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Queensland Health Systems Review


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Queensland Health Systems Review

  1. 1. Queensland Health Systems Review Peter Forster Independent Consultant
  2. 2. Requested to review <ul><li>administrative systems </li></ul><ul><li>clinical workforce management systems </li></ul><ul><li>performance management systems </li></ul><ul><li>to recommend how Queensland Health can provide better health services and health outcomes for Queenslanders. </li></ul>
  3. 3. Review process <ul><li>18 of 37 Districts visited </li></ul><ul><li>1300+ submissions </li></ul><ul><li>expert reference panels </li></ul><ul><li>interstate visits </li></ul><ul><li>literature research </li></ul>
  4. 4. 14 Reform Programs Stream Workforce Reforms Organisation, Team and Individual Development Structure/Systems Service Needs Relationships/ Partnerships Programs P1 Immediate Workforce Priorities P2 Leadership/Culture P3 Teaching/Training Workforce Planning (see P9) P4 Hospital/Health Service Improvement P5 Safety Quality Clinical Governance P6 Patient Complaints P7 New devolved structure P12 Performance Reporting P13 Information Technology P14 Assets P8 Strengthen Community Sector Partnerships P9 Health Service Planning and Workforce Planning P10 Service enhancement to address special needs P11 Strengthen Commonwealth Partnerships
  5. 5. 1. Immediate workforce priorities <ul><li>Overseas medical recruitment </li></ul><ul><li>Credential, privilege and support new and current doctors with special purpose registration </li></ul><ul><li>Encourage recognition of generalist positions (SMO, rural generalist) </li></ul><ul><li>Fair salaries relative to other States </li></ul><ul><li>Increase use of VMOs and GPs </li></ul><ul><li>Fund / Recruit additional allied health, former nurses & graduates </li></ul><ul><li>Expand nursing & allied health roles </li></ul><ul><li>Develop partnerships with private providers & NGOs </li></ul>
  6. 6. <ul><li>Replace reliance on oversees recruiting of $135M </li></ul><ul><li>RMOs with VMOs, GPs and SMOs </li></ul><ul><li>Backfill for nurses to enable change $112M </li></ul><ul><li>processes and training </li></ul><ul><li>Additional allied health to support new $150M </li></ul><ul><li>models of care </li></ul>
  7. 7. 2. Developing culture and leadership <ul><li>Appoint the leaders </li></ul><ul><li>Leaders and managers participate in leadership development programs </li></ul><ul><ul><li>understanding reforms and change agenda </li></ul></ul><ul><ul><li>articulate change behaviours and values </li></ul></ul><ul><ul><li>appropriate skills to manage and develop staff </li></ul></ul><ul><li>Formal assessment of leadership behaviours for senior leaders (top 500) with external oversight by District/Area Health Councils </li></ul><ul><li>Develop commitment to reforms, a new code of conduct and revised values </li></ul>
  8. 8. 3. Teaching and training renewal <ul><li>More registrar places and protected teaching time </li></ul><ul><li>Skills upgrades for all clinicians </li></ul><ul><li>More scholarships all categories </li></ul><ul><li>Fund re-entry training for nurses </li></ul><ul><li>In-service clinical teaching/training upgrades all categories </li></ul><ul><li>Fund the Skills Centre and relief pools all categories </li></ul><ul><li>New training/development pathways – competency based </li></ul><ul><li>Partnerships with the tertiary and vocational educational sectors </li></ul>
  9. 9. 4. Hospital/health service improvement <ul><li>New models of care and clinical roles </li></ul><ul><li>Urgent Elective Surgery Plan </li></ul><ul><li>Patient flow and longer term waiting list plans </li></ul><ul><li>Better connecting GPs to hospitals </li></ul><ul><li>Clinical Network Priorities/Plans </li></ul><ul><li>Environment for clinical teams to spontaneously improve work practices and develop skills </li></ul><ul><li>Budget reform: Regional Distribution Formula & casemix overtime to ensure fairer allocation </li></ul><ul><li>Better step-up and step-down facilities </li></ul>
  10. 10. 5. Safety, quality & clinical governance <ul><li>the right person , doing the right job (eg recruitment, performance assessment) </li></ul><ul><li>with the right skills (eg root cause analysis, open disclosure) </li></ul><ul><li>working in high-functioning teams </li></ul><ul><li>supported by effective organisational systems (eg clinical pathways, incident monitoring, enabling legislation) </li></ul><ul><li>external oversight by Health Commission and Parliamentary Committee and public reporting </li></ul>
  11. 11. 6. Patient Complaints <ul><li>Resourcing & training for staff addressing patient complaints </li></ul><ul><li>Timeframes for resolution of complaints </li></ul><ul><li>A statewide complaints recording system </li></ul><ul><li>External oversight by a Health Commission and a Parliamentary Committee </li></ul><ul><li>Members of the public to gain Whistleblower protection for disclosing danger to public health & safety  </li></ul><ul><li>Public Interest Disclosures may be lodged with Members of Parliament </li></ul>
