The document discusses a project to transition a rural Australian hospital from relying on locum doctors to a more permanent medical workforce. It describes redesigning the hospital's systems, implementing a three-pronged workforce strategy of attracting, developing, and retaining clinicians, establishing governance around recruitment and training, and engaging with the local community. As a result of these efforts, the hospital saw improvements like better emergency department workflow, increased capacity, and more positive community feedback. The challenges of maintaining services during a natural disaster are also noted.

1. Workforce stability and service
quality in rural health delivery
Moving from a locum to a permanent medical workforce
Dr Parbodh Gogna, MBChB MBA MRCGP FRACGP FACRRM
Medical Superintendent, Capricorn Coast Hospital and Health Service
Central Queensland Hospital and Health Service
Mr Jason Currie, BSc LLB MIP GCPA
Program Director - Health Services, Vanguard Health
Rural Medicine Australia 2016
20 October 2016

2. Context – Capricorn Coast Hospital and
Health Service
• Over 13,000 ED presentations pa
• 22 inpatient beds, running >90% occupancy
• 35 minutes by road to Rockhampton
Hospital, 1 hour by air to Brisbane
Rural Medicine Australia 2016
20 October 2016

3. Context – the Medical Workforce Project
• Increasing workloads leads to workforce attrition
• Permanent Medical Superintendent departed late 2013
• Ongoing issues attracting staff and reliance on fly-in, fly-out
locum workforce
• Decline in GP and community confidence in service
• Vanguard Health engaged early 2014 to increase and stabilise the
workforce
Rural Medicine Australia 2016
20 October 2016

4. The approach
• System redesign and enhancements
• Workforce plan with 3 central tenets drove
the activity
• Attract
• Develop
• Retain
• Governance System deployment
• Community engagement strategy
Rural Medicine Australia 2016
20 October 2016

5. System Redesign
• Business intelligence at the core -
analysis of activity, trends and
workflows
• Reshape workforce within constraints
including planned re-establishment of
training positions
• Maximise roster with balance
between workforce preferences
(sociability) and meeting community
requirements
Rural Medicine Australia 2016
20 October 2016

6. Workforce Strategy
• Attract the workforce – cumulative impact /
planned replacements with standard recruitment
activities and leverage professional networks
• Develop – attitude before aptitude (within
reason), upskill and mentor the team, enhance
skills and build capacity
• Retain – targeted retention packages, flexibility
and responsiveness, constant refinement of the
service to support staff as much as possible,
maximise financial and non-financial levers
Rural Medicine Australia 2016
20 October 2016

7. Governance System Deployment
• Quality and safety as the foundation for
enhancements and improvements
• Target recruitment activities with a focus on clear
performance expectations and role descriptions
• Establish frameworks for appropriate supervision,
professional development and active learning
• Ongoing peer review and a supportive learning
environment
Rural Medicine Australia 2016
20 October 2016

8. Community Engagement Strategy
• Dedicated significant resources to this in
the early phases to rebuild trust and
confidence
• Standard stakeholder engagement
framework and assessment (using a
influence / support matrix)
• Engagement schedule created
• 1:1 meetings
• Advisory Group
• Phone calls
Support / Interest
Influence /
Power
HighLow
Low
High
Manage
Closely
Keep
Satisfied
Keep
Informed
Monitor
(minimum effort)
Rural Medicine Australia 2016
20 October 2016

9. Outcomes
• A 2:1 potential ROI for the Health
Service based on released
capacity
• Improvements to ED workflow to
surpass national targets
• Absorption of growth in ED and
reductions in transfers to
secondary hospital site
• Increase in positive community
feedback 0
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Emergency Care Work Units per day (blue - LHS) and EDIS Transfers per day
(orange - RHS)
Rural Medicine Australia 2016
20 October 2016

10. The challenge of nature
• Township took direct impact of TC Marcia
• Benefit of local workforce
• Maintain service and performance despite
disaster
Rural Medicine Australia 2016
20 October 2016

11. Lessons
• Dedicated resources and focus
• Clear performance obligations (KPIs or contractual
terms)
• Time and space to focus (not someone re-tasked from
elsewhere)
• Different thinking and fresh ideas
• System design is essential to offer the best
possible opportunity for successful recruitment
and workforce retention
• Rebuilding a workforce is a long-term proposition
that takes 2-3 years of focused effort
Rural Medicine Australia 2016
20 October 2016

12. Questions
Dr Parbodh Gogna
parbodh.gogna@health.qld.gov.au
Mr Jason Currie
jason@vanguardhealth.com.au
Rural Medicine Australia 2016
20 October 2016