Queensland Health Systems Review

Peter Forster

Independent Consultant

Requested to review

administrative systems

clinical workforce management systems

performance management systems

to recommend how Queensland Health can provide better health services and health outcomes for Queenslanders.

Review process

18 of 37 Districts visited

1300+ submissions

expert reference panels

interstate visits

literature research

14 Reform Programs

Stream

Workforce Reforms Organisation, Team and Individual Development

Structure/SystemsService Needs Relationships/Partnerships

Programs

P1 Immediate Workforce Priorities

P2 Leadership/Culture

P3 Teaching/Training

Workforce Planning (see P9)

P4 Hospital/Health Service Improvement

P5 Safety Quality Clinical Governance

P6 Patient Complaints

P7 New devolved structure

P12 Performance Reporting

P13 Information Technology

P14 Assets

P8 Strengthen Community Sector Partnerships

P9 Health Service Planning and Workforce Planning

P10 Service enhancement to address special needs

P11 Strengthen Commonwealth Partnerships

1. Immediate workforce priorities

Overseas medical recruitment Credential, privilege and support new and current doctors with

special purpose registration Encourage recognition of generalist positions (SMO, rural

generalist) Fair salaries relative to other States Increase use of VMOs and GPs Fund / Recruit additional allied health, former nurses & graduates Expand nursing & allied health roles Develop partnerships with private providers & NGOs

Replace reliance on oversees recruiting of $135M

RMOs with VMOs, GPs and SMOs

Backfill for nurses to enable change $112M

processes and training

Additional allied health to support new $150M

models of care

2. Developing culture and leadership

Appoint the leaders Leaders and managers participate in leadership

development programs understanding reforms and change agenda articulate change behaviours and values appropriate skills to manage and develop staff

Formal assessment of leadership behaviours for senior leaders (top 500) with external oversight by District/Area Health Councils

Develop commitment to reforms, a new code of conduct and revised values

3. Teaching and training renewal

More registrar places and protected teaching time

Skills upgrades for all clinicians

More scholarships all categories

Fund re-entry training for nurses

In-service clinical teaching/training upgrades all categories

Fund the Skills Centre and relief pools all categories

New training/development pathways – competency based

Partnerships with the tertiary and vocational educational sectors

4. Hospital/health service improvement New models of care and clinical roles

Urgent Elective Surgery Plan Patient flow and longer term waiting list plans Better connecting GPs to hospitals Clinical Network Priorities/Plans Environment for clinical teams to spontaneously improve work

practices and develop skills Budget reform: Regional Distribution Formula & casemix

overtime to ensure fairer allocation Better step-up and step-down facilities

5. Safety, quality & clinical governance

the right person, doing the right job (eg recruitment, performance assessment)

with the right skills (eg root cause analysis, open disclosure)

working in high-functioning teams

supported by effective organisational systems (eg clinical pathways, incident monitoring, enabling legislation)

external oversight by Health Commission and Parliamentary Committee and public reporting

6. Patient Complaints

Resourcing & training for staff addressing patient complaints

Timeframes for resolution of complaints A statewide complaints recording system External oversight by a Health Commission and a

Parliamentary Committee Members of the public to gain Whistleblower protection

for disclosing danger to public health & safety  Public Interest Disclosures may be lodged with Members

of Parliament

7. New devolved structure

Smaller central office

3 Area Health Services (Southern, Central and Northern)

Devolved budget, authority, accountability and responsibility to Area Health Services

Retain 37 Health Service Districts

Clinical networks to be part of formal structure

Greater emphasis on performance monitoring and performance management

Central office

Director-General

Policy Planning andResourcing Southern Area Health Services

Performance Central Area Health Services

Chief Health Officer Northern Area health Services

Corporate ServiceChief Operations Officer

8. Strengthen community and sector

partnerships Invest in a broader range of partnerships Partnerships to recognise that other service providers

may be better able to meet patient and community needs

Consider models such as fund pooling, service devolution, service coordination and outsourcing

Partnerships will be included in performance agreements with AHS General Managers and District Managers and supported by an Innovation Fund

9. Health Service and Workforce Planning Plans developed by District, Area and State Clinical networks play an active role in service planning

& in the distribution of growth funding Universal service obligations defined Improve patient transport arrangements Transparency in decision making about local services

through community involvement Plan to address critical workforce shortages intensively

for 3 years & a longer term plan for the next 10 years Maximise value of existing health workforce through

advanced and new roles and increased linkages with the private sector

10. Service enhancement to address special needs

Indigenous health issues - more flexible approaches to indigenous health services: more funding, more services, community influenced models

Rural and remote issues - alternative funding & service models developed with Commonwealth, telehealth, remuneration and incentives packages to attract and retain staff

Mental health - Increased investment in: carers and consumers; community sector; supported accommodation; involvement private and NGO sectors

Child and youth health - State wide network developed

11. Negotiating new partnerships with the Commonwealth Government

Collaboration focussing on:

Health funding arrangements Teaching and training in public hospitals

Primary / acute partnerships

National standards for medical practitioner registration

Simplification of reporting arrangements

12. Performance Reporting

Standard set of indicators for all levels of reporting with emphasis on quality and safety and patient outcomes

Use of performance agreements with service managers including targets

Regular performance review processes that provides feedback to frontline staff

External review through District & Area Health Councils, a Health Commission overseen by a Parliamentary Committee & Auditor General performance audits

A range of public reports on performance at the District, Area Health Service and State wide level

13. Information management

Realign priorities & structures Systems enhancements (eg PRIME, ESP) Staff internet access provided Computer literacy training Increased desktop availability and access to mobile technology Support staff for clinicians Alternate sourcing models for project and contract

management Information Strategy and Investment Board and Operations

Board to prioritise in line with Review

14. Assets, capital and maintenance

Establish asset planning in Area Health Services with closer links with frontline staff

Establish Central Office Design Unit Urgently review maintenance list to identify priorities Function as part of Business Support Services Group Implement revised governance arrangements, reporting and

post occupancy evaluation frameworks Transfer project management role to the Dept. of Public

Works Establish a sustainable funding model for replacement,

purchase and recurrent costs of assets

Reform Implementation

3 year intense program of reform Reform driven by leaders in Districts, Areas and Central

Office Supported by a Reform Team and a network of reform

facilitators Reform Advisory Panel made up of eminent health

professionals to provide guidance