Project Overview

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Developing the Hospitalist Career Pathway in NSW
Health- Information Session - Concepts and
Process
June/July 2008
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Key Issues

• Introduction and rationale for hospitalist
  initiative
• Differences USA and NSW
• Hospitalist approach NSW
• Hospital Skills Program - NSW Institute Medical
  Education Training
• Staff Hospitalist role and training program
• Next steps

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Hospitalist in NSW - Rationale

• Changing profile of patients higher acuity,
  ageing population, increased expectations
• Changing profile of workforce reduced hours,
  increasing sub-specialisation, changed
  expectations
• Lack of recognition for non-specialist doctors in
  NSW Hospitals
• Opportunities for improved quality and safety
• Clinical Service improvement strategies - e.g.
  patient journey
• Building strong teams with stable senior workforce

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What is a Hospitalist in NSW?

• Generalist medical practitioner whose principal
  focus is provision of quality clinical care to
  patients in hospitals to ensure patient journey
  is co-ordinated and as effective, efficient and
  as safe as possible.
• Not in specialist training position or working
  towards Fellowship of Specialist Medical College
• Feasibility tested in 2007 pilot, with specific
  positions created
• New plans to extend pilot involving enhanced
  career pathway for CMOs, professional
  development and training to support new roles

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Hospitalists Differences - USA v NSW

• USA
• Hospitalist specialist (site based)
• Co-management of patients admitting rights
• Quality and systems improvement
• Patient journey, continuity of care
• Team based care

• NSW
• Hospitalist non-specialist (site-based)
• Work with specialists (specialist retains
  delegation)
• Quality and systems improvement
• Patient journey, continuity of care
• Team based care

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The new Hospitalist initiative

• Premiers announcement 29 Oct 2007
• New career pathway including education programs
  leading to a to more senior role in hospital
  system including
• Provide better recognition of our current CMO
  workforce
• Creation of a new more senior Staff Hospitalist
  classification
• Foundational education through Hospital Skills
  Program (IMET)
• Articulation into Staff Hospitalist training
  program linked to eligibility for Staff
  Hospitalist positions

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Career Medical Officers - NSW

• Profile
• 390 FTE in NSW Health
• Stable, senior workforce
• Median length of service 3yrs (ra. 0.3-36yrs)
• 8.5 of non-specialist workforce
• Under-utilising study leave and over-represented
  in overtime and penalty hours cw proportion of
  non-specialist workforce
• No defined professional development
  path/education program

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Example of career levels and flexible pathways
within the Hospital Skills Program
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Hospital Skills Program

• Development and delivery co-ordinated by IMET
• Formal recognition of skills and knowledge
• Provides career framework
• Responds to service requirements
• Flexible training program that is aligned to job
  requirements
• Modules in emergency, mental health, aged care,
  surgery, obstetrics and gynaecology, paediatrics
  and medicine
• Available to all non-specialist doctors working
  in health system

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Progress on Hospital Skills

• Clinical Chair appointed Dr Simon Leslie
• State Training Council and Reference Group
  appointed
• Curriculum development underway
• Area Directors of Hospital Training being
  appointed shared with Staff Hospitalist
  training program

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Staff Hospitalist role

• Generalist clinical service to NSW hospitals at a
  senior level
• Typically have other hospital wide functions
  patient safety, clinical service redesign,
  education functions, clinical leadership
• Senior to current senior CMO
• Aims to provide greater availability and
  consistency of senior medical service and
  decision making within hospitals
• Capabilities being defined

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Staff Hospitalist Training

• Professional development program providing
  standardised approach to education and training
• Identification of capabilities required for Staff
  Hospitalist role will inform training/education
  components
• Articulation from the HSP (or equivalent
  recognised prior learning)
• A pre-requisite for eligibility for Staff
  Hospitalist positions
• In development by the Department with advice from
  Hospitalist Steering Committee and relevant
  experts
• Timeframes training modules to commence 2009

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Next Steps

• Communication and consultation around hospitalist
  career pathway, in particular new Staff
  Hospitalist role
• Feedback from Hospitalist information sessions
• Development of further information materials
• Continuing key stakeholder involvement
• Identify the key knowledge, skills and behaviours
  for new Staff Hospitalist role
• Manage the curriculum development for the Staff
  Hospitalist training program and identify
  education delivery strategy
• AHS to determine number, location of Staff
  Hospitalist positions (2009)

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Why?

• The overwhelming conclusion is that to be
  appropriately effective in 2021 the health
  workforce will need to be differently configured
  and/or work differently.
• Professor Des Gorman, Head of School of Medicine,
  Auckland University

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• Thank you