Peter Brooks, Australian Health Workforce Institute - Nurses: The Key to Health Workforce Reform
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Peter Brooks, Australian Health Workforce Institute - Nurses: The Key to Health Workforce Reform

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Peter Brooks, Director, Australian Health Workforce Institute delivered this presentation at the 2012 Clinical Training & Workforce Planning Summit. ...

Peter Brooks, Director, Australian Health Workforce Institute delivered this presentation at the 2012 Clinical Training & Workforce Planning Summit.

The 2012 Clinical Training & Workforce Planning Summit discussed the future of Australia's nursing workforce, exploring ways to ensure the capacity and experience to provide high quality care for our nation's increasing healthcare needs.

For more information, please visit http://www.informa.com.au/clinicaltraining12

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Peter Brooks, Australian Health Workforce Institute - Nurses: The Key to Health Workforce Reform Presentation Transcript

  • 1. NURSES-The key to health workforce reform Peter Brooks AHWI University of Melbourne
  • 2. • What constitute the workforce • Why does it need to change • How can nurses assist in that change • How do we help the system work together • How do we pay for it
  • 3. THE RIGHT PEOPLE IN THE RIGHT JOB WITH THE RIGHT SKILLS AT THE RIGHT TIME
  • 4. Australia – Health Workforce Health and social assist 1.3 mill.-largest segment 60% fulltime 78% female Growing – 12% increase (95-2000)
  • 5. Why nurses • Largest group 2005 2009 Clinician 222974 259786 Education 7226 9570 Researcher 1970 2325 Total 244760 276751 Over 50yrs 35.8% 36.3%
  • 6. FINDINGS: Medical workforce results Scenario 2016 (Head count) 2025 (Head count) Supply Demand Gap Supply Demand Gap Doctors Comparison 93,687 89,903 3,784 109,225 111,926 -2,701 Productivity gain 93,687 87,966 5,720 109,225 106,413 2,811 Low demand 93,687 80,655 13,032 109,225 90,536 18,690 Medium self- sufficiency 91,956 89,903 2,053 102,626 111,926 -9,300 High self- sufficiency 90,398 89,903 495 96,686 111,926 -15,240 High demand 93,687 100,019 -6,333 109,225 135,349 -26,124 Undersupply of 5% 93,687 94,430 -744 109,225 117,615 -8,389 Capped working hours 91,687 89,863 1,824 106,781 111,960 -5,178
  • 7. FINDINGS: Nursing workforce results Scenario 2016 (Head count) 2025 (Head count) Supply Demand Gap Supply Demand Gap Nurses Comparison 296,552 316,632 -20,079 280,442 389,932 -109,490 Productivity gain 296,552 309,705 -13,153 280,442 370,435 -89,993 Low demand 296,552 282,551 14,002 280,442 311,797 -31,355 Workforce retention 318,578 316,715 1,863 367,240 392,086 -24,846 Medium self-sufficiency 292,370 316,632 -24261 260,114 389,932 -129,818 High self-sufficiency 288,606 316,632 -28,025 241,819 389,932 -148,113 High demand 296,552 353,109 -56,557 280,442 473,565 -193,122 Undersupply of 5% 296,552 329,657 -33,105 280,442 402,997 -122,555
  • 8. WHAT IMPACTS THE WORKFORCE
  • 9. Health 20-25% of GDP by 2025 (Source: R Fogel 2004) US doubling health expenditure by 2016 to 4.1 trillion dollars p.a. (Source: US Medicaid Report 2007) 7 trillion dollars global Australia – 10% GDP - $100 billion Doubling to $200 billion by 2018
  • 10. What drives health service demand • Ageing • Chronic disease- 30-40% of which is caused by obesity • Unrealistic expectations from community • Medical/ industrial complex • Un necessary ( avoidable )care
  • 11. What ‘drives ‘ the health system • Incentives – financial / non financial • Uncapped fee for service • Encourages activity • Not outcomes based ( clinical ) • Professional not patient centric NHS- No decision about me without me -
  • 12. • 1970 7.5 AT WORKING AGE PER 65+ • 2010 5 • 2050 2.7 AGED 65 OR LESS PER 65+ Intergenerational report 2010 States spending 30% annual new spend on health
  • 13. The Sustainability Funnel (Coiera 2010) • The problem of sustainability
  • 14. Health system • Hospital focused • Driven by technology • Little incentive for team care • Naturally ‘conservative ‘ • Vested interests • Has lost its ‘caring ‘ • ‘Rolls –Royce – but many just require a Mazda’
  • 15. Focus on ‘Illth’ rather than health • Hospitals • Beds • Acute medicine • Waiting lists • Issues of equity and access • Politicians alter the structures but no real reform
  • 16. Hospital beds • Aus--- 3.5/1000 pop • OECD- 3.82/1000 pop 9.35% hosp admissions preventable Number of procedures in hosp  162 discharges/ 1000 pop - Aus  158 OECD  138 NZ  126 US/UK  84 Canada Gregory G 2010
