Academic literature on the topic 'Management Australia Employee participation'

Non-union representative employee participation recently has attracted increasing international attention in employment relations due to the growing representation gap in many countries as union membership declines, and mounting evidence of the benefits of representative employee participation for enterprise flexibility and efficiency. However, relatively little is known about Australian experiments in employee participation, although it is essential to learn from Australian experience in order to develop effective public policy. This case study represents a contribution to this larger project. SMEC is a non-union employee representative body that has adopted a European works council organizational model. The case study evaluates SMEC's effectiveness as a non-union form of representative employee participation. It concludes that the opportunities for the formation of genuinely independent works council style organs of employee participation remain severely constrained by the current Australian regulatory environment, which tends to encourage a union substitution role.

Unmet demand for union membership is defined as employees in non-union workplaces who would join a union if given the opportunity. Unmet demand is a significant issue for Australian unions as union density continues to decline and the current legislative environment remains hostile. This article gauges the contours of unmet demand for union membership in Australia, drawing on responses to the Australian Worker Representation and Participation Survey (AWRPS 2004). It finds a significant level of unmet demand for union membership in Australia. Unmet demand varies according to workplace and employee characteristics and is highest among low income earners, younger workers, workers with shorter organizational tenure and workers in routinized occupations. The practical implications of our findings are discussed in relation to union renewal and the legislative environment prevailing in 2008.

The international trend in the growth and incidence of “non‐standard employment”, and its highly gendered nature, is well documented. Similarly, interest in employee involvement or participation by academics and practitioners has seen the emergence of a rapidly growing body of literature. Despite the continued interest in each of these areas, the literature is relatively silent when it comes to where the two areas intersect, that is, what the implications are for employee participation in the growth of non‐standard employment. This paper seeks to redress this relative insularity in the literature by examining some broad trends in this area in Australia. The literature lacks one clear, accepted definition of “non‐standard” employment. For ease of definition, and because of the nature of the available data, we focus on part‐time employment in this paper. The paper analyses data from the Australian Workplace Industrial Relations Survey of 1995 (AWIRS 95). It tests the hypotheses that part‐time employees enjoy less access to participatory management practices in the workplace than their full‐time counterparts, and that this diminishes the access to participation in the workplace enjoyed by female workers in comparison with their male colleagues, since the part‐time workforce is predominantly feminised. These hypotheses were strongly confirmed. This has major implications for workplace equity, and for organisational efficiency.

Objective. Recent health system enquiries and commissions, including the National Health and Hospital Reform Commission, have promoted clinical engagement as necessary for improving the Australian healthcare system. In fact, the Rudd Government identified clinician engagement as important for the success of the planned health system reform. Yet there is uncertainty about how clinical engagement is understood in health policy and management. This paper aims to clarify how clinical engagement is defined, measured and how it might be achieved in policy and management in Australia. Methods. We review the literature and consider clinical engagement in relation to employee engagement, a defined construct within the management literature. We consider the structure and employment relationships of the public health sector in assessing the relevance of this literature. Conclusions. Based on the evidence, we argue that clinical engagement is similar to employee engagement, but that engagement of clinicians who are employees requires a different construct to engagement of clinicians who are independent practitioners. The development of this second construct is illustrated using the case of Visiting Medical Officers in Victoria. Implications. Antecedent organisational and system conditions to clinical engagement appear to be lacking in the Australian public health system, suggesting meaningful engagement will be difficult to achieve in the short-term. This has the potential to threaten proposed reforms of the Australian healthcare system. What is known about the topic? Engagement of clinicians has been identified as essential for improving quality and safety, as well as successful health system reform, but there is little understanding of how to define and measure this engagement. What does this paper add? Clinical engagement is defined as the cognitive, emotional and physical contribution of health professionals to their jobs, and to improving their organisation and their health system within their working roles in their employing health service. While this construct applies to employees, engagement of independent practitioners is a different construct that needs to recognise out-of-role requirements for clinicians to become engaged in organisational and system reform. What are the implications for practitioners? This paper advances our understanding of clinical engagement, and suggests that based on research on high performance work systems, the Australian health system has a way to go before the antecedents of engagement are in place.

