sample plan - act health

8/4/2019 Sample Plan - Act Health

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Workforce Plan 2005-2010

Building a sustainable health

workforce for the people of the ACT

November 2005


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Workforce Plan 2005-2010

Building a sustainable health

workforce for the people of the ACT

November 2005


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CONTENTS

1 Executive Summary...................................................................... 1

2 Introduction ................................................................................... 4

2.1 The ACT Governments Vision For Canberra................5

2.2 ACT Health Action Plan ......................................................5

2.3 The Clinical Services Plan 2005 - 2011..............................6

2.4 Human Resource Plan ..........................................................7

2.5 Aboriginal & Torres Strait Islander Health Plan ..........7

2.6 Major National Workforce Advisory Committees .......8

2.7 The National Health Workforce Framework ................8

2.8 Australian Health Care Agreements.................................9

2.9 Quality And Safety .............................................................. 10

2.9.1. Safety............................................................................10

2.9.2 Quality..........................................................................11

2.10 National Nursing And Nursing

Education Taskforce (N3et) .............................................. 11

2.11 Allied Health........................................................................... 12

3 The Health Context For Health Workforce Planning................ 13

3.1 New Models Of Care .......................................................... 13

3.2 New Technology.................................................................. 14

3.3 Workforce Redesign........................................................... 16

3.4 Empowered Consumers..................................................... 17

3.5 Attraction And Retention ................................................. 17

3.6 Education And Training..................................................... 17


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3.7 Societal And Cultural Changes........................................ 18

3.8 Regulatory/Legislative Arrangements............................ 18

4 Current Workforce Capacity ...................................................... 19

4.1 Demographic Analysis........................................................ 19

4.2 ACT Population And Trends........................................... 20

4.3 Profiling The Australian Health Workforce................ 22

4.4 ACT Health Workforce Profile....................................... 23

4.5 Medical .................................................................................. 24

4.6 Nursing And Midwifery.................................................... 25

4.7 Allied Health .........................................................................27

4.8 Technical And Support Staff.............................................27

4.9 Current Trends In The ACT Health Workforce ........ 28

4.10 Transfers In/Out Within ACT Health .......................... 29

4.11 Retirements .......................................................................... 29

4.12 Growth Positions................................................................ 29

5 Existing Strategies...................................................................... 30

5.1 Current ACT Health Recruitment Strategies ............. 30

5.1.1 Marketing ................................................................... 31

5.1.2 Attraction Strategies................................................ 31

5.1.3 Retention Strategies.................................................33


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5.2 Workforce Redesign...........................................................35

5.2.1 Certified Agreements...............................................35

5.3 Multi-Disciplinary Education Opportunities ..............36

6 Achieving Our Objectives .......................................................... 38

6.1 A Workforce Profile........................................................... 39

6.2 A Responsive Workforce.................................................. 39

6.3 Education And Training.................................................... 40

6.4 Effective Linkages................................................................41


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1 EXECUTIVE SUMMARY

The ACT Governments vision for the Territory involves investing in

the people of the ACT to build a stronger community. A key priority to

realising this goal is addressing workforce issues.

The ACT Health Workforce Plan sets out the issues, evidence and

strategies required to deliver a sustainable ACT Health workforce capable

of continuing to deliver high quality health care to the people of the ACT,

and the surrounding region, to 2010.

Health workforce planning aims to determine the future need on the basis

of information we currently have. The evidence available on the current

ACT Health workforce shows that it is unsustainable into the future

without modernisation.

This Plan builds upon the directions set out in the Health Action Plan

2002, and is aligned with the overarching framework agreed by all

Australian Health Ministers for achieving national sustainability in our

health workforce.

We need to have the capability to respond quickly and effectively to the

increased demand for health care in the ACT. We also know that the models

of care for service delivery are changing and we need to plan to assure an

adequate supply of appropriately qualified health practitioners working

where they are needed. This plan therefore looks firstly at achieving

parity and in the longer term, job redesign, workforce re-engineering and

a greater emphasis on community based care and self-directed care. The

ACT Clinical Services Plan (CSP) complements this Plan and describesin further detail the proposed models of care and direction for clinical

services across ACT Health.

Increases in population especially a proportional increase in older people,

the changes in services in response to the increase in chronic and complex

disease, use of increasingly sophisticated technologies and medications

and changes in the modes of delivery of clinical services result in an ever-

increasing demand for health services. To deal with these demands this

plan looks at the most effective and efficient means of having the right

people with the right skills undertaking the right tasks.


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Our plan for building a sustainable health workforce means we have to

set targets to facilitate recruitment in areas of known shortages but at the

same time put in place strategies to retain existing staff. In this way the

ACT Health Workforce Plan is engaged at all levels of the supply of healthworkers. It also aims to influence how our workforce is educated, trained

and developed into the future.

The Key initiatives are to:

Develop tools to predict workforce supply & demand, based on a

range of scenarios including alternative models of care.

Develop approaches to workforce redesign to develop safe and

effective workplace practice models.

Align workforce planning with clinical service planning.

Develop formal partnerships with the tertiary and VET sectors to

facilitate better alignment between education outcomes & health

workforce needs.

Develop new models of learning through multi-disciplinary

approaches and simulated environments.

Increase access to learning and further education for all workers.

Participate in and contribute to the national health workforce

committees and maintain linkages with other relevant health

workforce strategies, policies and plans through local and national

forums and networks.

Develop joint government and intra-agency partnerships.


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Table 1: ACT Health workforce objectives and strategies at a glance

Objective Desired Outcome Strategies

1. A workforce profile ACT Health requires access to

replicable and reliable data for effective

analysis of the workforce. Historically

workforce planning in ACT Health has

been undertaken along professional

streams. However, future work will

include development of an analytical

workforce framework that incorporates a

model of care approach

Derive improved workforce

supply & demand data including

evaluation tool

Develop models of care planning

and analysis tools

Build workforce supply and demand

scenarios based on predictions of

models of care

2. A responsive workforce To develop and maintain a responsiveworkforce, that is flexible, productive

and happy, ACT Health needs to

focus initially on the correct mix of

competencies and skills, and later,

evaluating new job roles to support

existing roles. This will include taking

the best practice patient care pathways

as the initial focus for thinking differently

about roles

Provide research reports onworkforce redesign, extended job

roles and scopes of practice

Identify and develop safe and

effective workplace practice models

Align workforce planning with clinical

service planning

3. Education and training ACT Health requires access to a labourpool of graduate health professionals

that are work-place ready. In this regard

ACT Health will seek to influence new

methods of interdisciplinary learning, the

types of courses and numbers of places

in the ACT tertiary and VET sectors.

Prevocational learning will be

considered over the life of this plan

Develop formal partnerships with the

tertiary and VET sectors

Facilitate better alignment between

education outcomes & health

workforce needs

Develop new models of learning

through multi-disciplinary

approaches and simulated

environments

Increase access to learning and

further education for all workers

4. Effective linkages ACT Health participates in and

contributes to comprehensive policy

discourse within a system of national

health committees that include all

sectors of governments and other

stakeholders in Australia and New

Zealand

Participate in and contribute to

the national health workforce

committees

Develop joint government and

intra-agency partnerships

Develop joint agency work programs

with other ACT Government bodies

Maintain linkages with other relevanthealth workforce strategies, policies

and plans through local and national

forums and networks


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2 INTRODUCTION

The ACT Health Workforce Plan sets the direction for building a

sustainable workforce, capable of ensuring the continued delivery of high

quality health and community care services to the people of the ACT and

the surrounding region, to the year 2010.

