Multiskilling the future healthcare workforce

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Multiskilling the future healthcare workforce

• Professor Robyn Nash
• Faculty of Health, QUT

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Setting the scene.

• Multiskilling can be described as
• a form of flexible working in which employees are
  available to undertake a number of different
  jobs.
• training individuals to undertake a variety of
  work tasks within the same organisation.
  Multi-skilling is not synonymous with being a
  generalist. A multi-skilled employee is expected
  to be competent in more than one function and
  might be considered a versatile specialist. The
  challenge is to combine flexibility with a set of
  core competencies. Specialist skills remain
  central to organisational and career success.
  But, as the nature of work alters, the importance
  of functional flexibility is growing (UWA 2001).

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Whats the agenda?

• Supply
• projected staff shortages
• nurses - the single largest health profession
• ageing of nursing workers
• ?proportion of part-time

• Demand
• increasing patient community expectations
• ageing population
• increasing prevalence of chronic disease

Significant challenges for the healthcare industry
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Whats the agenda?

• The Productivity Commission recommended four
  main approaches to solving current health
  workforce shortages and unequal distribution of
  labour
• Reduce the demand for acute and chronic health
  care services through a focus on prevention
  strategies
• Increase, at least in the short term, the number
  of education and training places in some
  professions
• Place greater emphasis on retention and re-entry
  to stabilise and even increase the numbers in the
  workforce
• Improve the productivity, satisfaction and
  effectiveness of the workforce (2006)

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Vision for the future

• Australia will have a sustainable 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 be
  able to work within a supportive environment and
  culture. It will provide safe, quality,
  preventative, curative and supportive care, that
  is population and health consumer focused and
  capable of meeting the health needs of the
  Australian community
• National Health Workforce Strategic Framework,
  AHMC (2004)

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Strategies include

• Systems oriented responses
• innovation in workforce design
• roles and relationships between roles
• Education oriented responses
• preparation of future health care workers

A workforce that can respond flexibly to
changing client needs to ensure high quality
healthcare
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From a systems perspective...

• Strategies include
• New models of healthcare delivery that
• promote better utilisation of the existing
  workforce
• support the optimal use of skills and workforce
  adaptability
• Exploration and support of new and emerging roles
  in the health workforce
• service integration across the care continuum
• collaboration across professions

• Key principles
• team working across professional
  organisational boundaries
• flexible working to make best use of the range
  of staff skills and knowledge
• maximising the contribution of all staff to
  patient care
• (NHS, 1999 in NHWT, 2009)

The potential of health care teams is not being
recognised because of the lack of effective
communication and team working practices NCIS
(2003, p.15)
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From an educational perspective...

• Strategies include
• Models that enable articulated, multiple pathways
• New and innovative ways to deliver health
  education and training
• Workplace, professional and education and
  training practices that facilitate team
  approaches and multidisciplinary care
• National Health Workforce Strategic Framework
  (AHMC, 2004)

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Double degree programs

• Double / joint / dual / combined degrees
• 2 degrees studied concurrently in a shorter
  period of time than would be required for the 2
  degrees undertaken individually
• 2 qualifications on completion
• cross-disciplinary / multidisciplinary /
  potentially transdisciplinary in nature
• multiskilling - versatile specialist notion?

Potential for well educated graduates who are
able to adapt their mix of knowledge and skills
in flexible and responsive ways
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Double degree programs

• QUT
• 100 double degree combinations (approx.)
• Faculty of Health, QUT
• 10 single degrees (undergraduate)
• 22 double degrees (undergraduate)
• 10 intra-faculty double degrees
• 12 inter-faculty double degrees, eg. Health
  Business/ Law/ Education/ Media and Communication
  

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Double degree programs

• School of Nursing and Midwifery, QUT
• Bachelor of Nursing/Bachelor of Applied Science
  (in Human Movement Studies)
• Bachelor of Nursing/Bachelor of Health Science
  (Public Health)
• Bachelor of Nursing/Bachelor of Midwifery
• Bachelor of Nursing/Bachelor of Health Science
  (Paramedic)
• Bachelor of Nursing/Bachelor of Behavioural
  Science (Psychology)

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Double degree example
Year4 Year 3 Year 2
Year 1
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Double degree programs

• Strong student demand
• Most want to acquire job-relevant skills, improve
  employment prospects and, to a lesser extent,
  explore different areas of study
• I chose to do the double as I thought it would
  benefit me in the science sector as I wanted to
  get into mining with my geology background. I
  knew that mining companies used the stock market
  quite a bit and I was also interested in the
  finance side of things (Science-Commerce)
• Russell et al. (2007)

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Double degree programs

• What do graduates find?
• most agree that they gained a broad base of
  knowledge and skills (87)
• however fewer agree that
• the skills learned have been useful at work (52)
• they were more competitive for jobs (54)
• linking/integration of disciplines was a main
  benefit of a double degree (11)
• Russell et al. (2007)

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Double degree programs

• Challenges / opportunities
• Educationally
• integrated Vs separatist course structures?
• supported Vs individual integration at the
  learning interface?
• Work perspective
• impact on job design and/or recruitment?
• usage of graduates extra knowledge and skills?

