Transcript
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Workforce Plan 2005-2010
Building a sustainable health
workforce for the people of the ACT
November 2005
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Workforce Plan 2005-2010
Building a sustainable health
workforce for the people of the ACT
November 2005
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CONTENTS
1 Executive Summary...................................................................... 1
2 Introduction ................................................................................... 4
2.1 The ACT Governments Vision For Canberra................5
2.2 ACT Health Action Plan ......................................................5
2.3 The Clinical Services Plan 2005 - 2011..............................6
2.4 Human Resource Plan ..........................................................7
2.5 Aboriginal & Torres Strait Islander Health Plan ..........7
2.6 Major National Workforce Advisory Committees .......8
2.7 The National Health Workforce Framework ................8
2.8 Australian Health Care Agreements.................................9
2.9 Quality And Safety .............................................................. 10
2.9.1. Safety............................................................................10
2.9.2 Quality..........................................................................11
2.10 National Nursing And Nursing
Education Taskforce (N3et) .............................................. 11
2.11 Allied Health........................................................................... 12
3 The Health Context For Health Workforce Planning................ 13
3.1 New Models Of Care .......................................................... 13
3.2 New Technology.................................................................. 14
3.3 Workforce Redesign........................................................... 16
3.4 Empowered Consumers..................................................... 17
3.5 Attraction And Retention ................................................. 17
3.6 Education And Training..................................................... 17
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3.7 Societal And Cultural Changes........................................ 18
3.8 Regulatory/Legislative Arrangements............................ 18
4 Current Workforce Capacity ...................................................... 19
4.1 Demographic Analysis........................................................ 19
4.2 ACT Population And Trends........................................... 20
4.3 Profiling The Australian Health Workforce................ 22
4.4 ACT Health Workforce Profile....................................... 23
4.5 Medical .................................................................................. 24
4.6 Nursing And Midwifery.................................................... 25
4.7 Allied Health .........................................................................27
4.8 Technical And Support Staff.............................................27
4.9 Current Trends In The ACT Health Workforce ........ 28
4.10 Transfers In/Out Within ACT Health .......................... 29
4.11 Retirements .......................................................................... 29
4.12 Growth Positions................................................................ 29
5 Existing Strategies...................................................................... 30
5.1 Current ACT Health Recruitment Strategies ............. 30
5.1.1 Marketing ................................................................... 31
5.1.2 Attraction Strategies................................................ 31
5.1.3 Retention Strategies.................................................33
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5.2 Workforce Redesign...........................................................35
5.2.1 Certified Agreements...............................................35
5.3 Multi-Disciplinary Education Opportunities ..............36
6 Achieving Our Objectives .......................................................... 38
6.1 A Workforce Profile........................................................... 39
6.2 A Responsive Workforce.................................................. 39
6.3 Education And Training.................................................... 40
6.4 Effective Linkages................................................................41
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1 EXECUTIVE SUMMARY
The ACT Governments vision for the Territory involves investing in
the people of the ACT to build a stronger community. A key priority to
realising this goal is addressing workforce issues.
The ACT Health Workforce Plan sets out the issues, evidence and
strategies required to deliver a sustainable ACT Health workforce capable
of continuing to deliver high quality health care to the people of the ACT,
and the surrounding region, to 2010.
Health workforce planning aims to determine the future need on the basis
of information we currently have. The evidence available on the current
ACT Health workforce shows that it is unsustainable into the future
without modernisation.
This Plan builds upon the directions set out in the Health Action Plan
2002, and is aligned with the overarching framework agreed by all
Australian Health Ministers for achieving national sustainability in our
health workforce.
We need to have the capability to respond quickly and effectively to the
increased demand for health care in the ACT. We also know that the models
of care for service delivery are changing and we need to plan to assure an
adequate supply of appropriately qualified health practitioners working
where they are needed. This plan therefore looks firstly at achieving
parity and in the longer term, job redesign, workforce re-engineering and
a greater emphasis on community based care and self-directed care. The
ACT Clinical Services Plan (CSP) complements this Plan and describesin further detail the proposed models of care and direction for clinical
services across ACT Health.
Increases in population especially a proportional increase in older people,
the changes in services in response to the increase in chronic and complex
disease, use of increasingly sophisticated technologies and medications
and changes in the modes of delivery of clinical services result in an ever-
increasing demand for health services. To deal with these demands this
plan looks at the most effective and efficient means of having the right
people with the right skills undertaking the right tasks.
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Our plan for building a sustainable health workforce means we have to
set targets to facilitate recruitment in areas of known shortages but at the
same time put in place strategies to retain existing staff. In this way the
ACT Health Workforce Plan is engaged at all levels of the supply of healthworkers. It also aims to influence how our workforce is educated, trained
and developed into the future.
The Key initiatives are to:
Develop tools to predict workforce supply & demand, based on a
range of scenarios including alternative models of care.
Develop approaches to workforce redesign to develop safe and
effective workplace practice models.
Align workforce planning with clinical service planning.
Develop formal partnerships with the tertiary and VET sectors to
facilitate better alignment between education outcomes & health
workforce needs.
Develop new models of learning through multi-disciplinary
approaches and simulated environments.
Increase access to learning and further education for all workers.
Participate in and contribute to the national health workforce
committees and maintain linkages with other relevant health
workforce strategies, policies and plans through local and national
forums and networks.
Develop joint government and intra-agency partnerships.
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Table 1: ACT Health workforce objectives and strategies at a glance
Objective Desired Outcome Strategies
1. A workforce profile ACT Health requires access to
replicable and reliable data for effective
analysis of the workforce. Historically
workforce planning in ACT Health has
been undertaken along professional
streams. However, future work will
include development of an analytical
workforce framework that incorporates a
model of care approach
Derive improved workforce
supply & demand data including
evaluation tool
Develop models of care planning
and analysis tools
Build workforce supply and demand
scenarios based on predictions of
models of care
2. A responsive workforce To develop and maintain a responsiveworkforce, that is flexible, productive
and happy, ACT Health needs to
focus initially on the correct mix of
competencies and skills, and later,
evaluating new job roles to support
existing roles. This will include taking
the best practice patient care pathways
as the initial focus for thinking differently
about roles
Provide research reports onworkforce redesign, extended job
roles and scopes of practice
Identify and develop safe and
effective workplace practice models
Align workforce planning with clinical
service planning
3. Education and training ACT Health requires access to a labourpool of graduate health professionals
that are work-place ready. In this regard
ACT Health will seek to influence new
methods of interdisciplinary learning, the
types of courses and numbers of places
in the ACT tertiary and VET sectors.
Prevocational learning will be
considered over the life of this plan
Develop formal partnerships with the
tertiary and VET sectors
Facilitate better alignment between
education outcomes & health
workforce needs
Develop new models of learning
through multi-disciplinary
approaches and simulated
environments
Increase access to learning and
further education for all workers
4. Effective linkages ACT Health participates in and
contributes to comprehensive policy
discourse within a system of national
health committees that include all
sectors of governments and other
stakeholders in Australia and New
Zealand
Participate in and contribute to
the national health workforce
committees
Develop joint government and
intra-agency partnerships
Develop joint agency work programs
with other ACT Government bodies
Maintain linkages with other relevanthealth workforce strategies, policies
and plans through local and national
forums and networks
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2 INTRODUCTION
The ACT Health Workforce Plan sets the direction for building a
sustainable workforce, capable of ensuring the continued delivery of high
quality health and community care services to the people of the ACT and
the surrounding region, to the year 2010.
