July 29, 2018

Improving Workforce Performance at Sydney Local Health Centres

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EXECUTIVE SUMMARY

Local Health Centres (LHDs) form the basis of the health care system in Australia by providing all basic health care facilities at a fair price to the Australian consumers. LHDs provide a range of healthcare services like mental, cancer care, maternity, oral health, etc. Maintaining a good supply of healthcare workers is crucial for the smooth functioning any LHD. Sydney LHD has a total of 10,000 healthcare workers but is still facing a shortage in the doctors and other healthcare staff due to several reasons. It spends a substantial amount of money for paying its regular staff and visiting doctors. Sydney LHD should consider undertaking several steps to develop a balanced workforce plan. More pertinently, Sydney LHD is facing acute shortage of workforce in the areas of general patient care where there has been an increase in the number of patients. Some of the steps that Sydney LHD could consider for improving workforce performance are entering into tie-ups with local universities to provide training to its existing and prospective employees, hire more part-time doctors, having a recruitment program where healthcare workers are hired round the year, and find ways to increase its revenues from patient fees.

INTRODUCTION

The demand for health services is on a continuous rise due to the rising incomes of people around the world. Governments too are putting more and more efforts to provide better quality healthcare services to their populations. Some other factors that are leading to an increase in the demand for healthcare services around the world are ageing populations and the increased burden of chronic diseases (Anderson and Catchlove 2012). Several innovations were considered by governments all over the world to provide affordable health care services to people. One such innovation started by the Australian government are the local health districts (LHDs) which bring some key health care services within the reach of people who are living within a particular locality. LHDs provide a range of health care services to people living in a particular locality like mental health, aboriginal health, oral health, forensic medicine, etc.

But a key challenge for hospitals and other health care provision centres is the availability of skilled man power. The increase in the demand for high quality healthcare services also increased the demand for healthcare workforce like doctors, laboratory professionals, and nurses (World Health Organization 2012). Maintaining a good flow of qualified health care professionals involves forecasting the exact number of people required for a given job and the number of people who will be available in the near future. This involves developing a good workforce plan for the organization that provides health care services. The current report focuses on developing a workforce plan for the Sydney Local Health District.

SYDNEY LOCAL HEALTH DISTRICT

The development of a workforce plan involves seven different steps: defining the organizational strategy, external and internal scanning, assessing workforce requirements, demand and supply forecasting, gap analysis, workforce plan, and implementation process. Each of these seven steps for Sydney Local Health District are given below:

Organizational Strategy and Service Delivery Expectations

All the public sector hospitals and other healthcare facilities situated in the Sydney metropolitan area come under the Sydney Local Health District (NSW Government, n.d.). The Sydney LHD covers some of the key suburbs in the region like Earlwood, Darlington, Tempe, etc. With a total land area covered of 127 square kilometres, Sydney LHD is one of the biggest LHDs in Australia. There are 5 major hospitals under its purview of the Syndey LHD. It includes eight Local Government Areas (LGAs).

Sydney LHD works with the vision ‘to achieve excellence in healthcare for all’ and the mission of ensuring its community has access to high quality patient centred health care. The key strategic goals of Sydney LHD are divided into those directed towards its staff, towards the general community, towards education, and towards research (SLHD Health Profile 2013). Sydney LHD provides a range of services to people which range from the general community health and allied health services like early intervention, community-based prevention, physiotherapy, nutrition/dietics to specialized health care services like mental health and forensic medicine. Sydney LHD also has a special Aboriginal Health Unit whose main job is to provide health care services to Australia’s Aboriginal populations. Aboriginal Health Unit is responsible for developing strategic partnerships, planning, and coordination of Aboriginal health programs across the nation. The Aboriginal Health Unit of Sydney LHD provides support, leadership, education, and cultural support to the core health services provided by Sydney LHD. Apart from this, the Aboriginal Health Unit also develops partnerships with other LHDs for the effective implementation of health programs across the health service.

Environmental Scan

External Environment Scan

Sydney LHD provides healthcare to over 580,000 residents of the inner west of Sydney and other surrounding areas. By the year 2021, the total population that will be covered by Sydney LHD is expected to reach a number of 6 24,000 (SLHD Health Profile 2013). Unlike other LHDs in Australia, Sydney LHD is ethnically diverse. Nearly 51.5 percent of its population speak languages other than English like Arabic, Cantonese, Arabic, and Greek. A significant Aboriginal population also lives in Sydney LHD. This diverse population of the LHD makes it imperative to hire staff which is proficient in the different languages spoken and the cultures practiced by them. Over the next 10 years, the number of people who are aged 70 and above is expected to significantly and represent 9.7 percent of the LHD’s population (SLHD About us n.d.). The number of people in the age group of 20-69 years is also expected to grow by 8.5 percent over the next 10 years. A significant growth in the population aged above 70 means more facilities to take care of older population.