The Canberra Plan1, the ACT Health Action Plan2, The National Health WorkforceFramework3 and the Clinical Services Plan4 (CSP), in addition to the Working

Together Shaping Our Future With Our People5 and the ACT Health Qualityand Safety Plan (2003-2008) are all key strategic documents that have

guided the development of this plan and will continue to influence the

implementation phase of this plan. Health care professionals, particularly

Allied Health Professionals, Nurses, Midwives and Medical Practitioners

in the ACT and surrounding region have contributed to the development

of this plan, as have policy makers and consumers. The health care

environment is a rapidly changing one. The implementation of the plan

will also be influenced by the:

1. Productivity Commissions Research Study of the Health Workforce

2. Health Reform Agenda outlined in the Australian Health

Care Agreements

3. Outcomes of the COAG Health Working Group

1 http://www.cmd.act.gov.au/canberraplan/pdfs/Canberra_Plan.pdf

2 http://www.health.act.gov.au/c/health

3 http://www.healthworkforce.health.nsw.gov.au/amwac/pdf/NHW_stratfwork_AHMC_2004.pdf

4 http://www.health.act.gov.au/c/health?a=da&did=10010771&pid=1086133754

5 http://www.health.act.gov.au


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2.1 THE ACT GOVERNMENTS VISION FOR CANBERRA

The ACT Government aims to have Canberra recognised throughout

the world not only as the beautiful city, uniquely designed in harmonywith its environment, the seat of Australias Government and the home of

its pre-eminent national institutions but also as a place that

represents the best in Australian creativity, community living and

sustainable development.

The Canberra Plan released in 2004 broadly guides the planning, growth

and development of the ACT. The Canberra Plan has several components,

which include the Canberra Spatial Plan, the Economic White Paper and

The Canberra Social Plan.

Building our Community The Canberra Social Plan holds particular

relevance to the planning of ACT Health. It presents the action plan for the

next 10 to 15 years, and sets goals together with actions to achieve those

outcomes. The Plans stated health priority is to improve the health and

wellbeing of ACT residents. One of the seven major priorities under the

Canberra Plan is addressing workforce issues.

2.2 ACT HEALTH ACTION PLAN

In 2002, the ACT Government released the ACT Health Action Plan (HAP)

which provides the strategic framework for public health services over

a three to five year period across two key areas: Healthy People and

Healthy Systems. The aim of the HAP is to enable a more focused planning

approach in a range of key priority areas and one priority is to build a

sustainable workforce to support strengthening the capacity of the ACT

Health system.

The need to protect and grow our workforce to ensure the people of the

ACT continue to receive quality and effective health care remains ever

present. The priorities identified in 2002 continue to be relevant in 2005.


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2.3 THE CLINICAL SERVICES PLAN 2005 2011

The Clinical Services Plan (CSP) has been developed in the context of:

An ageing population.

Increasing health care expenditure.

The need to reduce waiting times.

Alternative organisational models.

Declining numbers of health professionals.

An increasing focus on patients needs.

An increasing focus on public health issues and development ofdisease management programs.

Achieving equity of access.

Improving the quality and safety of care.

The CSP identifies a number of service delivery initiatives that will impact

on the health workforce. These include:

Increased elective surgery provision, starting with an additional

300 operations in 2005-06.

Introduction of dedicated laparoscopic theatres and robotic surgery

services.

Opening of an additional 20 medical beds (12 at Calvary and 8 at The

Canberra Hospital) from July 2005.

Completion of a 60-bed Subacute Service on the Calvary campus

(40 rehabilitation beds and 20 psycho-geriatric beds).

Enhanced discharge lounge services.

A replacement acute psychiatric services facility for adults.

Development of a mental health inpatient facility for children and

adolescents.

Establishment of a forensic mental health facility.

Provision of paediatric support in Calvarys emergency department.

Expansion of capacity in neonatal intensive care services.

Redesign of ambulatory care services. Redesign of imaging services.


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Increased chemotherapy services.

Increased radiation oncology services with reduced outflows to NSW.

Improved chronic disease management with an early focus onimproved integration and coordination of diabetes services.

Increased initiatives to address falls prevention.

Increased dental health services.

2.4 HUMAN RESOURCE PLAN

The ACT Health human resource strategic plan Working Together ShapingOur Future With Our People nominates five strategic priorities:

Keeping staff safe and healthy preventing injury and supporting

injured workers to return to work early.

Building capacity capacity to be developed through recruitment and

retention initiatives, the establishment of career pathways, workforce

planning and workplace equity and diversity.

Valuing staff encouraging employees participation in workplace

decisions and planning, valuing employee contributions, makingACT Health a great place to work, recognising and valuing employee

contributions and promoting teamwork.

Promoting Ongoing Learning staff benefiting from appropriate work

related learning and development opportunities making sure that

expertise is current and continuously available.

Striving for Continuous Improvement working to continuously

improve outcomes for both patients and customers whilst working in

partnership to evaluate effectiveness and achieve excellence in patient

care and customer service.

2.5 ABORIGINAL & TORRES STRAIT ISLANDERHEALTH PLAN

The ACT Aboriginal & Torres Strait Islander Health & Family

Wellbeing Plan 2005-2010 encompasses a commitment to developing and

implementing an Aboriginal Health Workforce Plan for the ACT. The

above mentioned plan will complement the strategic directions containedin this plan.


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2.6 MAJOR NATIONAL WORKFORCE

ADVISORY COMMITTEES

The Australian Health Workforce Advisory Committee (AHWAC), theAustralian Medical Workforce Advisory Committee (AMWAC) and the

Australian Health Workforce Officials Committee (AHWOC), function

as the strategic advisors on national health workforce matters, including

workforce supply, distribution and future requirements. Several key

workforce strategic policy reports have emerged from these committees

many of which have guided the research phase of this plan, for example

Allied Health workforce planning, and career choice reports6.

2.7 THE NATIONAL HEALTH WORKFORCE FRAMEWORK

In 2004, all Australian Health Ministers endorsed the National Health

Workforce Strategic Framework7, which sets the direction for the

Australian health workforce including the National Health Workforce

Action Plan. The framework works within the national vision that:

Australia will have a sustainable health workforce that is knowledgeable, skilled and

adaptable. The workforce will be distributed to achieve equitable health outcomes,suitably trained and competent. The workforce will be valued and able to work within a

supportive environment and culture. It will provide safe, quality, preventative, curativeand supportive care, that is population and health consumer focused and capable of

meeting the health needs of the Australian community.

The principles guiding key areas for investment at the national level are:

Building and maintaining a sustainable supply.

A workforce distribution that optimises access to health care and

meets health needs for all Australians.

Health environments being places people want to work.

Ensuring the health workforce is always skilled and competent.

Optimal uses of competencies and workforce adaptability.

Recognising that health workforce policy and planning must be

informed by the best available evidence and linked with the broader

health system.

6 http://www.healthworkforce.health.nsw.gov.au/amwac/info.html

7 http://www.healthworkforce.health.nsw.gov.au/amwac/pdf/NHW_stratfwork_AHMC_2004.pdf


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Recognising that health workforce policy involves all stakeholders

working collaboratively with a commitment to the vision, principles

and strategies outlined in the document.

2.8 AUSTRALIAN HEALTH CARE AGREEMENTS

The primary objective of the Australian Health Care Agreements (AHCAs)

is to ensure the communitys access to public hospital services. A key

aspect of the AHCAs is to ensure that each jurisdiction provides people

eligible for free public hospital services with equitable access to those

services irrespective of their geographical location.

A core component of this Agreement is the Health Reform Agenda. This

agenda acknowledges the need to integrate and co-ordinate services

at the interface between the community and hospital based services,

to increase healthier outcomes, particularly for those with chronic and

aged conditions as well as our Indigenous citizens. The Agenda also

acknowledges the need for a sustainable, skilled and flexible workforce

to ensure the provision of health services into the future. There are

eleven nationally supported primary focal points for the Health Care

Reform Agenda:

The hospital interface between general practice and emergency

departments.

The transition between acute services and aged care.

Improving the health of Aboriginal and Torres Strait Islander peoples.

Improving access to elective surgery.

The continuum of care in services for chronic disease.

Cancer care. Mental health.

Pharmaceuticals.

Information management and information technology.

