Sandra G. Leggat

Background: Electronic medical records (EMRs) are widely implemented to improve information access, patient safety and care coordination. However, less is known about how EMRs are used in routine clinical processes such as nursing handover. Understanding how EMRs influence handover practices is important, given the central role of handover in continuity of care and patient safety. Method: An exploratory mixed-methods comparative case study using a cross-sectional survey design was conducted within a large multi-site public healthcare organisation in Victoria, Australia. An organisation-wide survey captured quantitative data on EMR use during preparation for and delivery of nursing handover, alongside qualitative free-text responses exploring perceived impacts, barriers and facilitators. Responses were compared between EMR-enabled clinical areas and predominantly paper-based or hybrid environments. Results: A total of 385 nurses completed the survey. EMR use during handover was substantially higher in EMR-enabled environments than in paper-based or hybrid settings. Qualitative analysis identified six key areas influencing handover: access to and visibility of clinical information; handover quality, safety and cognitive focus; usability and fit with nursing practice; system implementation and enabling conditions; impact on nursing workflows and time and bedside handover and patient engagement. EMR not only supported information access and verification during handover but also introduced cognitive and workflow challenges, particularly where usability, infrastructure or implementation maturity were limited. Conclusion: EMR use can support safer and more informed nursing handover by improving access to legible, real-time clinical information. However, its effectiveness is contingent on usability, infrastructure and alignment with nursing workflows, consistent with the principles of task-technology fit. Hybrid documentation environments and system access constraints limit the consistent realisation of benefits. Continued reliance on printed summaries, handwritten notes and personalised tools suggests that digital systems may complement, rather than completely replace, existing cognitive supports. Optimising EMR-supported handover requires organisational attention to implementation conditions, workflow integration and the practical realities of clinical work. Implications for health information management practice: Health information management professionals can contribute to EMR optimisation by supporting the accessibility, organisation and effective use of clinical information. Evaluation of information usability, documentation practices and ongoing reliance on paper-based workarounds can help identify opportunities to better support clinical information needs.

Background: Ineffective clinical handover has the potential to compromise patient safety and quality of care. Standardizing the handover process is a widely adopted improvement strategy intended to reduce failures of information transfer. By enabling real-time access to patient information, electronic medical records (EMRs) could address communication issues inherent to nursing handover. Objective: This case study sought to compare the quality of nursing handover occurring at EMR-enabled sites with that occurring at paper-based sites, within a single Australian public health service. Methods: A comparative case study design was used, using quantitative data collected from observational audits of 60 handovers and posthandover surveys conducted in EMR-enabled and paper-based ward environments. Handover quality was measured through compliance with the organization’s Clinical Handover Standard and staff-reported perceptions, enabling comparison between cohorts. Results: Compared with paper-based wards, EMR-enabled wards demonstrated more consistent communication of clinical alerts and risks and fewer interruptions, whereas paper-based wards showed higher rates of bedside handover and patient engagement. Conclusions: EMR implementation alone does not ensure high-quality nursing handover. EMR interface design and functionality may act as a barrier to bedside handover and patient engagement, and contribute to continued reliance on paper-based artifacts. Targeted EMR design and nursing informatics-led optimization are required to better support nursing handover as a complex and cognitively challenging communication process.

Purpose: This study explores how governance, cultural norms and resources contribute to workplace bullying in surgical teams across Australia and Aotearoa New Zealand. It draws on Systems Theory and the Resource Dependence Theory (RDT) to examine how these constructs interact to shape both the persistence of bullying and the conditions for reform. Design/methodology/approach: Qualitative data were collected through semi-structured interviews with 31 senior surgeons across diverse specialties and institutional contexts. Thematic analysis was conducted using NVivo, with findings mapped to Systems Theory and RDT. Findings: Bullying behaviours were linked to rigid hierarchies, fragmented governance and exclusionary norms. In public hospitals, resource volatility and team instability heightened strain and reduced accountability. In private settings, continuity was greater but oversight inconsistent. Weak feedback loops, disengaged leadership and informal power structures enabled harmful conduct. Intersectional factors, particularly gender, training background and career stage, disproportionately affected women and international medical graduates. Participants identified governance reform, inclusive leadership and structural accountability as critical levers for change. Practical implications: Reducing bullying requires attention to feedback systems, resourcing stability and organisational culture. Structural redesign, inclusive leadership and equity-focused governance may enhance psychological safety across surgical settings. Originality/value: By applying the Systems Theory and RDT, this study offers a structural account of bullying as a product of governance gaps, resource asymmetries and cultural norms rather than individual misconduct. It shows how these conditions interact to generate behavioural risk in high-stakes teams.