Internal Environment Scan

Like all the LHDs, Sydney LHD too is governed by two board members, a chief executive, and senior executive team directly reporting to the chief executive (Sydney LHD n.d.). Other people in the management team of the Sydney LHD are facility general managers, service managers, and district clinical directors. Sydney LHD also offers training facilities to the new aspirants who want to be a part of the team. It offers different kinds of programmes in the areas of innovation, management & leadership, clinical skills, technical skills, and engagement. With regard to income and expenditure, Sydney LHD gets a low share of revenues from patient fee. But most of the expenditure of Sydney LHD is employee related. Below are the details regarding the expenses and revenues of Sydney LHD:

Expenses and Revenues of Sydney LHD

Source: Sydney LHD, Year in Review 2011/12. Available from: <http://www.slhd.nsw.gov.au/pdfs/YIR_11-12.pdf>. [5 May 2014].

WORKFORCE REQUIREMENTS

Some of the priority health areas in Sydney LHD are Cancer, Maternal Health, Injury & Poisoning, and Communicable Diseases. Sydney LHD conducts mammographic screening for the detection of breast cancer and pap smear test for cervical cancer every two years. It also conducts bowel cancer screening for men and women turning 50 years of age. Sydney LHD was also planning to extend cancer screening for all the Australians between 50 and 74 years every two years. Similarly 171 residents of Sydney LHD died of injury and poisoning in the period 2006-2007. Communicable diseases like sexually transmissible diseases (STDs) and blood, air, and vector borne diseases too were highly prevalent in Sydney LHD. The incidence of these diseases is also expected to increase in future, requiring more number of experts to work in these areas.

Sydney LHD has an active human resource planning function which focuses on recruitment, training, and development of employees in the long term. Sydney LHD had a plan to stabilize the foundation of the hospitals by implementing versatile answers and assimilate the workforce planning steps. Some of the issues that Sydney wants to address in the future are (NSW Ministry of Health, 2012):

Provide all the required work environment related arrangements for healthcare workers so that they can discharge their duties effectively.
Focus on the development of skilled health care professionals and managerial staff who will govern the organization well in the future.
Work for the development of skills and knowledge of healthcare workers and other staff.
Support its staff in all the areas related to decision making.

DEMAND AND SUPPLY FORECASTING

For any organization which is both labour intensive, forecasting the demand for staff is crucial in order to hire the right number of staff required in the future. Proper forecasting of demand for workforce helps in providing efficient service to its customers (patients in the present case) and also analyze whether the expected supply of employees is enough to cater to the needs of the organization. Since healthcare organizations need to provide proper training to the employees before they are inducted into the organization, lack of adequate demand and supply planning could spell disaster to the organization in the long-term. Even though adequately staffed, the Sydney LHD is facing problems in meeting the demand requirements of its health-care staff. The total number of healthcare workers employed in Sydney LHD is 10,000. With a number of 4,700, nurses form the majority of these healthcare workers. Doctors constitute as little as 1,360 of the total workforce, while the balance constitute 1,000 allied healthcare workers and specialist healthcare workers who are trained to handle special cases. A unique aspect of the present Sydney LHD workforce is that nearly 72 percent of them are female (mostly nurses). Most of the workforce is young with just 20 percent of them aged above 55 years and above. With the 20 percent of workforce (aged 55 and above) close to retirement and a substantial number of workers working on specialized areas, there is an urgent need to hire new workers to quickly replace the aging lot and recruit new workers to work in the non-specialized (general areas). There is also a significant need to recruit more number of doctors. As Sydney LHD has a substantial aborigine population, the number of aborigine healthcare staff should also be increased from the present 1.8 percent of the total. This would help in understanding the language and food habits of aborigines and provide better service quality in the future.

COMPOSITION OF SYDNEY LHD’S WORKFORCE

Gap analysis involves identifying the gaps between the existing workforce of an organization and the required number in future. Appropriate gap analysis helps in planning the future demand and supply of workforce needed for an organization. Demand and supply forecasting also requires recruitment and training of the workforce with the skills that are required for the workforce staff. The 1,360 staff who are working in specialized areas are enough to meet the requirements of treating Cancer, the biggest health concern in Sydney LHD. Some training related to cancer treatments like chemotherapy and radiotherapy could also benefit the cancer sufferers in Sydney LHD. But as more number of people are also suffering from other ailments like general communicable diseases, injury and poisoning, and maternal health; more number of employees who would work in the general category (non-specialist) are required for Sydney LHD. The growth in the chronic diseases needs special attention. Old patients suffering from chronic diseases need long term care and they keep visiting the hospitals frequently. As Sydney LHD has its own internal training division for hiring and recruiting new healthcare workers, focus must be put on getting more non-specialist workers to meet the organization’s requirements. A good strategy for meeting this acute shortage of healthcare workers in some key areas is to look for a strategy where the high-school pass outs and impart them with the requisite training to succeed as both general and specialist healthcare workers. Focusing on recruiting the candidates who are fully qualified with university degrees to work as healthcare workers could delay the process of filling the gaps further and impact the quality of services provided to the patients.