Safety, quality improvement and assurance.

Addressing health workforce issues.


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Drawing from this list, the six major priorities for reform identified by

ACT Health include:

Improving outcomes for Aboriginal and Torres Strait Islander peoples.

The GP / Emergency Department interface.

Aged care / acute care interface.

Improved access to elective surgery.

Improved access to mental health.

Improved access to cancer care.

To achieve these reforms, ACT Health is working to achieve the workforce

numbers and skills mix to develop and maintain a positive workforce,which responds to changing client profiles and can focus on outcomes.

2.9 QUALITY AND SAFETY

Quality and safety are key considerations for health service providers.

ACT Health has committed itself to enhancing quality and assuring

safety within its agencies. ACT Health has endorsed an $11.4m allocation

for quality programs under the Australian Health Care Agreement

2003-2008.

2.9.1 Safety

The Australian Council for Safety and Quality in Health Care has identified

these key priority actions to improve health care safety:

Enhanced consumer involvement.

Improved data and communication flows.

More support for health care workers.

Redesign of systems to create a safety culture.

Building awareness and understanding of the importance of health

care safety.

The ACT Health Quality and Safety Plan (2003-2008) builds upon previousQuality First planning successes by working closely with consumers, health

professionals and other health care providers to develop policies and

implement strategies that will improve the quality and safety of healthcare in the ACT.


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2.9.2 Quality

Quality First identified five guiding principles to facilitate better

coordination of quality activities across the Australian jurisdictions. These

principles and their goals are:

Safety: Safety in the process of care delivery to avoid and minimise the

potential risk of harm to consumers.

Effectiveness: Routine best practice interventions that produce the

desired outcome for consumers.

Appropriateness: Timely care tailored to meet individual needs

performed according to agreed evidence based considerations.

Accessibility: Services based on the proper assessment of consumerneeds and re-configured to meet changing requirements.

Efficiency: Utilisation of resources in a way that delivers maximum

benefits to consumers.

Maintaining a consumer focus in health care systems is essential to

ensuring quality and safety. This can be achieved by enhancing the

capacity of organisations and individuals participating in the planning,

management and review of health care services, which is currently shaping

workforce design.

2.10 NATIONAL NURSING AND NURSING EDUCATION

TASKFORCE (N3ET)

In November 2003, State/Territory and Australian Government Ministers

for Education and Health announced the establishment of a National

Nursing and Nursing Education Taskforce (NET). NET was established

to implement certain recommendations, and work with other key

stakeholders in the monitoring of all recommendations of Our Duty ofCare8, the report of the National Review of Nursing Education.

The recommendations in Our Duty of Care encompass a diverse range of

issues such as the skill mix and work organisation of Nurses and Midwives,

augmentation and retention of the current Nursing and Midwifery

workforce, training of care assistants, funding of clinical education and

national education standards.

8 National Review of Nursing Education 2002.


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NET is also responsible for a number of the recommendations from three

recent Australian Health Workforce Advisory Committee (AHWAC)

Nursing workforce reports: The Critical Care Workforce in Australia

2001-2011 (2002), The Midwifery Workforce in Australia 2002-2012 (2002), and Australian Mental Health Nurse Supply, Recruitment and Retention (2003), in

addition to further work regarding nurse specialisation.

2.11 ALLIED HEALTH

AHWOC recently released a publication concerned with establishing a

strategic planning basis for planning the future national Allied Health

workforce9. The report identified that there is currently no clear and

consistent agreement on what occupations comprise the Allied Health

workforce. This has an impact on data collection and benchmarking.

The ACT has a wide grouping of 23 disciplines which make up its Allied

Health workforce, this group includes disciplines such as Audiology,

Biomedical Engineering, Nuclear Medicine Technology, Pharmacy,

Physiotherapy, Radiochemistry, Radiation Therapy and Social Work.

Professions requiring tertiary education, delivering a clinically related

service which are non-Medical and non-Nursing are included in the AlliedHealth cohort in the ACT.

It is only recently that Allied Health has been acknowledged as a major

health workforce group and it constitutes the second largest employee

group after Nurses and Midwives.

Apart from the issue of the definition of Allied Health, the AHWOC Report

raises other issues such as most of the clinical practitioners are young and

female and the pool of Allied Health Professionals is much greater than the

number actually employed within their respective discipline which maybe indicative of lack of career pathways, access to postgraduate education

and little recognition of clinical skills.

9 AHWOC Report 2004.4

AHWAC Reprt 2002.1

AHWAC Reprt 2002.2

AHWAC Reprt 2002.3


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3 THE HEALTH CONTEXT FOR HEALTHWORKFORCE PLANNING

A vision for the future ACT Health workforce is reliant on acknowledgingthe inter relationships that exist in the global and national workforcescene. This chapter highlights major issues expected to impact on thedevelopment of strategic directions to build the sustainable healthworkforce that is required for 2010.

Globally, the greatest challenge for health care provision is that it is in aconstant state of evolution. Health care is both labour, and technologicallyintensive. We know that health professionals, particularly Nurses,Midwives, Medical Practitioners and Dentists are ageing and are workingfewer hours than they were 5 to 10 years ago. All this is happening at a timewhen there is an increasing demand for health care services. Furthermore,health care provision must be carried out safely and in line with communityexpectations grounded in economic reality. Any health policy, servicedelivery or technology change has an impact on demand, productivityor practice, or a combination of all three. Approximately 70% of health

expenditure is on labour costs and unlike other industries where newtechnologies are introduced, these high-tech initiatives do not necessarilylead to reductions in workforce numbers. Technology can require evenmore highly skilled workers or create new categories of workers. Accordingto the Industry Skills Report, May 2005 employment in health has expanded

by 3% per annum nationally over the last few years.

3.1 NEW MODELS OF CARE

New models of care are evolving in response to the move away frominstitutionalised care in hospitals all over the world. A Model of Care10 isdefined widely to mean taking a particular care group such as mentalhealth, children, or diabetes, and identifying a best practice model designedto meet the needs but not the demands, of a particular population. Theskills and capabilities required to provide that service are determinedand the required workforce supply can then be described. The result isa greater focus on the persons pathway throughout the care process andmore effective, or optimal outcomes for those with chronic illnesses and

other complex care needs.

10 Queensland Health (2000), Changing Models of Care Framework.


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A major future direction in service models is the increasing importance

of community-based and ambulatory care services that will provide care

in a user-friendly environment. A consequence of this change will be the

development of improved self-management skills for people with chronichealth needs, and the development of more networked services that

provide for the full health care needs of people across a range of services.

This approach is evolving in many jurisdictions and is reflected in the ACT

Health Clinical Services Plan.

Most jurisdictions in Australia have adopted an Area or Network approach

to health service delivery with the ultimate objective of ensuring care is

integrated between agencies and reflects the philosophy of a continuum

of care. The move to introduce clinical streams into the ACT follows theadoption of the Reid report by ACT Health, and national and international

moves toward emphasising consumer perspectives, clinical teams, clinical

delivery structures, involving clinicians in management, promoting

clinical governance and conceptualising care beyond any one organisation

and into the community.

The development of the Primary Health Care Strategy is an example of

the framework being developed to strengthen relationships between

non-government services, primary care, community providers and

hospitals to enhance management of chronic diseases, disease preventionand holistic health care.

3.2 NEW TECHNOLOGY

A key factor underpinning service delivery changes is whether a sufficiently

skilled and available workforce currently exists or can be developed by the

time the expected need arises. In addition to service delivery changes, other

factors also impact upon workforce planning. These include advances inhealth related technology. Health care is technologically driven, changing

and new technologies from information technology through to equipment

have already impacted significantly upon models of care, business

administration and patient outcomes.

The impact of technology on practitioner skill mix is high and presents

challenges in relation to professional boundaries and established roles, in

addition to competencies to be acquired, maintained and/or expanded.


