Progressing the national health workforce reform agenda

Peter Carver
Executive Director National Health Workforce Taskforce Thursday 10th September, 2009

National health workforce reform agenda

  

COAG and health workforce reform 2008 An acknowledgment that large reform is necessary with a particular focus on bridging health and education National health workforce agency


 

Specific focus on implementing workforce reform integrating workforce planning and policy with necessary and complementary reforms to education and training Will subsume the NHWT and its work program Budget of approximately $1.55B over 4 years

Progressing the national agenda for the first time will be meaningfully inclusive of the private and not for profit sectors and acute, sub acute, community, rehabilitation, community care and aged care settings

Progressing the health workforce reform agenda



The national agenda is three pronged and intersecting

  

Innovation and reform Research and workforce planning Education and training

 

The NHWT, then the national agency (Health Workforce Australia) will progress the national agenda Legislation passed June 2009 HWA is expected to be transiting to operation from October 2009 Location: Adelaide

Supporting innovation and reform



COAG allocated over $70M over four years to

 

Promote better utilisation and adaptability of the workforce Explore new and emerging roles to respond to changing demands Promote national uptake of innovative reforms


How?
 

Development of tools, guidelines and a national evaluation framework A cycle of phased work through to 2012/13 Phase 1 aged care - Phase 2 rural and remote - Phase 3 primary care

Test health workforce reform models



  

Research local, national and international innovation initiatives for whole of system uptake Promote VET and assistant roles Explore policy and regulatory barriers to new workforce models

Researching and building the evidence base



COAG allocated over $24M over four years to lead, encourage and support a health workforce research, planning and policy development agenda How?


Continually improve national health workforce information

  

National workforce data, data standards, frameworks and process National health workforce statistical dataset National clinical placement data and management system National supply and demand model Supply and demand projections global and by specialty Workforce demand and supply workload measures

National workforce projections and research

  

National health workforce research collaboration

Reforming education and training



COAG allocated over $1.2 billion over four years to

 

Maximise the capacity of the health and education systems to provide sufficient trained graduates to meet demand Ensure education and training is appropriate, responsive and relevant to changing health system needs and supports innovation and reform Funding, planning and coordinating clinical training to provide effective, streamlined, integrated placements Increasing number of places and expanding into non traditional settings, including simulation training, rural and remote, NFP and private sectors

How?
 

Reforming education and training



How?
    

Providing and attaching funding to students in whatever service setting they train Training and supporting clinical supervisors Funding training infrastructure and simulated learning environments Development of a national health leadership strategy and programs A focus on
 

Inter-professional learning and placements Competency based rather than time based learning

Exploration of common competencies in health professions and greater consistency in curriculum within and across professions

Reforming education and training



HWA
 

Devise solutions that integrate workforce policy and reform with reforms to education and training Work across geography, sectors, organisations and professions Develop policy, national KPIs, support accreditation bodies, identify and foster cultural change, best practice and innovation Fund support for placement management and brokerage Fund clinical placements on an output based funding model

HWA responsible for setting strategic direction

  

Objective is to utilise existing arrangements and networks and not duplicate functions but ensure outcomes are achieved with clear accountabilities allocated

Funding clinical placements

Federal government departments/agencies Jurisdictional governments departments/agencies

Universities and other education providers including simulation

Public hospitals (metro & rural)

C Simulated Learning Environments D

Medical students

Nursing students

Health science students

Primary care / communitybased settings Private/NFP hospitals

CLINICAL PLACEMENTS

Key Objectives A. Maintain and strengthen existing relationships between education providers and health care settings B. Develop new relationships between education providers and health care settings particularly fostering innovation eg SLEs C. Promote cooperation between all parties for clinical placements D. Increase efficiency of existing training E. Make better use of under-utilised capacity (e.g. in regional/remote hospitals, primary care/ community-based settings and private hospitals)

Funding clinical placements



Total of $992 million over four years to subsidise professional entry clinical training