Sound management practices, and employee awareness and commitment, are the keys to eliminating workplace injury. In Esso Australia's production operations, the goal is NO INJURIES for both company and contractor employees. Achieving this goal entails significant commitment to putting safety first, and elimination of conflicting messages about the production versus safety priorities.Throughout the last decade, Esso Australia has increasingly sought to heighten the safety awareness of all people working within and supporting its production operations. The emphasis has gradually moved from hardware safety to focusing on attitudes within the workforce — at the same time, however, ensuring that facilities meet industry standards.Results in 1988 show a marked drop in injury days lost for the total company and contractor employee group in production operations.A safe work environment is good business. Putting safety first need not cost money; indeed a safer workplace can be more efficient. Achieving a safe environment involves clear communication of goals and values, employee participation, delegation of authority, increasing accountability, effective incident investigation and follow- up, appropriate discipline, and recognition of positive contributions. Of paramount importance is a clear direction from top management that safety is the top priority.

This paper presents an overview of industrial relations in Nordic countries. Key features are a high degree of centralisation, high levels of unionisation, a tripartite approach to government decision making and a keen interest in employee participation. The last decade has seen the onset of more turbulent economic forces, moves to decentralisation and a shift in wage determination towards a greater role for enterprise bargaining. Several parallels with Australian experience are explored. A critical difference is that Nordic unions have escaped the significant falls in membership suffered by Australian unions.

This study examines the behavioral commitment ( intent to stay) of a sample of blue-collar employees from a manufacturing firm in Australia. The purpose was to test an integrated causal model of behavioral commitment based on four general classes of variables: structural, pre-entry, environmental, and employee orientations. The LISREL results indicate that variables rank ordered in terms of importance for their total causal effects on the decision process of employees to stay or leave an organization is as follows: job search, job satisfaction, job security, attitudinal commitment, union participation, environmental opportunity, physical conditions, job hazards, met expectations, equity, family responsibility, centraliza tion, supervisory support, and work group cohesion.

Given the increasing high social and economic costs of occupational injury and illness to the Australian community, identification of initiatives to reduce the burden is urgently required. Paramount to reversing this trend is the need to identify and address the causes of the injury and illness. Employee involvement in occupational health and safety has for some time been espoused as an essential element in any occupational health and safety program, but its relationship with safety performance still remains unexplored. Although various theories suggest that the involvement of employees will increase their sense of ownership, there is little research to suggest that employees have the ability to develop a valid and reliable tool to measure safe practices in the workplace. The primary purpose of this study was to provide preliminary evidence of content and construct validity of an employee developed checklist in measuring compliance with safe behaviours. The second objective was to compare behaviours at two workplaces, one with an incentive scheme to promote safe behaviour and one without. The third objective was to determine the relationships between demographic characteristics of participants and compliance with safe behaviour. The study was conducted in two distinct phases. The first phase was an instrument development phase while the second was an implementation phase. Phase I involved the design of an employee developed checklist (EDC) and a theoretically developed checklist (TDC). Content validity testing was conducted by a panel of five experts in the field of instrument design and occupational health and safety. Phase II involved the observation of a sample of 44 ride on lift truck operators from two large manufacturing and logistics companies based in Victoria, over a three month period to measure compliance with safe work practices. Data was analysed to establish whether the EDC is a valid and reliable tool when compared against the TDC. The results provide preliminary evidence to suggest that employees possess the necessary skill and knowledge to develop a valid observational checklist. A Wilcoxon signed-ranks test for dependent samples indicates that there was no significant difference between the compliance scores recorded on the EDC and the scores recorded on the TDC. Further analysis of scores obtained for three items on the EDC were analysed against similar items on the TDC with no significant deficiencies found. Additionally, analysis of the correlation between the scores obtained on the TDC and EDC revealed a moderately strong positive relationship between the two checklists (r, = 0.414, p=.032). Inter rater reliability testing by intra class correlation and percentage agreement revealed problems with both the EDC and TDC, which may be partially explained by the relatively high level of compliance with safe behaviour at both sites and the method of testing. In this sample, age, gender and the presence of safety incentive schemes had no significant effect on the level of compliance. The level of experience did, however, show a positive relationship with compliance levels (r, = 0.32, p=.048). The results of this study present a number of potential benefits for workplaces including the justification of employee involvement in occupational health and safety measurement, employee involvement in goal setting and the feasibility of developing a proactive, inexpensive and flexible measure of occupational health and safety performance.