BACKGROUND Ineffective clinical handover has the potential to compromise patient safety and quality of care. Standardising the handover process is a widely adopted improvement strategy intended to reduce failures of information transfer. By enabling real-time access to patient information, Electronic Medical Records (EMRs) could address communication issues inherent to nursing handover. OBJECTIVE This case study sought to compare handover occurring at EMR-enabled sites with that occurring at paper-based sites in a single Australian public health service to examine differences in handover quality. METHODS A mixed-methods research design was utilised, incorporating an observational audit of 60 handovers and post-handover surveys conducted in both EMR-enabled and paper-based ward environments, allowing analysis between the two cohorts. Quality was measured as compliance against key principles of the organisation’s Clinical Handover Standard and ratings of perceived handover quality from handover recipients. RESULTS Overall compliance with the Clinical Handover Standard was comparable. Key differences between the two cohorts included improved bedside handover and patient engagement factors in the paper-based environments, while improved transfer of critical alerts and risks occurred in the EMR-enabled wards both more efficiently and with fewer interruptions. CONCLUSIONS The presence of an EMR, particularly the design and functionality of the EMR interface, may act as a barrier to bedside handover, patient engagement in the handover process and the delivery of patient centred care. These barriers require further investigation and targeted solutions. While reported benefits suggest a degree of user acceptance of the EMR, the ongoing reliance on paper-based handover forms indicates a gap where the EMR does not yet adequately support nursing handover. CLINICALTRIAL N/A

Purpose: This study investigates the drivers and mitigators of workplace bullying in surgical environments in Australia and Aotearoa New Zealand, utilizing social identity theory (SIT) and contemporary models of psychological safety. It introduces the concept of personality traits as a bridging factor between drivers and mitigators.Design/methodology/approach: Qualitative interviews were conducted with 31 surgeons. Thematic analysis, supported by NVivo, was used to map findings to the SIT framework and incorporate psychological safety and personality theory.Findings: Key drivers of workplace bullying include entrenched hierarchical power structures, gender dynamics and early socialization in competitive environments. The “bad apple” phenomenon, where personality traits such as narcissism and low emotional intelligence exacerbate bullying, contrasts with individuals demonstrating empathy and interpersonal awareness, who mitigate such behaviors. Effective leadership, generational shifts and team stability through procedural inclusion are key mitigators that promote psychological safety and collaboration.Research limitations/implications: Sample diversity, self-reporting bias and temporal context may impact the generalizability of findings across broader health and surgical settings in contemporary practice.Practical implications: Addressing entrenched power imbalances and fostering inclusive leadership and practices are critical to mitigating bullying. Promoting psychological safety and leveraging generational change can reshape surgical culture, leading to healthier teams and improved patient outcomes.Originality/value: This study bridges SIT with theories of personality and psychological safety, offering new perspectives on how individual traits and systemic dynamics shape bullying behaviors and culture in surgical teams, highlighting the need for targeted interventions.

This Rapid Evidence Assessment (REA) aimed to investigate the impact of electronic medical record (EMR) implementation on the process and outcomes of nursing handover by synthesising the existing scientific literature. Clinical nursing handover involves transferring patient information, responsibility and accountability to ensure continuity of care and patient safety. Poor or absent clinical handover can negatively impact quality of care, patient safety and patient outcomes. EMRs are patient information systems that facilitate the real‐time sharing of patient data. It has been proposed that EMRs may assist in addressing communication issues often associated with poor nursing handover, yet the implementation and impact of EMR implementations remain varied. A database search was conducted in PubMed, CINAHL and Cochrane. Articles for inclusion were studies in which the impact of an EMR implementation was evaluated, where participants were nurses performing handover from shift to shift in a hospital setting. Eleven studies from 4 different countries were included. The study findings revealed 4 broad themes that serve to answer the research question: use of the EMR during handover; nurse perceptions and satisfaction with the EMR; barriers to use; and enablers to use. EMR‐mediated handover was described in 7 studies. EMR‐structured handover was described in 7 studies. EMR‐generated printouts were described in 4 studies. While the EMR was routinely used to validate and check certain pieces of information during handover, nurses considered their personalised paper‐based forms to be the preferred handover tool. The main findings were that nurses generally expressed dissatisfaction with using the EMR to facilitate handover, with three studies reported dissatisfaction with EMR‐based handover. 50% of nurses found printouts cumbersome, and 69% reported irrelevant information. Barriers to EMR use included 6 studies that identified design‐related barriers. 4 studies emphasised the importance of cognitive support and situational awareness. 4 studies highlighted the lack of nursing engagement and codesign. 5 studies discussed variations in nurse digital literacy. Enablers to EMR use included two studies highlighting the importance of nurse engagement and codesign in successful EMR‐facilitated handover. Three studies showed nurses deliberately adopting EMR‐based handover tools, contrasting with previous examples of forced adaptation. No single tool was able to provide nurses with the whole patient story, the required situational awareness, nor the cognitive support required to convey and receive information during handover. An effective EMR‐mediated solution that improves the efficacy and quality of nursing handover has not yet been realised. Future efforts to design EMR‐mediated solutions to better support nurses must fully appreciate the complexities of nursing handover, the mental workload associated with the task and the definitive qualities of tools to provide this support. This REA has demonstrated the need for clinical nurses to be more directly involved in the iterative development and evaluation of these tools in order to specifically enhance processes and outcomes of nursing handover.