The Canberra Plan1, the ACT Health Action Plan2, The National Health WorkforceFramework3 and the Clinical Services Plan4 (CSP), in addition to the Working
Together Shaping Our Future With Our People5 and the ACT Health Qualityand Safety Plan (2003-2008) are all key strategic documents that have
guided the development of this plan and will continue to influence the
implementation phase of this plan. Health care professionals, particularly
Allied Health Professionals, Nurses, Midwives and Medical Practitioners
in the ACT and surrounding region have contributed to the development
of this plan, as have policy makers and consumers. The health care
environment is a rapidly changing one. The implementation of the plan
will also be influenced by the:
1. Productivity Commissions Research Study of the Health Workforce
2. Health Reform Agenda outlined in the Australian Health
Care Agreements
3. Outcomes of the COAG Health Working Group
1 http://www.cmd.act.gov.au/canberraplan/pdfs/Canberra_Plan.pdf
2 http://www.health.act.gov.au/c/health
3 http://www.healthworkforce.health.nsw.gov.au/amwac/pdf/NHW_stratfwork_AHMC_2004.pdf
4 http://www.health.act.gov.au/c/health?a=da&did=10010771&pid=1086133754
5 http://www.health.act.gov.au
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2.1 THE ACT GOVERNMENTS VISION FOR CANBERRA
The ACT Government aims to have Canberra recognised throughout
the world not only as the beautiful city, uniquely designed in harmonywith its environment, the seat of Australias Government and the home of
its pre-eminent national institutions but also as a place that
represents the best in Australian creativity, community living and
sustainable development.
The Canberra Plan released in 2004 broadly guides the planning, growth
and development of the ACT. The Canberra Plan has several components,
which include the Canberra Spatial Plan, the Economic White Paper and
The Canberra Social Plan.
Building our Community The Canberra Social Plan holds particular
relevance to the planning of ACT Health. It presents the action plan for the
next 10 to 15 years, and sets goals together with actions to achieve those
outcomes. The Plans stated health priority is to improve the health and
wellbeing of ACT residents. One of the seven major priorities under the
Canberra Plan is addressing workforce issues.
2.2 ACT HEALTH ACTION PLAN
In 2002, the ACT Government released the ACT Health Action Plan (HAP)
which provides the strategic framework for public health services over
a three to five year period across two key areas: Healthy People and
Healthy Systems. The aim of the HAP is to enable a more focused planning
approach in a range of key priority areas and one priority is to build a
sustainable workforce to support strengthening the capacity of the ACT
Health system.
The need to protect and grow our workforce to ensure the people of the
ACT continue to receive quality and effective health care remains ever
present. The priorities identified in 2002 continue to be relevant in 2005.
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2.3 THE CLINICAL SERVICES PLAN 2005 2011
The Clinical Services Plan (CSP) has been developed in the context of:
An ageing population.
Increasing health care expenditure.
The need to reduce waiting times.
Alternative organisational models.
Declining numbers of health professionals.
An increasing focus on patients needs.
An increasing focus on public health issues and development ofdisease management programs.
Achieving equity of access.
Improving the quality and safety of care.
The CSP identifies a number of service delivery initiatives that will impact
on the health workforce. These include:
Increased elective surgery provision, starting with an additional
300 operations in 2005-06.
Introduction of dedicated laparoscopic theatres and robotic surgery
services.
Opening of an additional 20 medical beds (12 at Calvary and 8 at The
Canberra Hospital) from July 2005.
Completion of a 60-bed Subacute Service on the Calvary campus
(40 rehabilitation beds and 20 psycho-geriatric beds).
Enhanced discharge lounge services.
A replacement acute psychiatric services facility for adults.
Development of a mental health inpatient facility for children and
adolescents.
Establishment of a forensic mental health facility.
Provision of paediatric support in Calvarys emergency department.
Expansion of capacity in neonatal intensive care services.
Redesign of ambulatory care services. Redesign of imaging services.
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Increased chemotherapy services.
Increased radiation oncology services with reduced outflows to NSW.
Improved chronic disease management with an early focus onimproved integration and coordination of diabetes services.
Increased initiatives to address falls prevention.
Increased dental health services.
2.4 HUMAN RESOURCE PLAN
The ACT Health human resource strategic plan Working Together ShapingOur Future With Our People nominates five strategic priorities:
Keeping staff safe and healthy preventing injury and supporting
injured workers to return to work early.
Building capacity capacity to be developed through recruitment and
retention initiatives, the establishment of career pathways, workforce
planning and workplace equity and diversity.
Valuing staff encouraging employees participation in workplace
decisions and planning, valuing employee contributions, makingACT Health a great place to work, recognising and valuing employee
contributions and promoting teamwork.
Promoting Ongoing Learning staff benefiting from appropriate work
related learning and development opportunities making sure that
expertise is current and continuously available.
Striving for Continuous Improvement working to continuously
improve outcomes for both patients and customers whilst working in
partnership to evaluate effectiveness and achieve excellence in patient
care and customer service.
2.5 ABORIGINAL & TORRES STRAIT ISLANDERHEALTH PLAN
The ACT Aboriginal & Torres Strait Islander Health & Family
Wellbeing Plan 2005-2010 encompasses a commitment to developing and
implementing an Aboriginal Health Workforce Plan for the ACT. The
above mentioned plan will complement the strategic directions containedin this plan.
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2.6 MAJOR NATIONAL WORKFORCE
ADVISORY COMMITTEES
The Australian Health Workforce Advisory Committee (AHWAC), theAustralian Medical Workforce Advisory Committee (AMWAC) and the
Australian Health Workforce Officials Committee (AHWOC), function
as the strategic advisors on national health workforce matters, including
workforce supply, distribution and future requirements. Several key
workforce strategic policy reports have emerged from these committees
many of which have guided the research phase of this plan, for example
Allied Health workforce planning, and career choice reports6.
2.7 THE NATIONAL HEALTH WORKFORCE FRAMEWORK
In 2004, all Australian Health Ministers endorsed the National Health
Workforce Strategic Framework7, which sets the direction for the
Australian health workforce including the National Health Workforce
Action Plan. The framework works within the national vision that:
Australia will have a sustainable health workforce that is knowledgeable, skilled and
adaptable. The workforce will be distributed to achieve equitable health outcomes,suitably trained and competent. The workforce will be valued and able to work within a
supportive environment and culture. It will provide safe, quality, preventative, curativeand supportive care, that is population and health consumer focused and capable of
meeting the health needs of the Australian community.
The principles guiding key areas for investment at the national level are:
Building and maintaining a sustainable supply.
A workforce distribution that optimises access to health care and
meets health needs for all Australians.
Health environments being places people want to work.
Ensuring the health workforce is always skilled and competent.
Optimal uses of competencies and workforce adaptability.
Recognising that health workforce policy and planning must be
informed by the best available evidence and linked with the broader
health system.
6 http://www.healthworkforce.health.nsw.gov.au/amwac/info.html
7 http://www.healthworkforce.health.nsw.gov.au/amwac/pdf/NHW_stratfwork_AHMC_2004.pdf
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Recognising that health workforce policy involves all stakeholders
working collaboratively with a commitment to the vision, principles
and strategies outlined in the document.
2.8 AUSTRALIAN HEALTH CARE AGREEMENTS
The primary objective of the Australian Health Care Agreements (AHCAs)
is to ensure the communitys access to public hospital services. A key
aspect of the AHCAs is to ensure that each jurisdiction provides people
eligible for free public hospital services with equitable access to those
services irrespective of their geographical location.
A core component of this Agreement is the Health Reform Agenda. This
agenda acknowledges the need to integrate and co-ordinate services
at the interface between the community and hospital based services,
to increase healthier outcomes, particularly for those with chronic and
aged conditions as well as our Indigenous citizens. The Agenda also
acknowledges the need for a sustainable, skilled and flexible workforce
to ensure the provision of health services into the future. There are
eleven nationally supported primary focal points for the Health Care
Reform Agenda:
The hospital interface between general practice and emergency
departments.
The transition between acute services and aged care.
Improving the health of Aboriginal and Torres Strait Islander peoples.
Improving access to elective surgery.
The continuum of care in services for chronic disease.
Cancer care. Mental health.
Pharmaceuticals.
Information management and information technology.
Safety, quality improvement and assurance.