This thesis is an empirical examination which links two important areas of management accounting research. The first area relates to the relation between superiors' evaluative styles and the two dependent variables of job related tension and managerial performance. The second area relates to the impact of culture on management accounting system. Two of Hofstede's (1980) dimensions of culture were used in this study. They were power distance and individualism. Two studies, Brownell and Hirst (1986) and Brownell and Dunk (1991), both of which were conducted with samples from a low power distance/high individualism nation were re-examined within the framework suggested by Harrison (1992) that research results related to budgetary participation can be generalized between high power distance/low individualism and low power distance/high individualism nations. Multiple linear regressions were used to test the three-way interaction between budget emphasis, budgetary participation and task characteristics (task uncertainty, task variability or task difficulty), affecting each of the two dependent variables of managerial performance and job related tension. A four-way interaction between budget emphasis, budgetary participation, task difficulty and culture was also tested. A questionnaire was administered to a sample of 410 functional heads from 142 manufacturing companies located in Singapore and Western Australia. Singapore was selected as a surrogate for a high power distance/low individualism culture and Western Australia as a surrogate for a low power distance/high individualism culture. The results of the study lend support to the existence of a three-way interaction affecting managerial performance in the case of task difficulty (Van de Ven & Delbecq,1974) but not in the results of Brownell and Hirst (1986) and Brownell and Dunk (1991). No significant three-way interaction between the independent variables affecting job related tension was found. Furthermore, the absence of any four-way significant interaction between budget emphasis, budgetary participation, task difficulty and culture affecting managerial performance provide strong support for Harrison's (1992) hypotheses that research results on budgetary participation can be generalized between nations with high power distance/low individualism culture and nations with low power distance/high individualism culture.

This thesis explores employee participation in the management of workplace change through an organisational justice framework within the context of the Australian Higher Education (HE) sector. The thesis examines the extent to which the Australian HE sector makes provisions for participative workplace change, the extent to which participants within the sector perceive participative workplace change as providing fairness, and practices that can facilitate and foster participative workplace change. The provisions for participative workplace change are examined through a longitudinal study of enterprise bargaining agreements across all public universities in Australia for the period of 1997-2006. The research findings identify a decline in both the degree and form of employee participation in workplace change across this decade. The perceptions of participative workplace change are examined through an altitudinal survey of management and union executives within all public universities in Australia. The research findings identify considerable divergence between management and union executives in relation to employee participation, workplace change and organisational justice. The practices for participative workplace change are examined through twenty semi-structured interviews with management and union executives drawn from amongst the respondents to the attitudinal survey. The research findings identify areas of convergence around organisational justice dimensions and workplace change practices between management and union executives. The thesis concludes that it is a combination of fair processes and fair interactions which are most effective in facilitating workplace change and fostering employee participation in the Australian HE sector and which in turn are seen to be able to contribute to shared perceptions of organisational justice.

A lot of attention over the years has been focused on understanding employees resistance to change. A few researchers have provided insights into the reasons why some employees remain positive and engaged during times of uncertainty and changes in the organosation. To help build this knowledge area the study was aimed to investigating the factors that drive employee engagement during change. One-hundred-and-twenty employees, across a cross-section of jobs at a specific bank in South Africa, were surveyed. The empirical results obtained from the survey showed that independent variables such as dialogue, organisational culture and a clear4 career plan were congruent with the expected results. In other words these vriables displayed a significant association with the de[endent variables (e.g. job involvement, organisational commitment and organisational citizenship behaviour.).

