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PubMed2006

Educating to improve population health outcomes in chronic disease: an innovative workforce initiative across remote, rural and Indigenous communities in northern Australia.

INTRODUCTION: Like Indigenous populations in other countries, an epidemic of chronic disease has swept across Australia's Indigenous communities in the past decade. The Northern Territory and Queensland health departments initiated preventable chronic disease strategies in 1999 and 2001, respectively. Yet finding innovative ways to translate this to the health workforce was challenging. Through support from the Australian Government, three universities, two health departments and two Indigenous organisations worked in partnership to improve workforce capacity in remote and rural communities through innovative education. METHODS: The methods included: (i) a training needs analysis consisting of 76 semi-structured interviews with key informants, and 35 surveys of remote staff; (ii) a literature and resource review; (iii) the development of a curriculum framework using: the existing competencies and standards across the health disciplines; the identified workforce needs; and what the workforce can impact upon; (iv) a multidisciplinary workshop with 35 educators across northern Australia that resulted in the basis for agreement of the final curriculum content and framework; (v) the development of a chronic disease self-assessment tool that was piloted with remote health staff; (vi) an assisted integration process for key stakeholders. An evaluation framework was also developed, as a separate project, in conjunction with the project partners during this time. RESULTS: This project identified that a paradigm shift is required in the way in which we educate the entire health workforce to deal effectively with the impact of chronic disease across remote, rural and Indigenous populations. In particular a need was found to educate the educators in the chronic care model and in using a population health approach. The training needs analysis identified very little difference between the education and training needs across the rural and remote health disciplines; it was perceived that they managed chronic disease fairly well yet found prevention and early detection to be at the 'hard end'. The main barriers identified were the demands of acute care over chronic disease management, compounded by high workforce turnover in remote areas. The curriculum framework, in particular the domains of remote practice, is being used by several Australian universities, health departments and non-government organisations in adapting their existing or new education programs. The self-assessment tool was based on the curriculum outcomes and was piloted in 2005 and found to be very useful for pre- and post-training purposes and as a discussion starter for all disciplines and groups. CONCLUSIONS: A practical curriculum framework now exists to integrate a population health approach for the prevention and early detection of chronic disease when educating the primary healthcare workforce. It is relevant to all health disciplines and is flexible in that it can be adapted, or adopted, depending on the educational needs of the disciplinary group. It is being imbedded into numerous undergraduate, postgraduate, and professional development programs in Australia. It includes: the core learning outcomes expected of any workforce, resources, and a self-assessment tool in chronic disease. These tools are assisting educators in the required paradigm shift required of the workforce to alter the single disease based practice model towards a comprehensive and integrated population based approach required for the workforce in the 21st century.

Chronic Disease↗
PubMed2006

Occupational health for an ageing workforce: do we need a geriatric perspective?

Extending retirement ages and anti-age discrimination policies will increase the numbers of older workers in the future. Occupational health physicians may have to draw upon the principles and experience of geriatric medicine to manage these older workers. Examples of common geriatric syndromes that will have an impact on occupational health are mild cognitive impairment and falls at the workplace. Shifts in paradigms and further research into the occupational health problems of an ageing workforce will be needed.

Journal Article↗
PubMedDate not supplied

"Effect typology" and work ability index: evaluating the success of health promotion in elder workforce.

Changes in work ability and work interest (meaning) after the participation in a health promotion program were perceived and evaluated. Drivers of the Munich Transport Authority (n = 122) of an average age of 50 years participated in 20 health days during working time over 1 year. The evaluation instruments of the health promotion program were the Work Ability Index (WAI) developed by the Finnish Institute of Occupational Health (FIOH) and the Effect Typology developed by the Institute of Occupational Health Promotion (IBG Austria). No changes were found in the WAI score. The Effect Typology evaluated the optimal effect "evolution," i.e., psychological and noetic (mental) changes, for 50% of the participants. A variance analysis of the WAI pre-post differences according to the effect classes of the Effect Typology showed significant differences, namely an increase in the WAI in the evolution group and a drop in the recovery group. The Effect Typology is suitable for the evaluation of occupational health promotion and for the further understanding and development of the WAI.

Aging↗
PubMed2003

Providers issue brief: Medical malpractice: tort reform: year end report-2003.

Many questions exist surrounding the origins of the escalating cost of medical malpractice coverage. Insurers and health providers claim excessive litigation and overly generous jury awards have hardened the market. The American Trial Lawyers Association and consumer advocacy groups claim insurance premium rates have not tracked medical inflation or the payouts of jury awards over the last 30 years. State efforts have been hampered by the lack of conclusive data as to the cause . However, the potential impact is very clear, limited health care access as result of a loss in the health care workforce.

Health Care Reform↗
PubMed1997

Health sector reform in central and eastern Europe: the professional dimension.

The success or failure of health sector reform in the countries of Central and Eastern Europe depends, to a large extent, on their health care staff. Commentators have focused on the structures to be put in place, such as mechanisms of financing or changes in ownership of facilities, but less attention has been paid to the role and status of the different groups working in health care services. This paper draws on a study of trends in staffing and working conditions throughout the region. It identifies several key issues including the traditionally lower status and pay of health sector workers compared to the West, the credibility crisis of trade unions, and the under-developed roles of professional associations. In order to implement health sector reforms and to address the deteriorating health status of the population, the health sector workforce has to be restructured and training programmes reoriented towards primary care. Finally, the paper identifies emerging issues such as the erosion of 'workplace welfare' and its adverse effects upon a predominantly female health care workforce.

Developing Countries↗
PubMed2005

The health care work force.

This month's gatefold examines the distribution of the health care workforce state by state. It also compares the commitment level of health care workers with workers in other fields and within health care by job category and organization type.

Career Mobility↗
PubMed2005

Development of a mentorship programme for new graduate nurses in mental health.

A university and three area mental health services collaborated in developing a mentorship programme for new graduate nurses in mental health. The programme evolved from initiatives identified by the New South Wales Government to address recruitment and retention problems impacting on the mental health nursing workforce. This mentorship programme was identified as a strategy to potentially contribute to retention of novice nurses within the local mental health nursing workforce. New graduate nurses entering the mental health field were provided the opportunity to engage in a temporary supportive professional mentoring relationship. The present paper describes the background of the programme and provides an overview of how it was developed. It serves as a starting point for others contemplating developing similar programmes. Evaluation of the programme is incomplete, therefore, formal results will be presented in a subsequent paper.

Attitude of Health Personnel↗
PubMed2001

Wagging the dog: an analysis of year 2000 workforce and education outcomes from recommendations of the 1995 Pew Commission report.

Over-production in the number of hospitals and health care workers has led to increased cost of medical care and inequities within the health care delivery system. An increase in managed care penetration within the market-place is believed to mandate dramatic changes in the way that health care is structured and delivered. The 1995 Pew Commission report projected major changes in health care organizations and health manpower through the effects of managed care and public regulation. This paper describes the outcomes to health delivery organizations and the health care workforce five years since the Pew Commission Report and discusses the belief that market forces are more effective mechanisms for addressing health care delivery and workforce requirements than public regulatory initiatives.

Allied Health Personnel↗
PubMed2001

Designing employer health benefits for a heterogeneous workforce: risk adjustment and its alternatives.

Many health economists recommend that employers provide employees with a risk-adjusted choice among competing health insurance plans. However, formal risk adjustment is rarely if ever used by employers. This paper examines a range of health benefit design options available to employers, focusing attention not only on risk adjustment but also on its alternatives. We argue that while formal risk adjustment is rare, employers commonly use strategies that accomplish some of the same objectives at less cost.

Actuarial Analysis↗