CYWHS Workforce Roundtable

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CYWHS Workforce Roundtable

• Patrick Cregan
• 29 Nov 2005

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Public Hospital Expenditure
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Nurse ratios
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Nurse / Physician Population Ratios
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Why now?

• CYWHS Roundtable
• Productivity Commission
• NSW IMET
• National Health Workforce Strategic Framework

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Workforce Challenges

• Global shortages of specialist doctors and of
  registered nurses
• Ageing of the health workforce
• Increased in patient acuity
• Ageing of the population
• Increase in the complexity of care provided
• Increased pressure on the workplace
• Reduced access to patients for training
• Increased numbers of overseas trained HCPs
  (Health Care Professionals)

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Political imperatives

• Camden Campbelltown
• Dr Patel / Bundaberg
• King Edward
• Cost

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National Health Workforce Strategic Framework

• Australia should focus on achieving, at a
  minimum, national self sufficiency in health
  workforce supply, whilst acknowledging it is part
  of a global market.
• 5. To make optimal use of workforce skills and
  ensure best health outcomes, it is recognised
  that a complementary realignment of existing
  workforce roles or the creation of new roles may
  be necessary. Any workplace redesign will address
  health needs, the provision of sustainable
  quality care and the required competencies to
  meet service needs.

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Productivity Commission Position
PaperAustralias Health Workforce

• Workplace innovation to better use skills
  available
• Responsive education and training arrangements
• National accreditation standards and processes to
  remove inconsistencies
• Workplace change to enhance delegation to less
  highly qualified, but more cost effective, health
  professionals
• Workforce adaptation for special needs groups or
  areas such as rural and remote.

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Three Ss of Best Care
Best Science Evidence Based Care Meta-analyses Ran
domized Controlled Trials Guidelines
Best Systems Protocols Team Work Human
Factors Appropriate Culture Clinical Governance
Best Care
Best Skills Technical Communication Ethics Compete
nce assessed Simulation
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Science William Osler

• Observe, apply knowledge, hypothesize, test,
  diagnose, treat, observe, adjust hypothesis or
  treatment etc
• Problem based learning is reflected in and used
  to teach this approach

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Skills WS Halsted

• Formalized the apprenticeship system into the
  American Residency Training Model
• Systematic, Time based graduated increase in
  responsibility

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Systems Florence Nightingale
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Systems 2

• Florence Nightingale. Introductory notes on
  lying-in institutions. London Longmans, Green,
  and Co, 1871.St. Thomas's Medical Collection S2
  6.10.
• Florence Nightingale. Notes on Hospitals. John W.
  London Parker and Son, 1859. St. Thomas's
  Medical Collection S2 b.9.
• Florence Nightingale. Notes on Nursing what it
  is and what it is not. London Harrison,
  1860.St. Thomas's Medical Collection S2 b.7.
• Florence Nightingale. A Contribution to the
  Sanitary History of the British Army. London
  Harrison and Sons, 1859. St. Thomas's Medical
  Collection S2 c.11.

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Training is a large part of the Problem

• Osler / Science based Undergraduate, FRACP part
  1, PBL
• Halsted / Skills Postgraduate, Procedural
  practice
• Nightingale / Systems - Nursing

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Problem Solving

• when all you have is a hammer every problem
  looks like a nail

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Training

• Three distinct bases to the training of the
  health workforce the three Ss
• Science
• Skills
• Systems
• Three silos result

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Currently addressing the problem

• Interdisciplinary education
• Emphasis on team work
• Role extension, particularly in rural areas
• Skill mix changes, increased number of ENs and
  AINs
• Increased emphasis on quality and safety,
  including performance appraisal / competence
  assessment
• Evidence based practice

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Is this enough?

• Why cant we train nurses to prescribe
  antibiotics or supervise anaesthetics?
• Why cant ENs scrub in the OR?
• Why cant ENs give Narcotics?
• Why cant Physiotherapists manage simple
  fractures?

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Is this enough ?

• Why does Medicine need to be a postgraduate
  course?
• Why do we substitute length of training for
  demonstration of competence?
• Why do we not have career planning?
• Why is specialist training run by guild like
  organizations with less transparency of process
  than golf clubs?

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Why? Could?

• Why does it take a minimum of 13 years of
  training after leaving school to become a
  specialist? (When we get given the brightest,
  second most ethically driven group with on the
  job assessment, repeated examinations and a good
  long term reward system?)
• Could another system or set of trainers do it
  better?
• Are there other approaches?

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Public Hospital Expenditure
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Why is there any human in the Operating Room
other than the Patient?
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Other approaches 1

• Penelope a voice activated, speech recognizing
  robotic tool changer
• Penelope ( Surgical Instrument Server) Dr
  Michael Treat
• ?Replacing scrub nurses?
• June 16 2005, Mercy Medical Centre NY 1st use in
  humans (Dr Spencer E Armory)

http//global.med.cornell.edu/news/nyp/nyp_2005/06
_16_05.shtml
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Other Approaches 2
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Other Approaches 3

• Target Controlled Infusion in Anaesthesia
• Propofol, Remifentanil
• Ethicon

Andrew J Fox and David J Rowbotham
1999319557-560 BMJ
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Other Approaches 4

• Virtual Critical Care Unit ViCCU
• CSIRO / Nepean Hospital
• Ultrabroadband Internet for Remote Telepresence
• Leverage off existing workforce
• Remote supervision of a Cardiac Arrest

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Can we replace the Surgeon?
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Can we replace the surgeon?

• (Gordon E) Moores founder of Intel Law
  computing power doubles every 18 months and
  halves in price
• Problem of complex pattern recognition and
  strategy formation and necessary computing power
  / floating point calculations
• Should be right to 2030 ?????

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Can we replace the surgeon yes!

• Growth in IT doubling every year a factor of a
  billion in 30 years
• 2030 the non-biological portion of our
  intelligence will dominate
• 1988 John Gage the network is the computer
• The net 1 kilohertz clock speed, 200 terabytes
  of RAM, 10 terrabits per second transfer, 20
  exabytes of data.
• ie the net is now about the size and complexity
  of a human brain

http//www.kurzweilai.net/brain/frame.html?startTh
oughtAge20of20Spiritual20Machines
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Public Hospital Expenditure- 2030