The purpose of this research was to compare employee participation practices in a Swedish and a British bank. There has been considerable interest in human resource management over the past decade, of which employee participation forms an important part, but there have been very few studies which attempt a qualitative comparison of international aspects of this subject. By using a wider study, the Price Waterhouse Cranfield Project on . International Human Resource Management, a European context is provided for the case study material, which examines in depth the forms and outcomes of employee participation in a Swedish and British setting. A triangulation methodology was employed using two questionnaires given to employees of each organisation, a series of in-depth interviews, a reading of company documentation and personal visits. This enabled the use of a multiple of approaches with the questionnaires providing a framework for the in-depth interviews. Four hypotheses were posed which offered tentative explanations for the similarities and differences in employee participation practices in Sweden and Britain. The findings were then analysed using Poole's Framework of Participation which proposes a number of contingent factors which influence the outcomes of employee participation. The thesis showed that Swedes allow greater participation in the workplace than the British, explanations of which are rooted in the cultural and ideological differences of the two societies. Secondly, it was shown that the drive for profit or financial stability will override participation mechanisms if it is felt necessary for survival. Thirdly, HRM techniques of employee participation are used mainly at a micro (workplace) level in the organisation as they can safely be distanced from any strategic decision making. Thus the strength of employee participation is very much anchored to the latent power of employees which is influenced by convergent forces such as economic, technological and political factors, and divergent forces such as cultural and ideological factors.

The research was conducted in a case study organisation and involved two stages. An initial attitude survey was administered to employees in the first three months of the company's employee share ownership scheme and a second survey was administered eighteen months later. In addition to the surveys, data were also obtained via depth interviews with senior managers and group discussions with employees. A series of models were developed to test possible reasons why employees joined the scheme and the nature of the relationship between the reason for joining and both participation in the scheme as well as the level of investment made to the scheme. Of particular interest was whether financial capacity was a significant factor influencing whether employees joined or the level at which they invested. The results showed that two of the models of reasons for joining predicted either participation in the scheme or the level of investment made. Financial capacity was also highly significant in predicting both participation in the scheme as well as the level of the investment. Outcomes of the scheme, both attitudinal and behavioural, were examined using employees' self-reports and 'objective' measures comparing changes over time. Analysis was also conducted to determine whether reasons for joining influenced subsequent outcomes. Employees' indicated that they expected or experienced only modest attitudinal changes as a result of the scheme and they did not expect behaviour to change. The 'objective' measures confinned that neither participation in the scheme, nor the level of investment made to the scheme were significant predictors of attitudes or behaviour eighteen months after employees had joined. Attitudes generally declined over the eighteen months between the surveys, but this again was unrelated to participation or to the level of investment in the scheme. The employees' reason for joining also did not appear to be a significant predictor of attitudes.

There has been a recent upsurge in media attention surrounding Australia’s ageing workforce. A review of academic, media and grey literature highlighted inadequacies in existing workplace polices, as well as flaws in financial and social security schemes. Of particular concern were persistent negative attitudes and counterproductive policies regarding mature age employees (MAEs). Poor retention rates among this cohort of workers aged 45 years and over are leading to skilled labour shortages and losses in corporate knowledge. This expected mass exodus of mature cohorts into retirement has been predicted to negatively impact the socio-economic sustainability of ageing societies world-wide and is a pertinent issue for Western Australia (WA). The overarching objective of this study was to identify the ‘place’ of mature cohorts within WA workplaces and promote strategies that will improve the employment conditions and overall quality of life of ageing workforces. Research questions aimed to address the need for greater mature age employment up to and beyond pensionable age; identify ‘gaps’ in policies and programmes; and explore how mature cohorts were perceived (valued) and the extent their departure may affect WA society (labour force). By using a mixed methods research design, this Doctoral dissertation developed a conceptual framework for limiting significant issues individuals, businesses and society may experience as a result of WA’s ageing workforce; whilst simultaneously promoting the benefits of maturity and mature age employment. This Re-Model draws upon the community development work principles of social justice, empowerment and social capital; and is further contextualised by methods of best practice identified from the triangulation of secondary sources, quantitative data and qualitative inquiry. Primary data collection involved the completion of 362 surveys, followed by 27 semistructured interviews and four focus group activities, with a cross section of MAEs, volunteers, their employers, retirees and unemployed cohorts from across WA. Over one-third of current MAEs, employers and volunteers in this study reported they intended working later than the traditional age of retirement, with 71 per cent of this sample planning to semi-retire. Furthermore, almost 60 per cent of a sample that had previously exited the labour force was working at the time of data collection as semi-retirees or rehired retirees (rehirees). Collectively, these statistics indicated that despite predictions of mass disengagement among mature cohorts, most of this crosssection of Western Australians are seeking to remain in (or re-enter) the WA workforce beyond pensionable age. However, quantitative and qualitative findings revealed several barriers to their continued engagement, including access to ‘age-friendly’ workplaces; a dearth of targeted training (career) development and employment assistance; and a lack of value attributed to mature age skills and experience, particularly deleterious in WA’s youth-centric culture. Primary data also highlighted several enabling factors for mature age employment. ‘Flexibility’ and ‘autonomy of choice’ were cited as key dimensions across all aspects of paid work, volunteering and retirement – whether in terms of worklife- balance; the individuation of training and development; or options available to those transitioning out of traditional employment. Data indicated that sustainable cultural change required more than just the removal of negative policies or introduction of punitive legislation. Maintaining a positive outlook among mature age individuals and simultaneously educating (younger) co-workers, employers, policy-makers (stakeholders) and society about the virtues of maturity and non-traditional work (skills) were considered essential to changing societal attitudes, behaviour and culture.

