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Article Title

The Challenge of Change: A South Australian Experience

The only thing that seems to be a constant in health today is change. Healthcare in the 21st century faces a number of challenges and opportunities, including the emergence of evidence-based practice and patient centred care and the need to underpin health care with quality constructs such as safety, effectiveness, patient centeredness, timeliness, efficiency, and equity. In addition to this, the demand for health services around the world continues to increase.1 There are a number of drivers for this including factors such as population growth, an ageing population with increasing risk factors linked to chronic disease, increased patient expectations, advances in technology, demographic shifts, increased cost of healthcare provision, and workforce shortages. Therefore healthcare today needs to change and evolve to meet these requirements.

Many strategies have been put in place in order to address these demands including expansion of the workforce, major reforms in healthcare delivery (both in structure and process), and alternative healthcare programs.2 Many of these have focused on improving the quality, safety, patient centeredness, effectiveness, responsiveness, and efficiency of healthcare services.

However, despite many international developments in healthcare, delivery has often fallen short of expectations primarily because investments and strategies into healthcare delivery have not met demand or have not been cost effective.3 In South Australia there is a risk that increasing healthcare costs will be unsustainable in the near future, leading to calls for vital reforms. Continuing with the traditional health workforce into the future may not be viable nor sustainable. To do so would require a treble increase in numbers of staff.4

Therefore, recognising these unique influences, in South Australia, rather than merely developing and implementing more and more strategies, healthcare stakeholders have come up with a new model of care altogether. This Model of Care is a key component of the South Australia’s Health Care Plan (2007-2016) and is underpinned by a number of important principles: integrated healthcare; services that respond to and are driven by the needs of patients; evidence-informed decisions and practices, and a flexible workforce.2 This is seen as an innovative solution as it not only supports but reforms health care delivery and its workforce into the future and takes a system-wide perspective.

However, if innovation and change (such as a new model of care) is to be successfully implemented and sustained, challenges needs to be anticipated and addressed, such as those with clinical practice, professionalism, and clinical leadership.

Clinical practice is influenced by many factors including the structure of the workforce, the environment, workforce redesign, motivation to provide high standards of service delivery, increasing knowledge of patients and service users, and the predictability and uniformity of healthcare activities and tasks. As patients and consumers gain more knowledge and expertise in navigating the health services and expect greater involvement in decisions about their care, it is anticipated that the delivery of healthcare will become a more collaborative process between individual patients and their healthcare providers. Empowering consumers will therefore be a key feature of future services.

Any change in clinical practice demands a thorough understanding of the nature of the work, workforce requirements, and staff available with the relevant skills and competencies. Delivery of the Model of Care might require significant change in numbers, skill mix, or specialisation of professions.

For sustainable clinical reform, clinician engagement, awareness, and clinical leadership will be crucial. The processes and strategies by which an organisation engages its staff will be important and will require a timely introduction to enhance the successful implementation.

For some, the changes associated with the introduction of the new SA Model of Care might be seen as threats; for others they will be viewed as opportunities. What is clear is that the new SA Model of Care affords numerous opportunities, including greater chance of providing more patient centred and holistic care, improved cost effectiveness, greater levels of efficiency, and safer care delivery. The system-wide perspective offers innovative opportunities (such as reconfiguring workforce roles) to address emerging challenges (such as improving access to care and enhancing the patient’s journey). How successful and sustainable the new model of care will be, and its impact on process and outcomes of healthcare in South Australia, only time will tell, but for now, the challenge has been accepted.

To paraphrase the great John F. Kennedy, "we choose to implement innovation and change into health care and do the other things, not because they are easy, but because they are hard…”

References

  1. Higgins I. Benchmarking in health care: a review of literature. Aust Health Rev 1997; 20(4): 60-9. doi: 10.1071/AH970060.
  2. SA Health. South Australia’s Health Care Plan 2007 – 2016. Adelaide: Government of South Australia; 2007. ISBN: 978-0-7308-9905-1.
  3. Altenstetter C, Bjorkman JW. Health Policy reform, national variations and globalisation. New York; MacMillan Press Ltd; 1997. ISBN: 0333659538.
  4. NHHRC 920090 Final Report p61 http:www.health.gov.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report

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