In 2022 the Australian Data Availability and Transparency Act (DATA) commenced, enabling accredited “data users” to access data from “accredited data service providers.” However, the DATA Scheme lacks guidance on “trustworthiness” of the data to be utilised for reuse purposes. Objectives : To determine: (i) Do researchers using government health datasets trust the data? (ii) What factors influence their perceptions of data trustworthiness? and (iii) What are the implications for government and data custodians? Method: Authors of published studies (2008–2020) that utilised Victorian government health datasets were surveyed via a case study approach. Twenty-eight trust constructs (identified via literature review) were grouped into data factors, management properties and provider factors. Results: Fifty experienced health researchers responded. Most (88%) believed that Victorian government health data were trustworthy. When grouped , data factors and management properties were more important than data provider factors in building trust. The most important individual trust constructs were: “compliant with ethical regulation” (100%) and “monitoring privacy and confidentiality” (98%). Constructs of least importance were knowledge of “participant consent” (56%) and “major focus of the data provider was research” (50%). Conclusion: Overall, the researchers trusted government health data, but data factors and data management properties were more important than data provider factors in building trust. Implications : Government should ensure the DATA Scheme incorporates mechanisms to validate those data utilised by accredited data users and data providers have sufficient quality (intrinsic and extrinsic) to meet the requirements of “trustworthiness,” and that evidentiary documentation is provided to support these “accredited data.”

Background: Health data sharing is important for monitoring diseases, policy and practice, and planning health services. If health data are used for secondary purposes, information needs to be provided to assist in reuse. Objectives: To review government health information asset websites to ascertain the extent of readily available, explanatory documentation for researcher sharing and reuse of these data. Method: Documentary analysis was undertaken on selected Victorian Government health information assets’ websites in Australia. Data were obtained on nine information-categories: data custodian; data context; data dictionary; quality controls; data quality; limitations; access process; privacy/confidentiality/security and research requests/outputs. Information-categories were compared by dataset type (administrative or population-health) and by curating organisation (government or other agency). Descriptive statistics were used. Results: The majority of the 25 websites examined provided information on data custodian (96%) and data context (92%). Two-thirds reported access process (68%) and privacy/confidentiality/security information (64%). Compared with population-health websites, administrative dataset websites were more likely to provide access to a data dictionary (67% vs 50%) and information on quality controls (56% vs 44%), but less likely to provide information on the access process (56% vs 75%) and on research requests/outputs (0% vs 56%, p = 0.024). Compared with government-curated websites, other agency websites were more likely to provide information on research requests/outputs (80% vs 7%, p < 0.001). Conclusion: There is inconsistent explanatory documentation available for researchers for reuse of Victorian Government health datasets. Importantly, there is insufficient information on data quality or dataset limitations. Research-curated dataset websites are significantly more transparent in displaying research requests or outputs.

Purpose: To investigate the association between implementation of clinical governance and patient safety. Design/methodology/approach: A pre-post study was conducted in an Australian health service following the implementation of clinical governance systems (CGS) in the inpatient wards in 2016. Health service audit data from 2017 on CGS implementation and the rate of adverse patient safety events (PSE) for 2015 (pre-implementation) and 2017 (post-implementation), across 45 wards in six hospitals were collected. CGS examined compliance with 108 variables, based on the Australian National Safety and Quality Health Service standards. Patient safety was measured as PSE per 100 bed days. Data were analysed using odds ratios to explore the association between patient safety and CGS percentage compliance score. Findings: There was no change in PSE between 2015 and 2017 (MD 0.04 events/100 bed days, 95% CI -0.11 to 0.21). There were higher odds that wards with a CGS score >90% reported reduced PSE, compared to wards with lower compliance. The domains of leadership and culture, risk management and clinical practice had the strongest association with the reduction in PSE. Practical implications: Given that wards with a CGS score >90% showed increased odds of reduced PSE health service boards need to put in place strategies that engage frontline managers and staff to facilitate full implementation of clinical governance systems for patient safety. Originality/value: The findings provide evidence that implementation of all facets of CGS in a large public health service is associated with improved patient safety.

Background: Governments have responsibility for ensuring the quality and fitness-for-purpose of personal health data provided to them. While these health information assets are used widely for research, this secondary usage has received minimal research attention. Objective: This study aimed to investigate the secondary uses, in research, of population health and administrative datasets (information assets) of the Department of Health (DoH), Victoria, Australia. The objectives were to (i) identify research based on these datasets published between 2008 and 2020; (ii) describe the data quality studies published between 2008 and 2020 for each dataset and (iii) evaluate “fitness-for-purpose” of the published research. Method: Using a modified scoping review, research publications from 2008 to 2020 based on information assets related to health service provision and containing person-level data were reviewed. Publications were summarised by data quality and purpose-categories based on a taxonomy of data use. Fitness-for-purpose was evaluated by comparing the publicly stated purpose(s) for which each information asset was collected, with the purpose(s) assigned to the published research. Results: Of the >1000 information assets, 28 were utilised in 756 publications: 54% were utilised for general research purposes, 14% for patient safety, 10% for quality of care and 39% included data quality-related publications. Almost 85% of publications used information assets that were fit-for-purpose. Conclusion: The DoH information assets were used widely for secondary purposes, with the majority identified as fit-for-purpose. We recommend that data custodians, including governments, provide information on data quality and transparency on data use of their health information assets.