of knowledge intensive workers in dispersed occupational communities is investigated. Based on social network theories of strength of weak ties and structural holes, and the social influence model of technology use, a theoretical framework is developed. In conjunction with qualitative interviews conducted with subject matter experts, the framework is used to further develop and refine a valid and reliable survey instrument. Secondly, network measures of degree centrality, density, structural holes (constraint and efficiency), tie strength and tie diversity are applied for exploring the association with ICT use and performance from a sample of 110 rural general practitioners. Empirical results suggest that network structure, position and ties of knowledge workers play a crucial role in individual performance and ICT use. In particular, degree centrality and task-level ICT use was found to be positively associated with performance while ego-network constraint was found to be negatively correlated with performance. In terms of ICT use, functional diversity and degree centrality were positively associated with task-level ICT use whereas ego-network efficiency was found to be negatively correlated with ICT use at the communication-structure level. Among the variables that showed significance, degree centrality best explained overall variance for performance, and functional diversity best explained overall variance for task-level ICT use, although professional accreditations remains a potent indicator also. The results from this study resonate with findings from past literature and extend traditional theory of social networks and performance within the micro level to include geographically dispersed individuals involved in knowledge intensive work. For individuals in such non-competitive settings, traditional network theories such as structural holes theory still apply. However, a key finding is that network structure is a much more potent predictor of performance although network position is important. The second key finding addresses a major gap in the literature concerning understanding social processes that influence ICT use. As the technology acceptance and the social influence models lack empirical evidence from a social networks perspective, this research shows that rather than the strength of ties which functions as a conduit of novel ideas and information, it is the functional tie diversity within individual professionals networks that increase ICT use at the task-level. Methodologically, the study contributes towards a triangulation approach that utilises both qualitative and quantitative methods for operationalising the study. The quantitative method includes a non-traditional “networks” method of data collection and analysis to serve as a fine complement to traditional research methods in behavioural studies. The outcome is a valid and reliable survey instrument that allows collection of both individual attribute and social network data. The instrument is theoretically driven, practically feasible to implement, time-efficient and easily replicable for other similar studies. At the domain level, key findings from this study contradict previous literature which suggests that professionals in occupational communities such as general practitioners decline in performance as they age. In fact, findings from this study suggest that age and experience do not affect for performance; rather, there is a negative relationship between experience and task-level ICT use, and that task-level ICT use is positively associated with performance in terms of attitudes to interpersonal care. Furthermore, degree centrality is also positively associated with professional accreditations, such as fellowship of the Royal Australian College of General Practitioners, which is conducive to performance in terms of attitudes to interpersonal and technical care. The contextual implication from the quantitative and qualitative evidence of this study is that while contemplating strategies for optimising ICT use or for improving attitudes to quality of care at the technical and interpersonal level, the importance of social structure, position and relations in the practitioner’s professional network needs to be considered carefully as part of the overall individual and organisation-level goals.

Research Doctorate - Doctor of Philosophy (PhD) / Background Due to an ongoing shortage of rural medical professionals both in Australia and internationally, the recruitment and retention of rural doctors has been extensively researched. Mostly the research used quantitative methods to focus on factors associated with rural medical workforce recruitment and retention issues, and until now, limited work has investigated inter-relationships between these factors. Although a few qualitative studies have used thematic analysis to develop models to better understand these issues, none have specifically considered the attitudes of medical students, and female rural doctors. This Thesis responds to this need by using qualitative research methods to develop a model which incorporates feminisation of the medical workforce and generational change in the 21st century. Data were collected from Australian medical students and female rural general practitioners (GPs) as study participants. Aims The broad aims were to develop a model for understanding recruitment and retention of rural doctors in Australia, incorporating concepts of place, gender, and professional identity. Research Questions How are Australian medical students' and female general practitioners' perceptions of entering and remaining in a rural health career influenced by the constructs of place, gender and professional identity? Does this perception change as doctors progress through their careers from students to practising general practitioners? Methods A case series of three qualitative studies were used to develop a model for understanding rural GP recruitment and retention. Data, collected using focus groups and interviews, were analysed thematically by domains describing participants’ lives, and the interaction between the domains was explored to better understand influences on location choice. Results The ����Landscape of fulfilment��� model which is integral to this research, incorporates the domains of self, place, work, significant others, recreation, and significant others’ work as the domains of life which influence location choice. Most participants sought balance within their lives, and maximum fulfilment in all domains, but at times they faced conflict between domains. Individuals’ gender, professional, and place identities were related to how they viewed the domains and how the domains interacted. Conclusion This model provides a way of understanding the complex interaction between aspects of life which affect a doctor’s location choice. There is important potential to use the model to inform the development of rural medical recruitment and retention strategies, and as a basis for further rural health workforce research. The model has already been used by General Practice Education and Training (GPET) in developing post graduate general practice training research, and also by the Sustainable Practice Working Group of the Rural Faculty of the Royal Australian College of General Practitioners (RACGP) in developing strategies for sustainable rural general practice.

