HEALTHCARE FUTURES -HOW NURSES NEED TO RESPOND WHATS NEW-WHY CHANGE. What drives health service demand. Current status of health system 5/11/2013

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1 HEALTHCARE FUTURES -HOW NURSES NEED TO RESPOND Peter Brooks AHWI University of Melbourne and Executive Research Director Northern Health WHATS NEW-WHY CHANGE Chronic Disease and Ageing Workforce Shortages Rising Costs BUT Opportunities- Technologies-educational /services - Models of Care - Use of Technology Current status of health system Short of workers Medically /hospital focused Not technology enabled Specialist focused Not patient centred Expensive What drives health service demand Ageing Chronic disease-30-40% of which is caused by obesity Unrealistic expectations from community Medical/ industrial complex Un necessary ( avoidable )care WHAT WILL WE PROVIDE HOW WE MIGHT DELIVER CARE WHO WILL DO IT HOW/WHERE WILL THEY DELIVER CARE HOW ARE WE TO KEEP PATIENTS OUT OF EMERGENCY ROOMS/ HOSPITALS CHRONIC DISEASE MANAGEMENT IN THE COMMUNITY PALLIATION PREVENTION 1

2 Australia Health Workforce Health and social assist 1.3 mill.-largest segment 60% fulltime 78% female Growing 12% increase ( ) Scenario FINDINGS: Medical workforce results 2016 (Head count) 2025 (Head count) Supply Demand Gap Supply Demand Gap Doctors Comparison 93,687 89,903 3, , ,926-2,701 Productivity gain 93,687 87,966 5, , ,413 2,811 Low demand 93,687 80,655 13, ,225 90,536 18,690 Medium selfsufficiency High selfsufficiency 91,956 89,903 2, , ,926-9,300 90,398 89, , ,926-15,240 High demand 93, ,019-6, , ,349-26,124 Undersupply of 5% 93,687 94, , ,615-8,389 Capped working hours 91,687 89,863 1, , ,960-5,178 FINDINGS: Nursing workforce results 2016 (Head count) 2025 (Head count) Scenario Supply Demand Gap Supply Demand Gap Nurses Comparison 296, ,632-20, , , ,490 Productivity gain 296, ,705-13, , ,435-89,993 Low demand 296, ,551 14, , ,797-31,355 Workforce retention 318, ,715 1, , ,086-24,846 Medium self-sufficiency 292, , , , ,818 High self-sufficiency 288, ,632-28, , , ,113 High demand 296, ,109-56, , , ,122 Undersupply of 5% 296, ,657-33, , , ,555 WHERE ARE THE GAPS RANGE OF HEALTH ASSISTANTS NURSE/ALLIED HEALTH/PAs CARERS CARE NAVIGATORS NDIS GENERALISTS CARERS 1.5 MILLION/ 60000O NEEDED BY 2018 ( PC ) HOW TO TRAIN /SUPPORT/FUND 2

3 The problem of sustainability The Sustainability Funnel (Coiera 2010) THE RIGHT PEOPLE IN THE RIGHT JOB WITH THE RIGHT SKILLS AT THE RIGHT TIME CHALLENGES HOW DO WE USE THE NEW TECHNOLOGY EFFECTIVELY HEALTH APPS MONITORING / PATIENTS/ ENVIRONMENTS CARE IN AGED CARE FACILITIES WORKING AS TEAMS ROLE EXPANSION 3