Composition of Sydney LHD’s Workforce

GAP ANALYSIS

WORKFORCE PLANNING FOR IMPROVING WORKFORCE PERFORMANCE

Workforce planning refers to the methodology used to identify the required workforce for improving workforce performance (to deliver on both the strategic and operational objectives) and to manage the issues related to the organization’s work-force related issues. Workforce planning includes activities like recruitment, training, performance management, workforce appraisal, and succession planning. A significant part of Sydney LHD’s money was spent on people. Sydney LHD has spent $856 million for paying its regular staff and $42 million was spent on visiting doctors for the year 2011-2012 (Year in Review, Sydney LHD). This was almost double to the amount spent for other maintenance expenditure. For example, just $420 million was spent on administration costs like drugs, laboratory chemicals, x-ray film, and needles. Basing upon the demand and supply forecasting and gap analysis conducted above, the following are the strategies that need to be followed by Sydney LHD to get the requisite workforce to meet its current and future demands:

The organization needs to quickly fill the gaps in its workforce by filing up the vacancies in the areas where there is requirement like treating general ailments like injuries, chronic diseases, and maternal care. The number of doctors as a share of the total workforce should also be increased drastically.
New healthcare workers should be imparted with all the requisite training so that they can discharge their duties properly. If necessary, Sydney LHD should recruit fresh high-school pass outs and train them to be full-fledged health care workers.
The skill sets of the existing health care workers should be kept up to date so that they can meet any kind of work related challenges. More care should be taken to ensure that the older workforce of the organization stay itself up to date on all the advancements in the medical field.

IMPLEMENTATION

Implementation of a workforce plan required careful planning of the resources and the strategies that need to be implemented to ensure that things fall in place. Lack of proper strategic planning could result in the failing of the implementation of the workforce plan.

The following are some of the steps to be taken to achieve the goals listed in the workforce plan above:

Sydney LHD could explore the option of entering into tie ups with universities and vocational training institutions to get its present and future staff getting trained in the skills required.
Sydney LHD should explore the option of getting more number of part-time doctors to work for the organization. Part-time doctors can help in filling the needs till the time full-time doctors are found for the organization. Similarly, part-time workforce could also be hired to fill the gaps in the workforce temporarily.
In order to fill the gap in the non-specialist healthcare workers, care should be taken that the specialist workforce of Sydney LHD could also handle the general ailments like injuries and chronic diseases affecting older populaions like diabetes effectively. Some basic training to the specialist workforce can make them proficient in handling the general ailments.
The in-house training facilities of the organization should be augmented so that the workforce could be trained in all the skills more effectively.
The organization should start a 365 recruitment policy where eligible people can apply all through the year whenever there is a vacancy. A 365 recruitment policy helps in maintaining a steady stream of employees flowing into the organization.
One of the main reasons for not being able to find qualified workforce for many organizations is not being able to compensate qualified staff well. Even though working for the good of the public, Sydney LHD gets just 33 percent of its revenues from patient fees (Year in Review, Sydney LHD). Sydney LHD should try to increase its revenue from patient fees so that it could pay better salaries to its workforce.

CONCLUSION

Being one of the largest and leading LHDs in Australia, Sydney has several distinctive characteristics. It already covers a population of 580,000 residents which is expected to reach 624,000 by the year 2021. The increase in the number of patients would also put a burden on the requirement for healthcare workers. Sydney LHD could overcome the problems regarding its healthcare staff by following the above suggested workforce plan for improving workforce performance.

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REFERENCES

Anderson, T & Catchlove, B 2012, ‘Health and hospital reform in Australia- a local health district’s perspective’, World Hospitals and Health Services, vol. 48, no. 3, pp. 21-24.
NSW Government n.d.. Available from: < http://www.health.nsw.gov.au/lhd/pages/sydlhd.aspx>. [5 May 2014].
NSW Ministry of Health 2012, Health Professionals Workforce Plan, Available from: <http://www0.health.nsw.gov.au/pubs/2012/pdf/hprofworkforceplan201222.pdf>. [5 May 2014].
SLHD Health Profile 2013. Available from: < http://www.slhd.nsw.gov.au/pdfs/SLHD_Health_Profile_2013.pdf>. [5 May 2014].
Sydney LHD, About Us: Organizational Structure. Available from: < http://www.slhd.nsw.gov.au/about_goals.html>. [5 May 2014].
Sydney LHD, About Us: Interesting Facts. Available from: <http://www.slhd.nsw.gov.au/about_facts.html>. [5 May 2014].
Sydney LHD, Year in Review 2011/12. Available from: <http://www.slhd.nsw.gov.au/pdfs/YIR_11-12.pdf>. [5 May 2014].
World Health Organization 2012, World Health Statistics 2012. Available from: < http://www.who.int/gho/publications/world_health_statistics/2012/en/>. [5 May 2014].