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ACT Health has identified the following technologies for consideration

and/or for implementation over the next decade, and at least impacting

upon service delivery and workforce skills capacity by 2010:

Leading edge structural and functional imaging modalities

(e.g. ultrasound, Magnetic Resonance Imaging (MRI), Positron

Emission Tomography (PET)).

Point of care technology to enable pathology testing in community

based and outreach centres.

Implementation of telemedicine.

Migration to digital Picture Archiving and Communications System

(PACS) environments in medical imaging services.

Adoption of surgical robotics.

Performing laparoscopies through remote technologies.

Systems to support virtual surgery.

Emerging gene technology.

New cardiac technologies.

AHWOC has released its report Technology and Health Workforce Planning11

which looks into the impacts of technology. The report discusses thepotential impact of technological change on the Australian health

workforce, such changes can increase demand as more users are likely to

benefit from it, on-line learning can facilitate further demand for education

and training, new technologies can change the demands for different

categories of health workers.

One of the main recommendations of the report is the need for a WorkforceImpact Statement (WIS) to accompany the assessment of any new technology.

Currently this is not identified nor is the impact of education and training

needs or substitution capability of any new technology.

New technologies do not reduce the need for staff numbers in health as

might occur elsewhere however they do determine new models of care.

Information Technology has already delivered major changes but further

changes such as Electronic Health Records are expected. These changes

are expected to deliver further potential in online education and training,

better integration of information such as clinical reports and the capacity

to distribute them quickly as well as providing the capacity to better

organise health workloads

11 AHWOC (2005), Technology and Health Workforce Planning.


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3.3 WORKFORCE REDESIGN

Achieving the sustainable health workforce of the future will require

workforce redesign in the context of changing models of care. Workforceredesign is about new job roles and new ways of working.

It will also require an examination of organisational culture and workforce

climate. Health has traditionally been a very conservative labour

environment where staff are educated and function within their respective

professional discipline. The culture is one of a rigid hierarchy with

disciplinary demarcations in work practices. Unfortunately this system

does not have the potential to cope with the emerging challenges for

the 21st century workforce and emerging baby-boomer health consumer

cohort and merely impedes efficient service delivery.

In order to continue to meet the demand for health care, most health

organisations are challenging traditional boundaries of service delivery in

order to develop sustainable services.

Opportunities for workforce redesign can be associated with recruitment

and retention especially in the numerically smaller professions where

retention is a major issue. Professions such as Physiotherapy are exploring

initiatives which have been successful in the United Kingdom such as

Consultant/ Extended Scope of Practice Physiotherapists as well as the First Contact

Practitioner Status which is currently being trialled in Victoria.

Across professional disciplines there is a need to develop a shared set

of skills, competencies and attitudes so that there can be an increased

capacity for collaboration and team work.

The United Kingdom is leading the way with workforce redesign in health.

The scope of practice has been extended for Nursing and Allied Health

Professionals and Allied Health Assistants, trained using competencybased standards, are filling the labour void. In areas such as Radiology

overlapping of competencies between Radiologists and Radiographers has

been utilised with Radiographer reporting on basic skeletal radiographs.

Similar overlapping competencies are utilised with Nurse Practitioner

roles and with the establishment of Physiotherapy Soft Tissue Injury

Clinics attached to Emergency Departments in both the UK and Victoria.


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3.4 EMPOWERED CONSUMERS

A consumer base engaged in deciding on their health care provision is

anticipated, as increasingly consumers wish to be more informed aboutthe treatments proposed for them, their effectiveness and the track recordof the practitioners involved in their diagnosis, testing and treatment.Consumers will also have a much greater role in planning and evaluatinghealth service delivery.

The new focus allows service delivery to focus around the client ratherthan the provider eg the professional group or organisation.

3.5 ATTRACTION AND RETENTION

Global workforce tightening has occurred and will continue where theworkforce becomes more demanding and more selective about where itworks so that only employers and locations of choice may ever have anadequate workforce. Rather than using universally accepted and knownrecruitment and retention methods, increasingly agencies will need to usecreative attraction and retention strategies to draw talented practitionersfrom the global pool, then apply a personally tailored programme toencourage the move into the new environment.

Non-financial incentives such as opportunities for professionaldevelopment, access to child and aged care services and flexible rostering

are initiatives currently being developed for ACT Health workers.

3.6 EDUCATION AND TRAINING

Education, training and development are key, due to the increasing

demand for labour creating greater pressure to produce practitionersfaster. Similarly, there is an ever-present need to maintain and updateknowledge and competencies, and learning is seen in the context of alife-long event. The delivery of that learning is shifting towards computerbased and web based platforms.

Advances in technology have lead to pioneering the use of virtual realityin areas such as surgery and remote robotic control. In the health sector,multi-disciplinary simulation centres using computer haptics12 providea virtual environment where the user can practice and learn new skillsthrough the virtual object.

12 haptics: The science of applying tactile sensation to human interaction with computers.


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3.7 SOCIETAL AND CULTURAL CHANGES

There are a number of societal drivers and trends that are also likely to

impact on and influence the future workforce in the ACT. Among theseare the increasing number of single parents and dual income families.

Now, more than ever, people are responding to strategies that fit into the

career stage they are in and with their work life balance needs, and that

appropriately reward them for their qualifications. Planning for these

changes will mean that ACT Health will require effective human resource

support and be aligned with the global market place to effectively compete

in the health sector market place.

3.8 REGULATORY/LEGISLATIVE ARRANGEMENTS

The introduction of the Health Professionals legislation in the ACT has

resulted in ten health professional Acts being consolidated into a single

piece of legislation.10 The Health Professionals Act 2004 aims to protect thepublic from risk of harm by ensuring that health professionals regulated by

the Act are competent to provide health services.

Regulatory arrangements are changing. In addition, regulators have a role in

responding to the evolution of innovative solutions to work practice, work

place design (or redesign) and the associated recognition of knowledge

and competencies and the ability to practise safely and competently.

An Australia-wide system for nationally consistent medical registration has

been proposed whereby a practitioner registered in their state/territory of

primary practice would be able to practise in any other jurisdiction on the

basis of that registration. In the longer term a single national registration

system for all regulated health professionals has been advocated by the

Australian Health Ministers Advisory Council (AHMAC) submission tothe Productivity Commission (PC).

10 www.health.act.gov.au


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4 CURRENT WORKFORCE CAPACITY

4.1 DEMOGRAPHIC ANALYSIS

An analysis of the current demographic information available on the

Australian and ACT population, will indicate future population trends,

and hence assist in building a sustainable ACT Health workforce.

Chart 1: The Australian Population 2002-2032

To June 2002, the total Australian population was 19,662,000. By 2032,

the total population is projected to grow by five million to 25,040,000.

Growth is apparent in all age groups from early twenties, and there is a

consistent trend towards growth amongst the forty plus age group into

the early eighties.

0

200

400

600

800

1000

1200

1400

1600

1800

0-4 5-9 10-

14

15-

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25-

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85+

Year

Count

000's

2002 2032


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4.2 ACT POPULATION AND TRENDS

The Australian Capital Territory Population Projections 2002 2032 and Beyond

predicts that on current trends, the population of Canberra alone willgrow to approximately 389,000 by 2032. This is a similar trend to the ABS

and is shown in Chart 3 below:

Chart 2: The Australian Capital Territory Population

Projections 2002 2032

Source: ACT Spatial Plan, 2004

The ACT population is projected to 2032, however without the influence

of the surrounding sector. In 2002, the estimated ACT resident population

was 321,800 and neighbouring Queanbeyans was 33,300. If the surrounding

southern area of NSW is also included in the population that ACT Health

provides services to, the potential client population is closer to 500,000.

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

1954 1961 1971 1981 1991 2001 2011 2021 2032

Year


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Chart 3: The ACT Population 2002-2032

In 2032, the 85 years and over group is projected to more than quadruple

in number (from a low base), to over 12,000, while 20,000 more people

will be aged in their 70s, nearly three times greater than now. There is a

continuing low level of fertility, net migration to Canberra is 500 peopleper year and the median age is 40 in 2032.