Commonwealth/State and Territory 50/50 split Increase capacity and promote quality placements Attach to students in whatever service setting they train Which professions, qualifications and settings are eligible What weightings or other measures are needed How to ensure current contribution levels maintained Linking with accreditation bodies/universities for quality standards

Principles for the clinical training subsidy

 

Key policy issues include

   

Clinical supervisor support



Funding is provided for improving clinical supervision capacity and competence in professional entry training $56M committed over four years
 

$28M Commonwealth $28M States and Territories

All parties agree that the quality of supervision is the key influence on the quality of the clinical placement There is a pressing need to build up the numbers in the workforce who are prepared to take on this role

Clinical supervisor support



National framework to support services to train students and increase capacity to supervise students to be developed Key policy issues include
    

Recognising profession/provider differences How to ensure current contribution levels maintained Vertical integration of training How to ensure quality Should it include SLEs?

Clinical placement management system



A system that addresses data needs at all levels and supports the placing and receiving organisations has been agreed Either a national or local on-line system to support education providers, health services and students and reduce administrative burden Activity, supply, demand and planning data would be collected from the system as a by-product of its managing placement activity functions As far as is possible, it is intended to identify an existing system that can be adapted for the national IT system Provision of data will be mandated but health services and education providers not obliged to use any particular system

Clinical placement management system



Implementation approach
 

 

Detailed business requirements document Development of a detailed costed implementation plan and a functional and technical specifications document Investigation of the potential of existing systems (Australian and international) to provide the data and functionality consistent with the functional specifications Investigation of work needed to integrate legacy systems and/or translate data sets from old systems into the preferred system Software development, acceptance testing and implementation

Implementation will be phased with a scaled-back system implemented in the 2010 academic year

HWA


governance arrangements

For governance of the management of clinical training stakeholders support



 

An inter-sectoral and collaborative governance model that situates planning, coordination, policy direction, standard setting and quality assurance within the scope of HWA Placement management and brokerage to occur as close as possible to the activity, supporting at the same time the need for national, jurisdictional and regional planning where appropriate Mitigating the risk of over management Addressing real or perceived conflicts of interest in the distribution of placements and funds to the public, private and not for profit sectors

HWA



governance arrangements

Approaches supported by stakeholders

HWA must be responsible for setting strategic direction and determining outcomes for clinical training


 

Establish training priorities, monitor performance and promote continuous development Develop policy, national KPIs, supporting accreditation bodies, identify and foster cultural change, best practice and innovation Assess delivery of COAG outputs Fund regional communities of interest to support brokerage and collaboration

HWA flow student placement funds, according to an output based funding model

HWA



governance arrangements

One possible model

Agreed regional communities of interest universities and service providers identified through jurisdictional planning processes Regional/local entities identified to establish a support function for each community of interest Regional/local entities accountable to HWA for local management of placements, ensuring outcomes are met Clinical training outcomes national (from accreditation bodies and HWA) and from universities in accordance with curriculum Clinical training providers responsible for delivery of training, according to nationally agreed standards for clinical placement safety and quality and learning outcomes

HWA


governance arrangements

Implementation  The planned governance and organisation model will aim to respond to the key themes put forward by stakeholders  Directions paper will be released shortly to describe the outcome of the consultation process and the framework for the planned arrangements  Consultation will continue as the model moves to implementation

Simulated learning environments



$96.5M committed over four years by the Commonwealth

  

Capital works development of new centres and/or re-development/expansion of existing centres Fixed and Mobile resources Funding for equipment & staffing 09/10 $0.50m 10/11 $14.95m 11/12 $40.00m 12/13 $41.50m

Will encompass both high and low technical training needs

Simulated learning environments



A national strategy


what are we trying to achieve and how?

Increased use of simulated learning modalities in clinical training for entry level health professionals to support the growth in system wide clinical training capacity Optimised clinical training experiences through the use of simulated environments to develop clinical skills and competencies required by health professionals Increased equity of access for students to simulated training experiences in regional, rural and remote settings Improved quality and consistency of clinical training

Simulated learning environments



Scope


Definition: Simulation is a technique- not a technology- to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004) Professions: Any professions that could benefit from using simulation techniques to enhance the skills necessary for clinical practice while expanding the capacity of the health system to train students.

