Professor Rebecca Mitchell

© 2016 John Wiley & Sons Australia, Ltd.The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse has been described as enhancing health care outcomes largely through extensive collaboration with consumers, nurses, and other health professionals. However, little is known about the actual nature, amount, and quality of NC interactions. This study examines the connectivity of the NC role across metropolitan and rural contexts, using a mixed method sequential design with an online survey and focus groups with NCs and other stakeholders. Results demonstrated that NCs most commonly have high density connectivity patterns with other nursing colleagues, medical staff, patients/clients, and administrative staff. Position grade (1, 2 or 3) influences density of connectivity, as does location, with those based in metropolitan roles engaging significantly less with other clinicians. Findings demonstrate that many NCs are highly collaborative and predominantly embedded into interprofessional practice models. This study provides valuable insight into the diverse and often complex NC role and the way in which NC expertise and influence is deployed and integrated across a large local health district.

Aim: To describe the research protocol that will be used to investigate factors contributing to effective interprofessional practice in a rural context in Australia. Background: Interprofessional practice is a key strategy for overcoming rural health challenges; however, our knowledge of interprofessional initiatives and consequences in rural areas is limited. Design: A modified realistic evaluation approach will be used to explore the structures, systems, and social processes contributing to effective interprofessional outcomes. This 'context-mechanism-outcome' approach provides a useful framework for identifying why and how interprofessional practice works in rural contexts. Method: Initial propositions regarding the factors that explain effective collaborative practice will be generated through interviews with lead clinicians, policy-makers, and clinician managers. Clinician interviews, document analysis, and multi-participant focus groups will be used as evidence to support, refine, or redevelop the initial propositions. This will allow the development of a model of rural interprofessional practice that will explain how and why collaborative approaches work in rural environments. This study is funded by an Institute of Rural Clinical Services and Teaching grant (January 2010). Discussion: Rural healthcare challenges are well documented; however, studies investigating the nature of interprofessional practice in rural contexts are not common. Rural contexts also present research design, particularly data collection, challenges. This proposed research is one of the first to identify the factors that facilitate or constrain effective interprofessional work in rural settings. This is particularly important, given the continuing workforce shortages and maldistribution and poorer health outcomes in rural communities globally. © 2013 Blackwell Publishing Ltd.

OBJECTIVE: The objective of this study was to estimate productivity-related savings associated with employee participation in health promotion programs. METHODS: Propensity score weighting and multiple regression techniques were used to estimate savings. These techniques were adjusted for demographic and health status differences between participants who engaged in one or more telephonic health management programs and nonparticipants who were eligible for but did not engage in these programs. RESULTS: Employees who participated in a program and successfully improved their health care or lifestyle showed significant improvements in lost work time. These employees saved an average of $353 per person per year. This reflects about 10.3 hours in additional productive time annually, compared with similar, but nonparticipating employees. CONCLUSIONS: Participating in health promotion programs can help improve productivity levels among employees and save money for their employers. Copyright © 2013 by American College of Occupational and Environmental Medicine.

Workforce shortages are forecast for speech-language pathology in Australia, and will have a more significant impact on rural and remote areas than on metropolitan areas. Allied health (AH) disciplines such as physiotherapy and occupational therapy address the problem of workforce shortages and growing clinical demand by employing allied health assistants (AHAs) to provide clinical and administrative support to AH professionals. Currently, speech-language pathologists (SLPs) don't work with discipline-specific allied health assistants in all states of Australia (e.g., New South Wales). This paper aims to provide insight into the perceptions of SLPs in one Australian state (NSW) regarding working with AHAs. Semi-structured interviews were conducted with eight rural SLPs. Qualitative analysis indicated that participants perceived they had deficits in skills and knowledge required to work with AHAs and identified further training needs. Participants perceived the SLP role to be misunderstood and were concerned about poor consultation regarding the introduction of AHAs into the profession. Ambivalence was evident in overall perceptions of working with AHAs, and tasks performed. While previous research identified benefits of working with AHAs, results from this study suggest that significant professional, economic, and organizational issues need addressing before such a change should be implemented in speech-language pathology. © 2013 The Speech Pathology Association of Australia Limited.