0

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30

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75-79

80-84

85+

Age Bands

Population

000's

2002 2032


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4.3 PROFILING THE AUSTRALIAN HEALTH WORKFORCE

The Australian health workforce is in short supply and as previously

discussed there is a priority to address particular specialities in Medicine,Allied Health and Nursing and Midwifery. For the purpose of this plan

however, it is important to show the health disciplines known to be in

short supply in Australia between 2003-04 (Table 2) followed by the same

chart showing shortages by disciplines in the ACT (Table 3).

Table 2: Health disciplines known to be in short supply in

Australia in 2003-04

Nursing/Midwifery Allied Health Medicine Other

General Nursing;

Aged care;

Cardiothoracic;

Community;

Critical care;

Emergency;

Indigenous;

Neonatal;

Neurological;

Oncology;

Operating Theatre;

Paediatric;

Palliative;

Peri-operative;

Renal;

Midwifery;

Mental health; and

Enrolled Nurses

Physiotherapy;

Pharmacy

(hospital/retail);

Occupational Therapy;

Speech Pathology;

Diagnostic Radiography;

Radiation Therapy;

Sonography; and

Nuclear Medicine

Orthopaedic Surgery;

Ear Nose and Throat

Surgery;

Obstetrics;

Pathology;

Radiology;

Oncology;

Psychiatry;

Geriatric Medicine; and

General Practice

Dentistry; and

Pharmacy

Source: AHWOC 2004


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Table 3: ACT Health specialities identified as in short supply 2004-200513

Nursing/Midwifery# Allied Health* Medicine* Other*

Emergency;

Intensive Care;

Neonatal;

Neurological;

Oncology;

Operating Theatre;

Orthopaedic;

Stroke Unit;

Vascular/Urology;

Aged Care;

Midwifery; and

Mental Health

Podiatry;

Physiotherapy;

Radiation Therapy;

Social Workers; and

Occupational Therapy

Emergency;

Geriatrics;

Mental Health;

Surgical Anaesthesia;

Paediatricians;

Neonatal Specialists;

Intensive Care;

Plastic Surgery;

Radiation Oncology;

Endocrinology;

Renal Physician; and

Obstetrics

Mental Health

Source: # ACT Nursing & Midwifery Office, August 2005

It is acknowledged that shortages in certain Allied Health specialist areas

have not been identified separately. Shortages in specialist Paediatric andNeurological Physiotherapists as well as MRI Radiographers have been

areas of concern.

4.4 ACT HEALTH WORKFORCE PROFILE

A snapshot of the permanent ACT Health workforce as at June 2005

provides useful profession based information.

As at 30 June 2005 ACT Health employed 5635 people, 4748 Full Time

Equivalents. These figures include permanent officers, temporary

employees and casual employees. These figures do not include Visiting

Medical Officers or agency staff. The workforce is older than the median

age of Australia with few people under the age of 30.

13 Above 15% Vacancy Rate


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4.5 MEDICAL

The majority of the medical workforce is not permanent, being employed

instead on contract. However, Visiting Medical Officers (VMO),Registrars, Residents and Interns make up a vital part of the ACT

Health workforce.

Chart 4: Medical Officers: Employment Status

A general picture of the current VMO workforce shows approximately

22 (16%) are approaching retirement age within 5 years.

Registrars are Doctors undertaking vocational training to fulfil the

requirements of their particular specialist college. In 2005 ACT Health

had 135 Registrars on contract.

ACT Health is currently employing 29 Residents and Interns through the

NSW Post Graduate Medical Council. However, to provide the current

level of services, 73 Residents and Interns are required. To achieve this

number, ACT Health has focused on recruitment from overseas and has

employed 45 overseas trained Doctors to fill these posts.

According to the Australian Institute of Health and Welfares document

Medical Labour Force 2003, the ACT experienced a 6% increase in Medical

Practitioners between 2000 and 2003 (from 1,134 to 1,204) however in that

time it had a decrease in the number of General Practitioners from 451 to

398 (-13%).

There are 128 permanent Doctors across the portfolio making 113.6 FTE.

A total of 34 new permanent Doctors were appointed during 03/04-04/

05. The separation rate for medical staff (excluding Interns, Residents

and Registrars) is 7.1% with 16 Doctors separated during 03/04-04/05 and39 Doctors are expected to separate in 5 yrs.

125290

16 134

Permanent Temporary Casual VMO


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4.6 NURSING AND MIDWIFERY

The Nursing and Midwifery professions represent the largest professional

group within ACT Health, accounting for around 41% of the entireworkforce.

Nursing and Midwifery is a predominantly female discipline (91%), the

exception to this is Mental Health ACT where 31% are male. 58.9% of all

Nurses/Midwives work full-time, 90% are employed on a permanent basis,

6% on fixed-term contracts and 4% on a casual basis.

Like the workforce in general, the Nursing and Midwifery workforce is

ageing. Their average age is 43 years, and almost half (47%) are aged more than

45 years.

The average age varies by classification and division ranging from

40.0 years (RN/M-level 1) to 48.8 years (RN5) and 41.3 years (The

Canberra Hospital) to 47 years (Mental Health, Community Health, Aged

Care & Rehab stream).

Information on the utilisation of agency Nursing & Midwifery staff

is collated by the Nursing and Midwifery Informatics areas of ACT

Health. Agency staff are typically employed on a shift-by-shift basis or

to supplement staffing levels to meet shortfalls in service needs. There

continues to be an increasing trend in agency utilization.

Currently, there is limited information available on specialist qualifications

of Nursing and Midwifery staff. However, as part of the ACT Public

Sector Nursing Staff Agreement 2004-2007 (Section 38), a Qualifications

Allowance was recently introduced, recognising qualifications that are

directly relevant to the employees duties. Information on qualifications

for which this allowance is to be paid is captured and will be more freely

available in the near future.

Some information can be obtained from Nursing and Midwifery Labour ForceSurveys which are conducted annually by the Australian Institute of Health

and Welfare (AIHW).

Additional information can be obtained from the Nursing & Midwifery LabourForce Survey which is conducted annually by the Australian Institute of

Health and Welfare (AIHW) through the Nurses Board of the ACT. The

survey is distributed to all Nurses and Midwives who are registered or

enrolled with the Board to practice in the ACT, and is voluntary.


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These include Nurses & Midwives who work for ACT Health, private

hospitals, residential aged care, general practice, tertiary education, the

defence forces etc.

Data from the 2004 survey indicates that the ACT Nursing and Midwifery

workforce is well educated with around 43% having completed

post-registration /enrolment qualifications and half (49%) having obtained

more than one qualification.

These qualifications were predominantly in broad subject areas of High

Dependency (HD) (28%), Midwifery (20%) and Medical/Surgical (10%).

Within HD, qualifications were in Critical Care (20%), Peri-operative

(17%), Intensive Care(16%), Emergency/Trauma(12%), Neonatal Intensive

Care(10%).

Within Medical/Surgical, qualifications were in Oncology/Palliative

Care(37%), Wound Management(18%), Orthopaedic(11%), Renal/

Nephrology(10%).

In 2004/05, the total permanent ACT Health Nursing and Midwifery

workforce equated to an average of 1600 FTE or a headcount of 1934.

The average separation rate for permanent Nursing and Midwifery staff

over the last two financial years was 11.2% with a positive replacement of

12.6%.

Based on these ACT Health trends for separation, and if there is no change

in recruitment, retention, service delivery and models of care the potential

net supply loss is 869 head count over the next 5 years.

Acknowledgement must be given to the fact that Nursing and Midwifery

are mobile professions, this is one of the attractions of the professions.

It should be noted that in a clinical setting, Nurses and Midwives may

work until the age of 65 and may be able to work reduced work hours and

utilise flexible work arrangements.