  12. 12. 7. New devolved structure <ul><li>Smaller central office </li></ul><ul><li>3 Area Health Services (Southern, Central and Northern) </li></ul><ul><li>Devolved budget, authority, accountability and responsibility to Area Health Services </li></ul><ul><li>Retain 37 Health Service Districts </li></ul><ul><li>Clinical networks to be part of formal structure </li></ul><ul><li>Greater emphasis on performance monitoring and performance management </li></ul>
  13. 13. Central office Director-General Policy Planning and Resourcing Southern Area Health Services Performance Central Area Health Services Chief Health Officer Northern Area health Services Corporate Service Chief Operations Officer
  14. 14. 8. Strengthen community and sector partnerships <ul><li>Invest in a broader range of partnerships </li></ul><ul><li>Partnerships to recognise that other service providers may be better able to meet patient and community needs </li></ul><ul><li>Consider models such as fund pooling, service devolution, service coordination and outsourcing </li></ul><ul><li>Partnerships will be included in performance agreements with AHS General Managers and District Managers and supported by an Innovation Fund </li></ul>
  15. 15. 9. Health Service and Workforce Planning <ul><li>Plans developed by District, Area and State </li></ul><ul><li>Clinical networks play an active role in service planning & in the distribution of growth funding </li></ul><ul><li>Universal service obligations defined </li></ul><ul><li>Improve patient transport arrangements </li></ul><ul><li>Transparency in decision making about local services through community involvement </li></ul><ul><li>Plan to address critical workforce shortages intensively for 3 years & a longer term plan for the next 10 years </li></ul><ul><li>Maximise value of existing health workforce through advanced and new roles and increased linkages with the private sector </li></ul>
  16. 16. 10. Service enhancement to address special needs <ul><li>Indigenous health issues - more flexible approaches to indigenous health services: more funding, more services, community influenced models </li></ul><ul><li>Rural and remote issues - alternative funding & service models developed with Commonwealth, telehealth, remuneration and incentives packages to attract and retain staff </li></ul><ul><li>Mental health - Increased investment in: carers and consumers; community sector; supported accommodation; involvement private and NGO sectors </li></ul><ul><li>Child and youth health - State wide network developed </li></ul>
  17. 17. 11. Negotiating new partnerships with the Commonwealth Government <ul><li>Collaboration focussing on: </li></ul><ul><li>Health funding arrangements </li></ul><ul><li>Teaching and training in public hospitals </li></ul><ul><li>Primary / acute partnerships </li></ul><ul><li>National standards for medical practitioner registration </li></ul><ul><li>Simplification of reporting arrangements </li></ul>
  18. 18. 12. Performance Reporting <ul><li>Standard set of indicators for all levels of reporting with emphasis on quality and safety and patient outcomes </li></ul><ul><li>Use of performance agreements with service managers including targets </li></ul><ul><li>Regular performance review processes that provides feedback to frontline staff </li></ul><ul><li>External review through District & Area Health Councils, a Health Commission overseen by a Parliamentary Committee & Auditor General performance audits </li></ul><ul><li>A range of public reports on performance at the District, Area Health Service and State wide level </li></ul>
  19. 19. 13. Information management <ul><li>Realign priorities & structures </li></ul><ul><li>Systems enhancements (eg PRIME, ESP) </li></ul><ul><li>Staff internet access provided </li></ul><ul><li>Computer literacy training </li></ul><ul><li>Increased desktop availability and access to mobile technology </li></ul><ul><li>Support staff for clinicians </li></ul><ul><li>Alternate sourcing models for project and contract management </li></ul><ul><li>Information Strategy and Investment Board and Operations Board to prioritise in line with Review </li></ul>
  20. 20. 14. Assets, capital and maintenance <ul><li>Establish asset planning in Area Health Services with closer links with frontline staff </li></ul><ul><li>Establish Central Office Design Unit </li></ul><ul><li>Urgently review maintenance list to identify priorities </li></ul><ul><li>Function as part of Business Support Services Group </li></ul><ul><li>Implement revised governance arrangements, reporting and post occupancy evaluation frameworks </li></ul><ul><li>Transfer project management role to the Dept. of Public Works </li></ul><ul><li>Establish a sustainable funding model for replacement, purchase and recurrent costs of assets </li></ul>
  21. 21. Reform Implementation <ul><li>3 year intense program of reform </li></ul><ul><li>Reform driven by leaders in Districts, Areas and Central Office </li></ul><ul><li>Supported by a Reform Team and a network of reform facilitators </li></ul><ul><li>Reform Advisory Panel made up of eminent health professionals to provide guidance </li></ul>