Peter Carver

8/3/2019 Peter Carver

1/30

Progressing the national healthworkforce reform agenda

Peter CarverExecutive DirectorNational Health Workforce Taskforce

Thursday 10th September, 2009


2/30

National health workforce reform agenda COAG and health workforce reform 2008

An acknowledgment that large reform is necessarywith a particular focus on bridging health and education

National health workforce agency

Specific focus on implementing workforce reformintegrating workforce planning and policy with necessaryand 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 willbe meaningfully inclusive of the private and not for profitsectors and acute, sub acute, community, rehabilitation,community care and aged care settings


3/30

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 WorkforceAustralia) will progress the national agenda

Legislation passed June 2009

HWA is expected to be transiting to operation

from October 2009 Location: Adelaide


4/30

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

How?

Promote national uptake of innovative reforms

Development of tools, guidelines and a national evaluation framework

Test health workforce reform models

A cycle of phased work through to 2012/13Phase 1 aged care - Phase 2 rural and remote - Phase 3 primary care

Research local, national and international innovationinitiatives for whole of system uptake

Promote VET and assistant roles

Explore policy and regulatory barriers to new workforce models


5/30

Researching and building the evidence base COAG allocated over $24M over four years to lead, encourage

and support a health workforce research, planning and policydevelopment 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 workforce projections and research

National supply and demand model

Supply and demand projections global and by specialty

Workforce demand and supply workload measures

National health workforce research collaboration


6/30

Reforming education and training COAG allocated over $1.2 billion over four years to

Maximise the capacity of the health and education systemsto provide sufficient trained graduates to meet demand

Ensure education and training is appropriate, responsive

and relevant to changing health system needs andsupports innovation and reform

How?

Funding, planning and coordinating clinical trainingto provide effective, streamlined, integrated placements

Increasing number of places and expanding into non traditionalsettings, including simulation training, rural and remote, NFPand private sectors


7/30

Reforming education and training How?

Providing and attaching funding to studentsin whatever service setting they train

Training and supporting clinical supervisors

Funding training infrastructure and simulatedlearning environments

Development of a national health leadershipstrategy and programs

A focus on Inter-professional learning and placements

Competency based rather than time based learning

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


8/30

Reforming education and training HWA

Devise solutions that integrate workforce policy and reformwith reforms to education and training

Work across geography, sectors, organisations and professions

HWA responsible for setting strategic direction

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

Objective is to utilise existing arrangements and networksand not duplicate functions but ensure outcomesare achieved with clear accountabilities allocated


9/30

Funding clinical placements

CLINICAL PLACEMENTS

Medicalstudents

Universities and

other educationproviders including

simulation

Public hospitals(metro & rural)

SimulatedLearningEnvironments

Primary care /community-

based settings

Private/NFPhospitals

Healthsciencestudents

Jurisdictional governments departments/agencies

Federal government departments/agencies

Nursingstudents

A

B C D

E

Key Objectives

A. Maintain and strengthen existingrelationships between educationproviders and health care settings

B. Develop new relationshipsbetween education providers and

health care settings particularlyfostering innovation eg SLEs

C. Promote cooperation between allparties for clinical placements

D. Increase efficiency of existingtraining

E. Make better use of under-utilisedcapacity (e.g. in regional/remotehospitals, primary care/community-based settings andprivate hospitals)


10/30

Funding clinical placements Total of $992 million over four years to

subsidise professional entry clinical training

Commonwealth/State and Territory 50/50 split

Principles for the clinical training subsidy

Increase capacity and promote quality placements

Attach to students in whatever service setting they train

Key policy issues include

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/universitiesfor quality standards


11/30

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 thekey 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


12/30

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?


13/30

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 supporteducation providers, health services and studentsand reduce administrative burden

Activity, supply, demand and planning data wouldbe collected from the system as a by-productof its managing placement activity functions

As far as is possible, it is intended to identify an existingsystem that can be adapted for the national IT system

Provision of data will be mandated but health services andeducation providers not obliged to use any particular system


14/30

Clinical placement management system

Implementation approach

Detailed business requirements document

Development of a detailed costed implementation planand a functional and technical specifications document

Investigation of the potential of existing systems(Australian and international) to provide the data andfunctionality consistent with the functional specifications

Investigation of work needed to integrate legacy systems and/ortranslate data sets from old systems into the preferred system

Software development, acceptance testing and implementation

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


15/30

HWA governance arrangements

For governance of the management of clinical trainingstakeholders support

An inter-sectoral and collaborative governance model thatsituates 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 timethe need for national, jurisdictional and regional planningwhere appropriate

Mitigating the risk of over management Addressing real or perceived conflicts of interest in the

distribution of placements and funds to the public, privateand not for profit sectors