Research Doctorate - Doctor of Philosophy (PhD) / Background Due to an ongoing shortage of rural medical professionals both in Australia and internationally, the recruitment and retention of rural doctors has been extensively researched. Mostly the research used quantitative methods to focus on factors associated with rural medical workforce recruitment and retention issues, and until now, limited work has investigated inter-relationships between these factors. Although a few qualitative studies have used thematic analysis to develop models to better understand these issues, none have specifically considered the attitudes of medical students, and female rural doctors. This Thesis responds to this need by using qualitative research methods to develop a model which incorporates feminisation of the medical workforce and generational change in the 21st century. Data were collected from Australian medical students and female rural general practitioners (GPs) as study participants. Aims The broad aims were to develop a model for understanding recruitment and retention of rural doctors in Australia, incorporating concepts of place, gender, and professional identity. Research Questions How are Australian medical students' and female general practitioners' perceptions of entering and remaining in a rural health career influenced by the constructs of place, gender and professional identity? Does this perception change as doctors progress through their careers from students to practising general practitioners? Methods A case series of three qualitative studies were used to develop a model for understanding rural GP recruitment and retention. Data, collected using focus groups and interviews, were analysed thematically by domains describing participants’ lives, and the interaction between the domains was explored to better understand influences on location choice. Results The ����Landscape of fulfilment��� model which is integral to this research, incorporates the domains of self, place, work, significant others, recreation, and significant others’ work as the domains of life which influence location choice. Most participants sought balance within their lives, and maximum fulfilment in all domains, but at times they faced conflict between domains. Individuals’ gender, professional, and place identities were related to how they viewed the domains and how the domains interacted. Conclusion This model provides a way of understanding the complex interaction between aspects of life which affect a doctor’s location choice. There is important potential to use the model to inform the development of rural medical recruitment and retention strategies, and as a basis for further rural health workforce research. The model has already been used by General Practice Education and Training (GPET) in developing post graduate general practice training research, and also by the Sustainable Practice Working Group of the Rural Faculty of the Royal Australian College of General Practitioners (RACGP) in developing strategies for sustainable rural general practice.

Doctor of Philosophy (PhD) / Understanding factors that enhance or diminish performance levels of individuals is instrumental for achieving individual (low level) and organisational (high level) goals. In this study, the effect of social network structure, position, ties and information and communication technologies (ICT) use on performance attitudes of knowledge intensive workers in dispersed occupational communities is investigated. Based on social network theories of strength of weak ties and structural holes, and the social influence model of technology use, a theoretical framework is developed. In conjunction with qualitative interviews conducted with subject matter experts, the framework is used to further develop and refine a valid and reliable survey instrument. Secondly, network measures of degree centrality, density, structural holes (constraint and efficiency), tie strength and tie diversity are applied for exploring the association with ICT use and performance from a sample of 110 rural general practitioners. Empirical results suggest that network structure, position and ties of knowledge workers play a crucial role in individual performance and ICT use. In particular, degree centrality and task-level ICT use was found to be positively associated with performance while ego-network constraint was found to be negatively correlated with performance. In terms of ICT use, functional diversity and degree centrality were positively associated with task-level ICT use whereas ego-network efficiency was found to be negatively correlated with ICT use at the communication-structure level. Among the variables that showed significance, degree centrality best explained overall variance for performance, and functional diversity best explained overall variance for task-level ICT use, although professional accreditations remains a potent indicator also. The results from this study resonate with findings from past literature and extend traditional theory of social networks and performance within the micro level to include geographically dispersed individuals involved in knowledge intensive work. For individuals in such non-competitive settings, traditional network theories such as structural holes theory