Variable factors such as age of retirement; changing technology and

extended scope of Nursing & Midwifery roles; growth in demand for

health services, number of Nurses and Midwives working part time; and

the impact of decline in numbers of experienced staff with advanced skills

may potentially increase this estimate.


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4.7 ALLIED HEALTH

Allied Health professions are predominantly female (78%) and 13% of allied

staff work as temporary employees and 27% work part-time. This cohortof temporary staff provides operational flexibility and can be crucial to the

delivery of Allied Health services.

Unfortunately under the previous ACT Health Human Resources

Information System, Allied Health Professionals were only identified as

health professionals rather than by their particular discipline, therefore

it is difficult to identify characteristics unique to a particular profession.

The new Human Resources Information System will allow recognition of

individual professions.

The average age of permanent Allied Health Professionals is 41.

The separation rate for all Allied Health Professionals is 13.1% but it

is unfortunate that individual disciplines separation rates cannot be

reviewed at the present time. Because of the difficulties collecting

nationally consistent Allied Health data, it is difficult to compare

jurisdictional separation rate data.

4.8 TECHNICAL AND SUPPORT STAFF

The technical and support staff of ACT Health cover a wide group of

technical, administrative and support staff (eg Medical Transcription

Typists, Wardspersons, Policy Officers, Theatre Technicians and

Biomedical Engineering Technicians). The average age of the Administrative

Staff is 42 years and for Technical Officers is 43 years.

The separation rate for Administration Staff is 14.7% and is 10.1% for the

Technical Staff.

89% of Administrative Staff work full time whilst 62% of Technical Staff

are full time employees.


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4.9 CURRENT TRENDS IN THE ACT HEALTH WORKFORCE

A common strategy to determine future workforce needs is to undertake

trend information either through snapshot analyses or through projections.This analysis is initially conducted in the do nothing scenario across each

particular discipline, and estimates the impact on future requirements

if there is no change to the current separation and turnover rates. The

importance of this information is that it allows for assessment of the

trends in terms of our current capacity to replace the workforce.

Table 4 presents ACT Health workforce data for two financial years and

considers the current retirement rate, separation rate, and determines on

the basis of the current workforce what the net supply size is, and what

the projected losses would be over a time period without new strategies orcurrent recruitment activities.

Table 4: Snapshot Analysis of Supply Requirements to 2010

Discipline

& Level

Separation

Rate

Current

Workforce

(headcount)

Current

Workforce

(FTE)

Separations Net Supply/

Workforce Size

1yr 2yrs 5yrs 1yr 2yrs 5yrs

Total 12.18% 4202 3642.84 512 961 2007 3690 3241 2195

Nurse 11.24% 1934 1600.43 217 410 869 1717 1524 1065Medical 7.08% 128 113.60 9 17 39 119 111 89

Technical 10.11% 477 436.05 48 92 197 429 385 280

Allied 13.08% 691 591.82 90 169 348 601 522 343

Admin 14.67% 972 912 143 264 532 829 708 440

Source: ACT Health 2005

On the basis of available workforce data for 2003/04 2004/05, in the

last two financial years there were 1043 permanent appointments. The

annualised, permanent ACT Health workforce Total Separation Rate(TSR) is 12.18%. Based on this rate it is estimated that:

Over 510 permanent ACT Health workers will leave in 2005-06.

Over the next five years almost half (2,007 workers) of the total,

permanent ACT Health workforce will separate.

This figure is below the national average for all industries (14%)14 and the

Nursing and Midwifery specific turnover rate compares favourably with

the total Nursing and Midwifery workforce for 2002.

14 Graffam, J. (2004) Unpublished work for the ACROD Conference, Deakin University


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5 EXISTING STRATEGIES

5.1 CURRENT ACT HEALTH RECRUITMENT STRATEGIES

There are a number of levers that can be used to achieve a sustainable

health workforce and achieve workforce redesign as indicated by the

figure below.

Chart 5: Leverage points

ACT Health is already progressing with a number of these strategies.

Avoid

Unnecessary

Admissions

Expanded Pool of

Prospective Staff

Treat in Less

Intensive Settings

Reduce Patient

DemandIncrease Supply Improve efficiency

Workforce redesign

Traditional

segments

Minorities

Men

Increase

Educational

Capacity

Facility

Number of

training

positions

Clinical

placements

Extend

careers

Postponeretirement

Attract back

to the

workforce

Task

reallocation

Care Process

Improvement

Process Flow Technology

International

Source: Modified from The Advisory Board Company 2003


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5.1.1 Marketing

Along with other health services across Australia, ACT Health has

increased advertising and established partnerships with Australian and

overseas recruitment agencies. These strategies aim to raise awareness of

employment opportunities within ACT Health.

ACT Health has expanded its involvement with recruitment websites,

with a presence on:

www.anaesthesiacareer.com an international anaesthetics recruitment

website

www.doctorconnect.gov.au a website designed to attract and

assist Overseas Trained Doctors to apply for jobs in Australia. Thisinitiative has been developed by the Australian Government to assist

jurisdictions in accessing the global market.

www.Seek.Com has been used by Mental Health ACT to advertise

vacant positions.

ACT Health has also increased advertising across Australia and overseas

with professional organisations and colleges. In addition ACT Health

continues to raise its profile by attending interstate employment

expositions and universities.

ACT Health continues to be proactive in developing strategies to address

workforce shortages including Nursing and Midwifery recruitment

activity at the national and international level (including Canada, USA

and UK), marketing through printed media, development of an ACT

Health Promo CD, and ACT Health Nursing and Midwifery Brochures.

5.1.2 Attraction Strategies

Students

Establishment of Dedicated Education Units (DEU) provide a structured

learning environment in a partnership between ACT Health and the

University of Canberra for undergraduate Nursing education and

professional support.

In the Allied Health area, scholarships are now being offered to fourth year

Podiatry students and third year Radiation Therapy students dependent

on post graduate employment within ACT Health.


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In many Allied Health disciplines, there is no critical mass which will

allow under-graduate or post-graduate education for these professionals

in the ACT. To compensate ACT Health has developed and maintains

relationships with interstate tertiary institutions. Providing clinicaltraining places for these courses has proved to be an effective attraction

strategy. Recruitment of new graduates across the Allied Health disciplines

is frequently populated by staff who had prior clinical placements in the

ACT from interstate jurisdictions.

New Graduates

A strategy to address this will be to increase recruitment of new

graduates from the Australian National University Medical School

graduates in 2008.

Placement of graduates from the University of Canberra within the

ACT should be a key initiative to retain and recruit newly qualified

Physiotherapists, Pharmacists and Dieticians.

Professional development and recruitment of new Nursing and Midwifery

graduates is a significant component of a comprehensive education

strategy to meet projected workforce supply demands. New graduate

positions are promoted and have been increasing every year. Graduates arefrom the University of Canberra and there is a healthy interstate intake in

February each year.

In February 2005 ACT Healths intake of new graduate Nurses increased

by more than 60% from the same time last year.

Since August 2002 the retention rate on average for new graduates has

been more than 75%.

Refresher and re-entry

ACT Health, in conjunction with the higher education sector is facilitating

the development of a refresher and re-entry program for Nurses and

Midwives who wish to return to the professions after a period of absence.

A number of Allied Health disciplines already support re-entry programs

run under the auspices of the relevant professional associations.


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Overseas recruitment

ACT Health currently needs to recruit junior and senior Overseas Trained

Doctors (OTDs) to fill positions that remain vacant after allocation of Junior Doctors from the NSW Post Graduate Medical Council. This is

considered to be a short-medium term strategy.

Development of a Labour Agreement with the Australian Government

provides an immediate and longer term strategy to recruit overseas staff in

a range of health occupations experiencing shortage.

5.1.3 Retention Strategies

A number of strategies are already in place or in the planning stage.These include:

The development of improved data concerning retention issues and as a

priority the results of exit surveys.

The Allied Health professions such as Physiotherapy and Radiography

need further acknowledgement of their specialist skills as a retention

measure.