Addressing health workforce issues.
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Drawing from this list, the six major priorities for reform identified by
ACT Health include:
Improving outcomes for Aboriginal and Torres Strait Islander peoples.
The GP / Emergency Department interface.
Aged care / acute care interface.
Improved access to elective surgery.
Improved access to mental health.
Improved access to cancer care.
To achieve these reforms, ACT Health is working to achieve the workforce
numbers and skills mix to develop and maintain a positive workforce,which responds to changing client profiles and can focus on outcomes.
2.9 QUALITY AND SAFETY
Quality and safety are key considerations for health service providers.
ACT Health has committed itself to enhancing quality and assuring
safety within its agencies. ACT Health has endorsed an $11.4m allocation
for quality programs under the Australian Health Care Agreement
2003-2008.
2.9.1 Safety
The Australian Council for Safety and Quality in Health Care has identified
these key priority actions to improve health care safety:
Enhanced consumer involvement.
Improved data and communication flows.
More support for health care workers.
Redesign of systems to create a safety culture.
Building awareness and understanding of the importance of health
care safety.
The ACT Health Quality and Safety Plan (2003-2008) builds upon previousQuality First planning successes by working closely with consumers, health
professionals and other health care providers to develop policies and
implement strategies that will improve the quality and safety of healthcare in the ACT.
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2.9.2 Quality
Quality First identified five guiding principles to facilitate better
coordination of quality activities across the Australian jurisdictions. These
principles and their goals are:
Safety: Safety in the process of care delivery to avoid and minimise the
potential risk of harm to consumers.
Effectiveness: Routine best practice interventions that produce the
desired outcome for consumers.
Appropriateness: Timely care tailored to meet individual needs
performed according to agreed evidence based considerations.
Accessibility: Services based on the proper assessment of consumerneeds and re-configured to meet changing requirements.
Efficiency: Utilisation of resources in a way that delivers maximum
benefits to consumers.
Maintaining a consumer focus in health care systems is essential to
ensuring quality and safety. This can be achieved by enhancing the
capacity of organisations and individuals participating in the planning,
management and review of health care services, which is currently shaping
workforce design.
2.10 NATIONAL NURSING AND NURSING EDUCATION
TASKFORCE (N3ET)
In November 2003, State/Territory and Australian Government Ministers
for Education and Health announced the establishment of a National
Nursing and Nursing Education Taskforce (NET). NET was established
to implement certain recommendations, and work with other key
stakeholders in the monitoring of all recommendations of Our Duty ofCare8, the report of the National Review of Nursing Education.
The recommendations in Our Duty of Care encompass a diverse range of
issues such as the skill mix and work organisation of Nurses and Midwives,
augmentation and retention of the current Nursing and Midwifery
workforce, training of care assistants, funding of clinical education and
national education standards.
8 National Review of Nursing Education 2002.
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NET is also responsible for a number of the recommendations from three
recent Australian Health Workforce Advisory Committee (AHWAC)
Nursing workforce reports: The Critical Care Workforce in Australia
2001-2011 (2002), The Midwifery Workforce in Australia 2002-2012 (2002), and Australian Mental Health Nurse Supply, Recruitment and Retention (2003), in
addition to further work regarding nurse specialisation.
2.11 ALLIED HEALTH
AHWOC recently released a publication concerned with establishing a
strategic planning basis for planning the future national Allied Health
workforce9. The report identified that there is currently no clear and
consistent agreement on what occupations comprise the Allied Health
workforce. This has an impact on data collection and benchmarking.
The ACT has a wide grouping of 23 disciplines which make up its Allied
Health workforce, this group includes disciplines such as Audiology,
Biomedical Engineering, Nuclear Medicine Technology, Pharmacy,
Physiotherapy, Radiochemistry, Radiation Therapy and Social Work.
Professions requiring tertiary education, delivering a clinically related
service which are non-Medical and non-Nursing are included in the AlliedHealth cohort in the ACT.
It is only recently that Allied Health has been acknowledged as a major
health workforce group and it constitutes the second largest employee
group after Nurses and Midwives.
Apart from the issue of the definition of Allied Health, the AHWOC Report
raises other issues such as most of the clinical practitioners are young and
female and the pool of Allied Health Professionals is much greater than the
number actually employed within their respective discipline which maybe indicative of lack of career pathways, access to postgraduate education
and little recognition of clinical skills.
9 AHWOC Report 2004.4
AHWAC Reprt 2002.1
AHWAC Reprt 2002.2
AHWAC Reprt 2002.3
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3 THE HEALTH CONTEXT FOR HEALTHWORKFORCE PLANNING
A vision for the future ACT Health workforce is reliant on acknowledgingthe inter relationships that exist in the global and national workforcescene. This chapter highlights major issues expected to impact on thedevelopment of strategic directions to build the sustainable healthworkforce that is required for 2010.
Globally, the greatest challenge for health care provision is that it is in aconstant state of evolution. Health care is both labour, and technologicallyintensive. We know that health professionals, particularly Nurses,Midwives, Medical Practitioners and Dentists are ageing and are workingfewer hours than they were 5 to 10 years ago. All this is happening at a timewhen there is an increasing demand for health care services. Furthermore,health care provision must be carried out safely and in line with communityexpectations grounded in economic reality. Any health policy, servicedelivery or technology change has an impact on demand, productivityor practice, or a combination of all three. Approximately 70% of health
expenditure is on labour costs and unlike other industries where newtechnologies are introduced, these high-tech initiatives do not necessarilylead to reductions in workforce numbers. Technology can require evenmore highly skilled workers or create new categories of workers. Accordingto the Industry Skills Report, May 2005 employment in health has expanded
by 3% per annum nationally over the last few years.
3.1 NEW MODELS OF CARE
New models of care are evolving in response to the move away frominstitutionalised care in hospitals all over the world. A Model of Care10 isdefined widely to mean taking a particular care group such as mentalhealth, children, or diabetes, and identifying a best practice model designedto meet the needs but not the demands, of a particular population. Theskills and capabilities required to provide that service are determinedand the required workforce supply can then be described. The result isa greater focus on the persons pathway throughout the care process andmore effective, or optimal outcomes for those with chronic illnesses and
other complex care needs.
10 Queensland Health (2000), Changing Models of Care Framework.
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A major future direction in service models is the increasing importance
of community-based and ambulatory care services that will provide care
in a user-friendly environment. A consequence of this change will be the
development of improved self-management skills for people with chronichealth needs, and the development of more networked services that
provide for the full health care needs of people across a range of services.
This approach is evolving in many jurisdictions and is reflected in the ACT
Health Clinical Services Plan.
Most jurisdictions in Australia have adopted an Area or Network approach
to health service delivery with the ultimate objective of ensuring care is
integrated between agencies and reflects the philosophy of a continuum
of care. The move to introduce clinical streams into the ACT follows theadoption of the Reid report by ACT Health, and national and international
moves toward emphasising consumer perspectives, clinical teams, clinical
delivery structures, involving clinicians in management, promoting
clinical governance and conceptualising care beyond any one organisation
and into the community.
The development of the Primary Health Care Strategy is an example of
the framework being developed to strengthen relationships between
non-government services, primary care, community providers and
hospitals to enhance management of chronic diseases, disease preventionand holistic health care.
3.2 NEW TECHNOLOGY
A key factor underpinning service delivery changes is whether a sufficiently
skilled and available workforce currently exists or can be developed by the
time the expected need arises. In addition to service delivery changes, other
factors also impact upon workforce planning. These include advances inhealth related technology. Health care is technologically driven, changing
and new technologies from information technology through to equipment
have already impacted significantly upon models of care, business
administration and patient outcomes.
The impact of technology on practitioner skill mix is high and presents
challenges in relation to professional boundaries and established roles, in
addition to competencies to be acquired, maintained and/or expanded.
