Reforming healthcare workforce

In Australia, the current workforce will service the healthcare sector till around 2025. That is a further 14 years. If we fail to address the concerns facing the healthcare sector the next 14 years may look, in hindsight like a walk in the park.

The National Health and Hospitals Reform Commission has linked understaffing to around $2 billion per annum in wasted funding as well as contributing to critcal incidents, patient mortality and individual stress levels amongst medical, nursing and administrative staff. In reality any healthcare sector will never have sufficient people, or as many people as either patients or other staff would like there to be. There is however an elephant in the room, and its about to go on the rampage.

People are leaving the workforce faster than we can replace them. More importantly, there is not enough people entering the workforce to replace that that are leaving, without even considering future healthcare staffing needs. The healthcare sector will need every skilled professional it can get its hands on over the next 30 years. Technology will help bridge the gap, however the healthcare sector is an extremely wasteful sector and it doesnt have a history of effective use of technology, so the jury remains out on whether it will be able to utilise technology in a manner that helps to counter labour shortages and changing roles.

The impact upon the healthcare sector is a self feeding circle of issues. As the pressure upon workers increases, the level of workplace stress increases, as workers experience greater stress they make mistakes which impact upon patient care and may cause the death of a patient, as the level of stress rises more people leave the sector to work elsewhere which feeds back into the cycle of overwork and workplace stress.

The rational response is to throw more money at hospitals to recruit staff. That will happen in any case as healthcare providers pay more to compete with the rising cost of labour. Paying existing staff more money will not remove the core causes of workplace pressure and stress. In some instances it may encourage someone to remain in a role where they may well be putting themselves or others at risk.

A part of the problem is the beauracratic nature of the healthcare sector. It is afterall a Government funded system and there is a significant gap in knowledge and understanding between those providing tagged funding and those responsible for spending the money. That will never change. This suggests the impetus for change will not come from Government. Politicians will simply go to the polls and point to increased expenditure as a sign that they are doing the right thing.

If Government cannot reform the healthcare workforce then finding a solution swings back to those responsible for management of our hospitals. The problem here can be that so many of these people are merely administrators who see their role as following the guidelines established by Government. Often, when things go bad, their collective response is to point to Government and say we need more money. And so the blame game continues. At the same time, hospital managements are hamstrung by restrictive workplace agreements that were created in another time.

The world is changing rapidly. Reliance upon workplace arrangements created in another era will not serve our healthcare sector in the future. Clinging onto past industrial agreements created during a time of labour surpluses will not help those in the workforce when there are labour shortages. The answer might be to increase the workforce – if there were enough people entering the workforce to enable that to happen. There are not!

A new collaboration is needed. A collaboration between management and those on the floor, responsible for service delivery. A new way of providing healthcare is needed, based upon the knowledge and understanding of those who know the most effective way of doing things. Those processes and procedures, that contribute nothing towards patient safety or staff wellbeing need to be swept away and replaced with new, contemporary work practices. A new collaboration is needed between medical staff and nursing staff, where everyone works towards the same goal – wellbeing for both the patient and those that care for the patient.

A new collaboration is needed between Government and unions. A role of the union is to protect workers from predatory management behaviour – and it is necessary, yet a union is only effective if it protects the wellbeing of its members. How will the union protect the wellbeing of a declining membership group during a period of labour shortages, when there are increasing levels of workplace stress, when more money can be earned in other places for less stress, when there are a diminishing number of people entering the healthcare workforce? As we noted earlier, increased remuneration will occur anyhow but it will not relieve the root cause of workplace stress, nor will it create employees that don’t exist. The union needs to become proactive is looking at how work is done, how it can be done more effectively with less workers and what needs to be in place to minimise any negative impacts upon those remaining in the workplace.

The healthcare sector can continue to ignore the future and react only to emerging events for ever. At the end of the day it will always be able to treat people for their illnesses. However, in a decade, when our healthcare sector faces severe labour shortages, when workplace stress is driving people out of hospitals, when patients are dying due to clinical error or being unable to access care, when wards are being closed due to a lack of people to provide care, when waiting lists are growing longer and when more people are being admitted to hospital in need of critical care then our politicans will sit up and take notice, they in turn will apply pressure to management teams who will react by applying pressure to an already pressured workforce. When that occurs change will be painful and very expensive. The healthcare sector is like a big ship, it takes a long time to change direction. Now is the time to start.

Those are my thoughts for the day
John Coxon


About John Coxon

Principal consultant for John Coxon & Associates, a management consultancy working with boards and management teams in healthcare, aged care and not for profit organisations to develop effective strategic planning processes and social enterprise business plans
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