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Progressing the national healthworkforce reform agenda
Peter CarverExecutive DirectorNational Health Workforce Taskforce
Thursday 10th September, 2009
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National health workforce reform agenda COAG and health workforce reform 2008
An acknowledgment that large reform is necessarywith a particular focus on bridging health and education
National health workforce agency
Specific focus on implementing workforce reformintegrating workforce planning and policy with necessaryand complementary reforms to education and training
Will subsume the NHWT and its work program
Budget of approximately $1.55B over 4 years
Progressing the national agenda for the first time willbe meaningfully inclusive of the private and not for profitsectors and acute, sub acute, community, rehabilitation,community care and aged care settings
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Progressing the health workforce reform agenda The national agenda is three pronged and intersecting
Innovation and reform
Research and workforce planning
Education and training
The NHWT, then the national agency (Health WorkforceAustralia) will progress the national agenda
Legislation passed June 2009
HWA is expected to be transiting to operation
from October 2009 Location: Adelaide
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Supporting innovation and reform COAG allocated over $70M over four years to
Promote better utilisation and adaptability of the workforce
Explore new and emerging roles to respond to changing demands
How?
Promote national uptake of innovative reforms
Development of tools, guidelines and a national evaluation framework
Test health workforce reform models
A cycle of phased work through to 2012/13Phase 1 aged care - Phase 2 rural and remote - Phase 3 primary care
Research local, national and international innovationinitiatives for whole of system uptake
Promote VET and assistant roles
Explore policy and regulatory barriers to new workforce models
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Researching and building the evidence base COAG allocated over $24M over four years to lead, encourage
and support a health workforce research, planning and policydevelopment agenda
How?
Continually improve national health workforce information
National workforce data, data standards, frameworks and process
National health workforce statistical dataset
National clinical placement data and management system
National workforce projections and research
National supply and demand model
Supply and demand projections global and by specialty
Workforce demand and supply workload measures
National health workforce research collaboration
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Reforming education and training COAG allocated over $1.2 billion over four years to
Maximise the capacity of the health and education systemsto provide sufficient trained graduates to meet demand
Ensure education and training is appropriate, responsive
and relevant to changing health system needs andsupports innovation and reform
How?
Funding, planning and coordinating clinical trainingto provide effective, streamlined, integrated placements
Increasing number of places and expanding into non traditionalsettings, including simulation training, rural and remote, NFPand private sectors
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Reforming education and training How?
Providing and attaching funding to studentsin whatever service setting they train
Training and supporting clinical supervisors
Funding training infrastructure and simulatedlearning environments
Development of a national health leadershipstrategy and programs
A focus on Inter-professional learning and placements
Competency based rather than time based learning
Exploration of common competencies in health professions andgreater consistency in curriculum within and across professions
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Reforming education and training HWA
Devise solutions that integrate workforce policy and reformwith reforms to education and training
Work across geography, sectors, organisations and professions
HWA responsible for setting strategic direction
Develop policy, national KPIs, support accreditation bodies,identify and foster cultural change, best practice and innovation
Fund support for placement management and brokerage
Fund clinical placements on an output based funding model
Objective is to utilise existing arrangements and networksand not duplicate functions but ensure outcomesare achieved with clear accountabilities allocated
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Funding clinical placements
CLINICAL PLACEMENTS
Medicalstudents
Universities and
other educationproviders including
simulation
Public hospitals(metro & rural)
SimulatedLearningEnvironments
Primary care /community-
based settings
Private/NFPhospitals
Healthsciencestudents
Jurisdictional governments departments/agencies
Federal government departments/agencies
Nursingstudents
A
B C D
E
Key Objectives
A. Maintain and strengthen existingrelationships between educationproviders and health care settings
B. Develop new relationshipsbetween education providers and
health care settings particularlyfostering innovation eg SLEs
C. Promote cooperation between allparties for clinical placements
D. Increase efficiency of existingtraining
E. Make better use of under-utilisedcapacity (e.g. in regional/remotehospitals, primary care/community-based settings andprivate hospitals)
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Funding clinical placements Total of $992 million over four years to
subsidise professional entry clinical training
Commonwealth/State and Territory 50/50 split
Principles for the clinical training subsidy
Increase capacity and promote quality placements
Attach to students in whatever service setting they train
Key policy issues include
Which professions, qualifications and settings are eligible
What weightings or other measures are needed How to ensure current contribution levels maintained
Linking with accreditation bodies/universitiesfor quality standards
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Clinical supervisor support Funding is provided for improving clinical supervision
capacity and competence in professional entry training
$56M committed over four years
$28M Commonwealth
$28M States and Territories
All parties agree that the quality of supervision is thekey influence on the quality of the clinical placement
There is a pressing need to build up the numbers in
the workforce who are prepared to take on this role
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Clinical supervisor support National framework to support services to train students
and increase capacity to supervise students to be developed
Key policy issues include
Recognising profession/provider differences
How to ensure current contribution levels maintained
Vertical integration of training
How to ensure quality
Should it include SLEs?