Simulated learning environments



Scope


Modalities: Simulation can involve the use of little or no technology, as in role plays, through to complex interactive patient simulators , including:
    

Verbal (Role playing) Standardised patients (Actor) Part-task trainer (Physical; virtual reality) Computer patient (Computer screen; screen based virtual world ) Electronic patient (Replica of clinical site; mannequin based; full virtual reality)

Simulated learning environments



Methodology aims to
  

Maximise existing investment and resources Ensure equitable access, especially rural and remote Achieve efficient and effective utilisation Nationally developed and endorsed approach as to what aspects of the various professions curricula are suitable for simulated learning

How?


Simulated learning environments



Phase 1 - Project Initiation



Research, clarify objectives, methodology etc Engage and resource universities and accreditation bodies Explore existing curricula and new opportunities Achieve national agreement within and where possible, across professions on what aspects of curricula will be delivered via SLEs Analyse outcomes of phase one to identify resources, tools, equipment, space and staffing required to deliver agreed curriculum

Phase 2 - National agreement on how SLEs will be used

  

Phase 3 - Infrastructure development



Simulated learning environments



Phase 3 - Infrastructure development



Identify existing, adapt or develop new modules to facilitate nationally consistent approaches. Undertake regional EoI process submission to cover
 

 

  

Audit existing SLE resources within the region Map student activity to identify quantum of resources needed to deliver curriculum Gap analysis to reveal where need exists Collaboration with all partners across regions to ensure geographic coverage How existing resources and infrastructure will be maximised How instructors will be supported Ensure sustainability

Simulated learning environments



Phase 4


Implementation

     

Develop and deliver relevant instructor training modules, ensuring relevant linkages with Clinical Supervisor Support initiative Prioritise developments over 4 yr period. Develop sustainability plans and business models Develop evaluation plan(s) Develop research plan Develop knowledge exchange plan Undertake fora and consultation activities as necessary

Simulated learning environments



Expert Working Group

Craig Winfield Dr Victoria Brazil Alice Burchill Dr Marino Festa Dr Ted Stewart-Wynne Prof Patrick Crookes Prof Michael Hensley Andrew Mereau Director, Health Workforce Reform Section Director, Qld Medical Education & Training Deputy Secretary, Tasmania Health Emergency Physician, Westmead Hospital Acting Deputy Director Clinical Services, WA Health Dean, Faculty of Health and Behavioural Sciences University of Wollongong Dean School of Medicine and Public Health Dean of Medicine University of Newcastle National Workforce Planning Manager Health Care

DoHA QLD TAS NSW WA Council of Deans of Nursing and Midwifery Medical Deans Australia & New Zealand Australian Private Hospitals Association

Simulated learning environments



Expert Working Group

Mr Tony McGillion Prof Peter Brooks Prof Phillip Della Dr Rohan Rasiah Manager - Education and Staff Development, Cabrini Health University of Queensland Head of School of Nursing & Midwifery, Curtin University of Technology University of Newcastle Incoming Head of School, School University of Western Australia of Dentistry,

Catholic Health Australia Australian Council of Pro-Vice Chancellors and Deans of Health Science Australasian Council of Dental Schools Australian Society for Simulation in Healthcare

Professor Andrew Smith Assoc Prof Leonie Watterson Assoc Prof Brendan Flanagan Michelle Kelly

Director Simulation Division, Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital Director, Southern Health Simulation Centre, Assoc Prof Patient Safety Education Monash University Project Manager - Curriculum Technologies Integration, Faculty of Nursing, Midwifery and Health

Implementation and communication



Simulated learning environments  Curriculum work led by Councils of Deans  Discussion paper  Fora and workshops as curriculum develops  Advice from Expert Working Group In all work NHWT and HWA will communicate with stakeholders through
   

Stakeholder advisory committees and expert working groups Consultation during projects Discussion papers, reference groups, forums Regular updates - website www.nhwt.gov.au and electronic newsletters