Constants and Change Drivers for Health


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This presentation given to the 16th Prevocational Medical Education conferenced in Auckland describes the history of postgraduate medical and clinical education and training in NSW, Australia.

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Constants and Change Drivers for Health

  1. 1. Reflections on the experience of NSW:Moving from a PMC to IMET to CETI to HETI. A 20 year journey Professor Steven Boyages Clinical Education and Training Institute 9th November 2011
  2. 2. Timeline and Definitions Postgraduate Medical Council (PMC) Institute of Medical Education and Training (IMET) Clinical Education and Training (CETI) Health Education and Training Institute (HETI)
  3. 3. Constants of health• Clinician patient relationship• Clash of culturesChange Drivers• Patient experience and safety• Staff experience and safety• DemographyResilience• Individual, self efficacy, social cognitive theory• OrganisationalAdaptability and Agility• New models of education and learning• Technology
  4. 4. Health is a knowledge based profession Impart Knowledge • Research • Care • Development • Education • Prevention • Training Generate Apply Knowledge Knowledge
  5. 5. Constants of HealthTO RECHON him who taught me this Art equally dear to me as my parents, to share mysubstance with him, and relieve his necessities if required; to look up his offspring in thesame footing as my own brothers, and to teach them this art, if they shall wish to learn it,without fee or stipulation; and that by precept, lecture, and every other mode ofinstruction, I will impart a knowledge of the Art to my own sons, and those of my teachers,and to disciples bound by a stipulation and oath according the law of medicine, but tonone others. (Hippocrates 460-370 BC)
  6. 6. The nature of patient care is a constant
  7. 7. Health work is a balanced matrix High High Touch Tech Team and Technology Workflow Platform Platform
  8. 8. Planetary orbits are constantManagers are from Mars and Clinicians are from Venus
  9. 9. These “language” differences may lead to a clash of cultures
  10. 10. A crisis is usually an opportunity for change
  11. 11. Institute of Medical Education andTraining (IMET) Vocational Postgraduate Medical Networks Council Standards & Accreditation Allocation, Supervision HSP
  12. 12. The Perfect Storm Changing Health PatternsRising cost of Need for new health care models of care Increasing consumer Technology expectations
  13. 13. Patient Safety
  14. 14. Staff Experience
  15. 15. Intergenerational report 2010
  16. 16. Future workforce growth at Feb 2010Future industry job growth – Australia 5 years from 2009-10 to 2014-15(‘000) - DEEWR projections
  17. 17. Four Pillars CETI CEC ACI BHI19
  18. 18. Clinical Education and Training Institute (CETI)Allied Health Institute of Medical Education and Nursing Training (IMET) Medical Vocational Postgraduate Medical Networks Oral Health Council Rural Standards & Accreditation Allocation, Supervision HSP Centre forLearning and Teaching
  19. 19. What are we trying to do? To improve teamwork, communication and collaboration for safer patient-centred care, and better staff experiencesWhy are we trying to do this? Increased staff motivation, well-being and retention Decrease in staff turnover Increased patient and carer satisfaction Increased patient safety Increase in appropriate use of specialist clinical resources Reductions in patient mortality and critical incidents Increase in access to and coordination of health services 21
  20. 20. What do we mean by Team Work?Interprofessional Education (IPE) Occasions when two or more professions learn from, with and about each other to improve collaboration and the quality of careInterprofessional Practice (IPP) Occurs when two or more professions work together as a team with a common purpose, commitment and mutual respect (Freeth et al, 2005). 22
  21. 21. Team Health Foundations – Right Start • Individual • Roles and Responsibilities • Risks and Rewards High Performance Teams • Roles • Reflection • Respect • Resilience Advanced Settings of Care • Advanced Clinical Modules • Simulation
  22. 22. What Is Self-Efficacy?According to Albert Bandura, self-efficacy is “thebelief in one’s capabilities to organize and executethe courses of action required to manageprospective situations” (1995, p. 2).In other words, self-efficacy is a person’s belief inhis or her ability to succeed in a particular situation.Bandura described these beliefs as determinants ofhow people think, behave, and feel (1994).
  23. 23. Sources of self efficacy1. Mastery Experiences• "The most effective way of developing a strong sense of efficacy is through mastery experiences," Bandura explained (1994). Performing a task successfully strengthens our sense of self-efficacy. However, failing to adequately deal with a task or challenge can undermine and weaken self-efficacy.2. Social Modeling• Witnessing other people successfully completing a task is another important source of self-efficacy. According to Bandura, “Seeing people similar to oneself succeed by sustained effort raises observers beliefs that they too possess the capabilities master comparable activities to succeed” (1994).3. Social Persuasion• Bandura also asserted that people could be persuaded to belief that they have the skills and capabilities to succeed. Consider a time when someone said something positive and encouraging that helped you achieve a goal. Getting verbal encouragement from others helps people overcome self-doubt and instead focus on giving their best effort to the task at hand.4. Psychological Responses• Our own responses and emotional reactions to situations also play an important role in self-efficacy. Moods, emotional states, physical reactions, and stress levels can all impact how a person feels about their personal abilities in a particular situation. • Bandura, A. (1995). Self-Efficacy in Changing Societies. Cambridge University Press.
  24. 24. Review ArticleAmerican Medical Education 100 Years after the Flexner ReportMolly Cooke, M.D., David M. Irby, Ph.D., William Sullivan, Ph.D., and Kenneth M. Ludmerer, M.D. N Engl J Med Volume 355(13):1339-1344 September 28, 2006
  25. 25. Figure 1Source: The Lancet (DOI:10.1016/S0140-6736(10)61854-5)Terms and Conditions
  26. 26. What is the literature saying? 30
  27. 27. Figure 12 31 Source: The Lancet (DOI:10.1016/S0140-6736(10)61854-5) Terms and Conditions
  28. 28. We need to embrace social media
  29. 29. Health Education and Training InstituteUndergraduate Clinical Education and Training Institute (CETI) Vocational Training Allied Health Institute of Medical Education Nursing and Training (IMET)Leadership and Management Medical Postgraduate Medical Council Oral Health Vocational Networks HSP Standards & Allocation, Accreditation Supervision Clinical Rural
  30. 30. HETI Function Domains Undergraduate clinical placements Vocational Education and Training Post graduate clinical prevocational and vocational training Management and Leadership Development
  31. 31. Investment and Risk Strategy
  32. 32. “Storm Damage” Staff Shortages Poor Economic Competency gaps Development Poor staffIncreased Medical utilisation and Error productivity Poor Staff Morale
  33. 33. Bridging the Gap
  34. 34. ReflectionsConstants of health• Clinician patient relationship• Clash of culturesChange Drivers• Demography• Patient experience and safety• Staff experience and safetyResilience• Individual, self efficacy, social cognitive theory• OrganisationalAdaptability and Agility• New models of education and learning• Technology