CYWHS
Workforce
Roundtable
Patrick Cregan
29 Nov 2005
Public Hospital Expenditure
Nursing
Other People
Payments
Everything Else
Nurse ratios
Nurse / Physician Population Ratios
Why now?
CYWHS Roundtable
 Productivity
Commission
 NSW IMET
 National Health
Workforce Strategic
Framework

Workforce Challenges:
• Global shortages of specialist doctors and of
registered nurses
• Ageing of the health workforce
• Increased in patient acuity
• Ageing of the population
• Increase in the complexity of care provided
• Increased pressure on the workplace
• Reduced access to patients for training
• Increased numbers of overseas trained
HCPs (Health Care Professionals)
Political imperatives
Camden Campbelltown
 Dr Patel / Bundaberg
 King Edward
 Cost

National Health Workforce
Strategic Framework:
1.
Australia should focus on achieving, at a minimum,
national self sufficiency in health workforce supply, whilst
acknowledging it is part of a global market.
5. To make optimal use of workforce skills and ensure best
health outcomes, it is recognised that a complementary
realignment of existing workforce roles or the creation of
new roles may be necessary. Any workplace redesign will
address health needs, the provision of sustainable quality
care and the required competencies to meet service
needs.
Productivity Commission Position
Paper:
Australia’s Health Workforce
•
•
•
•
•
Workplace innovation to better use skills available
Responsive education and training arrangements
National accreditation standards and processes to remove
inconsistencies
Workplace change to enhance delegation to “less highly
qualified, but more cost effective, health
professionals”
Workforce adaptation for special needs groups or areas
such as rural and remote.
Three S’s of Best Care
Best Systems
Protocols
Team Work
Human Factors
Appropriate Culture
Clinical Governance
Best Science
Evidence Based Care
Meta-analyses
Randomized Controlled Trials
Guidelines
Best Care
Best Skills
Technical
Communication
Ethics
Competence assessed
Simulation
Science – William Osler
Observe, apply
knowledge,
hypothesize, test,
diagnose, treat,
observe, adjust
hypothesis or
treatment etc
 Problem based
learning is reflected in
and used to teach this
approach

Skills – WS Halsted
Formalized the
apprenticeship system
into the American
Residency Training
Model
 Systematic, Time
based graduated
increase in
responsibility

Systems – Florence Nightingale
Systems 2




Florence Nightingale. Introductory notes on lying-in
institutions. London: Longmans, Green, and Co,
1871.[St. Thomas's Medical Collection S2 6.10.]
Florence Nightingale. Notes on Hospitals. John W.
London: Parker and Son, 1859. [St. Thomas's Medical
Collection S2 b.9.]
Florence Nightingale. Notes on Nursing: what it is and
what it is not. London: Harrison, 1860.[St. Thomas's
Medical Collection S2 b.7.]
Florence Nightingale. A Contribution to the Sanitary
History of the British Army. London: Harrison and Sons,
1859. [St. Thomas's Medical Collection S2 c.11.]
Training is a large part of the
Problem
Osler / Science based – Undergraduate,
FRACP part 1, PBL
 Halsted / Skills – Postgraduate, Procedural
practice
 Nightingale / Systems - Nursing

Problem Solving
“when all you have is a hammer
every problem looks like a nail”
Training

Three distinct bases to the training of the
health workforce – the three S’s
 Science
 Skills
 Systems
 Three
silos result
Currently addressing the problem:






Interdisciplinary education
Emphasis on team work
Role extension, particularly in rural areas
Skill mix changes, increased number of ENs and
AINs
Increased emphasis on quality and safety,
including performance appraisal / competence
assessment
Evidence based practice
Is this enough?
Why can’t we train nurses to prescribe
antibiotics or supervise anaesthetics?
 Why can’t EN’s scrub in the OR?
 Why can’t EN’s give Narcotics?
 Why can’t Physiotherapists manage simple
fractures?

Is this enough ?
Why does Medicine need to be a
postgraduate course?
 Why do we substitute length of training
for demonstration of competence?
 Why do we not have career planning?
 Why is specialist training run by guild like
organizations with less transparency of
process than golf clubs?

Why? Could?
Why does it take a minimum of 13 years of
training after leaving school to become a
specialist? (When we get given the brightest,
second most ethically driven group with on the
job assessment, repeated examinations and a
good long term reward system?)
 Could another system or set of trainers do it
better?
 Are there other approaches?

Public Hospital Expenditure
Nursing
Other People
Payments
Everything Else
Why is there any human in
the Operating Room other
than the Patient?
Other approaches 1




Penelope – a voice
activated, speech
recognizing robotic tool
changer
Penelope ( Surgical
Instrument Server) – Dr
Michael Treat
?Replacing scrub nurses?
June 16 2005, Mercy
Medical Centre NY 1st use
in humans (Dr Spencer E
Armory)
http://global.med.cornell.edu/news/nyp/nyp_2
005/06_16_05.shtml
Other Approaches 2
Other Approaches 3
Target Controlled
Infusion in
Anaesthesia
 Propofol, Remifentanil
 Ethicon

Andrew J Fox and David J Rowbotham
1999;319;557-560 BMJ
Other Approaches 4





Virtual Critical Care Unit –
ViCCU
CSIRO / Nepean Hospital
Ultrabroadband Internet
for Remote Telepresence
Leverage off existing
workforce
Remote supervision of a
Cardiac Arrest
Can we replace the Surgeon?
Can we replace the surgeon?
(Gordon E) Moore’s founder of Intel Law
“computing power doubles every 18
months and halves in price”
 Problem of complex pattern recognition
and strategy formation and necessary
computing power / floating point
calculations
 Should be right to 2030 ?????

Can we replace the surgeon – yes!


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

Growth in IT doubling every
year = a factor of a billion in
30 years
2030 the non-biological portion
of our intelligence will
dominate
1988 John Gage “the network
is the computer”
The net =1 kilohertz clock
speed, 200 terabytes of RAM,
10 terrabits per second
transfer, 20 exabytes of data.
ie the net is now about the
size and complexity of a
human brain
http://www.kurzweilai.net/brain/frame.html?start
Thought=Age%20of%20Spiritual%20Machines
Public Hospital Expenditure
- 2030
Computing
People Payments
Everything Else