AbstractCrowdsourcing has become one of the main resources for working on so-called microtasks that require human intelligence to solve tasks that computers cannot yet solve and to connect to external knowledge and expertise. Instead of using external crowds, several organizations have increasingly been using their employees as a crowd, with the aim of exploiting employee’s potentials, mobilizing unused technical and personal experience and including personal skills for innovation or product enhancement. However, understanding the dynamics of this new way of digital co-working from the technical point of view plays a vital role in the success of internal crowdsourcing, and, to our knowledge, no study has yet empirically investigated the relationship between the technical features and participation in internal crowdsourcing. Therefore, this chapter aims to provide a guideline for organizations and employers from the perspective of the technical design of internal crowdsourcing, specifically regarding issues of data protection privacy and security concerns as well as task type, design, duration and participation time based on the empirical findings of an internal crowdsourcing platform.

Today’s technological and societal developments are creating new possibilities for designing an economical, flexible and human-oriented work organization e.g. by facilitating more agile management concepts. Research has been concerned with participative leadership styles for many decades, and these have recently been gaining renewed relevance in meeting the demands placed on leadership in modern management settings. Therefore, existing concepts of participative leadership need to be put to test for today’s work organization.An established concept of participative leadership is the model by Vroom (2000, based on Vroom & Yetton, 1973 and Vroom & Jago, 1988), which distinguishes between different degrees of employee participation in decision-making processes depending on situational contextual factors. Empirical studies show that managers who use a participative decision-making style consistent with the model by Vroom have more productive and satisfied employees as well as higher decision quality (e.g. Paul & Ebadi, 1989, Pasewark & Strawser, 1994). Because this model outlines clear implications for employee participation in decision-making based on if-then operations, it can help young managers in particular to structure decision-making processes and to reflect on how to involve employees depending on specific situational contextual factors.As in other sectors, healthcare is affected by the challenges of today's work organization. As far as leadership is concerned, managers usually learn leadership behavior implicitly and there is a high demand of leadership development and the teaching of useful leadership models (McAlearney, 2006). Therefore, this study focuses on the application of the model on employee participation in decision-making processes in healthcare context and poses the following research question: Which situational contextual factors influence managers’ decision to involve employees?As a first step, literature and semi-structured interviews with healthcare managers were used to identify relevant situational contextual factors in decision-making for healthcare: time pressure, information availability, employee acceptance, employee expertise and employee engagement.In a second step, assumptions about the degree of participation depending on given situational factors in healthcare were formulated, based on empirical findings on the model by Vroom.In a third step, healthcare managers (N=30) were asked to complete a questionnaire indicating what level of participation they would choose for different combinations of the given situational contextual factors in decision-making. Following assumptions regarding participation depending on situational contextual factors were confirmed by the healthcare managers: -If there is time pressure, the manager would make decisions without employee participation. -If employee acceptance is important, there would be a group decision-making process. -If an employee has more knowledge or expertise on a decision problem than the manager, the person would be involved in the decision-making process. -If employees share the organization's goals, they can participate in the decision-making process.The findings show consistency with the decision-making model by Vroom and support the relevance of participative leadership in healthcare. Possibilities for the next step of developing a decision tree that links situational factors with if-then operations and lead to a recommended level of employee participation in decision-making processes in the healthcare context are discussed.