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Clinical placement management system A system that addresses data needs at all levels and supports
the placing and receiving organisations has been agreed
Either a national or local on-line system to supporteducation providers, health services and studentsand reduce administrative burden
Activity, supply, demand and planning data wouldbe collected from the system as a by-productof its managing placement activity functions
As far as is possible, it is intended to identify an existingsystem that can be adapted for the national IT system
Provision of data will be mandated but health services andeducation providers not obliged to use any particular system
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Clinical placement management system
Implementation approach
Detailed business requirements document
Development of a detailed costed implementation planand a functional and technical specifications document
Investigation of the potential of existing systems(Australian and international) to provide the data andfunctionality consistent with the functional specifications
Investigation of work needed to integrate legacy systems and/ortranslate data sets from old systems into the preferred system
Software development, acceptance testing and implementation
Implementation will be phased with a scaled-back systemimplemented in the 2010 academic year
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HWA governance arrangements
For governance of the management of clinical trainingstakeholders support
An inter-sectoral and collaborative governance model thatsituates planning, coordination, policy direction, standard
setting and quality assurance within the scope of HWA Placement management and brokerage to occur as close
as possible to the activity, supporting at the same timethe need for national, jurisdictional and regional planningwhere appropriate
Mitigating the risk of over management Addressing real or perceived conflicts of interest in the
distribution of placements and funds to the public, privateand not for profit sectors
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HWA governance arrangements
Approaches supported by stakeholders
HWA must be responsible for setting strategic directionand determining outcomes for clinical training
Establish training priorities, monitor performance
and promote continuous development Develop policy, national KPIs, supporting accreditation bodies,
identify and foster cultural change, best practice and innovation
Assess delivery of COAG outputs
Fund regional communities of interest to support brokerage
and collaboration HWA flow student placement funds,
according to an output based funding model
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HWA governance arrangements
One possible model
Agreed regional communities of interest universitiesand service providers identified through jurisdictionalplanning processes
Regional/local entities identified to establisha support function for each community of interest
Regional/local entities accountable to HWA for localmanagement of placements, ensuring outcomes are met
Clinical training outcomes national (from accreditation bodies
and HWA) and from universities in accordance with curriculum Clinical training providers responsible for delivery of training,
according to nationally agreed standards for clinical placementsafety and quality and learning outcomes
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HWA governance arrangements
Implementation
The planned governance and organisation modelwill aim to respond to the key themes put forwardby stakeholders
Directions paper will be released shortly to describethe outcome of the consultation process and theframework for the planned arrangements
Consultation will continue as the model movesto implementation
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Simulated learning environments
$96.5M committed over four years by the Commonwealth
Capital works development of new centresand/or re-development/expansion of existing centres
Fixed and Mobile resources
Funding for equipment & staffing
09/10 10/11 11/12 12/13
$0.50m $14.95m $40.00m $41.50m
Will encompass both high and low technical training needs
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Simulated learning environments
A national strategy what are we trying to achieve and how?
Increased use of simulated learning modalities in clinicaltraining for entry level health professionals to support thegrowth in system wide clinical training capacity
Optimised clinical training experiences through the useof simulated environments to develop clinical skills andcompetencies required by health professionals
Increased equity of access for students to simulatedtraining experiences in regional, rural and remote settings
Improved quality and consistency of clinical training
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Simulated learning environments
Scope
Definition:Simulation is a technique- not a technology- to replace oramplify real experiences with guided experiences that evoke
or replicate substantial aspects of the real world in a fullyinteractive manner (Gaba, 2004)
Professions:Any professions that could benefit from using simulationtechniques to enhance the skills necessary for clinicalpractice while expanding the capacity of the healthsystem to train students.
