It’s no secret demands placed on health facilities are constantly changing, which means the services provided need to be flexible.
So can you really plan and forecast the needs of the Australian population?
There are a few strands that emerged during the round table discussion recently held for Australian Healthcare Week 2014 . Stuart Moore (Epworth Healthcare) referred to the analytical information Epworth use during the development stages of projects and how this can help with mapping provisions: “We look at data in terms of trends in clinical areas of all sides, public and private, across Australia. We use this data to try to map out growth areas across Victoria (the market in which we operate). That information directly impacts the development projects for our existing sites. We also look at Greenfield opportunity sites in Geelong.
“That information is used alongside the figures we get from Government forecasting such as funding models etc.”
There’s a whole range of information available from the Government that can be incorporated into plans. Anna Morgan (Southern Health) uses information based on areas of growth to gain a better understanding of the timing for expected growth in particular areas when mapping out services.
“The growth catchment predictions impact decisions made in our area quite heavily. We have a lot of older established areas that we currently serve, but in the outer regions there are identified nominated growth areas. We have to understand what the time frames are for that growth so we can incorporate them into our plans.”
The fluctuating population growth rates and behaviour predictions of those people have certainly been a challenge for health facilities in the past.
Leonie Hobbs (Carramar Consulting) has first-hand experience in Queensland, where unexpected population growth led to a long term design predicament: “We closed many beds because we had huge facilities at the time. Then something happened that we weren’t expecting: we had a huge population influx. We hadn’t designed to manage that. That’s the dilemma we are still stuck with now. The population modelling was done correctly, it was the provision of services themselves that we got wrong – we were hearing people would use more ambulatory services and therefore need less bed days, but we still needed the beds.”
So how can we really predict population? Ultimately, modelling can never be exact, but the message is to use the data sources available to make the most informed decisions.
The workforce challenge
Of course, the adaptability challenge extends beyond the build of facilities to occupy surrounding communities; the service itself needs to be just as flexible.
Two themes tie into the debate: the provision of services themselves and the location.
Perhaps one of the most interesting pieces of research happening currently is in Queensland around contestability. Leonie explained: “With the potential of outsourcing public work, there’s becoming a trend in QLD, NSW and WA where we are seeing more of a ‘Fee for Service’ model provided by the private sector. This may be something on the landscape for the future.”
Time will tell how much of an impact outsourcing and contestability will have. Projections produced by HWA in the ’Health Workforce 2025’ report make it pretty clear that without major reform in the pattern of health service delivery, Australia faces huge shortfalls in the nursing and related workforce nationwide, and in the supply of general practice and many specialities outside inner metropolitan areas.
There are considerations that should be made during the design and development to start to tackle this challenge.
The first is around staff and the experience they have. If we make our facilities a better place to be, we’re more likely to retain staff. The roundtable participants discussed how the biggest asset to any facility is the people who work within it, they therefore need to also be at the centre of the design.
We looked at several examples, ranging from the layout of facilities to providing open spaces for staff to relax and research.
The second consideration is around how we’re providing the service itself and a question that was raised by Arch Fotheringham (Brookfield Multiplex): “Are we taking the person to the facility or the facility to the person?”
Location based health
As mentioned earlier, the Government growth reports are one tool for forecasting. Arch suggests that it’s important not to reduce options when providing services in these expanding areas: “It’s easy to say there’s a growth area but you need to look at how you get people out to where that facility is. A good example is if you look at the Western Melbourne area, where a large percentage travel to Central Melbourne for treatment because it’s not available in that area. It extends beyond buildings…”
Anna spoke of a recent project in Dandenong, where they experienced similar location issues. The team are in the process of building new and improved facilities at Dandenong Hospital to ensure continued access to the highest quality of care for the community.
The work redevelops a number of community and ambulatory care services provided in disparate locations, bringing them into one central precinct. It’s an approach that extends existing services rather than builds new ones.
“As we continue forward, we’re about to do master planning in a growth area to do a very similar thing to what we’ve done in Dandenong. It’s about community services, medical consulting, allied health consulting and referring back to our main bases in adjacent areas where the tertiary services are. Understand the services you already have, look at how you can build on them.”
We couldn’t look at location services without discussing at least part of the rural health challenge. We have an ageing population; a large number of people are retiring and moving out to more rural areas where there aren’t as many accessible sub-acute services. They currently have to gravitate back into the capitals.
The population will still also continue to be dispersed – inner city health facilities are run off their feet whilst rural facilities are much quieter and come with their own workforce challenges.
Australia can’t continue to be so metro-centric.
Leonie confirmed, “The models of care are changing rapidly. We design to a model of care and it quickly changes. Take cancer care: we used to bring patients in for treatment and get great outcomes and survival rates. We’re now seeing the day ambulatory oncology unit gets just as good outcomes. Another example is around physiotherapists. I’m consulting with a facility at the moment that has a strong Allied Health background, the whole structure needs to change as we’re now moving into therapy aids. There will be fewer physios and more aids, more groups and less individual spaces. I’m learning people will require less cube rooms and bigger group spaces. We have to be flexible enough to change models of care.”
Solutions need to be found and they’re expected to be driven through design innovations, extended workforce training and technology.
Next week we’ll cover ‘Part Two: Funding’ or download the full report here: www.austhealthweek.com.au