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

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 2012/13 Phase 1 aged care - Phase 2 rural and remote - Phase 3 primary care

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 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

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

How? 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

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 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 networks and not duplicate functions but ensure outcomes are achieved with clear accountabilities allocated

Funding clinical placements

CLINICAL PLACEMENTS

Medical student

s

Universities and other education

providers including

simulation

Public hospitals (metro &

rural)Simulated Learning Environments Primary

care / community-

based settings

Private/NFP hospitals

Health science student

s

Jurisdictional governments departments/agencies

Federal government departments/agencies

Nursing student

s

A

BC D

E

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

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/universities

for quality standards

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 10/11 11/1212/13

$0.50m $14.95m $40.00m$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

How? Nationally developed and endorsed approach as to what

aspects of the various professions’ curricula are suitable for simulated learning

Simulated learning environments 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 be delivered via SLEs

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

tools, equipment, space and staffing required to deliver agreed curriculum

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 GroupDoHA 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 Ted Stewart-Wynne

Acting Deputy Director Clinical Services, WA Health

Council of Deans of Nursing and Midwifery

Prof Patrick Crookes

Dean, Faculty of Health and Behavioural Sciences University of Wollongong

Medical Deans Australia & New Zealand

Prof Michael Hensley

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

Australian Private Hospitals’ Association

Andrew Mereau National Workforce Planning ManagerHealth Care

Simulated learning environments Expert Working GroupCatholic Health Australia

Mr Tony McGillion

Manager - Education and Staff Development, Cabrini Health

Australian Council of Pro-Vice Chancellors and Deans of Health Science

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 Council of Dental Schools

Professor Andrew Smith

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

Australian Society for Simulation in Healthcare

Assoc Prof Leonie Watterson

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

Assoc Prof Brendan Flanagan

Director, Southern Health Simulation Centre, Assoc Prof Patient Safety Education Monash University

Michelle Kelly 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