  • 17. CHALLENGES • HOW DO WE USE THE NEW TECHNOLOGY EFFECTIVELY • HEALTH APPS • MONITORING / PATIENTS/ ENVIRONMENTS • CARE IN AGED CARE FACILITIES • WORKING AS TEAMS • ROLE EXPANSION
  • 18. Future Technology Trajectory • Smaller • Less invasive • Convenient • Faster • Cheaper • Earlier in disease cycle
  • 19. • Innovation Think tank opportunity to identify new issues relating to health workforce facilitate translation of research planning into innovative practice develop position papers and then involve stakeholders Exemplar – Non Medical prescribing
  • 20. Health Informatics • Communication Technology to acquire, store, analyse, communicate and display health information – To facilitate understanding – To improve decision making
  • 21. HEALTH WORKFORCE • AGEING • FEMINISED • PARTIME • WORKLIFE BALANCE – GENERATIONAL ISSUE • SAFE HOURS
  • 22. WHO / WHAT CONSTITUTES THE WORKFORCE • IS IT JUST THE PROFESSIONALS • HOW DO WE WANT TO ENGAGE PATIENTS • PATIENT CENTRED CARE – OR IS IT HEALTH PROFESSIONAL FOCUSSED • HOW DO WE PUT THE PATIENT AT THE CENTRE OF THE HEALTH SYSTEM
  • 23. • WHAT ARE WE GOING TO BE DOING • WHAT SKILLS DO WE NEED FOR THE 21ST C
  • 24. What is the health professional of the 21st Century going to deal with? Chronic disease Ageing New interventions Communication Cost issues Information
  • 25. What is the health professional of the 21st Century going to deal with? Need to ‘network’ Participation of non-medical groups in healthcare Ambulatory vs hospital care Patient pressure Changing work ethos Team care
  • 26. Basic Competencies of Health Professional for 21 Century • Patient centred care • Partnering • Quality improvement • Information and communication technology • Public health perspective
  • 27. TOMORROW IS THE FIRST DAY OF THE REST OF YOUR LIFE • What did I do yesterday that could have been done by some one else ? • How can I prevent this referral ( hosp admission ) ? • What could I have done to prevent this exacerbation/ disease
  • 28. Health Professional Training Core Competencies How to evaluate (national exam) Training for (independent) practice Insight to limitations Team care Competency based rather than time based
  • 29. Behaviours of high performing teams • Shared vision • Temporal situation awareness • Standardised procedures • Formalised communication • Structured check lists • Extensive reporting systems • Preempt problems • Acknowledge and address errors
  • 30. HOW ARE WE GOING TO TRAIN THE FUTURE WORKFORCE • ‘APPRENTICE ‘ MODEL • TEACHING INSTITUTIONS OR DIFFERENT NOW • USE MODELS FROM OTHER INDUSTRIES
  • 31. Simulation • Verbal (role playing) • Actor/Trained Patients • Computer based – virtual world • Mannequins • High end Skills Training • Virtual hospital/environment • Technique - Evaluate
  • 32. • Does Performance integrated into practice • Shows How Demonstration of Learning • Knows How Interpretation Application • Knows Fact Gathering
  • 33. • TELL ME, AND I WILL FORGET • SHOW ME, AND I MAY REMEMBER • INVOLVE ME, AND I WILL UNDERSTAND • CONFUCIOUS, 450BC
  • 34. Models of Care PA’S – Delegated – Generalist NP’s – Autonomous – Specialist Assistants Carers Health system ‘facilitators’/navigators
  • 35. Projected Number of PAs in the US Workforce 41,200 45,000 49,100 53,500 58,826 76,600 38,000 35,000 24,000 16,000 11,500 4,500 250 y = -172.43x2 + 7140.2x - 8125.6 R2 = 0.9963 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 70 75 80 85 90 96 97 98 99 '00 '01 '02 '04 '05 '06 '07 '08 '09 '10 '15 Estimated Source: Hooker & Cawley, 2005; AAPA Masterfile, 2003
  • 36. Specialists Vs Generalists - Need to create incentives – Financial / kudos To drive generalism Training in ‘uncertainty’
  • 37. THE RIGHT PEOPLE IN THE RIGHT JOB WITH THE RIGHT SKILLS AT THE RIGHT TIME
  • 38. • What services do we deliver • Who delivers them • Where /how are these services delivered • How are we going to train
  • 39. • NEED TO GET SERIOUS ABOUT PRIMARY CARE • ISSUES OF INEQUALITY • SOCIAL DETERMINANTS PUT PATIENT AND PRIMARY CARE AT THE CENTRE OF THE HEALTH SYSTEM
  • 40. Health workforce shortages in Australia • DRIVEN BY AN AGEING WORKFORCE • SUGGESTIONS OF 20000 NURSES • ALLIED HEALTH PROFESSIONALS • CARERS NEED TO RECRUIT 400,000 TO HEALTH WORKFORCE BY 2025 JUST TO MAINTAIN STAFF LEVELS
  • 41. • Nano Medicine • Smart Living • Mind/Body Bionics • Virtual Reality Surgery • Remote Teletreatment • Games for Health Education
  • 42. WE KNOW WHAT TO DO • SO WHY CANT WE DO IT • RISK AVERSE • CONSERVATISM • CAPTIVE TO ‘INDUSTRY/ TECHNOLOGY
  • 43. Research Teaching Service Health Care