16/30


Approaches supported by stakeholders

HWA must be responsible for setting strategic directionand 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


17/30


One possible model

Agreed regional communities of interest universitiesand service providers identified through jurisdictionalplanning processes

Regional/local entities identified to establisha support function for each community of interest

Regional/local entities accountable to HWA for localmanagement 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 placementsafety and quality and learning outcomes


18/30


Implementation

The planned governance and organisation modelwill aim to respond to the key themes put forwardby stakeholders

Directions paper will be released shortly to describethe outcome of the consultation process and theframework for the planned arrangements

Consultation will continue as the model movesto implementation


19/30

Simulated learning environments

$96.5M committed over four years by the Commonwealth

Capital works development of new centresand/or re-development/expansion of existing centres

Fixed and Mobile resources

Funding for equipment & staffing

09/10 10/11 11/12 12/13

$0.50m $14.95m $40.00m $41.50m

Will encompass both high and low technical training needs


20/30


A national strategy what are we trying to achieve and how?

Increased use of simulated learning modalities in clinicaltraining for entry level health professionals to support thegrowth in system wide clinical training capacity

Optimised clinical training experiences through the useof simulated environments to develop clinical skills andcompetencies required by health professionals

Increased equity of access for students to simulatedtraining experiences in regional, rural and remote settings

Improved quality and consistency of clinical training


21/30


Scope

Definition:Simulation is a technique- not a technology- to replace oramplify real experiences with guided experiences that evoke

or replicate substantial aspects of the real world in a fullyinteractive manner (Gaba, 2004)

Professions:Any professions that could benefit from using simulationtechniques to enhance the skills necessary for clinicalpractice while expanding the capacity of the healthsystem to train students.


22/30


Scope

Modalities: Simulation can involve the use of little or notechnology, 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)


23/30


Methodology aims to

Maximise existing investment and resources

Ensure equitable access, especially rural and remote

Achieve efficient and effective utilisation

How?

Nationally developed and endorsed approach as to whataspects of the various professions curricula are suitablefor simulated learning


24/30


Phase 1 - Project Initiation

Research, clarify objectives, methodology etc

Phase 2 - National agreement on how SLEs will be used

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 bedelivered via SLEs

Phase 3 - Infrastructure development Analyse outcomes of phase one to identify resources,

tools, equipment, space and staffing required to deliveragreed curriculum


25/30


Phase 3 - Infrastructure development

Identify existing, adapt or develop new modulesto 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 resourcesneeded 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


26/30


Phase 4 Implementation

Develop and deliver relevant instructor training modules,ensuring relevant linkages with Clinical Supervisor Supportinitiative

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


27/30


Expert Working Group

DoHA Craig Winfield Director, Health Workforce Reform Section

QLD Dr Victoria Brazil Director, Qld Medical Education & Training

TAS Alice Burchill Deputy Secretary, Tasmania Health

NSW Dr Marino Festa Emergency Physician, Westmead Hospital

WA Dr TedStewart-Wynne

Acting Deputy Director Clinical Services, WA Health

Council of Deans ofNursing and Midwifery

Prof PatrickCrookes

Dean, Faculty of Health and Behavioural SciencesUniversity of Wollongong

Medical DeansAustralia & NewZealand

Prof MichaelHensley

Dean School of Medicine and Public Health Dean ofMedicine University of Newcastle

Australian PrivateHospitals Association

Andrew Mereau National Workforce Planning ManagerHealth Care


28/30


Expert Working Group

Catholic HealthAustralia

Mr Tony McGillion Manager - Education and Staff Development,Cabrini Health

Australian Council ofPro-Vice Chancellors

and Deans of HealthScience

Prof Peter Brooks University of Queensland

Prof Phillip Della Head of School of Nursing & Midwifery,Curtin University of Technology

Dr Rohan Rasiah University of Newcastle

Australasian Councilof Dental Schools

Professor AndrewSmith

Incoming Head of School, School of Dentistry,University of Western Australia

Australian Society forSimulation in

Healthcare

Assoc Prof LeonieWatterson

Director Simulation Division, Sydney Clinical Skills andSimulation Centre, Royal North Shore Hospital

Assoc ProfBrendan Flanagan

Director, Southern Health Simulation Centre, AssocProf Patient Safety Education Monash University

Michelle Kelly Project Manager - Curriculum TechnologiesIntegration, Faculty of Nursing, Midwifery and Health


29/30

Implementation and communication


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 withstakeholders through

Stakeholder advisory committees and expert working groups

Consultation during projects

Discussion papers, reference groups, forums

Regular updates - website www.nhwt.gov.auand electronic newsletters


30/30

Documents

Peter Carver