Driving efficiency across healthcare – are nurses the answer?

Australia’s productivity agenda has prompted the healthcare sector to improve efficiency, because patient demand and complex healthcare needs have dramatically increased.

The sector cannot afford cost blowouts, and efficiency is the way forward for patient flow, work flow and waste reduction.

Queensland Health recently set out to achieve an efficiency savings target of $214.8 million to support wage increases outlined within the Nurses and Midwives (Queensland Health) Certified Agreement (EB8) 2012. It has placed the role of nursing in a unique position to champion the productivity drive.

Ahead of Hospital Efficiency 2014, I touched base with Dr Frances Hughes, Chief Nursing and Midwifery Officer for Queensland Health, to get her insights into the challenges, strategies and results of this project.

The role of nursing

Nurses are a major stakeholder in the health sector, with 66,795 nurses and midwives employed throughout the State (as of 30 June 2013).

Queensland Health employs approximately 32,000 nurses, of which the nursing workforce comprises 42 per cent of the entire workforce and 61 per cent of the clinical workforce.

“We are a huge vehicle for change in the health sector, and we’ve had some really exciting efficiency data relating to multiple initiatives. We’re the largest clinical workforce and have a lot of knowledge and depth of capacity to think creatively about new efficiency models,” Frances noted.

Registered nurses equate to 83 per cent of the nursing workforce employed by Queensland Health – approximately 20,823 FTE.

The organisation’s focus on efficiency savings has yielded an incredible $221.3 million return, achieved within 12 months of the EB8 agreement deadline.

“We improved HR management and decreased high cost labour items such as agency, overtime and casual, as well as implemented criteria-led discharge and hospital in the home strategies,” Frances remarked.


A performance scorecard was developed to assist with reporting and monitoring trends across nursing and midwifery services within the public health care sector. These included skill mix, sustainability, productivity and quality.

This scorecard reflects the push to empower the executive directors of nursing with state-wide data to compare. More development is yet to be undertaken towards enhancements in productivity and efficiency measures this year, including a financial impact statement.


Nurses are well placed to collaborate across the healthcare continuum by virtue of their professional knowledge and adaptive capacity.

They are underpinned by numerous options in post-grad professional development pathways – nursing services are evident in all areas of the healthcare system including public, private, not for profit and commercial environments.

Business models

With increased patient demand comes the need to also improve agility within healthcare models.

Queensland Health has delivered nurse-led services through a range of business models including public/private partnerships, Medicare Locals, NGOs and community based services, therefore decreasing demand on acute services.

For example, the Metro South integrated chronic disease clinic, with coordination of heart failure, renal, diabetes and respiratory clinics.

It linked primary and secondary care, resulting in decreased re-admission rates. The savings for heart failure alone were estimated at $885,000 over three years.


Contestability is another element on which efforts have been focused. Frances gave an example:

“We introduced the application of an Investment Management Framework, which demonstrated nurse endoscopy as a suitable patient-focused, cost effective, and quality solution to minimise waitlists and improve health outcomes for Queenslanders. It was supported through purchasing framework levers such as Service Line Agreement targets and incentives,” she said.


Nursing is going through an innovative transformation in Queensland, but there are still lingering outdated policies and guidelines that impact the overall progress of this journey.

There are also outdated models for healthcare delivery, restricted autonomy in clinical decision-making, and a significant amount of supervision that hampers development.

The role of registered nurses needs to be perceived appropriately as well, to enable them to perform the full scope of work.

Frances noted that: “It’s important to support high-performing nursing services through evidence, continued learning, and understand the link between our skill mix, profiles, efficiencies and patient outcomes.”

Chronic health and an aging population are two issues in Queensland from which nurse-led services can manage, given the right framework.

According to Frances, services need to be driven by patient centricity and deliver safe, quality healthcare that is evidence-based.

“Nurses also need to participate in and lead clinical engagement activities and resource management processes. Furthermore, the services should integrate with business models and be a part of the development in health information technology,” she said.

The nursing portfolio is going through innovation for hospital efficiency. Its influence on the direction for productivity gains is already being realised through results such as the $221.3 million saved.

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