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ACT Health has identified the following technologies for consideration
and/or for implementation over the next decade, and at least impacting
upon service delivery and workforce skills capacity by 2010:
Leading edge structural and functional imaging modalities
(e.g. ultrasound, Magnetic Resonance Imaging (MRI), Positron
Emission Tomography (PET)).
Point of care technology to enable pathology testing in community
based and outreach centres.
Implementation of telemedicine.
Migration to digital Picture Archiving and Communications System
(PACS) environments in medical imaging services.
Adoption of surgical robotics.
Performing laparoscopies through remote technologies.
Systems to support virtual surgery.
Emerging gene technology.
New cardiac technologies.
AHWOC has released its report Technology and Health Workforce Planning11
which looks into the impacts of technology. The report discusses thepotential impact of technological change on the Australian health
workforce, such changes can increase demand as more users are likely to
benefit from it, on-line learning can facilitate further demand for education
and training, new technologies can change the demands for different
categories of health workers.
One of the main recommendations of the report is the need for a WorkforceImpact Statement (WIS) to accompany the assessment of any new technology.
Currently this is not identified nor is the impact of education and training
needs or substitution capability of any new technology.
New technologies do not reduce the need for staff numbers in health as
might occur elsewhere however they do determine new models of care.
Information Technology has already delivered major changes but further
changes such as Electronic Health Records are expected. These changes
are expected to deliver further potential in online education and training,
better integration of information such as clinical reports and the capacity
to distribute them quickly as well as providing the capacity to better
organise health workloads
11 AHWOC (2005), Technology and Health Workforce Planning.
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3.3 WORKFORCE REDESIGN
Achieving the sustainable health workforce of the future will require
workforce redesign in the context of changing models of care. Workforceredesign is about new job roles and new ways of working.
It will also require an examination of organisational culture and workforce
climate. Health has traditionally been a very conservative labour
environment where staff are educated and function within their respective
professional discipline. The culture is one of a rigid hierarchy with
disciplinary demarcations in work practices. Unfortunately this system
does not have the potential to cope with the emerging challenges for
the 21st century workforce and emerging baby-boomer health consumer
cohort and merely impedes efficient service delivery.
In order to continue to meet the demand for health care, most health
organisations are challenging traditional boundaries of service delivery in
order to develop sustainable services.
Opportunities for workforce redesign can be associated with recruitment
and retention especially in the numerically smaller professions where
retention is a major issue. Professions such as Physiotherapy are exploring
initiatives which have been successful in the United Kingdom such as
Consultant/ Extended Scope of Practice Physiotherapists as well as the First Contact
Practitioner Status which is currently being trialled in Victoria.
Across professional disciplines there is a need to develop a shared set
of skills, competencies and attitudes so that there can be an increased
capacity for collaboration and team work.
The United Kingdom is leading the way with workforce redesign in health.
The scope of practice has been extended for Nursing and Allied Health
Professionals and Allied Health Assistants, trained using competencybased standards, are filling the labour void. In areas such as Radiology
overlapping of competencies between Radiologists and Radiographers has
been utilised with Radiographer reporting on basic skeletal radiographs.
Similar overlapping competencies are utilised with Nurse Practitioner
roles and with the establishment of Physiotherapy Soft Tissue Injury
Clinics attached to Emergency Departments in both the UK and Victoria.
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3.4 EMPOWERED CONSUMERS
A consumer base engaged in deciding on their health care provision is
anticipated, as increasingly consumers wish to be more informed aboutthe treatments proposed for them, their effectiveness and the track recordof the practitioners involved in their diagnosis, testing and treatment.Consumers will also have a much greater role in planning and evaluatinghealth service delivery.
The new focus allows service delivery to focus around the client ratherthan the provider eg the professional group or organisation.
3.5 ATTRACTION AND RETENTION
Global workforce tightening has occurred and will continue where theworkforce becomes more demanding and more selective about where itworks so that only employers and locations of choice may ever have anadequate workforce. Rather than using universally accepted and knownrecruitment and retention methods, increasingly agencies will need to usecreative attraction and retention strategies to draw talented practitionersfrom the global pool, then apply a personally tailored programme toencourage the move into the new environment.
Non-financial incentives such as opportunities for professionaldevelopment, access to child and aged care services and flexible rostering
are initiatives currently being developed for ACT Health workers.
3.6 EDUCATION AND TRAINING
Education, training and development are key, due to the increasing
demand for labour creating greater pressure to produce practitionersfaster. Similarly, there is an ever-present need to maintain and updateknowledge and competencies, and learning is seen in the context of alife-long event. The delivery of that learning is shifting towards computerbased and web based platforms.
Advances in technology have lead to pioneering the use of virtual realityin areas such as surgery and remote robotic control. In the health sector,multi-disciplinary simulation centres using computer haptics12 providea virtual environment where the user can practice and learn new skillsthrough the virtual object.
12 haptics: The science of applying tactile sensation to human interaction with computers.
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3.7 SOCIETAL AND CULTURAL CHANGES
There are a number of societal drivers and trends that are also likely to
impact on and influence the future workforce in the ACT. Among theseare the increasing number of single parents and dual income families.
Now, more than ever, people are responding to strategies that fit into the
career stage they are in and with their work life balance needs, and that
appropriately reward them for their qualifications. Planning for these
changes will mean that ACT Health will require effective human resource
support and be aligned with the global market place to effectively compete
in the health sector market place.
3.8 REGULATORY/LEGISLATIVE ARRANGEMENTS
The introduction of the Health Professionals legislation in the ACT has
resulted in ten health professional Acts being consolidated into a single
piece of legislation.10 The Health Professionals Act 2004 aims to protect thepublic from risk of harm by ensuring that health professionals regulated by
the Act are competent to provide health services.
Regulatory arrangements are changing. In addition, regulators have a role in
responding to the evolution of innovative solutions to work practice, work
place design (or redesign) and the associated recognition of knowledge
and competencies and the ability to practise safely and competently.
An Australia-wide system for nationally consistent medical registration has
been proposed whereby a practitioner registered in their state/territory of
primary practice would be able to practise in any other jurisdiction on the
basis of that registration. In the longer term a single national registration
system for all regulated health professionals has been advocated by the
Australian Health Ministers Advisory Council (AHMAC) submission tothe Productivity Commission (PC).
10 www.health.act.gov.au
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4 CURRENT WORKFORCE CAPACITY
4.1 DEMOGRAPHIC ANALYSIS
An analysis of the current demographic information available on the
Australian and ACT population, will indicate future population trends,
and hence assist in building a sustainable ACT Health workforce.
Chart 1: The Australian Population 2002-2032
To June 2002, the total Australian population was 19,662,000. By 2032,
the total population is projected to grow by five million to 25,040,000.
Growth is apparent in all age groups from early twenties, and there is a
consistent trend towards growth amongst the forty plus age group into
the early eighties.
0
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400
600
800
1000
1200
1400
1600
1800
0-4 5-9 10-
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000's
2002 2032
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4.2 ACT POPULATION AND TRENDS
The Australian Capital Territory Population Projections 2002 2032 and Beyond
predicts that on current trends, the population of Canberra alone willgrow to approximately 389,000 by 2032. This is a similar trend to the ABS
and is shown in Chart 3 below:
Chart 2: The Australian Capital Territory Population
Projections 2002 2032
Source: ACT Spatial Plan, 2004
The ACT population is projected to 2032, however without the influence
of the surrounding sector. In 2002, the estimated ACT resident population
was 321,800 and neighbouring Queanbeyans was 33,300. If the surrounding
southern area of NSW is also included in the population that ACT Health
provides services to, the potential client population is closer to 500,000.
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
1954 1961 1971 1981 1991 2001 2011 2021 2032
Year
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Chart 3: The ACT Population 2002-2032
In 2032, the 85 years and over group is projected to more than quadruple
in number (from a low base), to over 12,000, while 20,000 more people
will be aged in their 70s, nearly three times greater than now. There is a
continuing low level of fertility, net migration to Canberra is 500 peopleper year and the median age is 40 in 2032.