still apply. However, a key finding is that network structure is a much more potent predictor of performance although network position is important. The second key finding addresses a major gap in the literature concerning understanding social processes that influence ICT use. As the technology acceptance and the social influence models lack empirical evidence from a social networks perspective, this research shows that rather than the strength of ties which functions as a conduit of novel ideas and information, it is the functional tie diversity within individual professionals networks that increase ICT use at the task-level. Methodologically, the study contributes towards a triangulation approach that utilises both qualitative and quantitative methods for operationalising the study. The quantitative method includes a non-traditional “networks” method of data collection and analysis to serve as a fine complement to traditional research methods in behavioural studies. The outcome is a valid and reliable survey instrument that allows collection of both individual attribute and social network data. The instrument is theoretically driven, practically feasible to implement, time-efficient and easily replicable for other similar studies. At the domain level, key findings from this study contradict previous literature which suggests that professionals in occupational communities such as general practitioners decline in performance as they age. In fact, findings from this study suggest that age and experience do not affect for performance; rather, there is a negative relationship between experience and task-level ICT use, and that task-level ICT use is positively associated with performance in terms of attitudes to interpersonal care. Furthermore, degree centrality is also positively associated with professional accreditations, such as fellowship of the Royal Australian College of General Practitioners, which is conducive to performance in terms of attitudes to interpersonal and technical care. The contextual implication from the quantitative and qualitative evidence of this study is that while contemplating strategies for optimising ICT use or for improving attitudes to quality of care at the technical and interpersonal level, the importance of social structure, position and relations in the practitioner’s professional network needs to be considered carefully as part of the overall individual and organisation-level goals.

Darbo tikslas. Atskleisti gydytojų požiūrį į motyvavimą dirbti rajoninėse sveikatos priežiūros įstaigose. Uždaviniai. 1. Išskirti pagrindinius veiksnius, susijusius su gydytojo darbo rajono sveikatos priežiūros įstaigoje pasirinkimu. 2. Atskleisti problemas, su kuriomis susiduria gydytojai, neseniai pradėję dirbti rajoninėse sveikatos priežiūros įstaigose. 3. Išsiaiškinti gydytojų nuomonę apie priemones, kurios yra taikomos arba galėtų būti taikomos siekiant pritraukti ir išsaugoti gydytojus dirbti rajonuose. Tyrimo metodika. Taikant kokybinį tyrimo metodą, giluminio interviu būdu, apklausti 8 Lietuvos rajonų sveikatos įstaigose dirbantys gydytojai rezidentai ir 3 neseniai (iki 3 metų) rajonų gydymo įstaigose pradėję dirbti gydytojai. Rezultatai. Dirbti į rajonines sveikatos priežiūros įstaigas vykstama dėl mažesnės konkurencijos darbo rinkoje, didesnių atlyginimų. Gydytojai apie darbo vietas sužino skambindami patys į ligonines arba per turimus ryšius. Rajoninės įstaigos motyvuoja gydytojus atvykti dirbti į rajoną finansinėmis ir nepiniginėmis priemonėmis, siūlant didesnį atlyginimą, rezidentūros apmokėjimą, palankų darbo grafiką atvykstančiam gydytojui. Universitetų priemonės vertinamos negatyviai, nes yra netiesioginis dėstytojų ir gydytojų nuteikimas prieš darbą rajone, nėra sudaromos sąlygos studijų metų padirbti rajone. Gydytojas rajone įgauna žinių ir praktinių įgūdžių atlikdamas įvairesnių procedūrų, kartais srityse, kurios yra už jo kompetencijos ribų. Rajoninėse... [toliau žr. visą tekstą] / Aim of the study. To identify and analyze the doctors’ motivation aspects to work at hospitals in the rural areas. Objectives. 1. To identify the main factors that influence the doctors’ decision to work at hospitals in the rural areas. 2. To determine the problems that doctors are facing in their beginning at work in the rural areas. 3. To investigate the doctors’ opinion about the instruments that were used or could be adopted in practice to attract and retain doctors in rural hospitals. Methods. Qualitative study was used to get the information which contains motivating factors for doctors to work at the rural hospitals. Using in-deph semistructured questionnaires were asked 8 residency students and 3 doctors at rural hospitals. Respondents were selected using short (less than 3 years) working period in rural hospital criteria. Results. Lower competition in labor market and higher salaries are the push factors for doctors to choose the rural workplace. Most of the doctors request the hospitals directly for the vacant positions or get the information about available positions from people they know. Rural hospitals attract doctors with higher wages, refund the payment of residency studies and adjust a better working schedule. The incentives of universities should be better developed because there is lack of rural practice possibilities for the students. There is indeed strong influence made by lecturers who spread negative and inadequate approach about rural hospitals... [to full text]