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Simulated learning environments
Scope
Modalities: Simulation can involve the use of little or notechnology, as in role plays, through to complex interactive
patient simulators, including:
Verbal (Role playing) Standardised patients (Actor)
Part-task trainer (Physical; virtual reality)
Computer patient (Computer screen; screen based virtual world)
Electronic patient (Replica of clinical site; mannequin based;
full virtual reality)
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Simulated learning environments
Methodology aims to
Maximise existing investment and resources
Ensure equitable access, especially rural and remote
Achieve efficient and effective utilisation
How?
Nationally developed and endorsed approach as to whataspects of the various professions curricula are suitablefor simulated learning
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Simulated learning environments
Phase 1 - Project Initiation
Research, clarify objectives, methodology etc
Phase 2 - National agreement on how SLEs will be used
Engage and resource universities and accreditation bodies
Explore existing curricula and new opportunities
Achieve national agreement within and where possible,across professions on what aspects of curricula will bedelivered via SLEs
Phase 3 - Infrastructure development Analyse outcomes of phase one to identify resources,
tools, equipment, space and staffing required to deliveragreed curriculum
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Simulated learning environments
Phase 3 - Infrastructure development
Identify existing, adapt or develop new modulesto facilitate nationally consistent approaches.
Undertake regional EoI process submission to cover
Audit existing SLE resources within the region
Map student activity to identify quantum of resourcesneeded to deliver curriculum
Gap analysis to reveal where need exists
Collaboration with all partners across regions to ensure
geographic coverage How existing resources and infrastructure will be maximised
How instructors will be supported
Ensure sustainability
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Simulated learning environments
Phase 4 Implementation
Develop and deliver relevant instructor training modules,ensuring relevant linkages with Clinical Supervisor Supportinitiative
Prioritise developments over 4 yr period. Develop sustainability plans and business models
Develop evaluation plan(s)
Develop research plan
Develop knowledge exchange plan
Undertake fora and consultation activities as necessary
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Simulated learning environments
Expert Working Group
DoHA Craig Winfield Director, Health Workforce Reform Section
QLD Dr Victoria Brazil Director, Qld Medical Education & Training
TAS Alice Burchill Deputy Secretary, Tasmania Health
NSW Dr Marino Festa Emergency Physician, Westmead Hospital
WA Dr TedStewart-Wynne
Acting Deputy Director Clinical Services, WA Health
Council of Deans ofNursing and Midwifery
Prof PatrickCrookes
Dean, Faculty of Health and Behavioural SciencesUniversity of Wollongong
Medical DeansAustralia & NewZealand
Prof MichaelHensley
Dean School of Medicine and Public Health Dean ofMedicine University of Newcastle
Australian PrivateHospitals Association
Andrew Mereau National Workforce Planning ManagerHealth Care
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Simulated learning environments
Expert Working Group
Catholic HealthAustralia
Mr Tony McGillion Manager - Education and Staff Development,Cabrini Health
Australian Council ofPro-Vice Chancellors
and Deans of HealthScience
Prof Peter Brooks University of Queensland
Prof Phillip Della Head of School of Nursing & Midwifery,Curtin University of Technology
Dr Rohan Rasiah University of Newcastle
Australasian Councilof Dental Schools
Professor AndrewSmith
Incoming Head of School, School of Dentistry,University of Western Australia
Australian Society forSimulation in
Healthcare
Assoc Prof LeonieWatterson
Director Simulation Division, Sydney Clinical Skills andSimulation Centre, Royal North Shore Hospital
Assoc ProfBrendan Flanagan
Director, Southern Health Simulation Centre, AssocProf Patient Safety Education Monash University
Michelle Kelly Project Manager - Curriculum TechnologiesIntegration, Faculty of Nursing, Midwifery and Health
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Implementation and communication
Simulated learning environments
Curriculum work led by Councils of Deans
Discussion paper
Fora and workshops as curriculum develops
Advice from Expert Working Group
In all work NHWT and HWA will communicate withstakeholders through
Stakeholder advisory committees and expert working groups
Consultation during projects
Discussion papers, reference groups, forums
Regular updates - website www.nhwt.gov.auand electronic newsletters
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