0
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Population
000's
2002 2032
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4.3 PROFILING THE AUSTRALIAN HEALTH WORKFORCE
The Australian health workforce is in short supply and as previously
discussed there is a priority to address particular specialities in Medicine,Allied Health and Nursing and Midwifery. For the purpose of this plan
however, it is important to show the health disciplines known to be in
short supply in Australia between 2003-04 (Table 2) followed by the same
chart showing shortages by disciplines in the ACT (Table 3).
Table 2: Health disciplines known to be in short supply in
Australia in 2003-04
Nursing/Midwifery Allied Health Medicine Other
General Nursing;
Aged care;
Cardiothoracic;
Community;
Critical care;
Emergency;
Indigenous;
Neonatal;
Neurological;
Oncology;
Operating Theatre;
Paediatric;
Palliative;
Peri-operative;
Renal;
Midwifery;
Mental health; and
Enrolled Nurses
Physiotherapy;
Pharmacy
(hospital/retail);
Occupational Therapy;
Speech Pathology;
Diagnostic Radiography;
Radiation Therapy;
Sonography; and
Nuclear Medicine
Orthopaedic Surgery;
Ear Nose and Throat
Surgery;
Obstetrics;
Pathology;
Radiology;
Oncology;
Psychiatry;
Geriatric Medicine; and
General Practice
Dentistry; and
Pharmacy
Source: AHWOC 2004
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Table 3: ACT Health specialities identified as in short supply 2004-200513
Nursing/Midwifery# Allied Health* Medicine* Other*
Emergency;
Intensive Care;
Neonatal;
Neurological;
Oncology;
Operating Theatre;
Orthopaedic;
Stroke Unit;
Vascular/Urology;
Aged Care;
Midwifery; and
Mental Health
Podiatry;
Physiotherapy;
Radiation Therapy;
Social Workers; and
Occupational Therapy
Emergency;
Geriatrics;
Mental Health;
Surgical Anaesthesia;
Paediatricians;
Neonatal Specialists;
Intensive Care;
Plastic Surgery;
Radiation Oncology;
Endocrinology;
Renal Physician; and
Obstetrics
Mental Health
Source: # ACT Nursing & Midwifery Office, August 2005
It is acknowledged that shortages in certain Allied Health specialist areas
have not been identified separately. Shortages in specialist Paediatric andNeurological Physiotherapists as well as MRI Radiographers have been
areas of concern.
4.4 ACT HEALTH WORKFORCE PROFILE
A snapshot of the permanent ACT Health workforce as at June 2005
provides useful profession based information.
As at 30 June 2005 ACT Health employed 5635 people, 4748 Full Time
Equivalents. These figures include permanent officers, temporary
employees and casual employees. These figures do not include Visiting
Medical Officers or agency staff. The workforce is older than the median
age of Australia with few people under the age of 30.
13 Above 15% Vacancy Rate
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4.5 MEDICAL
The majority of the medical workforce is not permanent, being employed
instead on contract. However, Visiting Medical Officers (VMO),Registrars, Residents and Interns make up a vital part of the ACT
Health workforce.
Chart 4: Medical Officers: Employment Status
A general picture of the current VMO workforce shows approximately
22 (16%) are approaching retirement age within 5 years.
Registrars are Doctors undertaking vocational training to fulfil the
requirements of their particular specialist college. In 2005 ACT Health
had 135 Registrars on contract.
ACT Health is currently employing 29 Residents and Interns through the
NSW Post Graduate Medical Council. However, to provide the current
level of services, 73 Residents and Interns are required. To achieve this
number, ACT Health has focused on recruitment from overseas and has
employed 45 overseas trained Doctors to fill these posts.
According to the Australian Institute of Health and Welfares document
Medical Labour Force 2003, the ACT experienced a 6% increase in Medical
Practitioners between 2000 and 2003 (from 1,134 to 1,204) however in that
time it had a decrease in the number of General Practitioners from 451 to
398 (-13%).
There are 128 permanent Doctors across the portfolio making 113.6 FTE.
A total of 34 new permanent Doctors were appointed during 03/04-04/
05. The separation rate for medical staff (excluding Interns, Residents
and Registrars) is 7.1% with 16 Doctors separated during 03/04-04/05 and39 Doctors are expected to separate in 5 yrs.
125290
16 134
Permanent Temporary Casual VMO
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4.6 NURSING AND MIDWIFERY
The Nursing and Midwifery professions represent the largest professional
group within ACT Health, accounting for around 41% of the entireworkforce.
Nursing and Midwifery is a predominantly female discipline (91%), the
exception to this is Mental Health ACT where 31% are male. 58.9% of all
Nurses/Midwives work full-time, 90% are employed on a permanent basis,
6% on fixed-term contracts and 4% on a casual basis.
Like the workforce in general, the Nursing and Midwifery workforce is
ageing. Their average age is 43 years, and almost half (47%) are aged more than
45 years.
The average age varies by classification and division ranging from
40.0 years (RN/M-level 1) to 48.8 years (RN5) and 41.3 years (The
Canberra Hospital) to 47 years (Mental Health, Community Health, Aged
Care & Rehab stream).
Information on the utilisation of agency Nursing & Midwifery staff
is collated by the Nursing and Midwifery Informatics areas of ACT
Health. Agency staff are typically employed on a shift-by-shift basis or
to supplement staffing levels to meet shortfalls in service needs. There
continues to be an increasing trend in agency utilization.
Currently, there is limited information available on specialist qualifications
of Nursing and Midwifery staff. However, as part of the ACT Public
Sector Nursing Staff Agreement 2004-2007 (Section 38), a Qualifications
Allowance was recently introduced, recognising qualifications that are
directly relevant to the employees duties. Information on qualifications
for which this allowance is to be paid is captured and will be more freely
available in the near future.
Some information can be obtained from Nursing and Midwifery Labour ForceSurveys which are conducted annually by the Australian Institute of Health
and Welfare (AIHW).
Additional information can be obtained from the Nursing & Midwifery LabourForce Survey which is conducted annually by the Australian Institute of
Health and Welfare (AIHW) through the Nurses Board of the ACT. The
survey is distributed to all Nurses and Midwives who are registered or
enrolled with the Board to practice in the ACT, and is voluntary.
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These include Nurses & Midwives who work for ACT Health, private
hospitals, residential aged care, general practice, tertiary education, the
defence forces etc.
Data from the 2004 survey indicates that the ACT Nursing and Midwifery
workforce is well educated with around 43% having completed
post-registration /enrolment qualifications and half (49%) having obtained
more than one qualification.
These qualifications were predominantly in broad subject areas of High
Dependency (HD) (28%), Midwifery (20%) and Medical/Surgical (10%).
Within HD, qualifications were in Critical Care (20%), Peri-operative
(17%), Intensive Care(16%), Emergency/Trauma(12%), Neonatal Intensive
Care(10%).
Within Medical/Surgical, qualifications were in Oncology/Palliative
Care(37%), Wound Management(18%), Orthopaedic(11%), Renal/
Nephrology(10%).
In 2004/05, the total permanent ACT Health Nursing and Midwifery
workforce equated to an average of 1600 FTE or a headcount of 1934.
The average separation rate for permanent Nursing and Midwifery staff
over the last two financial years was 11.2% with a positive replacement of
12.6%.
Based on these ACT Health trends for separation, and if there is no change
in recruitment, retention, service delivery and models of care the potential
net supply loss is 869 head count over the next 5 years.
Acknowledgement must be given to the fact that Nursing and Midwifery
are mobile professions, this is one of the attractions of the professions.
It should be noted that in a clinical setting, Nurses and Midwives may
work until the age of 65 and may be able to work reduced work hours and
utilise flexible work arrangements.
Variable factors such as age of retirement; changing technology and
extended scope of Nursing & Midwifery roles; growth in demand for
health services, number of Nurses and Midwives working part time; and
the impact of decline in numbers of experienced staff with advanced skills
may potentially increase this estimate.