Purpose: The growing prominence of knowledge workers in contemporary organisations has led to a considerable amount of research into their role and activities, however, despite this growing interest, there remains a lack of clarity regarding the relationship of knowledge workers to management. This paper aims to respond by investigating the features of knowledge work that impose barriers to traditional managerial control methods and exploring the extent to which alternative approaches to influence are available to knowledge work managers, and the circumstances under which these different approaches are indicated. Design/methodology/approach: The paper utilised agency theory to investigate the implications of knowledge asymmetry in principal-knowledge worker exchanges, and argues against the utility of models of control based on principles of scientific management on which agency models are typically based, towards models of control based on reciprocity and commitment. Findings: The paper has two main outputs. First, it argues that situations in which knowledge-based specialists are hired to perform tasks requiring expertise can be viewed as principal-agent exchanges (Mills) and are therefore open to analysis through an agency theory lens. The second endeavour is to discuss the implications of knowledge asymmetry in principal-knowledge worker relationships for managerial control and influence, and posit alternative modes of managerial control based on normative influence and valiant rewards. Further, it develops propositions relating to the factors likely to moderate the utility of each managerial influence strategy. Originality/value: By undertaking this investigation, the paper responds to calls by Frenkel et al. to understand process and dynamics of control in managing knowledge workers. It moves away from models of control based on principles of scientific management on which agency models are typically based, towards models of control based on reciprocity and commitment. It develops testable propositions regarding specific sources of influence in knowledge work and the circumstances under which the employment of these influence strategies is indicated. This responds to calls by authors such as Tampoe; and Lord to develop a detailed understanding of the manner and extent to which influence strategies need to complement specific knowledge worker characteristics. © Emerald Group Publishing Limited.

The objective of this study was to determine the relationship between health status and productivity loss and to provide estimates of the business implications of lost work performance. Health risk appraisal responses from over 1 million participants were analyzed to determine productivity loss associated with several common health conditions and health risks. Propensity scores and a matching technique were used to create analysis groups that differed only by presence of a particular health condition or risk. Results were monetized and multiplied by the average number of employees with conditions or risks to illustrate the potential impact of productivity loss to employers. Costs of productivity loss were compared to medical costs for the same conditions and health risks. Practical benchmarks of lost work performance may help employers assess the financial impact of suboptimal health in their own companies. Estimates of lost work time can help employers realize the value of maintaining a healthy population. © Copyright 2011, Mary Ann Liebert, Inc.

The results of research on diversity in teams suggest that it offers both a great opportunity for organisations as well as an enormous challenge. However, current research is plagued by a lack of overall consistency, indicating that the relationship between diversity and team performance is not well understood. This study examines the components of cognitive conflict in order to assess whether construct operationalisation may explain this inconsistency. Analysis of the existing operationalisations of cognitive conflict reveals that it incorporates both disagreement about information and reasoning, and debate of rival hypotheses or recommendations. We propose that functional diversity leads to cognitive disagreement but not debate, and that debate enhances knowledge creation, with which cognitive disagreement shows no relationship. Our results support these hypotheses, which provide a powerful explanation for the contrary results found by researchers investigating cognitive conflict. Given that extant measures of cognitive conflict include scale items which measure both debate and cognitive disagreement, cognitive conflict may be viewed as an aggregate measure of these two distinct constructs. This study contributes to research on diversity and conflict by providing an explanation for contrary results, and by providing and a detailed operationalisation of cognitive conflict and its component constructs. It also contributes to research into creativity and innovation by providing insight into the dynamics underpinning knowledge sharing and creation.

This paper contributes to our understanding of the process of knowledge creation in organisations. Based on a process model, the paper develops propositions relating to factors facilitating knowledge creation in cross-functional work teams. These propositions relate to the constructs of cognitive diversity, transactional memory, trans-specialist knowledge and their contribution to new knowledge development through knowledge boundary spanning. © 2006 Operational Research Society Ltd. All rights reserved.

This paper contributes to our understanding of knowledge creation by developing a comprehensive model of the knowledge creating process in organisational work teams. It subsequently synthesises contemporary theory across research streams to develop hypotheses relating to three factors capable of facilitating the knowledge development process - cognitive diversity, transactional memory and openmindedness norms. In combination, the conceptual rationale and empirical support act to substantiate three key relationships in the knowledge creation process.

This study explores the assumption that the impact of diversity on knowledge creating capability is consequent to associated differences in knowledge and perspectives, and contrast this mechanism against an alternative pathway, the utilisation of deliberative, collaborative behaviours. To investigate this theory, we assess whether cognitive heterogeneity and debate operate as mediating variables between two types of diversity, functional and cultural, and knowledge creation. The results provide support for both mediators and also generate evidence suggesting that functional and cultural diversity impact on knowledge creation through different mechanisms.