In the past decade Western Australia’s hospital infrastructure has undergone an unprecedented modernisation. The Sustainable Health Review (SHR), released in April 2019, makes clear what needs to happen next: ensuring expensive assets are used efficiently, achieving equitable access to outstanding care and better balancing hospital and community-based care.
The SHR is framed around the need to respond to the doubling in the state’s health budget in the past decade – a challenge WA shares with many developed health systems. But the SHR also represents a golden opportunity to embrace technology, to integrate the health system and to deliver better outcomes for consumers.
These reforms will let the health system better meet the changing health needs of West Australians and the need to deliver seamless healthcare. To do this, the health and wellbeing ecosystem must realise person-centred care – not just aspire to do so.
The WA health system is set to change significantly over the next decade, using the SHR to enact lasting reform and shift the paradigm in how health services are conceived, delivered and experienced. This reform will impact the whole system, including the government and non-government sectors, commissioners and providers, health professionals and health consumers.
All organisations in the health system will be impacted in some way and need to get ready to implement the SHR’s recommendations. The SHR interim report prefaced many changes, including that some resources will be reallocated to achieve more care in the community; an expectation for services to change with greater and more systemic use of technology; and the achievement of a more flexible workforce.
Leaders across the WA health system can immediately focus their organisation on three practical things that will enable them to best meet the opportunities that the SHR will create:
We will briefly explore each of these.
The achievement of person-centred services has underpinned health reform across the world in recent years. Simple yet often misunderstood, the concept has been used as a label for change rather than as the outcome of change.
All healthcare organisations understand the importance of being consumer-focused, but often this just manifests in improved consumer engagement and greater transparency in performance – both important, but often focused on the organisation in isolation rather than on its role in a wider health and wellbeing ecosystem.
In essence, achieving “person-centred services” means health services operate in a health system that is seamless to navigate for staff and consumers, is proactive and collaborative rather than reactive and insular, and gives patients and their loved-ones control over matters including how and where they access care.
Continuous and authentic consumer engagement is a given in a person-centred system, but will need to shift from asking “How did we do?” to “What do you need?” and “How can we help?”.
To support the SHR, Nous led the person-centred services research and consultations. We saw health, aged care and disability sector leaders embrace the need for integration, but we also heard about the barriers to achieving this – such as funding silos, a lack of information sharing, and a lack of awareness of the system as a whole.
Overcoming these barriers and moving to a person-centred system will take time, but for now every healthcare leader needs a nuanced understanding of what person-centred services means to their organisation and to determine their place in a person-centred and connected system.
There is no prescription for a person-centred service. The principles described above need to be applied in the context of the service and the wider WA health system, but much inspiration can be drawn from other jurisdictions, nationally and internationally.
Nous is one of Australia’s leading person-centred care advisors. We worked with the Australian Commission on Safety and Quality in Health Care to develop a national capability framework for person-centred care and are working with health and hospital services nationally to build their strategies and capabilities in this regard.
GPs and hospitals are the foundation of our health system, but GPs are in short supply in WA (especially in country areas) and hospitals are expensive to build and operate; many patients visiting GPs or being treated in hospital do not need this level of care. An increasing awareness of mental health, the prevalence of chronic disease and the ageing of our population will add strain to the WA system as it is currently configured, meaning our new hospital infrastructure will reach capacity much earlier than planned.
The SHR makes the case for reducing the burden on GPs and hospitals and shifting services into the community. By investing in fundamentally different models of care, the health system can support more people at home and in their communities with greater efficiency and better outcomes.
To realise this shift, service providers must take advantage of technology and deploy a flexible workforce capable of adapting to new work contexts and processes.
This long-term transition cannot be achieved if organisations only think in three-to-five-year strategic planning cycles. The SHR sets a vision for 10 to 15 years into the future, and organisations need to do the same. Otherwise organisations will always be 10 to 15 years away from the desired future state.
Nous is working with government and non-government health providers across Australia to establish long-term strategic plans. The common theme is that frontline staff and consumers are excited by the future and understand it will take time. The challenge for organisations is preparing a plan to achieve this vision and balance the demands of today with progress to tomorrow.
The WA health system has many outstanding leaders, but there is little investment in developing the next generation of leaders or in shifting leadership closer to the frontline. Leadership capability has traditionally been a lower priority than patient outcomes or financial performance, so leadership capability is rarely captured by performance metrics. But leaders that fail to think seriously about leadership and its impact on culture are doing their organisation a disservice. In 2015, UK health researcher The King’s Fund linked leadership development with patient satisfaction, patient mortality, organisational financial performance, staff well-being, turnover and absenteeism, and overall quality of care.
Leadership at all levels of healthcare organisations will be essential to executing and embedding the systemic changes required by the SHR. Genuine leadership is not ordained through an individual’s job title; it is about the decisions made, the teams managed, the behaviours exhibited and the trust placed in colleagues and partners.
Some healthcare organisations are recognising the importance of good leadership. Nous is working with government agencies and public health services in eastern states to improve their understanding of effective leadership, to build their leadership capability and to shift the culture and behaviour of all staff. Essential to this work is establishing leadership capability as being equally important as professional and technical capabilities.
Get in touch to discuss how you can prepare your WA health organisation for the opportunities ahead.
 The King’s Fund, “Leadership and leadership development in health care: The evidence base”, 25 February 2015