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4.7 ALLIED HEALTH
Allied Health professions are predominantly female (78%) and 13% of allied
staff work as temporary employees and 27% work part-time. This cohortof temporary staff provides operational flexibility and can be crucial to the
delivery of Allied Health services.
Unfortunately under the previous ACT Health Human Resources
Information System, Allied Health Professionals were only identified as
health professionals rather than by their particular discipline, therefore
it is difficult to identify characteristics unique to a particular profession.
The new Human Resources Information System will allow recognition of
individual professions.
The average age of permanent Allied Health Professionals is 41.
The separation rate for all Allied Health Professionals is 13.1% but it
is unfortunate that individual disciplines separation rates cannot be
reviewed at the present time. Because of the difficulties collecting
nationally consistent Allied Health data, it is difficult to compare
jurisdictional separation rate data.
4.8 TECHNICAL AND SUPPORT STAFF
The technical and support staff of ACT Health cover a wide group of
technical, administrative and support staff (eg Medical Transcription
Typists, Wardspersons, Policy Officers, Theatre Technicians and
Biomedical Engineering Technicians). The average age of the Administrative
Staff is 42 years and for Technical Officers is 43 years.
The separation rate for Administration Staff is 14.7% and is 10.1% for the
Technical Staff.
89% of Administrative Staff work full time whilst 62% of Technical Staff
are full time employees.
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4.9 CURRENT TRENDS IN THE ACT HEALTH WORKFORCE
A common strategy to determine future workforce needs is to undertake
trend information either through snapshot analyses or through projections.This analysis is initially conducted in the do nothing scenario across each
particular discipline, and estimates the impact on future requirements
if there is no change to the current separation and turnover rates. The
importance of this information is that it allows for assessment of the
trends in terms of our current capacity to replace the workforce.
Table 4 presents ACT Health workforce data for two financial years and
considers the current retirement rate, separation rate, and determines on
the basis of the current workforce what the net supply size is, and what
the projected losses would be over a time period without new strategies orcurrent recruitment activities.
Table 4: Snapshot Analysis of Supply Requirements to 2010
Discipline
& Level
Separation
Rate
Current
Workforce
(headcount)
Current
Workforce
(FTE)
Separations Net Supply/
Workforce Size
1yr 2yrs 5yrs 1yr 2yrs 5yrs
Total 12.18% 4202 3642.84 512 961 2007 3690 3241 2195
Nurse 11.24% 1934 1600.43 217 410 869 1717 1524 1065Medical 7.08% 128 113.60 9 17 39 119 111 89
Technical 10.11% 477 436.05 48 92 197 429 385 280
Allied 13.08% 691 591.82 90 169 348 601 522 343
Admin 14.67% 972 912 143 264 532 829 708 440
Source: ACT Health 2005
On the basis of available workforce data for 2003/04 2004/05, in the
last two financial years there were 1043 permanent appointments. The
annualised, permanent ACT Health workforce Total Separation Rate(TSR) is 12.18%. Based on this rate it is estimated that:
Over 510 permanent ACT Health workers will leave in 2005-06.
Over the next five years almost half (2,007 workers) of the total,
permanent ACT Health workforce will separate.
This figure is below the national average for all industries (14%)14 and the
Nursing and Midwifery specific turnover rate compares favourably with
the total Nursing and Midwifery workforce for 2002.
14 Graffam, J. (2004) Unpublished work for the ACROD Conference, Deakin University
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5 EXISTING STRATEGIES
5.1 CURRENT ACT HEALTH RECRUITMENT STRATEGIES
There are a number of levers that can be used to achieve a sustainable
health workforce and achieve workforce redesign as indicated by the
figure below.
Chart 5: Leverage points
ACT Health is already progressing with a number of these strategies.
Avoid
Unnecessary
Admissions
Expanded Pool of
Prospective Staff
Treat in Less
Intensive Settings
Reduce Patient
DemandIncrease Supply Improve efficiency
Workforce redesign
Traditional
segments
Minorities
Men
Increase
Educational
Capacity
Facility
Number of
training
positions
Clinical
placements
Extend
careers
Postponeretirement
Attract back
to the
workforce
Task
reallocation
Care Process
Improvement
Process Flow Technology
International
Source: Modified from The Advisory Board Company 2003
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5.1.1 Marketing
Along with other health services across Australia, ACT Health has
increased advertising and established partnerships with Australian and
overseas recruitment agencies. These strategies aim to raise awareness of
employment opportunities within ACT Health.
ACT Health has expanded its involvement with recruitment websites,
with a presence on:
www.anaesthesiacareer.com an international anaesthetics recruitment
website
www.doctorconnect.gov.au a website designed to attract and
assist Overseas Trained Doctors to apply for jobs in Australia. Thisinitiative has been developed by the Australian Government to assist
jurisdictions in accessing the global market.
www.Seek.Com has been used by Mental Health ACT to advertise
vacant positions.
ACT Health has also increased advertising across Australia and overseas
with professional organisations and colleges. In addition ACT Health
continues to raise its profile by attending interstate employment
expositions and universities.
ACT Health continues to be proactive in developing strategies to address
workforce shortages including Nursing and Midwifery recruitment
activity at the national and international level (including Canada, USA
and UK), marketing through printed media, development of an ACT
Health Promo CD, and ACT Health Nursing and Midwifery Brochures.
5.1.2 Attraction Strategies
Students
Establishment of Dedicated Education Units (DEU) provide a structured
learning environment in a partnership between ACT Health and the
University of Canberra for undergraduate Nursing education and
professional support.
In the Allied Health area, scholarships are now being offered to fourth year
Podiatry students and third year Radiation Therapy students dependent
on post graduate employment within ACT Health.
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In many Allied Health disciplines, there is no critical mass which will
allow under-graduate or post-graduate education for these professionals
in the ACT. To compensate ACT Health has developed and maintains
relationships with interstate tertiary institutions. Providing clinicaltraining places for these courses has proved to be an effective attraction
strategy. Recruitment of new graduates across the Allied Health disciplines
is frequently populated by staff who had prior clinical placements in the
ACT from interstate jurisdictions.
New Graduates
A strategy to address this will be to increase recruitment of new
graduates from the Australian National University Medical School
graduates in 2008.
Placement of graduates from the University of Canberra within the
ACT should be a key initiative to retain and recruit newly qualified
Physiotherapists, Pharmacists and Dieticians.
Professional development and recruitment of new Nursing and Midwifery
graduates is a significant component of a comprehensive education
strategy to meet projected workforce supply demands. New graduate
positions are promoted and have been increasing every year. Graduates arefrom the University of Canberra and there is a healthy interstate intake in
February each year.
In February 2005 ACT Healths intake of new graduate Nurses increased
by more than 60% from the same time last year.
Since August 2002 the retention rate on average for new graduates has
been more than 75%.
Refresher and re-entry
ACT Health, in conjunction with the higher education sector is facilitating
the development of a refresher and re-entry program for Nurses and
Midwives who wish to return to the professions after a period of absence.
A number of Allied Health disciplines already support re-entry programs
run under the auspices of the relevant professional associations.
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Overseas recruitment
ACT Health currently needs to recruit junior and senior Overseas Trained
Doctors (OTDs) to fill positions that remain vacant after allocation of Junior Doctors from the NSW Post Graduate Medical Council. This is
considered to be a short-medium term strategy.
Development of a Labour Agreement with the Australian Government
provides an immediate and longer term strategy to recruit overseas staff in
a range of health occupations experiencing shortage.
5.1.3 Retention Strategies
A number of strategies are already in place or in the planning stage.These include:
The development of improved data concerning retention issues and as a
priority the results of exit surveys.
The Allied Health professions such as Physiotherapy and Radiography
need further acknowledgement of their specialist skills as a retention
measure.
Expansion of access to funded professional development activities as wellas the existing Allied Health Postgraduate Scholarships.