Fourth industrial revolution and digital economy have affected many organizations and fostered them to become digital in order to survive and succeed. Leaders of digital organizations need to embrace numerous changes not only in organizational structure that becomes flat with mini­mal hierarchy, control, bureaucracy but also in all organizational processes and activities. One of the most important organizational processes is in­ternal communication which becomes digital due to modern information and communication technologies and tools. This paper shows the role and importance of agile leaders in establishing and nurturing effective internal communication in digital organizations. To achieve the goal of effective digital communication in all directions and through the entire organization, leaders should be agile enough to establish appropriate communication channels, stimulate creative and critical thinking, new ideas, information and knowledge share, real time feedback, build and nurture trust among employees and engage employee participation in decision making.

This empirical research is aimed to develop knowledge especially human resource management and resolve problem through a research about employee performance measurement through quality of work life, commitment and job satisfaction as the intervening variable with employees of PDAM TIRTAWENING as a sample as 102 questionnaires distributed to the chosen respondent and used as stastistic analysis. A measurement of quality of work life consists of four dimensions : growth and development, salary (reward system), participation, and work environment. Three model components and measurement of organization commitment such as affective commitment, continuance commitment and normative commitment. Job satisfaction consists of five factors that are the work itself, salary, promotion, relationship between the superior and the subordinates. Whereas employee performances consists of six factors : quality, quantity, proficiency, knowledge, punctuality, and communication. The result of the reseach using Path Analysis to show that to optimalize employee performance, need to notice another variables that not shown in this research.

While managers and supervisors may be hired for certain variety of skills sets, abilities, and knowledge, not all of these workers may be educated or trained to be workplace coaches or mentors may or may not have the tolerance and patience for such a role. However, Human Resource Management professionals in the workplace need to realize that there may be a need for coaching training and skills enhancement workshops to prepare today’s workforce managers. The key for success in this area is to conduct a need assessment for the workers and managerial staff to determine what is needed from today’s workplace coaches in terms of needed skills sets and strategies to be utilized by them to help enhance, motivate, monitor, and evaluate the human capital working for today’s organization. Next, the development and design of a coaching program can be instrumental in moving today’s managerial workforce from general coaches to more specialized coaches to help develop and today’s workforce, as well as help strengthen their own skills sets and knowledge in order to help obtain better results of organizational goals, as well as develop stronger working relationships and bonding with the workers. Equally important, today’s workers need to exert an equal amount of effort and participation in a coaching environment in order to gain better outcomes in terms of performance and efficiency. This presentation will focus on the creation of better coaching programs and evaluation of coaching relationships and outcomes.

Accidents related to production, processing, storage and transportation of oil and its by-products have been studied extensively because of their social and environmental impacts. However, accidents relating to construction of oil facilities have been largely ignored by researches, perhaps because such accidents involve a smaller group of people and result in smaller-scale environmental impacts. Pipeline construction projects are particularly unique. As opposed to construction of processing plants, pipeline construction covers a very long reach, often involving varying site conditions. Consequently, there are more environmental issues, many of which vary from place to place along the pipeline route as a result of the differing soil, drainage, vegetation and exposure conditions. The variable conditions, exposure and consequences of accidents along a pipeline route result in many challenges related to risk management. Specifically, risk management is difficult as a result of transportation along the pipeline corridor, multiple access routes to the pipeline corridor, unique culture and social issues in various parts of the country, and remote working conditions. Major issues are moving work sites; crossing of different areas of the country with several typical cultural and regional aspects; multiple work sites and the isolation of workers in small groups. These factors make risk management particularly important, but easy to ignore. In this paper we discuss the major potential risks in every phase of the pipeline construction. The paper describes the company’s process for managing risk during pipeline construction. It identified the limitations of traditional safety management systems in coping with the critical problems related to environmental and safety issues. Many company are using integrated management systems as the major tools to control risk. Such systems cover health, safety and environmental issues (HSE). PETROBARS, as the largest Brazilian oil company and one of the leading oil companies in the world, has adopted the HSE system. The system focuses on employee participation in implementation of the HSE system.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.