4 Future Technology Trajectory Smaller Less invasive Convenient Faster Cheaper Earlier in disease cycle FUTURE TECHNOLOGY 10 BILLION MOBILE DEVICES by ,000 MOBILE APPS M-HEALTH -25% REDUCTION IN COSTS OF MEDICAL CARE TO ELDERLY PRODUCTIVITY GAINS of $305 Billion IN 10 yrs BROOKINGS INSTITUTE REPORT 2012 MOBILE HEALTH -MH CALL CENTRES APPT REMINDERS TELEMED PATIENT RECORDS SURVEILLANCE AWARENESS PATIENT MONITORING DECISION SUPPORT Nano Medicine Smart Living Mind/Body Bionics Virtual Reality Surgery Remote Teletreatment Games for Health Education Disruptive Technologies-MGI may potentially disruptive technologies Mobile internet Automation of knowledge work Internet of things Cloud technology Advanced robotics Autonomous / semi autonomous vehicles Disruptive technologies -MGI 2013 Next generation genomics Energy storage 3 D printing Advanced materials Advanced oil/gas recovery Renewable energy 4

5 WHAT MODELS OF CARE Innovation Think tank opportunity to identify new issues relating to health workforce facilitate translation of research planning into innovative practice develop position papers and then involve stakeholders Exemplar Non Medical prescribing Models of Care PA S Delegated Generalist NP s Autonomous Specialist Assistants Carers Health system facilitators /navigators Paramedics Pharmacists Physician Assistants Recent HWA report -Potential Role of PAs in the Australian Context ( Extending /expanding medical workforce capability Providing alternate pathways Para medics etc Waiting lists Primary care PAs international experience US/Canada /UK/ Netherlands Israel / South Africa NZ Various Militaries Roles Rural / remote Emergency / chronic disease/ primary care Procedural / followup/patient education 5

6 ROLE OF SIMULATION TEACHING TEAM CARE IMPROVING EFFICIENCY IMPROVING EFFECTIVENESS PRODUCTIVITY GAINS SEE WHAT OTHER INDUSTRIES DO AVIATION/ ENGINEERING / ARCHITECTURE / BUSINESS SIMLABS/ EMBEDDED SIM TELL ME, AND I WILL FORGET SHOW ME, AND I MAY REMEMBER INVOLVE ME, AND I WILL UNDERSTAND CONFUCIOUS, 450BC Productivity Wii training Bokhari- Am Surg ,583-6 Mayo clinic IV lines ITU bed management Student learning enhanced over PBL or standardized patients Global Commission global cost health education-$100 billion-2% health costs -poor team skills -gender issues - mismatch of competencies between patient and population needs -imbalances in the labour market -leadership and change management - health professionals need to manage lancet CURRENT CHALLENGES IN HEALTH EDUCATION NUMBERS NEEDS NEW LEARNINGS CLINICAL PLACEMENTS- where do we train focus on acute care and tertiary hospitals Aged care facilities / mental health /primary care /RURAL 6

7 Health Professional Training Core Competencies How to evaluate (national exam) Training for (independent) practice Insight to limitations Team care Competency based rather than time based Simulation enabled INTERPROFESSIONAL LEARNING INTERPROFESSIONAL PRACTICE TEAM CARE USE EVERY ENVIRONMENT PRIVATE PRACTICE PRIMARY CARE Behaviours of high performing teams Shared vision Temporal situation awareness Standardised procedures Formalised communication Structured check lists Extensive reporting systems Preempt problems Acknowledge and address errors The new health Nano Medicine Smart Living Virtual Reality Surgery Remote Teletreatment Games for Health Education Personal controlled health care TOMORROW IS THE FIRST DAY OF THE REST OF YOUR LIFE What did I do yesterday that could have been done by some one else? How can I prevent this referral ( hosp admission )? What could I have done to prevent this exacerbation/ disease NEED TO GET SERIOUS ABOUT PRIMARY CARE ISSUES OF INEQUALITY SOCIAL DETERMINANTS PUT PATIENT AND PRIMARY CARE AT THE CENTRE OF THE HEALTH SYSTEM 7

8 Health workforce shortages in Australia DRIVEN BY AN AGEING WORKFORCE Health Care SUGGESTIONS OF NURSES ALLIED HEALTH PROFESSIONALS CARERS NEED TO RECRUIT 400,000 TO HEALTH WORKFORCE BY 2025 JUST TO MAINTAIN STAFF LEVELS Research Teaching Service 8