Developing a proposal to strengthen the Nursing support structures in
Community Nursing and Child Youth and Womens Health Programs.
ACT Health is moving towards establishing safe working hours for
Medical staff. This has resulted in an increase in the overall Medical staff
numbers. Two benefits of this strategy are that overtime spending on the
Medical workforce should decrease, and Doctors will not be expected to
work an unsafe number of hours.
ACT Health is implementing a range of initiatives. These are aimed at
a systems, organisational and professional level. To promote healthy
workplace environments based on best practice; a strong learning culture
that enhances personal and professional growth and development through
on-going learning and education; work-life balance, and support for
research into evidence based-practice.
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The establishment of 21 new Clinical Development Nurse positionsacross the ACT will provide Nursing and Midwifery staff additionalclinical support for ongoing learning and skill development. A Career
Advancement and Selection Co-ordinator has been established as the22nd position for the registered Nurse/Midwife level 1 2 project which ispart of the ACT Public Sector Nursing Staff Agreement 2004-2007.
New and innovative models of health care. For example, these may includeextending the scope of practice to enable authorised Enrolled Nurses toadminister permitted medications and extensive work to establish NursePractitioner and Allied Health Assistants positions.
Encouraging a strong learning culture that enhances personal and
professional growth and development through on-going learning andeducation, including:
Provision of financial scholarships to assist Nurses and Midwivesto undertake postgraduate studies in a clinical, education, research,leadership/management area.
Continuing to provide a number of education programs in conjunctionwith the University of Canberra, supporting current and potentialNursing and Midwifery staff to undertake postgraduate courses inidentified skills shortage areas: Critical Care, Paediatrics, Midwifery,Neonatal, Peri-operative, Intensive Care.
Development of thePositive Professional Development Pathway Scheme toassist all staff with fee payment of tertiary education related to theiremployment.
Exploration of opportunities to develop different educationalpathways including work experience, and the articulation of trainingprograms to tertiary courses.
ACT Health under the direction of the Nursing & Midwifery Office are
investigating the opportunities for multi/modular educational programsthat are evidence based and built on adult learning principles. They willbe offered in the unit, by the unit, and for the unit with articulation tothe tertiary level, ensuring ownership, team building, and the immediateapplication of learning to improve patient outcomes.
ACT Health is reviewing what constitutes safe working hours for Nurses
and Midwives and processes to assess and manage risk and fatigue.
Allied Health benchmarks for staffing in acute care and community settings
will be developed in the operational areas, this will impact significantly onservice planning/equity of workloads.
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5.2 WORKFORCE REDESIGN
A joint ACT Health and Department of Disability, Housing and Community
Services (DDHCS) project has been undertaken to establish an AlliedHealth Assistant Training program in the ACT. This will allow ACTHealth to establish a recognised Allied Health Assistant Certificate levelIII and IV course to support the Allied Health workforce to provide highquality health care. These staff members will not be a replacement for, buta complement to the Allied Health Professionals. The development of theseassistants courses will allow for the broadening of the scope of practiceof current Allied Health professions such as has been achieved in the
United Kingdom.
5.2.1 Certified Agreements
Nursing/Midwifery
The ratification of the A.C.T. Public Sector Nursing Staff Agreement 2004-2007 sees ACT Nurses and Midwives with some of the best conditions andbeing among the most highly paid in Australia.
Currently, eight project initiatives have been identified in the Agreementto support workforce redesign, attraction and retention of Nurses andMidwives to ACT Health. These are:
RN 2 Phase 1: initial advancement and selection project
Review of RN3 and above classifications
Scope of Practice for Enrolled Nurses including the implementation ofthe EN2 classification project
ACTPS Performance Management Framework -application to Nursesand Nursing services project
ACTPS Learning and Development Framework -application to Nurses
and Nursing services project
Introduction of the 10 Hour night shift at Calvary Hospital andMaternity Unit at The Canberra Hospital project
Workload and staffing measurement, assessment and research project
Allied Health
A review of the various classification structures, revised progressionmodels and competency development has enhanced and modernised the
public service. Salary and allowance increases provide more appropriateremuneration levels and systems for the public service.
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Medical
An ACT Health working party developed a framework to deal with issues
confronting the Medical Workforce in the ACT, including an actionplan for the next triennium. The framework identified four objectives:attract and retain Medical Officers, deliver high quality clinical services,deliver cost-effective and cost-efficient clinical services, and implementGovernment industrial relations policies. The certified agreement will bean avenue through which the four objectives set out in the framework will
be achieved.
5.3 MULTI-DISCIPLINARY EDUCATION OPPORTUNITIES
Under current models of education, health professionals are educatedin isolation within their particular discipline or profession, when theygraduate they are expected to work as part of a team. ACT Health hasdeveloped an Inter-Professional Learning Framework which will facilitatea collegiate and collaborative inter-professional approach to delivering aholistic view and options for the provision of clinical education support.
A key focus of workforce planning is on those professions where growth
is expected with priority given to those areas where ACT and nationalshortages are being experienced.
The establishment of the Australian National University MedicalSchool with its first graduates in 2008 will provide ACT Health with anopportunity to grow its own junior medical staff into the future.
The establishment of the ANU Medical School will assist in attractingclinicians to the ACT as well as providing a valuable addition to healthresearch in the Territory.
The ACT Government has committed $10 million to establish a faculty toeducate a number of Allied Health disciplines at the post-graduate level.ACT Health is closely involved in this development.
The ACT will continue to work with the University of Canberra theAustralian Catholic University to assist in meeting the Nursing and AlliedHealth needs of the community into the future.
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The ACT will continue to implement workforce recruitment and retentionstrategies that build and enhance the capacity of the workforce toensure that the community continues to have access to high quality health
care services.
Professional learning in all disciplines that promotes learning in bothundergraduate and postgraduate levels will build workforce capability.Focusing on working in teams and in multi disciplinary groups, providinglearning and development opportunities, increasing base level capacityand aligning capability for service provision to the community needs willachieve this.
An ACT Health Learning and Development Framework for Career and
Professional Practice Development (Performance Management) hasbeen developed to provide the structure to meet capability, skills andknowledge to be competent. The Framework facilitates protected timefor learning, availability and expertise of peers, effective instructionalmethods, participation and collaboration, activities that encourageproblem posing and critical reflection, learning with hands on experience,external acknowledgement, articulation across the pathway for educationand training, and appropriate modes of education across ACT.
ACT Health currently provides four postgraduate diplomas in Nursing
in partnership with the University of Canberra. Nursing and Midwiferywill be working towards including recognition of short courses conductedwithin ACT Health and the further development of certificate courses thatarticulate into diplomas and masters degrees.
Mental Health ACT (MHACT) has a post graduate mental healthRN Nursing program with the academic provider and partner beingLatrobe University in Victoria, MHACT also runs an EN programthrough Latrobe. Both of these programs are funded through the Nursingscholarship program.
MHACT has a Psychiatry Registrar training program to facilitatemedical training.
The Australian Catholic University (Signadou) is now providing bothgraduate and undergraduate studies in Social Work for current andpotential ACT Health staff.
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6 ACHIEVING OUR OBJECTIVES
Sustaining levels of healthcare provision at current levels and to improve
healthcare provision wherever possible requires substantial workforce
redesign and modernisation across the public and private sectors. If we are
to succeed in meeting these challenges, we need to consider existing and
potential developments to design a workforce that is fit for purpose, meets
the healthcare needs of the population and sustains safe and effective
models of care. There is a commitment to developing and supporting the
ACT Health workforce in order to:
Meet current and anticipated gaps in service provision.
Increase the overall numbers in key sections of the workforce.
Plan the workforce from the perspective of the patient and for patient-
centred models of care.
Develop workforce frameworks with an emphasis on workforce
development by care group.
Improve attraction and retention of staff by supporting the
development of the concepts of the skills escalator, continuing
professional development, career progression and lifelong learning
resulting in a much more dynamic workforce.