Expansion of access to funded professional development activities as wellas the existing Allied Health Postgraduate Scholarships.

Developing a proposal to strengthen the Nursing support structures in

Community Nursing and Child Youth and Womens Health Programs.

ACT Health is moving towards establishing safe working hours for

Medical staff. This has resulted in an increase in the overall Medical staff

numbers. Two benefits of this strategy are that overtime spending on the

Medical workforce should decrease, and Doctors will not be expected to

work an unsafe number of hours.

ACT Health is implementing a range of initiatives. These are aimed at

a systems, organisational and professional level. To promote healthy

workplace environments based on best practice; a strong learning culture

that enhances personal and professional growth and development through

on-going learning and education; work-life balance, and support for

research into evidence based-practice.


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The establishment of 21 new Clinical Development Nurse positionsacross the ACT will provide Nursing and Midwifery staff additionalclinical support for ongoing learning and skill development. A Career

Advancement and Selection Co-ordinator has been established as the22nd position for the registered Nurse/Midwife level 1 2 project which ispart of the ACT Public Sector Nursing Staff Agreement 2004-2007.

New and innovative models of health care. For example, these may includeextending the scope of practice to enable authorised Enrolled Nurses toadminister permitted medications and extensive work to establish NursePractitioner and Allied Health Assistants positions.

Encouraging a strong learning culture that enhances personal and

professional growth and development through on-going learning andeducation, including:

Provision of financial scholarships to assist Nurses and Midwivesto undertake postgraduate studies in a clinical, education, research,leadership/management area.

Continuing to provide a number of education programs in conjunctionwith the University of Canberra, supporting current and potentialNursing and Midwifery staff to undertake postgraduate courses inidentified skills shortage areas: Critical Care, Paediatrics, Midwifery,Neonatal, Peri-operative, Intensive Care.

Development of thePositive Professional Development Pathway Scheme toassist all staff with fee payment of tertiary education related to theiremployment.

Exploration of opportunities to develop different educationalpathways including work experience, and the articulation of trainingprograms to tertiary courses.

ACT Health under the direction of the Nursing & Midwifery Office are

investigating the opportunities for multi/modular educational programsthat are evidence based and built on adult learning principles. They willbe offered in the unit, by the unit, and for the unit with articulation tothe tertiary level, ensuring ownership, team building, and the immediateapplication of learning to improve patient outcomes.

ACT Health is reviewing what constitutes safe working hours for Nurses

and Midwives and processes to assess and manage risk and fatigue.

Allied Health benchmarks for staffing in acute care and community settings

will be developed in the operational areas, this will impact significantly onservice planning/equity of workloads.


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5.2 WORKFORCE REDESIGN

A joint ACT Health and Department of Disability, Housing and Community

Services (DDHCS) project has been undertaken to establish an AlliedHealth Assistant Training program in the ACT. This will allow ACTHealth to establish a recognised Allied Health Assistant Certificate levelIII and IV course to support the Allied Health workforce to provide highquality health care. These staff members will not be a replacement for, buta complement to the Allied Health Professionals. The development of theseassistants courses will allow for the broadening of the scope of practiceof current Allied Health professions such as has been achieved in the

United Kingdom.

5.2.1 Certified Agreements

Nursing/Midwifery

The ratification of the A.C.T. Public Sector Nursing Staff Agreement 2004-2007 sees ACT Nurses and Midwives with some of the best conditions andbeing among the most highly paid in Australia.

Currently, eight project initiatives have been identified in the Agreementto support workforce redesign, attraction and retention of Nurses andMidwives to ACT Health. These are:

RN 2 Phase 1: initial advancement and selection project

Review of RN3 and above classifications

Scope of Practice for Enrolled Nurses including the implementation ofthe EN2 classification project

ACTPS Performance Management Framework -application to Nursesand Nursing services project

ACTPS Learning and Development Framework -application to Nurses

and Nursing services project

Introduction of the 10 Hour night shift at Calvary Hospital andMaternity Unit at The Canberra Hospital project

Workload and staffing measurement, assessment and research project

Allied Health

A review of the various classification structures, revised progressionmodels and competency development has enhanced and modernised the

public service. Salary and allowance increases provide more appropriateremuneration levels and systems for the public service.


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Medical

An ACT Health working party developed a framework to deal with issues

confronting the Medical Workforce in the ACT, including an actionplan for the next triennium. The framework identified four objectives:attract and retain Medical Officers, deliver high quality clinical services,deliver cost-effective and cost-efficient clinical services, and implementGovernment industrial relations policies. The certified agreement will bean avenue through which the four objectives set out in the framework will

be achieved.

5.3 MULTI-DISCIPLINARY EDUCATION OPPORTUNITIES

Under current models of education, health professionals are educatedin isolation within their particular discipline or profession, when theygraduate they are expected to work as part of a team. ACT Health hasdeveloped an Inter-Professional Learning Framework which will facilitatea collegiate and collaborative inter-professional approach to delivering aholistic view and options for the provision of clinical education support.

A key focus of workforce planning is on those professions where growth

is expected with priority given to those areas where ACT and nationalshortages are being experienced.

The establishment of the Australian National University MedicalSchool with its first graduates in 2008 will provide ACT Health with anopportunity to grow its own junior medical staff into the future.

The establishment of the ANU Medical School will assist in attractingclinicians to the ACT as well as providing a valuable addition to healthresearch in the Territory.

The ACT Government has committed $10 million to establish a faculty toeducate a number of Allied Health disciplines at the post-graduate level.ACT Health is closely involved in this development.

The ACT will continue to work with the University of Canberra theAustralian Catholic University to assist in meeting the Nursing and AlliedHealth needs of the community into the future.


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The ACT will continue to implement workforce recruitment and retentionstrategies that build and enhance the capacity of the workforce toensure that the community continues to have access to high quality health

care services.

Professional learning in all disciplines that promotes learning in bothundergraduate and postgraduate levels will build workforce capability.Focusing on working in teams and in multi disciplinary groups, providinglearning and development opportunities, increasing base level capacityand aligning capability for service provision to the community needs willachieve this.

An ACT Health Learning and Development Framework for Career and

Professional Practice Development (Performance Management) hasbeen developed to provide the structure to meet capability, skills andknowledge to be competent. The Framework facilitates protected timefor learning, availability and expertise of peers, effective instructionalmethods, participation and collaboration, activities that encourageproblem posing and critical reflection, learning with hands on experience,external acknowledgement, articulation across the pathway for educationand training, and appropriate modes of education across ACT.

ACT Health currently provides four postgraduate diplomas in Nursing

in partnership with the University of Canberra. Nursing and Midwiferywill be working towards including recognition of short courses conductedwithin ACT Health and the further development of certificate courses thatarticulate into diplomas and masters degrees.

Mental Health ACT (MHACT) has a post graduate mental healthRN Nursing program with the academic provider and partner beingLatrobe University in Victoria, MHACT also runs an EN programthrough Latrobe. Both of these programs are funded through the Nursingscholarship program.

MHACT has a Psychiatry Registrar training program to facilitatemedical training.

The Australian Catholic University (Signadou) is now providing bothgraduate and undergraduate studies in Social Work for current andpotential ACT Health staff.


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6 ACHIEVING OUR OBJECTIVES

Sustaining levels of healthcare provision at current levels and to improve

healthcare provision wherever possible requires substantial workforce

redesign and modernisation across the public and private sectors. If we are

to succeed in meeting these challenges, we need to consider existing and

potential developments to design a workforce that is fit for purpose, meets

the healthcare needs of the population and sustains safe and effective

models of care. There is a commitment to developing and supporting the

ACT Health workforce in order to:

Meet current and anticipated gaps in service provision.

Increase the overall numbers in key sections of the workforce.

Plan the workforce from the perspective of the patient and for patient-

centred models of care.

Develop workforce frameworks with an emphasis on workforce

development by care group.