Id jump at the chance to undertake a project
that allowed me to integrate my research.
(Russell et al. 2007)
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Inter-professional education (IPE)

• IPE can be defined as occasions when two or more
  professions learn from, with and about each other
  to improve collaboration and the quality of care
  (CAIPE, 2007 )
• not a new concept, but has taken on new
  importance within the current context of drivers
  for change, eg. multidisciplinary and
  multiskilled teams (Van Der Weyden 2006)
• multiskilling - functional flexibility notion?

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Inter-professional education (IPE)

• Interprofessional education focusses on
  knowledge, skills and attitudes required for
  collaborative practice, eg.
• roles and responsibilities of different
  professions
• working with other professions to effect change
  and resolve conflict in the provision of care and
  treatment
• working with others to assess, plan, provide and
  review care for individual patients
• facilitating interprofessional case conferences,
  team meetings, etc.
• entering into interdependent relations with other
  professions (Barr, 1998)

Integrative problem solving Collaborative
practice Innovation in the workplace
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Inter-professional education (IPE)

• Issues being raised..
• requires the identification of inter-professional
  competencies, preparation of effective
  educators, and implementation within curricula at
  undergraduate, postgraduate and clinical
  education levels
• concerns that an emphasis on inter-professionalism
  may water down/erode the essence/value of
  discipline-specific contributions to health care
  
• apparent lack of systematic evidence of the
  effectiveness of IPE
• student satisfaction Vs performance outcomes
• cross-sectional Vs longitudinal research

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Inter-professional education (IPE)

• IPE initiatives include
• Curriculum related
• development of core units/subjects within
  undergraduate degrees
• development of targetted IPE modules, eg.
  multidisciplinary teamwork
• IPE clinical placement programs, especially in
  rural settings
• Extra-curricular
• Health Fusion Team Challenge
• Important implications for clinical education and
  clinical practice, including inter-professional
  competencies

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Inter-professional competencies

• Health professional competencies
• Profession specific
• Core common workforce competencies (NHWT, 2009)
• Particularly important is the introduction of a
  competency-based framework. Competencies are what
  a person needs to do and to know to carry out a
  particular job role or function. A competency
  framework would allow for a variety of entry
  points into health care careers, recognise prior
  learning and foster more flexible
  multidisciplinary training across undergraduate
  programs
• National Health and Hospitals Reform Commission,
  2008

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Inter-professional competencies

• Expected benefits of a shared, principles-based
  competency framework
• revitalisation of workforce models
• job enhancement
• delivery of safe, effective care
• improved education and training pathways
• Health Workforce Competency Principles A
  Victorian Discussion Paper, Victorian Government
  Dept. of Human Services, 2009

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Inter-professional competencies

• Resonance with current university agendas
  regarding generic capability/skill development
• the qualities, skills and understandings a
  university community expects its students to
  develop during their time at the institution and,
  consequently, shape the contribution they are
  able to make to their profession and as a
  citizen (ATN 2000)

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Generic capabilities/Employability skills

• communication skills
• teamwork skills
• problem solving skills
• self-management skills
• planning organising skills
• technology skills
• life-long learning skills
• initiative enterprise skills
• (DEST 2002a)

• knowledge skills pertinent to a
  discipline/professional area
• critical, creative analytical thinking, and
  effective problem solving
• effective communication
• capacity for lifelong learning
• ability to work independently and collaboratively
  
• social and ethical responsibility
• self-reliance and leadership
• (QUT)

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Generic capabilities/Employability skills
Students core employability skills
Increase in domestic students core employability
skills throughout their courses, of students
rating their skills as fairly strong/very strong
(University and Beyond 2008)
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Challenges to change.

• Professional demarcations, mirrored in
  professional differentiation through training
• Accreditation and professional registration
  requirements which lead to specialisation of
  functions and impede collaboration or
  multidisciplinary team work
• Entrenched cultural resistance to change and
  innovation as well as a high and low work
  status distinction preserved through workplace
  practices and hierarchical roles in health
  services which greatly reduce flexibility and
  productivity
• Chamber of Commerce Industry WA, 2008

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In conclusion.

• Currently, great momentum for change
• Bilateral action the key to creating innovative
  solutions
• think outside traditional work roles and ways
  of working to maximise staff contribution to
  patient care
• think beyond traditional educational structures
  and pedagogies
• Being the change in our respective
  jurisdictions

Change is the law of life. And those who look
only to the past or present are certain to miss
the future. John F. Kennedy