What will it take to get health reform?

7 May 2014

Left image: Dr Michael Spence, Professor Kathryn Refshauge, Belinda Hutchinson AM and Jillian Skinner MP discuss health reform. Right image: Jillian Skinner addressing attendees
Left image: Dr Michael Spence, Professor Kathryn Refshauge, Belinda Hutchinson AM and Jillian Skinner MP discuss health reform. Right image: Jillian Skinner addressing attendees


In a special Dean's Reception event, held on 30 April, the University of Sydney's Faculty of Health Sciences convened a distinguished panel of health experts to consider these key questions, which are driving the debate over the transformation of health education and delivery in Australia. In front of 175 leaders from across the health sector, Emeritus Professor Stephen Leeder AO, Professor of Public Health and Community Medicine, Menzies Centre for Health Policy, led a panel discussion to consider what changes must be made to meet the community's future health needs.
The panel members were:

 The Hon. Jillian Skinner MP, NSW Minister for Health and Minister for Medical Research
 Ms Liz Forsyth, Senior Partner, KPMG Sector Lead for Health, Ageing and Human Services
 Ms Heather Gray, Chief Executive, Higher Education and Training Institute (HETI).

With projections that health care will employ one in four Australian workers and cost $110 billion per year in the next couple of decades, a key challenge for policy makers, health educators and health workers is how to make the best use of the enormous resources we devote to health.

Professor Kathryn Refshauge, Dean of the Faculty of Health Sciences, described the health system as like a patient that needed to be treated with a wholistic, team-based approach, as she opened the breakfast event, titled 'What will it take to get health reform?' "When we are thinking of health reform we need to think of the whole," she said. She added that she had attended too many "siloed discussions" that looked at health care from the perspective of single issues - such as fee for service or private versus public funding.

A related key challenge, Professor Refshauge said, was for stakeholders to work more closely together. "The vision for policy makers and decision makers is for an affordable, effective, joined-up system," she said. But that vision is often not shared by the profession and the educators, even though "the best outcomes occur when universities and researchers work in tandem.

"We know that when you embed research with health delivery, that gives the best outcomes to patients," Professor Refshauge added. "We need two-way translation. We shouldn't just be inventing a new idea in our office: a lot of research ideas should be developed by clinicians and by patients - that's the only way you're going to get translatable research."

Universities and the health sector also needed to work more closely to ensure graduates have the skills needed in a changing health system, she said. "There's no point in educating practitioners for the future if, on clinical placements, they are treated like apprentices who need to be clones of the old ways.

"We need placements where our students can flourish."

According to Professor Refshauge, her students are now taking part in mentoring and leadership programs where they are sitting on health boards and being asked their opinions. Others are helping to design real-world health services, such as stroke and cardiac rehabilitation clinics, from the ground up.

"Students find it transformative" to be involved in these sorts of programs, she said. "We are graduating different kinds of health professionals."

The event's moderator, the University of Sydney's Professor Stephen Leeder AO, conducted several interactive polls of the audience throughout the event, and the results showed strong support for multi-pronged approaches to creating a more flexible and adaptable workforce. For example, 71 percent of the audience responded with 'enabling the health workforce to adopt different service delivery models' to the question 'What is the most significant health workforce challenge in Australia?', and this emphasis shaped much of the panel debate.

The Dean's comments about producing graduates who can think broadly, flexibly and innovatively were echoed by other panel members at the breakfast event. The NSW Health Minister, Jillian Skinner, said her government's reform agenda was for a health system that delivers "seamless, integrated care".

Minister Skinner said the health system of the future would require practitioners with generalist skills, and that meant graduates equipped with a broad range of competencies, including people and budget management skills. "The very specialist roles of people, whether they're doctors or nurses or allied health professionals, will have to be much broader," she said. She described a visit to a mental health facility in Wagga Wagga where health professionals - including occupational therapists, physiotherapists, nurses and medical doctors and non-government organisations providing community-based care - were working collaboratively from the point of admission.

"Patients spend less time in the acute area, they get better quicker, they go into rehabilitation and [are prepared] for independent living faster… And then they're discharged into the community with the care of someone in the community watching out for them, so that they're not being readmitted."
"This has had an amazing impact on the mental health of people not just in Wagga, but in the whole district." This model of integrated care is the "reform I'm now pushing as my priority", Minister Skinner said.
Panel member Liz Forsyth, a partner at KPMG in charge of the firm's national health and human services practice, also said the "capabilities and skills and competencies" of future health workers were critical.

In her experience, while she finds graduates are "very technically capable…the real challenge is finding graduates with good communication skills". She said the workplace needed graduates who could clearly and succinctly present rational arguments about options and then "reach an informed conclusion based on evidence from an array of perspectives".

According to Ms Forsyth, health workplaces are moving away from rules-based to team-based ways of working. The ability to "build rapport" will be key, and "rigid attempts to define my role as 'you do this' and 'I do that' are things of the past".

Stakeholders - consumers, family members, other professionals and bureaucrats - would all come together to solve problems, she said. "Interpersonal skills, for me, are one of the major areas that we really need to bring back into the curriculum as part of the repertoire of capabilities we need to see our graduates emerge with."

The growing demands on the health system will also require professionals who are "agile and flexible, who can work across boundaries", she added. We need to think about sharing capabilities and competencies in a trans-disciplinary way, because our workforce "won't have the breadth of supply that we need".

The final panel member, Heather Gray, chief executive of the Health Education and Training Institute (HETI), proposed a radical solution to the need for health graduates with a broad range of competencies: a four-year generalist degree for all future nurses and midwives, medical students and allied health professionals.

A shared generalist knowledge was particularly important when "you've got teams of people working together", she said. "You don't need the disciplines as formally as we've got them at the moment."

The patient doesn't know what type of professional is in front of them, they "just want someone who cares, they want someone who can help them", according to Ms Gray.

Ms Gray also questioned why the public hospital system was responsible for the lion's share of clinical placements. She suggested the private sector and the community health sector could do much more to shoulder the responsibility for clinical placements.

In her closing comments, Professor Refshauge said clinical placements were "central to students' education. They are a powerful role model: that is where they are socialised and where the culture is established, so it's really critical that we work together".

Professor Refshauge concluded by saying the sector also needed to listen to young people - the workforce of the future. "They are the ones who are shaping the vision."

View the event report online or download the pdf 

Contact: Michelle Blowes

Phone: 02 9036 7486

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