Improve attraction and retention of staff by supporting the

development of the concepts of the skills escalator, continuing

professional development, career progression and lifelong learning

resulting in a much more dynamic workforce.

Enable emphasis on partnerships and working across traditional

organisational and professional boundaries.

Enable a focus on a system-wide approach to workforce redesign.


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6.1 A WORKFORCE PROFILE

ACT Health requires access to replicable and reliable data for effective

analysis of the workforce. Historically workforce planning in ACT Healthhas been undertaken along professional streams. However, future work

will include development of an analytical workforce framework that

incorporates a model of care approach. ACT Health over the life of this

plan will:

Continue to monitor the workforce by discipline and classification.

Continue to develop the workforce profile to derive workforce

demand and supply information by:

- Using a variety of models and approaches to support workforceredesign including toolkits, supply and demand models, and

training needs analysis.

- Integrated data warehousing (integrated workforce data with

health-care data), including a workforce minimum-data-set.

Develop planning tools that consider new models of care including

scenarios for workforce demand prediction.

Create reports on current research, trends and current practice inworkforce redesign.

6.2 A RESPONSIVE WORKFORCE

To develop and maintain a responsive workforce, that is flexible, productive

and happy, ACT Health needs to focus initially on the correct mix of

competencies and skills, and later, evaluating new job roles to support

existing roles and then look to extending others in concert with national

and international trends. This will include taking the best practice patient

care pathways as the initial focus for thinking differently about roles. ACT

Health will:

Align the Clinical Services Plan (CSP), Workforce and Human

Resources plans with performance activity reporting.

Develop a process of role redesign that is aligned with the CSP. It will

involve staff, patients, carers and other consumers. It will also include

identifying the organisational development and change management

implications of redesign.


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Align workforce initiatives with the CSP targeted directions in fields

such as subacute care, stroke care and ambulatory care streams.

Identify and evaluate effective and safe workforce practice models,linking staff numbers to models of care workloads wherever relevant

and possible, to ensure that patient outcomes can be met.

Develop extended workforce roles based on required

competencies and skill enhancement with a shift to

multi disciplinary team based working.

Explore the opportunities offered by networking between hospitals,

including the potential of telemedicine.

Build in evaluation processes to make sure the expected benefits are

realised and that safety is not compromised.

Develop enterprise bargaining agreements which include stated

requirements for supervising students in clinical competence

to encourage a learning environment and education for the next

generation of health professionals.

6.3 EDUCATION AND TRAINING

ACT Health requires access to a ready labour pool of graduate health

professionals that are work-place ready. In this regard ACT Health will

seek to influence new methods of interdisciplinary learning, the types of

courses and numbers of places in the ACT tertiary sectors. To achieve this

ACT Health will:

Develop formal partnerships with the tertiary sector so that education

and training programs better align new graduates to job roles.

Develop new job roles based on required competencies and skill

enhancement. Ensure that competencies are generated and relevant

links made to education, training and development to ensure that

extended workforce roles are sustainable and safe.

Increase access to learning and development opportunities and further

education for all staff.

Work collaboratively with the higher education and VET sectors to

develop new models of learning, including simulated environments

and interdisciplinary association and practices.


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6.4 EFFECTIVE LINKAGES

ACT Health participates in and contributes to comprehensive policy

discourse within a system of national health committees that crossall sectors of governments and other stakeholders in Australia and

New Zealand. ACT Health will:

Participate in national workforce committee agenda initiatives and

workforce work programs.

Develop joint government and intra-agency partnerships including the

tertiary sectors.

Develop joint agency work programs with other relevant ACT

Government bodies of expertise, such as ACT Demographics andBusiness ACT.

Participate in policy debate about the definition of the future roles,

ways of working and regulation that will define the healthcare

workforce in the ACT, building on local innovation and change.


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Table 5: ACT Health workforce objectives and strategies at a glance

Objective Desired Outcome Strategies Who When

A workforce

profile

ACT Health requires

access to replicable

and reliable data for

effective analysis

of the workforce.

Historically

workforce planning

in ACT Health has

been undertaken

along professional

streams. However,future work will

include development

of an analytical

workforce framework

that incorporates

a model of care

approach

Derive improved

workforce supply

& demand

data including

evaluation tool

Workforce Policy

& Planning Unit

Information

Management/

Information

Technology

Chief Nurse/

Nursing &

Midwifery Office,

Allied HealthAdviser

ACT Registration

Boards

Short-term

Develop models

of care planning

and analysis tools

Workforce Policy

& Planning Unit

Medium-term

Build workforce

supply and

demand

scenarios based

on predictions of

models of care

Government

Relations and

Planning

Long-term


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A responsiveworkforce

To developand maintain

a responsive

workforce, that is

flexible, productive

and happy, ACT

Health needs to

focus initially on

the correct mix of

competencies and

skills, and later,evaluating new job

roles to support

existing roles.

This will include

taking the best

practice patient

care pathways as

the initial focus for

thinking differently

about roles

Provide researchreports on

workforce

redesign,

extended job

roles and scopes

of practice

Chief Nurse/Nursing &

Midwifery Office

Allied Health

Adviser

Workforce Policy

& Planning Unit

Short-term

Identify and

develop effective

workplacepractice models

Workforce Policy

& Planning Unit

Chief Nurse/Nursing &

Midwifery Office

Allied Health

Adviser

Medium-term

Align workforce

planning with

clinical service

planning

Government

Relations and

Planning

Medium-term

Explore

professional

development

opportunities

offered by

networked

health facilities

ACT Health

Tertiary

Education

Liaison

Committee

Workforce Policy

& Planning

Allied Health

Adviser

Chief Nurse/

Nursing &Midwifery Office

Medium-term

Remain cognisant

of regulatory

constraints but

not viewing

these as

insurmountable

obstacles

ACT Registration

Boards

Allied Health

Adviser

Chief Nurse/

Nursing &

Midwifery Office

Medium-term


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Education and

training

ACT Health requires

access to a labourpool of graduate

health professionals

that are work-place

ready. In this regard

ACT Health will

seek to influence

new methods of

interdisciplinary

learning, the types

of courses andnumbers of places in

the ACT tertiary and

VET sectors

Develop formal

partnerships withthe tertiary and

VET sectors

Workforce Policy

& Planning Unit

Liaison

Committee

Department

of Education,

Science &

Technology

Short-term

Facilitate better

alignment

betweeneducation

outcomes &

health workforce

needs

Allied Health

Adviser

Chief Nurse/

Nursing &

Midwifery Office

Workforce Policy

& Planning Unit

Peak Regulatory

Bodies

Medium-term

Develop new

models of

learning through

multi-disciplinary

approaches

and simulated

environments

ANU Medical

School

University of

Canberra

Canberra

Institute of

Technology

Australian

Catholic

University

Allied HealthAdviser

Chief Nurse/

Nursing &

Midwifery Office

Short to

Medium-term

Increase access

to learning and

further education

for all workers

Staff

Development

Unit

Ongoing


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Effective

linkages

ACT Health

participates inand contributes

to comprehensive

policy discourse

within a system

of national health

committees that

include all sectors

of governments and

other stakeholders

in Australia andNew Zealand

Participate in

and contributeto the national

health workforce

committees

Government

Relations &Planning

Short-term

and ongoing

Develop joint

government and

intra-agency

partnerships

Allied Health

Adviser

Chief Nurse/

Nursing &

Midwifery Office

Workforce Policy

& Planning

Short-term

and ongoing

Develop joint

agency work

programs with

other ACT

Government

bodies

Allied Health

Adviser

Chief Nurse/

Nursing &

Midwifery Office

Workforce Policy

& Planning

Short-term

and ongoing

Maintain

linkages with

other relevant

health workforce

strategies,

policies and plans

through local and

national forums

and networks

Allied Health

Adviser

Chief Nurse/

Nursing &

Midwifery Office

Workforce Policy

& Planning

sample plan - act health

Documents