Rural and remote areas of Australia remain the last bastion of health disadvantage in a developed nation with an enviable health score-card. During the last ten years, rural and remote health has emerged as a significant issue in the media and the political arena. This thesis examines print media, policy documents and interviews from selected informants to ascertain how they represent medical practitioners and health services in rural and remote areas of Australia, why they do so, and the consequences of such positions. In many of these representations, rural and remote medical practitioners are aligned with national and cultural mythologies, while health services are characterised as dysfunctional and at crisis point. Ostensibly, the representations and identity formulations are aimed at redressing the health inequities in remote rural and Australia. They define and elaborate debates and contestations about needs and claims and how they should be addressed; a process that is crucial in the development of professional identity and power (Fraser; 1989). The research involves an analysis and critical reading of the entwined discourses of culture, power, and the politics of need. Following Wodak and others (1999), these dynamics are explored by examining documents that are part of the discursive constitution of the field. In particular, the research examines how prevailing cultural concepts are used to configure the Australian rural and remote medical practitioner in ways that reflect and advance socio-cultural hegemony. The conceptual tools used to explore these dynamics are drawn from critical and post-structural theory, and draw upon the work of Nancy Fraser (1989; 1997) and Ruth Wodak (1999). Both theorists developed approaches that enable investigation into the effects of language use in order to understand how the cultural framing of particular work can influence power relations in a professional field. The research follows a cultural studies approach, focussing on texts as objects of research and acknowledging the importance of discourse in the development of cultural meaning (Nightingale, 1993). The methodological approach employs Critical Discourse Analysis, specifically the Discourse Historical Method (Wodak, 1999). It is used to explore the linguistic hallmarks of social and cultural processes and structures, and to identify the ways in which political control and dominance are advanced through language-based strategies. An analytical tool developed by Ruth Wodak, Rudolf de Cillia, Martin Reisigl and Karin Leibhart (1999) was adapted and used to identify nationalistic identity formulations and related linguistic manoeuvres in the texts. The dissertation argues that the textual linguistic manoeuvres and identity formulations produce and privilege a particular identity for rural and remote medical practitioners, and that cultural myth is used to popularise, shore up and advance the goals of rural doctors during a period of crisis and change. Important in this process is the differentiation of rural and remote medicine from other disciplines in order to define and advance its political needs and claims (Fraser, 1989). This activity has unexpected legacies for the rural and remote health sector. In developing a strong identity for rural doctors, discursive rules have been established by the discipline regarding roles, personal and professional characteristics, and practice style; rules which hold confounding factors for the sustainability of remote and rural medical practice and health care generally. These factors include: the professional fragmentation of the discipline of primary medical care into general practice and rural medicine; and identity formulations that do not accommodate an ageing workforce characterised by cultural diversity, decreasing engagement in full time work, and a higher proportion of women participants. Both of these factors have repercussions for the recruitment and retention of rural and remote health professionals and the maintenance of a sustainable health workforce. The dissertation argues that the formulated identities of rural and remote medical practitioners in the texts maintain and reproduce relationships of cultural, political and social power. They have also influenced the ways in which rural and remote health services have been developed and funded. They selectively represent and value particular roles and approaches to health care. In doing so, they misrepresent the breadth and complexities of rural and remote health issues, and reinforce a reputational economy built on differential professional and cultural respect, and political and economic advantage. This disadvantages the community, professions and interest groups of lower value and esteem, and other groups whose voices are often not heard. Thus, regardless of their altruistic motivations, the politics of identity and differentiation employed in the formulated identities in the texts are based on an approach that undermines the redistributive goals of justice and equity (Fraser 1997), and works primarily to develop and advantage the discipline of rural medicine.