Enable emphasis on partnerships and working across traditional
organisational and professional boundaries.
Enable a focus on a system-wide approach to workforce redesign.
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6.1 A WORKFORCE PROFILE
ACT Health requires access to replicable and reliable data for effective
analysis of the workforce. Historically workforce planning in ACT Healthhas been undertaken along professional streams. However, future work
will include development of an analytical workforce framework that
incorporates a model of care approach. ACT Health over the life of this
plan will:
Continue to monitor the workforce by discipline and classification.
Continue to develop the workforce profile to derive workforce
demand and supply information by:
- Using a variety of models and approaches to support workforceredesign including toolkits, supply and demand models, and
training needs analysis.
- Integrated data warehousing (integrated workforce data with
health-care data), including a workforce minimum-data-set.
Develop planning tools that consider new models of care including
scenarios for workforce demand prediction.
Create reports on current research, trends and current practice inworkforce redesign.
6.2 A RESPONSIVE WORKFORCE
To develop and maintain a responsive workforce, that is flexible, productive
and happy, ACT Health needs to focus initially on the correct mix of
competencies and skills, and later, evaluating new job roles to support
existing roles and then look to extending others in concert with national
and international trends. This will include taking the best practice patient
care pathways as the initial focus for thinking differently about roles. ACT
Health will:
Align the Clinical Services Plan (CSP), Workforce and Human
Resources plans with performance activity reporting.
Develop a process of role redesign that is aligned with the CSP. It will
involve staff, patients, carers and other consumers. It will also include
identifying the organisational development and change management
implications of redesign.
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Align workforce initiatives with the CSP targeted directions in fields
such as subacute care, stroke care and ambulatory care streams.
Identify and evaluate effective and safe workforce practice models,linking staff numbers to models of care workloads wherever relevant
and possible, to ensure that patient outcomes can be met.
Develop extended workforce roles based on required
competencies and skill enhancement with a shift to
multi disciplinary team based working.
Explore the opportunities offered by networking between hospitals,
including the potential of telemedicine.
Build in evaluation processes to make sure the expected benefits are
realised and that safety is not compromised.
Develop enterprise bargaining agreements which include stated
requirements for supervising students in clinical competence
to encourage a learning environment and education for the next
generation of health professionals.
6.3 EDUCATION AND TRAINING
ACT Health requires access to a ready labour pool of graduate health
professionals that are work-place ready. In this regard ACT Health will
seek to influence new methods of interdisciplinary learning, the types of
courses and numbers of places in the ACT tertiary sectors. To achieve this
ACT Health will:
Develop formal partnerships with the tertiary sector so that education
and training programs better align new graduates to job roles.
Develop new job roles based on required competencies and skill
enhancement. Ensure that competencies are generated and relevant
links made to education, training and development to ensure that
extended workforce roles are sustainable and safe.
Increase access to learning and development opportunities and further
education for all staff.
Work collaboratively with the higher education and VET sectors to
develop new models of learning, including simulated environments
and interdisciplinary association and practices.
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6.4 EFFECTIVE LINKAGES
ACT Health participates in and contributes to comprehensive policy
discourse within a system of national health committees that crossall sectors of governments and other stakeholders in Australia and
New Zealand. ACT Health will:
Participate in national workforce committee agenda initiatives and
workforce work programs.
Develop joint government and intra-agency partnerships including the
tertiary sectors.
Develop joint agency work programs with other relevant ACT
Government bodies of expertise, such as ACT Demographics andBusiness ACT.
Participate in policy debate about the definition of the future roles,
ways of working and regulation that will define the healthcare
workforce in the ACT, building on local innovation and change.
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Table 5: ACT Health workforce objectives and strategies at a glance
Objective Desired Outcome Strategies Who When
A workforce
profile
ACT Health requires
access to replicable
and reliable data for
effective analysis
of the workforce.
Historically
workforce planning
in ACT Health has
been undertaken
along professional
streams. However,future work will
include development
of an analytical
workforce framework
that incorporates
a model of care
approach
Derive improved
workforce supply
& demand
data including
evaluation tool
Workforce Policy
& Planning Unit
Information
Management/
Information
Technology
Chief Nurse/
Nursing &
Midwifery Office,
Allied HealthAdviser
ACT Registration
Boards
Short-term
Develop models
of care planning
and analysis tools
Workforce Policy
& Planning Unit
Medium-term
Build workforce
supply and
demand
scenarios based
on predictions of
models of care
Government
Relations and
Planning
Long-term
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Objective Desired Outcome Strategies Who When
A responsiveworkforce
To developand maintain
a responsive
workforce, that is
flexible, productive
and happy, ACT
Health needs to
focus initially on
the correct mix of
competencies and
skills, and later,evaluating new job
roles to support
existing roles.
This will include
taking the best
practice patient
care pathways as
the initial focus for
thinking differently
about roles
Provide researchreports on
workforce
redesign,
extended job
roles and scopes
of practice
Chief Nurse/Nursing &
Midwifery Office
Allied Health
Adviser
Workforce Policy
& Planning Unit
Short-term
Identify and
develop effective
workplacepractice models
Workforce Policy
& Planning Unit
Chief Nurse/Nursing &
Midwifery Office
Allied Health
Adviser
Medium-term
Align workforce
planning with
clinical service
planning
Government
Relations and
Planning
Medium-term
Explore
professional
development
opportunities
offered by
networked
health facilities
ACT Health
Tertiary
Education
Liaison
Committee
Workforce Policy
& Planning
Allied Health
Adviser
Chief Nurse/
Nursing &Midwifery Office
Medium-term
Remain cognisant
of regulatory
constraints but
not viewing
these as
insurmountable
obstacles
ACT Registration
Boards
Allied Health
Adviser
Chief Nurse/
Nursing &
Midwifery Office
Medium-term
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Objective Desired Outcome Strategies Who When
Education and
training
ACT Health requires
access to a labourpool of graduate
health professionals
that are work-place
ready. In this regard
ACT Health will
seek to influence
new methods of
interdisciplinary
learning, the types
of courses andnumbers of places in
the ACT tertiary and
VET sectors
Develop formal
partnerships withthe tertiary and
VET sectors
Workforce Policy
& Planning Unit
Liaison
Committee
Department
of Education,
Science &
Technology
Short-term
Facilitate better
alignment
betweeneducation
outcomes &
health workforce
needs
Allied Health
Adviser
Chief Nurse/
Nursing &
Midwifery Office
Workforce Policy
& Planning Unit
Peak Regulatory
Bodies
Medium-term
Develop new
models of
learning through
multi-disciplinary
approaches
and simulated
environments
ANU Medical
School
University of
Canberra
Canberra
Institute of
Technology
Australian
Catholic
University
Allied HealthAdviser
Chief Nurse/
Nursing &
Midwifery Office
Short to
Medium-term
Increase access
to learning and
further education
for all workers
Staff
Development
Unit
Ongoing
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Objective Desired Outcome Strategies Who When
Effective
linkages
ACT Health
participates inand contributes
to comprehensive
policy discourse
within a system
of national health
committees that
include all sectors
of governments and
other stakeholders
in Australia andNew Zealand
Participate in
and contributeto the national
health workforce
committees
Government
Relations &Planning
Short-term
and ongoing
Develop joint
government and
intra-agency
partnerships
Allied Health
Adviser
Chief Nurse/
Nursing &
Midwifery Office
Workforce Policy
& Planning
Short-term
and ongoing
Develop joint
agency work
programs with
other ACT
Government
bodies
Allied Health
Adviser
Chief Nurse/
Nursing &
Midwifery Office
Workforce Policy
& Planning
Short-term
and ongoing
Maintain
linkages with
other relevant
health workforce
strategies,
policies and plans
through local and
national forums
and networks
Allied Health
Adviser
Chief Nurse/
Nursing &
Midwifery Office
Workforce Policy
& Planning
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